1. MDA Pediatric Transport Pediatric Emergency Medicine October 13 th 2004

2. Talk Topics  EMS in Israel.  Pediatric EMS in Israel.  Pediatric transport in MCI.  The Use of Pediatric I/O in MDA.

3. Level Of Treatment Two Tier System Basic And Advanced Life Support. Basic And Advanced Life Support. Basic Level : B.L.S. Ambulance ( Including rural Ambulances) Medic/Driver (E.M.T) + E.M.T / Volunteer. E.M.T. Course - 205 Hours. 125 Ambulances In Morning shift. All equipped with A.E.D.’s 50-150 additional B.L.S. Units “on call”.

4. Level Of Treatment A.L.S. Level : M.I.C.U - Mobile Intensive Care Unit Physician, Paramedic, E.M.T / Driver. Physicians - From Regional Hospitals. 22 Units In Central Cities. I.C.A - Intensive Care Ambulance Paramedic, E.M.T / Driver. 29 Units In Small Cities / Rural Areas

5. Professional Activities A.L.S Level Of Treatment 50% Cardiac, Cardiopulmonary, and respiratory Problems50% Cardiac, Cardiopulmonary, and respiratory Problems 4%-7% Resuscitations4%-7% Resuscitations 3%-5% Pediatric Cases3%-5% Pediatric Cases 10%-15% Trauma Cases10%-15% Trauma Cases

6. Magen David Adom General and trauma activity ALS52 BLS125 ALS150.000 BLS300.000 ALS14.000 BLS36.000 Ambulances per Shift per Shift Calls per year per year Trauma calls per year (12%) per year (12%) MICU 22 (Physician) ICA 30 (Paramedic)

7. Training of M.D.A. B.L.S. providers  Total 205 course hours.  Pediatric resuscitation - 3 hours.  Pediatric Trauma – 1hour.  Pediatric Emergencies – 1 hour  Care of the newly born – 1hour

8. Training of M.D.A. Paramedics  Total 1565 hours.  Stage 1: Class based - 18w.  Stage 2: Hospital clerkship – 10w.  Stage 3: Mobile Intensive care unit clerkship 80 shifts.

9. Pediatric training in the various stages  Stage 1: Pediatric resuscitation - 20h. Pediatric emergencies - 16h. The newly born -6h.  Stage 2: Pediatric ED / PICU - 30h. Labor and Delivery - 30h. Adult and Trauma ED - 100h. Anesthesia – 60h.

10. Pediatric training in the various stages  Stage 3: MICU – 640h. PALS course. PHTLS course.

11. Pediatric Prehospital Care  In Israel: 3-5% of EMS calls.  In U.S.: 5-10% of EMS calls and only 5% involve life threatening problems.  A weak link in most EMS systems.  Controversial issues: Scoop and Run Vs. Stay and play. A.W. management in trauma.

12. Pediatric Bone Injection Gun usage in MDA

13. MDA experience  2 types an adult and pediatric device.  Introduced to all A.L.S. units in 2001.  All attempts to use the device require reporting to medical division on a “ special procedure form ”.

14. Success rate

15. Age distribution

16. Indication

17. Prehospital outcome

18. Bus number 2 explosion in Jerusalem

19. August 20, 2003, 12:35pm EDT TWENTY KILLED, SCORES HURT IN JERUSALEM BUS BOMBING A suicide attacker detonated a bomb on a packed Jerusalem bus Tuesday, killing at least 20 people and wounding more than 100.

20. Time table  21.10- initial phone call: ”explosion heard”.  21.11- M.C.I. protocol activated.  21.15- First B.L.S. unit at the scene.  21.17- Second B.L.S. unit at the scene.  21.18- First A.L.S. unit at the scene.  21.27- 5-B.L.S. and 3 A.L.S. units at the scene.

21. Time table-evacuation  21.10 Initial call  21.20- 4 non urgent victims evacuated.  21.21- 2 urgent and 1 non urgent victims evacuated.  21.38- last urgent victim evacuated.

22. Total units activated in this incident  39 B.L.S. units.  9 A.L.S. units.  1 M.C.R.V.  Manpower: Physicians-7 Paramedics-30 E.M.T.s -100

27. DISTRIBUTION of CASUALTIES

28. Pediatric victims  Of the 136 injured 45 were children and babies.  Of the 23 casualties 6 were children.  4 pediatric intubations were made at the scene.  3 pediatric patients were transported in secondary diversion.

29. Jerusalem bus explosion Secondary Diversion 2 2 Shaarei Zedek Level II Hadassah EK Level I Bikur Holim Level III Hadassah MS Level II

30. QUESTIONS ????????