Magen David Adom

Introduction: Magen David Adom (MDA), Israel’s national Emergency Medical Service (EMS), is responsible for responding to crises, including military conflicts, natural disasters, and cyber threats. Under the Magen David Adom Law 5710- 1950, MDA supports the Israeli Defense Forces (IDF) Medical Corps and ensures peacetime readiness. Methods: MDA’s All-Hazards approach creates adaptable emergency response plans for diverse crises, incorporating sheltering, mass casualty management, and communication continuity. Close collaboration with the National Emergency Management Authority (NEMA) and the Ministry of Health ensures that preparedness for military conflict strengthens readiness for natural disasters. Results: Following the October 7, 2023, Hamas attack, MDA rapidly updated its preparedness to address prolonged, multi-front warfare. Key goals included plans for extended power outages and managing multiple simultaneous incidents. Enhancements included autonomous regional hub operations, strengthened satellite communications, and mobile medical patrols. MDA’s resilience in non-traditional emergencies was demonstrated during the July 2024 CrowdStrike cybersecurity incident, where rapid manual operations and alternative communication methods ensured uninterrupted emergency response. Conclusion: MDA’s generic emergency plans, adaptable across various crises, provide a robust response model. This flexible approach, reinforced by interagency cooperation, strengthens MDA’s emergency preparedness and offers insights for EMS organizations worldwide.

To assess how inclusion criteria from major randomized controlled trials (RCTs) of extracorporeal cardiopulmonary resuscitation (ECPR) apply within a cannulated ECPR cohort and to benchmark observed outcomes against published trial results. We conducted a single-center retrospective cohort study at a 1,000-bed tertiary medical center of adults who underwent ECPR for out of hospital cardiac arrest. Inclusion criteria from the ARREST, PRAGUE, and INCEPTION trials were retrospectively applied. Analyses were restricted to cannulated patients, with survival evaluated overall and stratified by trial eligibility, and descriptively compared with published RCT outcomes. Sixty-six patients underwent ECPR, including 25 (38%) with a non-shockable initial rhythm. Overall survival to hospital discharge was 14% (9/66; 95% CI 6.4-24.3%), with favorable neurological outcome in 5/9 survivors. Survival was numerically higher among patients meeting trial inclusion criteria, but differences were not statistically significant. Survival was comparable to PRAGUE and INCEPTION and lower than ARREST. Within this program level, cannulated ECPR cohort, RCT-derived inclusion criteria did not clearly distinguish survivors from non-survivors, and survival occurred among patients not meeting one or more trial eligibility thresholds. Rigid application of trial criteria at the point of cannulation may therefore exclude some patients with potential for meaningful recovery.

Abstract The interesting story of how the Transfer Agreement (in Hebrew: “Ha’avara”), an agreement signed between the German government and Zionist authorities in 1933 to encourage Jewish emigration from Germany to Palestine, helped Jewish expatriates transfer their assets to their new home with the activities of two trust companies in Germany and Palestine. Taken from Alon Kaplan and Meytal Liberman’s book, Trusts and Estate Planning in Israel, 2016 and upcoming—Second Edition (Juris Publishing.)

IntroductionHuman breast milk is the recommended nutrition for newborns and premature neonates according to the World Health Organization. Breastmilk is of utmost physiological importance for neonates and is crucial for the survival of premature newborns, preventing necrotizing enterocolitis and other medical conditions. Recently, the National Israeli Human Milk Bank was established by the emergency medical service- Magen David Adom (MDA). Around 10% of women willing to donate milk to the milk bank are taking medications. The Drug Consultation Center at Shamir Medical Center provides guidance regarding dilemmas related to these milk donations. Our aim is to set criteria for milk donations designated for premature newborns, from women treated with medications. MethodsIn order to maximize the potential of milk donations, we assess the safety of the donation by evaluating the Relative Infant Dose (RID) and other pharmacokinetics (PK) parameters: molecular weight, protein binding and oral bioavailability of the medication. Possible undesirable effects on the premature newborn are also being taken into consideration. The attitude toward medication compatibility with breastfeeding differs between a mother breastfeeding her own child versus milk donation intended for premature newborns. Upon the safety assessment, recommendation regarding the milk donation are provided: decline, accept donation, or accept the donation-but, with dilution. In the latter case, the milk amount will not exceed 10% of the total batch. Other donations from the same batch should not contain other medications from the same pharmacological group. ResultsAround 65 consultations were performed. 30% of the queries were regarding anti-depressant and anti-anxiety medications, 14% regrading anti-thrombotic and anti-platelet therapy and 10% - treatment for allergic conditions. 5% of donations were declined due to potentially hazardous medications (e.g. doxorubicin). 21% of donations were accepted (e.g. loratadine). In 74% of the queries, the recommendation was to accept the milk donation with dilution (e.g. fluoxetine). ConclusionsThe human milk bank is a lifesaving service. In the near future, milk donations’ samples will be transferred to our unit in order to measure the concentration of the medications. This collaboration enables to use donated human breastmilk ”up to the last drop”.

Demands for whole blood (WB) and COVID-19 convalescent plasma (CCP) donations during the SARS-CoV-2 (COVID-19) pandemic presented unprecedented challenges for blood services throughout the world. This study aims to understand the motivating factors that drive WB and CCP donations in the context of the pandemic. This cross-sectional study is based on data extracted from surveys of the two volunteer donor cohorts. The findings reveal that when compared to CCP donors, WB donors were more likely to view donation as a form of social engagement (97.7% vs. 87.1%, p < 0.01), advantageous in the workplace (46.4% vs. 28.6%, p < 0.01), advantageous in their social network (58.6% vs. 47.0%, p = 0.01), and view their donation in the context of positive self-satisfaction (99% vs. 95.1%, p = 0.01). The average age of CCP donors was 7.1 years younger than those who donated WB (p < 0.01). Motivational factors were also analyzed by sex and religiosity. In conclusion, whereas both donor groups showed a high motivation to partake in these life-saving commitments, WB donors were more likely to be motivated by factors that, when better-understood and implemented in policies concerning plasma donations, may help to increase these donations.

