Magen David Adom Research Articles

Secondary Ambulance Transfers During the Mass-Casualty Terrorist Attack in Israel on October 7, 2023.

On October 7, 2023, Israel experienced the worst terror attack in its history - 1,200 people were killed, 239 people were taken hostage, and 1,455 people were wounded. This mass-casualty event (MCE) was more specifically a mega terrorist attack. Due to the overwhelming number of victims who arrived at the two closest hospitals, it became necessary to implement secondary transfers to centers in other areas of the country. Historically, secondary transfer has been implemented in MCEs but usually for the transfer of critical patients from a Level 2 or Level 3 Trauma Center to a Level 1 Center. Magen David Adom (MDA), Israel's National Emergency Pre-Hospital Medical Organization, is designated by the Health Ministry as the incident command at any MCE. On October 7, in addition to the primary transport of victims by ambulance to hospitals throughout Israel, they secondarily transported patients from the two closest hospitals - the Soroka Medical Center (SMC; Level 1 Trauma Center) in Beersheba and the Barzilai Medical Center (BMC; Level 2 Trauma Center) in Ashkelon. Secondary transport began five hours after the event started and continued for approximately 12 hours. During this time, the terrorist infiltration was still on-going. Soroka received 650 victims and secondarily transferred 26, including five in Advanced Life Support (ALS) ambulances. Barzilai received 372 and secondarily transferred 38. These coordinated secondary transfers helped relieve the overwhelmed primary hospitals and are an essential component of any MCE strategy.

Managing a Mega Mass Casualty Event by a Civilian Emergency Medical Services Agency: Lessons From the First Day of the 2023 Hamas-Israel War.

On 7 October 2023, Israel faced an unexpected attack by Hamas, causing over 1,200 deaths and injuring more than 9,000 individuals. This report delves into the rapid medical response spearheaded by Israel's civilian Emergency Medical Service, Magen David Adom (MDA), during this crisis. Utilizing data from MDA's electronic database, 4,097 dispatch records from the day were analyzed. Of these, 39.3% were directly related to the attack. EMS teams faced multiple challenges, including handling an overwhelming number of casualties and navigating active combat zones, which impeded safe access to victims, posed significant risks to teams' safety, and constrained patient evacuation strategies. This incident underscores the importance of reinforcing healthcare resilience, particularly emphasizing the need for centralizing various aspects of response efforts. These include streamlined communication, national coordination of pre-hospital resources, and systemic management of patient evacuations. Moreover, providing substantial support for EMS personnel, who operated in highly challenging conditions, is imperative.

The Crowd Crush at Mount Meron: Emergency Medical Services Response to a Silent Mass Casualty Incident.

On April 30, 2021, a total of 45 died and 112 were injured in a crowd crush at a religious festival on Mount Meron, Israel. Unlike a bomb blast, building collapse, mass shooting, or stampede, the incident lacked a dramatic, noticeable trigger and may be termed a "silent mass casualty incident (MCI)." This may have resulted in a slight delay in response. Magen David Adom (MDA)-Israel's National Emergency Medical Services Organization-was the main prehospital response to the MCI. MDA's intense planning, organization of medical infrastructure, and on-site MCI drill before the event allowed for the rapid, coordinated treatment and evacuation of casualties by ambulance and helicopter. The use of volunteers facilitated an effective response to the event. A "rolling reinforcement" system of ambulances helped treat and transport those at the scene while placing staff at stations throughout the country to serve routine emergency calls.

Responses of a Pre-hospital Emergency Medical Service During Military Conflict Versus COVID-19: A Retrospective Comparative Cohort Study.

