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Foreign Exchange National Merit How having a single healthcare system facilitates emergency preparedness To Americans used to wrestling with healthcare issues within the context of 50 state governments, the Israeli system starts with a key difference: It’s national. That simplifi es relations between its local arms (EMS, hospitals) and its national head (the Ministry of Health), as well as its opera- tions with other players (e.g., law enforcement, the military) and during emergencies. The country has 27 general hospitals, supplemented by 15 geriatric and 18 psychiatric hospitals and numerous private hospitals, to serve a population of nearly 8 million. There are six Level 1 trauma centers. Healthcare services are provided across 17 districts, while a single national ambulance provider, Magen David Adom (MDA), functions within 11 districts of its own. Four Health Maintenance Organizations (HMOs) provide universal insurance coverage to residents, with core services defi ned by the government. Physically, it’s a pretty healthy population; waits for primary care are short and costs are covered, with copays for specialists only. Citizens average more than seven doctor visits a year. The Israeli per-capita acute-care bed rate, 2.2 per 1,000 people, is lower than many western countries’, leading to high occupancy rates and low average lengths of stay. An American might expect that to make handling patient surges diffi cult, but Israeli hospitals are required to be able to increase their routine bed capacities by 20% in surge situations. That doesn’t mean backup beds sit empty; just that facilities have to have extra gurneys and gear on hand, plus plans and personnel practiced and ready. Extra capacity can also come via overfl ow agreements with specialty hospitals. Medical institutions are required to fund their own training and drills (which requirements are substantial), A casualty is evacuated following a 2009 Palestinian rocket attack in Beersheba. With universal military experience, citizens can be used as extra hands at mass-casualty scenes. Photo: Reuters/Eliana Aponte but the government covers equipment, infra- structure and development of doctrine and training materials. For EMS’ part, mutual aid is automatic, with reinforcements drawn from neighboring districts and volunteers ready to roll from home. Private ambulances can also assist in emergencies. Preparedness Emergency preparedness in Israeli healthcare is built on what’s called the 5C Model: Comprehensive contingency planning— Planning is based on an all-hazards approach focused on common components and the idea that standardization helps build capacity. Equipment and infrastructure are standardized to the extent possible. The common thread in emergencies is knowing exactly what your role is, when, where and with whom. Command of operations—Police are always in command of incident scenes. EMS is subordinate but in charge of medical opera- tions, casualty evacuation and communication with hospitals. Fire and environmental- protection providers are also fi rst responders. The military’s Home Front Command conducts rescues and directs secondary patient relo- cation. The Ministry of Health offers logis- tical support and has overall responsiblity for medical operations. Central control—Emergency preparedness and response are coordinated by the Ministry of Health’s Division for Emergency and Disaster Management, with policy set by the Supreme Health Authority, which includes representatives from government, hospitals, MDA, the HMOs and others. SOPs are developed, reviewed and approved nationally; then hospitals use them to develop their own standing orders. The national government also monitors hospital capacity and produces after- action reviews of events, as well as conducts annual preparedness evaluations. Coordination and cooperation— Healthcare system players utilize a joint EMS WORLD JULY 2011 7