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Foreign Exchange cially, we have so few chances to practice this stuff and learn from it.” A solution many U.S. systems are employing is to utilize ICS with any incident involving more than one patient. This familiarizes responders with its concepts, terminology and basic setup before it’s forced upon them in a big one. “Learn how to do disaster response every day,” suggests DeTienne. “We don’t always have to talk about the big earthquake or the big fi re. If we get better at doing MCIs with two patients, 10 patients, 20 patients, we’ll become better at the really big stuff.” THE SYSTEM Healthcare is a system, and no part of it works in a vacuum. EMS in particular goes hand-in-hand with hospitals in a sort of yin-yang of capabilities and responsibilities. That means, if you’re going to be clearing scenes rapidly and leaving things like decon for the hospitals, your hospitals better be 1) rapidly ready to receive and care for patients, and 2) prepared and effective at doing that decon and other care themselves. “It’s impressive to clear a large-scale incident in a short amount of time, but what that does is shift a fair amount of burden to the hospitals,” says Robinson. “Do our hospitals have the ability to ramp up like that? I think some do. But I think that sort of approach would bring other hospitals to their knees.” Of course it’s critical that communications to hospitals from the fi eld occur early and continually in big incidents. Appointing EMS liaison offi cers can be a great way to maintain those channels. “If that’s doable within the constraints of an incident, that’s a phenomenal way to make sure you have good, up-to-date information coming to the hospitals,” says Hick. “If that’s not possible, then make sure you have a Web- or radio-based mechanism by which alerts and updates can be sent, so the hospitals don’t operate in a vacuum.” Epilogue It was a casual comment over lunch late in the trip that stuck with Schmider. War, Violence and the Next Generation Like physicians and EMS providers, psychologists deal with the effects of crisis. Here delegation member Zandra Stewart, a school psychologist who accompanied her husband, Chicago First Deputy Fire Commissioner Charles Stewart, to Israel, explains the damage that can occur to children living in places like Sderot—or anyplace with high levels of random violence. Living in any environment that’s unstable for kids presents many problems. Anxiety disorders and fear are just a couple of psychological concerns. Experiences in our childhood provide the basis for how we interpret our environment as adults. If these experiences are full of fear, anxiety, uncertainty, etc., our ability to grow into secure teens and adults will likely not occur. Feelings of hopelessness, despair and depression, as well as behavioral problems accompanied by poor concentration, are likely to surface. With each traumatic experience, an initial response may require EMS assistance to help with an injury and/or the resulting panic that occurs. Children may not feel safe in their environment (home or school) or may be unable to function mentally or physically. Conditions such as select mutism, depression, hysteria and/or acting out can occur, requiring psychological or psychiatric intervention. Experiences in our childhood help form our adulthood. Whether we choose to internalize or externalize our reactions to what we experience determines our adult temperament and disposition. Some individuals will easily overcome the trauma, while others will not. Adults may also have feelings of helplessness and depression. They may resort to habits or avoidance behaviors to help them cope—examples may be smoking or not returning to work. Dealing with emergencies on a weekly, daily or monthly basis is exhausting. What’s best is to try and return to the normal routine of life. Distraction is good. Reading and/ or playing games with children is always good. Teaching various coping techniques to children and adults can be beneficial, such as visual imagery, deep breathing, positive statements. Group counseling can also be beneficial to provide support and emotional nourishment. — Zandra Stewart 18 JULY 2011 EMS WORLD Conference in 2012 In the spirit of exchanging good ideas, Israel has established a new emergency response conference, IPRED, the second occurrence of which is planned for 2012. IPRED stands for the International (Conference on Healthcare System) Preparedness and Response to Emergencies and Disasters. Scheduled for January 15–19, it will be hosted by the country’s Ministry of Health and Home Front Command. Aims of the show include providing a platform for the exchange of ideasa promoting international networking between healthcare professionals in emergency preparedness and responsea and enhancing international research collaboration in disaster medicine and public health preparedness. This year’s inaugural show featured a special biological event drille a radiological drill is planned for 2012. For more see www.ipred.co.il. “It was the woman who told us how she didn’t go shopping at the mall with her husband,” Schmider says, “because she was worried about her kids, and who would take care of them if both their parents got killed.” That’s a chilling off-the-cuff comment. But it suggests a mind-set that’s in many ways positive. It refl ects a family that is aware of its community’s threats and has taken a sensible measure to mitigate them, without sacrifi cing the daily acts of living. Wouldn’t EMS be easier, in major events and every day, if more Americans did likewise? “I think our citizens can learn a lot from them in the way of preparedness,” says McCaughan. “The idea in Israel is to be prepared. Be ready to stand on your own. Have a plan, have food, have a radio, have a fl ashlight, be prepared to take care of yourself. And while you’re taking care of yourself, check on your neighbor or that elderly person around the corner. I was really struck with their willingness to look out for and support one another—neighbors, friends, people you don’t even know.” There are good reasons behind that. But as desirable as it might be as an outcome, Americans should dearly hope those reasons are ones we never endure.