ABSTRACTBackgroundDecreases in routine healthcare practices have been shown to occur during disasters. However, research regarding the impacts of natural disasters, pandemics, or military conflicts on emergency medical services (EMS) is scarce.ObjectivesThis study assessed the impact of a military conflict versus the coronavirus disease 2019 (COVID-19) pandemic on a national EMS organization in terms of responses to overall daily emergencies, medical illnesses, motor vehicle collisions, and other injuries.MethodsThis retrospective comparative cohort study assessed daily routine emergency ambulance calls to Magen David Adom (MDA), Israel’s national EMS organization. This included overall emergency calls as well as those related to medical illnesses, motor vehicle collisions (MVCs), and other injuries. All data were obtained from the MDA command and control database. During the military conflict Operation Protective Edge (2014), the civilian population was subjected to intensive rocket attacks for 24 days, followed by 26 days of a progressive withdrawal of operations and then to a post-conflict period. During the first wave of the COVID-19 pandemic (March-April 2020), the population was subjected to 32 days of total lockdown, followed by 27 days of progressive relief of confinement, and then to a post-lockdown period.ResultsThe total number of emergency calls in this study was 330,430. During the conflict, the mean number of daily calls decreased, followed by an increase during Relief and Post-Conflict with higher values in Post-Conflict than in Pre-Conflict. During the COVID-19 pandemic, there was a decrease in the mean daily number of calls during Lockdown. It remained low during Relief and increased during Post-Lockdown. However, it remained lower in Post-Lockdown than during Pre-Lockdown. Calls related to medical illnesses decreased during the conflict and during the lockdown. The post-conflict period was characterized by a similar baseline call magnitude but not during the post-lockdown period. Decreases in calls for MVC and other injuries were significant during the lockdown but not during the military conflict. Post-lockdown was accompanied by return to baseline call volumes for MVC, whereas calls for other injuries increased above baseline both after the lockdown and military conflict.ConclusionThis study shows decreasing trends in routine daily calls for EMS during both Operation Protective Edge and COVID-19. However, different patterns of needs for EMS were evidenced for medical illnesses, MVC, or calls concerning other injuries. These results are instrumental for managing the operational demands of EMS during military conflicts and pandemics.

Lessons Learned From an Analysis of the Emergency Medical Services' COVID-19 Drive-Through Testing Facilities in Israel.

One strategy for the containment of a pandemic is mass testing. Magen David Adom (MDA), the Israeli National Emergency Medical Services (EMS) Organization undertook this mission by operating a nationwide series of drive-through testing complexes. The objective of this study is to learn lessons from an analysis of these centers. Data from 198 stationary and mobile drive-through complexes from March 20, 2020, through October 17, 2020, were analyzed for temporal and geographic factors, and cost. Also, an operational improvement program was implemented and analyzed. A total of 931,074 patients were sampled in the MDA drive-through system: 46.9% in stationary complexes, and 53.1% in mobile complexes. The optimized cost per patient of home testing was estimated at 74.5 USD compared with 6.55 USD in the drive-through centers. An operational improvement program lowered the total sampling time from 128 s/patient to 98 s and decreased the total cost per patient from 6.55 USD to 6.27 USD. The EMS led drive-through complexes were cost-effective and efficient in performing large numbers of viral tests, especially when compared with home testing. Established concepts in clinical operations should be implemented to increase the number of persons that can be tested and decrease cost.

An assessment of treatment, transport, and refusal incidence in a National EMS's routine work during COVID-19.

