Magen David Adom: Hoping for the Best, Preparing for the Worst

Thankfully, the following scenario is fiction: a missile slams into the bleachers of Haifa’s Sammy Ofer soccer stadium when 30,000 fans fill every seat. Dozens are killed and injured, possibly hundreds. Even though this has never happened, “that’s not to say that it never will,” says Magen David Adom’s head of disaster response, Senior Paramedic Lt. Col. (res.) Felix Lotan.

Israel is one of no more than a handful of countries whose emergency medical service system is national. “An important part of our job is to prepare for crisis. We’re charged by Israel’s 1950 Magen David Adom Law to manage the medical response to any type of disaster affecting the country’s population, whether as a result of extreme weather, fire or flood, earthquake or hazmat, terror or war,” Lotan explains.

Large-scale drills

The simulated disaster at the Sammy Ofer stadium was the finale of a three-day drill held in March. Part of a continuum of cross-agency drills conducted each year, it was the largest and most complex that Magen David Adom (MDA) has ever led. MDA teams worked with Israel’s police force, fire and rescue services, the City of Haifa, the IDF’s Home Front Command and its reservist EMTs and paramedics, responding throughout the three days of the exercise to simulated mortar fire into Israel across the northern border, rocket attacks on Haifa, and shootings in five civilian sites, in addition to the multi-casualty stadium scenario.

“We learned lessons from this drill as with every other,” says Guy Caspi, MDA’s director of hazardous materials (hazmat), exercises, and operational training, whose connection with MDA dates back to 1979, when he joined as a youth volunteer. “If you find nothing to learn, then either the drill is badly designed or its evaluation is poor.”

The evaluation was in fact as detailed as it was comprehensive. It examined how all those involved worked together – MDA, police, firefighters, the City of Haifa, stadium security, the IDF units, and the on-site MDA first responders present at all large-crowd events. The evaluation included an analysis of how closely procedures and protocols were followed, the functioning of the operations center, crowd control, and whether the right equipment was available and the right decisions made. It also studied the location and sealing of the security perimeter around the stadium, the routes opened for emergency vehicles to navigate the terrified crowds and reach casualty collection points, the clearing of surrounding roads for evacuating the injured to city hospitals, and the performance of the on-site medical first responders and the paramedics and EMTs who arrived after the simulated attack.

Ongoing training

“Our culture of ongoing training equips our paramedics and EMTs to cope with any catastrophe, whether naturally occurring or man-made,” explains Lotan. “Last year, we ran 320 live-action emergency drills, responding to simulated plane crashes, shootings, train derailments, earthquakes, and more.” This past February, earthquake response became real for Lotan when he joined Israel’s delegation to Turkey and helped pull a 12-year-old boy and a 23-year-old woman from the rubble. Both had been buried for almost 48 hours and both were alive.

“Together with Israel’s other national rescue and security organizations, our responsibility is to analyze potential threats and build integrated responses, reinforcing the teams’ professional preparedness,” says Caspi. “We play to our strengths, which are rapid medical treatment and evacuation according to the Anglo-American ‘scoop and run’ model, which brings patients rapidly to the hospital with only minimal intervention en route.”

While the three-day Haifa exercise was the largest that MDA has ever led, cross-agency drills feature regularly on its annual calendar. One held last November addressed the threat of chemical attack.

“Mindful of the sarin released in a Tokyo subway in 1998, we held the drill in a Tel Aviv railway station, three levels below ground,” says Caspi. “The police cleared the scene following the simulated attack, security personnel tracked the ‘perpetrators,’ Israel Railways staff handled the rail traffic, and we took care of the emergency medical intervention and getting the ‘casualties’ up to street level, where our ambulances took them to the hospitals.”

Unlike ambulance services in most other countries, all MDA emergency medical units carry personal protection equipment (PPE), with its staff fully trained in its use. MDA’s hazmat expertise has, to date, been confined to industrial leaks (eight tons of ammonia from a slaughterhouse in 2014) and toxic emissions (a bromide spill from a train in 2016), “but that doesn’t mean we’re unprepared,” says Caspi. “Hazmat is among the possible disaster scenarios for which we continually drill, learn, and adjust our protocols and doctrines. There’s no other rational choice.”

Automatic response plans

While injuries from chemical and missile attacks, suicide bombings, stabbings, vehicular assaults, and conflict are all part of MDA’s emergency response and training plans, they do not overlook the chest pains, domestic mishaps, road accidents, or babies ready to be born. MDA responded to 16,577 advanced labor calls in 2022, with 983 babies delivered on the way to the hospital.

“No patient is more important than any other,” says Lotan. “Ongoing daily needs can’t be abandoned because of other pressing situations, and so we prepare for this, too. For times of crisis, when we may have to double or triple our capacity in a disaster area, there are protocols for quickly increasing the capacity of our operation centers and ambulance teams in that area.”

Earthquakes, he continues, are another challenge for which MDA prepares. “Because a severe quake can knock out communications and make roads impassable, we have an automatic response plan in place, so that each team member knows when to come in, even when we’re unable to reach them. They’re all fully trained. They know what to do, how to coordinate, how to locate casualties, and how to free those who are trapped.”

There are lessons taught by every drill, Lotan says, and MDA is especially encouraged by what it was able to test and learn from the simulated soccer stadium disaster. “We’ll be holding another large-scale multi-casualty exercise like this in a different part of the country in a few months’ time,” says Caspi. “It’s costly due to the time spent before, during, and afterward, as well as housing and feeding all those who take part, from the teens who volunteer as our victims through all the services involved. But it’s clearly an investment whose return will be counted in lives saved.”

Israel relies on Magen David Adom

A nonprofit established 18 years before the State of Israel, Magen David Adom is the country’s national ambulance, blood, and disaster-relief service, as well as its representative to the International Red Cross. Consistent with the other Red Cross societies, MDA receives virtually no funds from the government for its day-to-day operations, despite being mandated by the government as Israel’s official emergency medical response agency.

Over the years, MDA has been at the forefront in times of need – during the Covid-19 pandemic, preparing for threatened Ebola outbreaks, and helping other nations, most recently Turkey following its catastrophic earthquake.

Some 2,000 emergency vehicles responded to more than 1.3 million calls last year. With just over 3,000 EMTs, paramedics, physicians, and phlebotomists on its staff, MDA relies heavily on its more than 30,000 trained volunteers, aged 14 to 93, and on donors who fund ambulances, training, supplies, and infrastructure.

American Friends of Magen David Adom (AFMDA) is MDA’s largest supporter, providing vehicles, equipment, medical supplies, and funding to build the Marcus National Blood Services Center and other facilities.

For more information and to learn how you can help, please visit >>

Partnered with American Friends of Magen David Adom