Until recently, gay, bisexual and other men who have sex with men (MSM) were deferred from donating blood for 3-12 months since the last male-to-male sexual contact. This MSM deferral has been discontinued by several high-income countries (HIC) that now perform gender-neutral donor selection. An international symposium (held on 20-04-2023) gathered experts from seven HICs to (1) discuss how this paradigm shift might affect the mitigation strategies for transfusion-transmitted infections and (2) address the challenges related to gender-neutral donor selection. Most countries employed a similar approach for implementing a gender-neutral donor selection policy: key stakeholders were consulted; the transition was bridged by time-limited deferrals; donor compliance was monitored; and questions or remarks on anal sex and the number and/or type of sexual partners were often added. Many countries have now adopted a gender-neutral approach in which questions on pre- and post-exposure prophylaxis for human immunodeficiency virus (HIV) have been added (or retained, when already in place). Other countries used mitigation strategies, such as plasma quarantine or pathogen reduction technologies for plasma and/or platelets. The experience with gender-neutral donor selection has been largely positive among the countries covered herein and seems to be acceptable to stakeholders, donors and staff. The post-implementation surveillance data collected so far appear reassuring with regards to safety, although longer observation periods are necessary. The putative risks associated with HIV antiretrovirals should be further investigated.

IntroductionTelemedicine has been widely used in various medical settings including in Emergency Medical Services (EMS). The goal of this study was to assess the possible roles of real-time video communication between paramedics and bystanders at scenes of emergency, in the analysis and treatment of patients.Methods44 experienced paramedics participated in a simulation. Participants communicated with the experimenter presenting video clips showing patients that simulated three emergency scenarios: trauma, an unresponsive patient with cardiac arrest, and an opiate overdose. The simulation sessions were conducted through Zoom™, recorded, and then analyzed to document participants’ questions, requests, instructions, and their timings during each scenario.ResultsThe trauma scenario was assessed most promptly, with instructions to handle the bleeding provided by all paramedics. In the unresponsive patient with cardiac arrest scenario, most of the participants achieved a correct initial diagnosis, and in the opiate overdose scenario over half of paramedics sought visual clinical clues for the differential diagnoses of loss of consciousness and their causes. Additional results show the type of assessment, treatment and diagnosis participants provided in each scenario, and their confidence about situation.ConclusionsThe findings show that direct video communication between paramedic and scene may facilitate correct diagnosis, provision of instructions for treatment, and early preparation of medications or equipment. These may decrease time to correct diagnosis and lifesaving treatment and impact patient morbidity and mortality. Moreover, the findings highlight the difference between incidents with higher visual clarity, such as trauma, and conditions that require an extended diagnosis to reveal, such as unresponsive patients. This may also increase the paramedics’ mental preparedness for what is expected at the scene.

Background. Arrival times at the scene and provision of initial emergency treatment have importance in pre-hospital care settings. Donning proper protective equipment by medical personnel, as was needed during the COVID-19 pandemic, prolongs the time between the arrival of medical personnel to a patient and provision of primary medical care. Objective. We examined the effect of a suggested personal protective equipment (PPE) wearing protocol (gown protocol) on shortening pre-hospital treatment times compared to the current coverall protocol. Method. In this prospective simulation-based study, participants were instructed to inject a practice epinephrine syringe into a simulation mannequin after donning either a gown or a coverall PPE kit in the shortest possible time. Participants performed the two protocols in a randomized order. Donning time, physiological measures, and participants’ perceptions were measured after completion of each of the protocols. Results. Donning times and heart rates were significantly lower in the gown protocol compared to the standard coverall protocol. In addition, participants reported that the gown protocol was more comfortable and allowed provision of better medical care. Conclusions. Advantages of using the new protocol included shortening the time until primary medical care can be provided, perceptions of greater comfort, less difficulty in administering medical care, and lower heart rate values.

Background and ObjectivesTimely and adequate access to safe blood forms an integral part of universal health coverage, but it may be compromised by natural or man‐made disasters. This systematic review provides an overview of the best available scientific evidence on the impact of disasters on blood donation rates and safety outcomes.Materials and MethodsFive databases (The Cochrane Library, MEDLINE, Embase, Web of Science and CINAHL) were searched until 27 March 2020 for (un)controlled studies investigating the impact of disasters on blood donation rates and/or safety. Risk of bias and overall certainty of the evidence were assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.ResultsEighteen observational studies were identified, providing very low certainty of evidence (due to high risk of bias, inconsistency and/or imprecision) on the impact of natural (12 studies) and man‐made/technological (6 studies) disasters. The available evidence did not enable us to form any generalizable conclusions on the impact on blood donation rates. Meta‐analyses could not detect any statistically significant changes in transfusion‐transmissible infection (TTI) rates [hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV)‐1/2, human T‐lymphotropic virus I and II (HTLV‐I/II) and syphilis] in donated blood after a disaster, either in first‐time or repeat donors, although the evidence is very uncertain.ConclusionThe very low certainty of evidence synthetized in this systematic review indicates that it is very uncertain whether there is an association between disaster occurrence and changes in TTI rates in donated blood. The currently available evidence did not allow us to draw generalizable conclusions on the impact of disasters on blood donation rates.