BackgroundCOVID-19 created lifestyle changes, and induced a fear of contagion affecting people's decisions regarding seeking medical assistance. Concern surrounding contagion and the pandemic has been found to affect the number and type of medical emergencies to which Emergency Medical Services (EMS) have responded.AimTo identify, categorize, and analyze Magen David Adom (MDA), Israel's national EMS, pre-hospital activities including patients' refusal to hospital transport, during the COVID-19 pandemic crises.MethodsA comparative before and after design study of MDA incidents during March/April 2019 and March/April 2020. Medical type, frequency, demographic, location, and transport refusal proportions and outcomes were analyzed.ResultsA decrease of 2.6% in the total volume of incidents was observed during March and April 2020 compared with the equivalent period in 2019. This contrasted with the retrospective trend of annually increase observed through 2016–2019. Medical categories showing increase in 2020 were infectious disease, cardiac arrest, psychiatric, and labor and deliveries, with out-of-hospital deliveries increasing by 14%. Decreases in 2020 were seen in neurology and trauma, with trauma incidents occurring at home showing an 8.6% increase. Patients' refusal to transport rose from 13.4% in 2019 to 19.9% in 2020. Cases of refusals followed by death within 8 days were more prevalent in 2020.ConclusionEMS must be prepared for changes in patients' behavior due to COVID concerns. Targeting populations at risk for refraining or refusing hospital transport and implementing diverse models of EMS, especially during pandemic times, will allow EMS to assist patients safely, either by reducing truly unnecessary ED visits minimizing contagion or by increasing hospital transports for patients in urgent or emergent conditions.

The Role of Israel's Emergency Medical Services During a Pandemic in the Pre-Exposure Period.

The scientific literature on coronavirus disease (COVID-19) is extensive, but little is written about the role of emergency medical services (EMS). The objective of this study is to describe the role of Magen David Adom (MDA), Israel's national emergency prehospital medical organization, in the pre-exposure period, before widespread governmental action. These efforts were based on (1) phone diagnosis, dispatch, and transport; and (2) border management checkpoints. This is a descriptive study of MDA's role in pandemic response during the pre-exposure period. Medical emergency telephone calls from either individuals or medical sources were identified by a dispatcher as "suspected COVID-19" based on symptoms and travel exposure. Data were also collected for travelers approaching the MDA border checkpoint at Ben-Gurion International Airport. The total number of protected transports during this time was 121. Of these, 44 (36.3%) were referred by medical sources, and 77 (63.7%) were identified as "suspected COVID-19" by dispatchers. The checkpoint was accessed by 156 travelers: 87 were sent to home-quarantine; 12 were transported to the hospital; 18 were refused entry; and 39 required no further action. EMS can work effectively in the pre-exposure period through instructing home quarantine, providing protected transport, and staffing border control checkpoints.

Identifying and minimizing abuse of emergency call center services through technology

BackgroundTo identify and minimize unnecessary calls to emergency numbers and to assess the effectiveness of call-tracking technology in addressing the problem. MethodsA retrospective, interventional study was conducted of all emergency calls made to Magen David Adom (MDA), Israel's national Emergency Medicine Service (EMS) during years 2012–2016. In 2015 a tiered technological intervention was developed and implemented by MDA. The call-tracking technology self-identified harassment calls by call duration and frequency. The system automatically diverted harassing calls to a non-emergency number system in order not to lose any call. The rates of harassment calls were analyzed by shift, region, and season. Trends were compared before and after intervention. ResultsDuring the years 2012–2016, 53,527 shifts took place, and 8.2% (4277) of shifts identified as receiving incoming harassment calls. The evening shift (11.5%), the Jerusalem region (16.9%), and the summer season (9.6%) were most prone to harassment calls. After implementing an intervention using specialized call-tracking technology, the prevalence of harassment calls decreased significantly (from 10.9% to 2.9% p < .001). The Jerusalem region showed the greatest decrease of 92% (from 26.5%–2.0% p < .001). ConclusionsMDA's call tracking technology has been shown to identify and minimize harassment calls and can be implemented by emergency organizations to reduce abuse of emergency call services.

