Chaim RAFALOWSKI Magen David Adom, Israel

1. Chaim Rafalowski
Disaster Management Coordinator
Magen David Adom
haimr@mda.org.il
MDA Mass Toxicological Response

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

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

13. Disaster Management dept Organo Phosphate