For some time now, the idea of a “Community Paramedic” has popped up in many discussions on how to better serve our patients. Some services, like Wake County EMS have instituted such a program with great success. Many other systems are also now taking what Wake County has learned, and are adapting it to fit there needs.
The current model is focused on identifying “at risk patients” (chronically ill, special needs, and what is sometimes referred to as frequent flyers ) and using specially trained Paramedics to better serve their individual needs, in a non emergent setting, with a style of care that mixes a home health nurse, social worker and a primary care physician.
Considering the fact that even in the “911 setting” much of what we do is non emergent primary care, and that unnecessary ER visits and hospitalizations significantly contribute to the rise in health care costs. Community Paramedicine is a logical evolution of the industry.
But what if you have a unique population to serve and want to better the prehospital care in your area? Well one such organization has met the challenge.
Hatzolah/Hatzalah (“rescue” or “relief” in Hebrew: הצלה) is a volunteer EMS organization serving mostly Jewish communities around the world. Most local branches operate independently of each other, but use the common name. It is also often called Chevra Hatzolah, which loosely translates as “Company of Rescuers.” 
The original Hatzolah EMS was founded in Williamsburg, Brooklyn, New York, by Rabbi Hershel Weber in the late 1960s, to improve rapid emergency medical response in the community, and to mitigate cultural concerns of a Yiddish-speaking, religious Hasidic community. The idea spread to other Orthodox Jewish neighborhoods in the New York city area, and eventually to other regions, countries, and continents. Hatzolah, as an organization, is the largest volunteer ambulance service in the world. Chevra Hatzalah in New York has more than a thousand volunteer EMTs and Paramedics who answer more than 250,000 calls each year with private vehicles and a fleet of more than 70 ambulances.
Hatzalah members were among the first responders to the World Trade Center on September 11, 2001. Alongside other rescue workers, Hatzalah volunteers risked their lives to rescue, treat, and transport countless victims of the terrorist attack. In the process they earned great respect from their peers in the emergency service community.
Hatzolah organizations now function in Israel, Australia, South Africa, Mexico City, Belgium, Switzerland, several provinces of Canada, Russia the United Kingdom, and at least five states in the US.
In Israel, the largest Hatzalah organization is called Ichud Hatzalah (Hebrew: איחוד הצלה), Hebrew for, “United Hatzalah.” Ichud was founded in the aftermath of Israel’s Second Lebanon War in 2006 when its founders decided they would like to improve unified central rescue response. A prior organization, Hatzolah Israel, also exists, and is of comparable size.
Hatzolah uses a fly-car system, where members are assigned to a district to respond from in the event of an emergency. The dispatcher requests any units for a particular emergency location. Members who think they will have best response times respond via handheld radios, and the dispatcher confirms the appropriate members. Two members will typically respond directly to the call in their private vehicles. A third member retrieves an ambulance from a base location.
Each directly-dispatched Hatzolah volunteer has a full medical technician “jump kit,” in their car, with oxygen, trauma, and appropriate pharmaceutical supplies. Paramedic members carry a full array of ALS supplies, including EKG monitors, IV equipment , intubation, and more pharmaceuticals. Each volunteer is called a Unit (as in, a crew of one), and is assigned a unit number that starts with a neighborhood code, followed by a serial number for that neighborhood (e.g., F-100 was Flatbush unit number 100, a”h). Ambulances also have unit numbers in the same format, with the first few numbers for each neighborhood reserved for the ambulance numbers. Some neighborhoods have begun to assign 3-digit unit numbers to their ambulances, using numbers out of the range assigned to human member units (e.g. 900-numbers).
In some areas there may be periods where coverage is not strong enough, for example on a summer weekend. When this happens, coordinators may assign an on-call rotation. The rotation may still respond from their houses, or they may stay at the garage through their shift. In such periods, Hatzoloh functions closer to a typical EMS crew setup, though the dispatchers may still seek non-on-call members to respond, and there will still often be a non-ambulance responder as first dispatched, even if that responder starts from the base.
One area where Hatzalah gets huge kudos from me is in the cultural consideration department. Cultural sensitives are an issue for any EMS that covers immigrant areas, especially when a given immigrant population is relatively small, speaks a unique language, and has a specialized insular culture. Hatzolah was formed in the Hasidic enclave of Williamsburg, in Brooklyn, NY, a community that matches this description. Language, religion, and culture barriers made emergency medical situations more difficult than they might be otherwise, especially as regards laws of the Jewish Sabbath and Holidays, and laws of modestly in clothing, and contact between males and females.
While the primary reason Hatzolah was formed was to speed up medical response, the cultural issues play no small part. Though long established in America and elsewhere, Hasidic communities in Williamsburg and elsewhere, to this date, continue to have the same milieu found when Hatzolah was formed.
A Jew reluctant to violate Sabbath rules when receiving medical attention from an “outsider,” may be more at ease and easily convinced of the medical urgency, when the EMT or Paramedic is a fellow Orthodox Jew, speaking the same patois of Yiddish, English, and Hebrew. A female worried about physical modesty and contact, knows that a Jewish provider is more aware of the details of her concerns, and will reduce the problem as much as possible.
In addition, in areas where EMS charges a fee, there is an additional factor. Lower income clientele that may lack health insurance may have a reluctance to call for an ambulance unless the evidence of urgency is overwhelming even to the layman. This may result in true emergencies not getting treatment until symptoms worsen, to avoid the cost. A volunteer service, with sensitivities to the local community, tends to reduce that reluctance; Hatzolah is well known for its willingness to handle the “check-out” case, where there is frequently no real emergency, without charge and with great patient sensitivity. In this way, the true emergencies among those check-outs may be recognized and treated quickly, where the caller might have otherwise not sought treatment.
We all experience cultural differences, but having a provider of the same heritage is priceless. Your community my not be as unique, but there is a lot to be learned from Hatzalah’s operation. For more information check out their website, and take a look at a true “community” EMS system.
I heard an interview with a Hatzalah EMT, and was interested in the service. I found Wikipedia to have the most content, and much of the information here is from that article. If anyone has any more info, or has experience working with them let me know.