Seven First Minutes - Community Emergency Response Training

Introduction:Following a mass casualty incident (MCI), it can take several minutes for emergency medical services (EMS) to arrive. The course was developed by Magen David Adom (MDA) based on unique experience in dealing with MCIs, and the time between alerting emergency services to such an incident until they arrive. The course is focused on teaching the general public to channel their desire to help in such a situation into useful skills which can potentially improve patient outcomes. The seminar focuses on key principles such as safety, calling for help, providing an accurate picture of the scene, and initiating basic treatment with an emphasis on hemorrhage control.Aim:MDA examined the ability of the general public with no previous medical training to perform a basic triage and treatment in an MCI situation. Additionally, the study examined the abilities of the study groups to manage a scene until the arrival of EMS based on the principles taught in the course.Methods:MDA has sent teams of instructors around the world to teach over 1,000 participants. Upon completing the course, the participants partake in a drill that assesses their ability to manage a scene of 20 patients. Their ability to initiate the call for help, provide an accurate picture, initiate treatment, and give an accurate report to arriving emergency responders are examined.Results:The average times were recorded. Within 38 seconds, dispatch was alerted to the situation. Within 2:30 minutes, treatment was initiated for all patients. Within 4:37 minutes, the scene was fully under control, and within 6:37 minutes, an accurate report was transferred to EMS on the scene.Discussion:The participants demonstrated an unexpected willingness to learn, practice, and partake in the drills, and the results were unexpected.

Watching to Save Lives

Introduction:As Israel's National Emergency Medical Services (EMS) provider, Magen David Adom (MDA) is constantly looking for ways to improve the response to mass casualty incidents (MCIs). Previous research has shown that in an MCI situation, the demand for resources is disproportionate to the available resources, thus creating a dilemma of how to triage and treat the patients, as well as how to best prioritize and treat the critical patients.Aim:Smartwatches have become an integral part of society. MDA constantly looks for ways to integrate new technologies into their emergency response protocols. Smartwatches were used in this experiment to determine if in an MCI, relaying live information to the dispatch center would improve the time it takes for emergency crews to effectively treat and transport critical patients.Methods:A drill and scenario were designed to simulate an MCI in which there were 3 severe, 2 moderate, and 5 lightly wounded patients. There were then different colored smartwatches placed on each victim. The watches transmitted real-time blood pressure, pulse, and oxygen saturation readings to the dispatch center. The live information was transferred directly to responding teams. A second drill was conducted using the same scenario, same number of patients, but without watches to examine the differences in response times.Results:MDA found that the use of smartwatches directly improved the times (by 3.27 minutes) in which emergency teams were able to reach the most severely wounded patients and evacuate them to the hospital in a timely manner.Discussion:Using smartwatches to transmit live information to the dispatch center allowed for effective treatment and transport of patients in an MCI. Use of such information allows the dispatch center to direct teams to provide accurate treatment to the patients according to their needs.

Operation Protective Edge - A Unique Challenge for a Civilian EMS Agency.

During July through August 2014, Operation Protective Edge, a military conflict between Israel and the Hamas regime in Gaza, dramatically affected both populations. Magen David Adom (MDA), the Israeli national Emergency Medical Service (EMS) and a member of the Red Cross, faced a unique challenge during the conflict: to continue providing crucial service to the entire civilian population of Israel, which was under constant missile threat. This challenge included not only providing immediate care for routine EMS calls under missile threat, but also preparing and delivering immediate care to civilians injured in attacks on major cities, as well as small communities, in Israel. This task is a challenge for a civilian EMS agency that normally operates in a non-military environment, yet, in an instant, must enhance its capability to respond to a considerable threat to its population. During Operation Protective Edge, MDA provided care for 842 wounded civilians and utilized a significant amount of its resources. Providing EMS services for a civilian population in a mixed civilian/military scenario is a challenging task on a national level for an EMS system, especially when the threat lasts for weeks. This report describes MDA's preparedness and operations during Operation Protective Edge, and the unique EMS challenges and dilemmas the agency faced.

Tranexamic acid at the point of injury: the Israeli combined civilian and military experience.

