2. •Area 8,522 sq miles
•Population: About 7.6 Million.
•92% Live In Urban Centers
•National Health Insurance Low (1995)
•27 General Hospitals , 26 With ED.
•6 Level І Trauma Centers
290 Miles
•General Hospital Beds :14,500
(20,000)
MDA Mass Toxicological Response
3. The Israeli National E.M.S System
Pre - hospital care
National Blood Services
Emergency Medicine training
National Red Cross Society
Civil Auxiliary Service to the I.D.F (Israel Defense Forces )
MDA Mass Toxicological Response
4. 1,545 Paid staff
11,450 Volunteers
1 National Operations and Medical Control Center
11 Regional Dispatch Centers
127 Dispatch posts
76 A.L.S. Ambulances (199)
125 B.L.S / I.L.S Ambulances (492)
167 B.L.S / I.L.S Ambulances in remote locations
121 First Responders motorcycles
25 Multi Casualty Response Vehicle (M.C.R.V)
2 Air Med Unit
MDA Mass Toxicological Response
5. Mass toxicological event = volatile agent
Patients will be exposed to vapors
Most of the volatile agents are irritant to mucus
membranes
Most important medical treatment – end of exposure
Concentration of contaminant can be assessed based on
the victims signs and symptoms
MDA Mass Toxicological Response
6. Most of the victims will attempt to run away.
Signs and symptoms allow “clinical detection”
Organophosphate intoxication can be “clinically defined”
MDA Mass Toxicological Response
7. Declaration of toxicological MCI (dispatch / incident
commander)
8. •Multi Casualty Incident
Toxicological MCI
•Victims from the same area and
different age groups
EMT
•Leading symptoms:
- Eye irritation
- Upper respiratory tract irritation NO YES
•Little trauma
• Secretion from mucous
Clinical Assessment for
membranes Signs and Symptoms
• In addition:
• Ocular pain / blurred vision
Of Organophosphate
• Shortness of breath
• Vomiting/nausea/diarrhea
Physician
• Tremor/ convulsions Paramedic
•More than 1 victim with CNS NO YES
involvement
9. Wherever victims show
signs of live – PPE Level
Can be reduced in order
to allow short entrance
to rescue victims:
Powered Air Purifying
Respirator (PAPR)
Industrial Chemical + War-
fare agents resistant :
garment, gloves, booties
ABEK2P3 filters
MDA Mass Toxicological Response
10.
11. Non ambulant patients – Disrobed on the scene
Wet decontamination – if necessary
at hospital’s gate
Patients transported by personnel
using PPE
Follow up on working time
of personnel
MDA Mass Toxicological Response
12. PPE in all the ambulances
Auto injectors for organophosphate
intoxication and Cyanide kit in all
ambulances
Joint procedure
Check lists
Training to all team members
as part of “normal training”
Joint training and exercises
MDA Mass Toxicological Response