Israeli Paramedic Efi Roe Discusses Multi-Casualty Situations at Center for MEDICS

An urgent call comes in: a suicide bomber detonated a bomb in a hotel dining room where 250 people are eating. In the ambulance en route, you put on a vest, helmet and gloves. Listening to the radio, you determine the best driving route and learn whether other dangers exist in the vicinity. You mentally review initial lifesaving procedures. Then you arrive at the scene.
Guest presenter paramedic Efi Roe covers this true event, which occurred in Israel in 2002, and discusses how paramedics can handle multi-casualty situations most effectively and efficiently. At the Center for MEDICS in Cambridge, MA, Roe lectures about open-air and bus bombings, drawing on more than 15 years of EMS experience in Israel as a paramedic and volunteer.
With the help of photographs and short videos, Roe explains the kinematics associated with a bomb blast. The heat, light and pressure waves, coupled with projectiles that may be attached to a bomb, can cause a range of critical injuries. For example, nails and screws on a bomb can cause penetrating wounds. Victims’ clothing and lungs may be burned from the heat, and extremities may be fractured or amputated. Vision and hearing losses also frequently occur.
The paramedics learn what they should do upon arriving at a scene. After finding out who the leader is, they should locate the zones for the different levels of casualties and follow any instructions they are given. Quickly surveying the injured, they should treat with emergency lifesaving measures until more personnel arrive. Urgent patients should be evacuated first and transported to designated hospitals.
Once the incident is over, paramedics should debrief to review their performance, as well as share emotional responses they experienced.
Roe’s presentation is part of a series of guest lectures at the Center for MEDICS designed to broaden paramedics’ training. While paramedics receive extensive training in their courses, guest presenters further add to their learning by sharing specific areas of expertise.
Reviewing an example of a multi-casualty incident allows Roe to illustrate how the EMS system in Israel operates. He believes it is crucial for paramedics to learn about emergency medical systems from other countries.
You need to open your mind to what other people are doing, Roe says, “If you think another group may be doing something better, you can give it a try.”
As Israel is much smaller than the U.S. – it’s roughly the size of Maryland – their EMS system consists of 11 dispatch zones. For every one employee, they have approximately 10 volunteers. In addition to routine patients and car accidents, terrorist actions are another element keeping ambulances and crews busy, not only in the major cities but throughout the country. Similar to U.S. personnel, Israeli employees and volunteers are trained as EMTs and paramedics.
Besides being a paramedic, Roe was a longtime EMT instructor in Israel. He acknowledges the importance of classroom learning, but maintains that some essential paramedic skills can only be learned while on the job. He began riding on ambulances as a 15-year-old volunteer in 1989. Details of the first major accident he assisted with – including the patient’s near-death state, amount of blood, and the vehicle wreckage – have stayed with Roe to this day.
“You can never learn how to stay cool unless you are in the field. You learn to deal with it, or you leave. You can’t panic,” Roe said.
He recognizes that treating badly injured individuals can take getting used to. “The first time you see someone seriously injured, it stays with you,” he says.
Learning how to manage and take care of people in an emergency situation is another skill that is honed through experience. Paramedics can learn how to interview patients in a course; however, Roe has found that each patient presents a unique challenge. A paramedic might initially interview patients similarly, but he or she will need to adjust further questions depending on factors such as the person’s medical condition, age, gender and language spoken.
As a job choice, Roe recommends being a paramedic. “I think it’s a great career,” he says, “It’s a way of life, helping people.” Yet he reiterates that paramedics aren’t always successful at saving lives. “As long as you’ve done the maximum, you need to be content with the results.”
He knows this firsthand; his father’s best friend died of a myocardial infarction after Roe and other workers tried unsuccessfully to save him. While Roe realized that he did everything to resuscitate the man, it didn’t make informing his father about the friend’s death any easier.
Roe received his paramedic training as part of his bachelor’s degree in EMS from Ben-Gurion University of the Negev. Other than university programs, paramedics in Israel can receive their training in two ways: through the army or through the national EMS. Both of these programs allow their graduates to complete a Bachelor of EMS degree in two years instead of three.
After Israel, Roe lived in Switzerland for three years before coming to the U.S. in 2008. With a master’s degree in business, he currently works in the medical field for Premier Research Group. He and his wife live in Andover, MA, and have two young sons.
Working in the emergency medical field runs in Roe’s family. His father worked as a nurse, and his sister is a paramedic volunteer. In addition, years ago before they were married, Roe convinced his wife to ride as a volunteer on the ambulance with him.
Roe looks forward to riding on an ambulance again to keep up his lifesaving skills, and plans to obtain his paramedic license in the U.S.
Being a paramedic is very gratifying, he says, “You can never help people enough.”

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