Accumulating evidence established the benefit of tranexamic acid (TXA) for traumatic bleeding in the hospital setting. TXA use in the field (at or near the point of injury [POI]) was described in the military setting but not in the civilian one. The current study describes the Israeli combined experience (civilian and military) of administering TXA in the field. The Israel Defense Forces (IDF) and Magen David Adom (MDA) (the national Israeli civilian emergency medical service) protocols for giving TXA at the POI are presented. We then review all trauma patients who received TXA in the field in accord with either protocol. Data were abstracted from the IDF Trauma Registry and from the MDA database. Data regarding casualties treated with TXA by the IDF Medical Corps and MDA between December 2011 and August 2013 are presented. One hundred three casualties who received TXA in the field were identified. The median age was 26.5 years, and 83 (88%) were male. The mechanism of injury was penetrating in 48 cases (51%). POI data indicate slightly higher injury severity for the group of patients treated by MDA compared with patients treated by the IDF (systolic blood pressure, 90 mm Hg vs. 110 mm Hg; Glasgow Coma Scale [GCS] score, 11 vs. 15; hemoglobin, 11.9 vs. 13.3; p < 0.05). On the basis of our combined data, it appears that administering TXA in the field is feasible in the civilian and the military setting. Lessons learned in military settings are applicable to civilian medical systems. Action investigations and comparison of the different protocols may further improve treatment at or near the POI. Therapeutic study, level V.

Volunteers and the risk of posttraumatic stress disorder

AbstractSymptoms of posttraumatic stress disorder (PTSD) result from exposure to a traumatic event and influence a person's ability to cope psychologically. Recent documentation from emergency rooms shows that medical personnel, including volunteers who treated severely injured people, can develop symptoms of PTSD even though the volunteers themselves were not personally subjected to the stressful event. This article finds similar results among adolescents who volunteered with Magen David Adom (MDA), Israel's national emergency medical, disaster, ambulance, and blood bank service. Because of the security threats Israel has faced, these adolescents are likely to be exposed to traumatic events during their volunteer service, and some may develop PTSD. This article explores who is most susceptible to developing PTSD and the underlying theories of why that may be the case. Since the adolescents' motives to volunteer vary, the article proposes that volunteers with certain motives retain their enthusiasm for volunteering despite the danger of developing PTSD symptoms. It also finds that some of the motives to volunteer correlated with a reduction in the level of PTSD symptoms. Understanding the adolescents' motivations to volunteer will help nonprofit leaders and managers allocate volunteers according to their motivations and the levels of threat a particular job entails.

(A319) Using a Computer Simulation (CS) to Improve Training and Event Management of Paramedics for Mass Casualty Incidents (MCI)

Using a Computer Simulation (CS) to improve training and event management of paramedics for Mass Casualty Incidents (MCI). Eli Jaffe, Avi Dagan, Eyal Zahavi, Einat Aviel, Bruria Adini. The Department of Emergency Medicine, Ben-Gurion University of the Negev Magen David Adom (MDA) is the national emergency organization in Israel. Over the past few decades MDA personnel have been required to deal with MCIs involving large numbers of casualties. Recently, there have been fewer terrorist related MCIs, however, there is a continuing need for to maintain the knowledge and skills of paramedics to manage MCIs.ObjectiveTo examine performance of paramedics exposed to a CS compared to a control group exposed to a traditional lecture based learning experience.MethodAn interactive CS based on the MDA standard operating procedure for managing MCIs was developed. The participants were randomly divided into two groups. Group 1 received the lecture format, and Group 2 the CS. Both groups were given a pre-test (Group 1 average score 56.3, Group 2 average score 53.1), and two post-tests. One immediately following completion of the intervention, and a second a month after completion of the course.ResultsAverage scores for the CS Group (n = 15) was significantly different on the first post-test (Group 1 average score 53.2, Group 2 average score 68.7), by 30% and on the second (Group 1 average score 71.9, Group 2 average score 80.8) by 12% compared to the Lecture Group (N = 17) (P = &lt; 0.00).ConclusionCS allow for the use of multiple media formats based on real events, and are able to replicate reality using real media material. MDA has recommended that continuing education interventions for emergency medical personnel for maintaining knowledge and skills required for the management of MCIs utilize a CS based training methods.

