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The contribution of on-call, volunteer first responders to mass-casualty terrorist attacks in Israel

Evan Avraham Alpert, MD, Ari M. Lipsky, MD, PhD, Navid Daniel Elie, BS, Eli Jaffe, EMT-P, PhD


Objective: To describe the contributions of on-call, volunteer first responders to mass-casualty terrorist attacks in Israel during the Second Intifada.

Design: Descriptive study evaluating data obtained from postevent debriefings after 15 terrorist attacks in Israel between 2001 and 2004.

Results: An average of 7.9 deaths (median 7.0, interquartile range [IQR] 2.5-12.5) and 53.8 injuries (median 50.0, IQR 34.0-62.0) occurred in each of these attacks. The average number of volunteers responding to each event was 50.3 (median 43.0, IQR 27.5-55.5). The volunteers were involved in extricating victims from imminent danger, and performing emergent tasks such as bag-valve ventilation, tourniquet application, and intravenous line insertion. They were also integral to the rapid evacuation of casualties from the scene.

Conclusion: On-call, volunteer first responders are an integral part of Israel's emergency medical response to mass-casualty terrorist attacks. This system may be used as a model for the development of similar services worldwide.


first responders, mass-casualty incident, volunteer

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Feigenberg Z: The prehospital medical treatment of the victims of multi-casualty incidents caused by explosions of suicide bombers during the Al-Aksa Intifada—April 2001 to December 2004: The activity and experience gained by the teams of Magen David Adom in Israel (in Hebrew). Harefuah. 2010; 149(7): 413-417.

Raiter Y, Farfel A, Lehavi O, et al.: Mass casualty incident management, triage, injury, distribution of casualties and rate of arrival of casualties at the hospitals: Lessons from a suicide bomber attack in downtown Tel Aviv. Emerg Med J. 2008; 25(4): 225-229.

Leiba A, Blumenfeld A, Hourvitz A, et al.: Lessons learned from cross-border medical response to the terrorist bombings in Tabba and Ras-el-Satan, Egypt, on 07 October 2004. Prehosp Disaster Med. 2005; 20(4): 253-257.

Schwartz D, Pinkert M, Leiba A, et al.: Significance of a Level-2, “selective, secondary evacuation” hospital during a peripheral town terrorist attack. Prehosp Disaster Med. 2007; 22(1): 59-66.

Israel Ministry of Foreign Affairs: Available at Accessed July 6, 2014.

Stiell IG, Nesbitt LP, Pickett W, et al.: The OPALS Major Trauma Study: Impact of advanced life-support on survival and morbidity. CMAJ. 2008; 178(9): 1141-1152

Cone DC, Weir SD, Bogucki S: Convergent volunteerism. Ann Emerg Med. 2003; 41(4): 457-462.

Auf der Heide E: Convergence behavior in disasters. Ann Emerg Med. 2003; 41(4): 463-466.

Kuehn BM: Medical reserves answer call to service. JAMA. 2012; 307(13): 1354-1355.



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