(A310) Academic Training for Paramedics - A Unique University Based Model

IntroductionThe paramedic profession is relatively new, dating to the 1970's. In Israel, it was introduced in 1980 and paralleled the introduction of advanced life support units (ALS) to Israel's national emergency medical services (EMS), Magen David Adom (MDA).The curriculum and assigned roles were adopted with minor changes from Anglo-American systems. Initially, paramedics were assigned alongside physicians, but in recent years a growing percentage of units operate without an on-board physician. Despite the increasing complexity of required tasks and the move toward paramedic-led crews, paramedic training has changed little. Most are trained through a non-academic, certificate granting tracts. In 1998, a fully academic bachelor's degree program was launched at the Ben-Gurion University (BGU).MethodsThe programs aims, curriculum, and experience are described, based on past and current curriculum and on interviews with past and current staff and students.ResultsThe BGU program is a three year program that grants its graduates both a University BA and professional paramedic certification. The program is housed as a university department within the Faculty of Health Sciences. First year courses center on basic sciences. The second year centers on classroom and simulation-based learning of the clinical topics. The third is devoted mostly to clinical clerkships, in hospital wards in the first semester and on MDA ALS units in the second. To date, the program boasts more than 300 graduates, many attaining higher academic degrees in healthcare sciences and many who work in Israel's national EMS.DiscussionThe BGU academic paramedic training program is the only such program in Israel and one of a few worldwide. Questions regarding the increasing responsibility and task complexity require a move from certificate training to University degree granting learning and the possible contribution of such

(P2-8) Analysis of the Performance of Emergency Medical Services Management of 51 Mass-Casualty Incidents in Israel

IntroductionBetween February 2002 and January 2004, a total of 51 terrorism-related mass-casualty incidents (MCIs) occurred in Israel.ObjectiveThe objective of this study was to analyze data provided in After Action Reports (AAR) held by Magen David Adom (MDA), after each MCI.MethodsInformation relating to the type of MCI, location, number of ambulances dispatched in five-minute intervals from time of notification, and number of casualties evacuated by urgency in five-minute intervals from the start of the incident was analyzed.ResultsThere were 34 MCIs in 2002, 15 in 2003, and two in 2004. More MCIs (24%) occurred on Wednesdays, and more MCIs occurred during the 05:30–08:59 (18%), 12:00–14:59 (20%), and 17.00–19.59 (24%) time slots. More MCIs occurred in the Jerusalem (24%) area, followed by Tel Aviv (16%). Twenty-six percent of the MCIs resulted from explosions in open areas, 22% in buses, 20% from shootings, and 28% from explosions in semi-closed and closed areas. The mean dispatch time of the first ambulance after notification was 48 seconds. An average of 14.25 ambulances were dispatched in the first five minutes, followed by eight, three, and three in the five-minute slots following. An ANOVA indicated a significant difference in dispatch times by towns/cities (p = 0.05). The average arrival of the first ambulance was 6.4 minutes, and evacuation of the first urgent casualty was 13.6 minutes, the last evacuation was 26.5 minutes after arrival. More urgent casualties (45%) compared to 20% non-urgent were evacuated in first 15 minutes; the majority of non-urgent victims (79%) were evacuated after 16 minutes. The mean number of dispatched ambulances ranged from 37.9 to 26 in urban versus rural areas, respectively. The number of ambulances actually used for evacuation in urban and rural areas was 55% and 44%, respectively.ConclusionsInformation analyzed from AAR is useful for improving Standard Operating Procedures and structuring continuing education interventions for MCIs.

(P2-10) Emergency Medical Services Workers' Willingness to Work during Pandemic Influenza

BackgroundEmergency medicine services (EMS) will play a key role in any response to a flu epidemic. In order to devise an effective preparedness plan for coping with pandemic, it is necessary to comprehend the factors affecting the willingness of EMS workers to respond during an outbreak.AimsThis study aims to: (1) examine the willingness of the workers of Israeli EMS (Magen David Adom (MDA)) to come to work during a pandemic flu; and (2) identify the factors that will increase the willingness of workers to come to work and the obstacles that will keep them from working during a flu pandemic.MethodsBetween November 2009 and January 2010, a representative sample of MDA workers in Israel were given questionnaires asking about their knowledge and attitudes in regard to pandemic flu, and concerning factors that may influence their willingness to come to work. Data analysis included descriptive statistics, central and dispersion measures, analyzes of variance, and an exploratory factor analysis.ResultsThe study population included 365 people (290 men and 75 women), with 84% aged 20–49 years. Of the respondents, 92% expressed willingness to come to work during a flu pandemic, even if they were asked and not obligated to report to work. An increase in willingness to come to work was found to be associated with the significance of the role of the workers, the guidance that they receive from the organization, their trust in the system, their knowledge, and their feeling of being protected.ConclusionWorkers' perception of the significance of their role and their trust in the system were found to be central factors in determining workers willingness to come to work during a time of an emergency.

(A312) Evaluation of a Continuing Education Intervention to Improve Management of Mass-Casualty Incidents

IntroductionEmergency medical services (EMS) personnel must continuously educate themselves on mass-casualty management. Emergency medical services personnel in Israel are provided with continuing education programs aimed at maintaining knowledge and skills to manage different types of mass-casualty incidents (MCIs). There are 11 Magen David Adom (MDA) regions that have different incidences and experience with MCIs.ObjectiveThe purpose of this study was to evaluate the effectiveness of an intervention for the management of conventional and mega MCIs.MethodsA 17-item, multiple choice question pre-test (n = 640) and post-test (n = 536) were administered after a brief continuing education intervention based on lectures and discussion in all 11 EMS regions. The MCI and mega MCI scores were combined to provide an overall MCI score. An independent t-test and ANOVA were used to examine for differences by age, seniority, role, and area of employment of EMS personnel. (p = 0.05)ResultsReliability of the pre- and post-tests was 0.70. The overall mean score and standard deviation for the pre- and post-test was 64.31% Â ± 14.2% and 75.0% Â ± 14.0%) respectively (p = 0.000). Distribution of scores on the pre- and post-tests were: 80%, 11.8% pre-test, 42.7% post-test. No significant differences were found in pre-/post-test scores by area. Older personnel (&gt; 50 years of age), and those who had been working in EMS for longer periods were found to have significantly lower scores (p = 0.05). Overall scores of paramedics was significantly higher than driver/medics. (p = 0.05).ConclusionsBoth pre- and post-tests were reliable. Post-test scores improved significantly after the intervention. Age and seniority are factors that must be considered when developing continuing education interventions. Possibility should be given to implementing role specific continuing education interventions. Attrition of knowledge must be investigated.

School injury in Israel: findings from Magen David Adom

BackgroundData on school injury are not always easy to obtain. Many of the existing data are based on schoolchildren's self-report. Self-reported data are vulnerable to recall bias, and to interpretation...

Corporate Image Reinforcement in an Era of Terrorism through Integrated Marketing Communication

Over the past decade or so, corporate image has become an essential strategy for many organizations. However, non-profit organizations have only recently adopted this strategy in order to better communicate with their stakeholders. The purpose of this case study is to trace the integrated marketing communication (IMC) strategy of the Magen David Adom (MDA) Society (the Israeli equivalent of the Red Cross) in its attempt to reinforce its corporate image in an era of terrorism. This paper describes a holistic process of reinforcing the MDA Society's corporate image, focusing on the implementation of its corporate communication process through an IMC strategy. The case study described here reveals that corporate image can be reinforced even in an era of terrorism, provided that an effective IMC strategy is developed and successfully implemented.