Race against the clock

LIKE thousands of their peers around the world, emergency medical technicians (EMTs) from the Palestine Red Crescent Society (PRCS) are used to saving lives, but also used to waiting at the station, talking about previous operations they have done, or simply about the weather, politics and family matters. Until the phone rings. When the call for assistance comes in, the crews respond quickly, changing from a state of friendly camaraderie to a rapid response by trained and prepared pre-hospital care professionals, as they obtain the call details and hurry to their ambulance to go to the aid of the person in need.

The difference between the PRCS emergency medical service (EMS) crews and most others around the world is that they are working in a context of occupation and conflict. After arriving at the scene of the incident, although they can see a wounded child lying on the ground or a woman calling for them to help her husband who is having a heart attack, they cannot provide aid immediately.

In order to access the patient safely, the EMT crew frequently has to make a request for "coordination". This process requires the involvement of the ICRC, which contacts the Israeli Defence Forces (IDF) to obtain permission for the PRCS ambulance, on a humanitarian basis, to enter the area. It means that the EMTs have to watch and wait until the "green light" is granted. Psychologically, this is a very challenging position for someone who has entered the profession to help those in urgent need of care and transportation. Even with such coordination, and after permission has been granted to enter the area, soldiers have sometimes opened fi re on the EMTs, leading to injuries and even deaths of those attempting to carry out their humanitarian medical mission. Such are the conditions under which the PRCS has provided its EMS during the past four years of the second Intifada.

In addition to frequent military operations, there are hundreds of checkpoints, barriers and earth mounds, as well as the West Bank barrier, that interfere with the ability of the PRCS EMTs to provide their services to the Palestinian population. To overcome these obstacles, assistance, in the form of coordination from the ICRC, is often — although not always — required. However, this takes time and delays a rapid response, sometimes leading to the deterioration of the health of the patient who has called for their assistance.

The PRCS became the main EMS provider to the public of the West Bank and Gaza Strip in 1996, when it was given the mandate by the Palestine National Authority to provide ambulance services throughout the Territories. Having a well-established network of branches and already providing a number of social and emergency humanitarian services, including ambulance services, the PRCS was able to support the Palestinian people. Since then it has carried out its mandate, often under very difficult circumstances, with an exceptional degree of professionalism and dedication.

Beyond the difficulties created by the occupation and military operations, the context in which the PRCS provides its EMS is further complicated by the fact that a number of other non-governmental organizations, hospitals, private operators and the Ministry of Health also operate "ambulance" services. The majority of these operators use vehicles identified as ambulances, often including a Red Crescent, Red Cross or a combination of both. These vehicles are not used mainly for the care and transportation of the seriously ill and injured, but to transport medical personnel, medical supplies, patients in a stable condition or the dead. The plethora of these other “ambulance” service providers makes it difficult for the public and the IDF to differentiate their role and function from that of the PRCS EMS, thereby further reducing the access and safety of their operations. Advocacy for and adoption of a draft law are needed to help reduce abuses of the emblem. In addition to these efforts towards proper identification of the PRCS as the future National Society of the Red Cross and Red Crescent Movement in the Palestinian Territories, the PRCS is encouraging the establishment of an EMS commission to better regulate the provision of ambulance services.

Key facts and figures

• National “101” telephone number
• Headquarters, 7 main stations and 23 substations in the West Bank; 6 main stations and 1 substation in the Gaza Strip
• Minimum of 44 vehicles staffed and on duty 24 hours a day
• Responds to an average of 7,200 calls per month

The PRCS has taken significant steps to establish a professional EMS operation, in spite of a lack of legislation, so that those who require its services know that the care provided is in keeping with international best practices of pre-hospital care. The PRCS has established an EMS education centre, to train EMTs, at both basic and intermediate levels, as well as drivers and dispatchers. The centre’s curriculum is currently under review, not only to ensure that the courses currently offered are up to date, but include an EMT paramedic-level curriculum. The PRCS has also set standards for its vehicles and the equipment they carry.

But it is not the system that gives the PRCS EMS department its strength, it is the staff and volunteers who answer the phone and respond. People like Luay Radad, 30, who began as a volunteer in 1997, progressed through the service to become a station director in Ramallah and later Jericho, and is now a member of the EMS education centre, passing along the knowledge and skills that he has learned to another generation. Luay initially wanted to pursue a career in medicine. However, the restrictions placed on the movement of Palestinians prevented his attendance at an appropriate university. He learned in 1996 that the PRCS was setting up an EMS department and decided to train as an EMT. Luay, like many other EMTs, has not been deterred by the situation under which the department currently operates. Instead, he says that it has given him and his colleagues the desire to reach higher levels of proficiency and training to ensure that the people who need their services receive professional, high-quality care. Luay is as dedicated to the PRCS as he is to the EMT profession, and looks forward to future opportunities to assist in the continuing improvements of the service.

Q&A with Younis Al-Khatib, President of the PRCS

What advice would you give to other National Societies about operating an EMS in conflict areas?
It goes without saying that in times of conflict, adherence to the Fundamental Principles is given greater impetus. In the area of emergency service provision, protection and respect for the work of medical missions in conflict areas is crucial in order for these missions to be able to alleviate suffering and save lives. It is also important for National Societies working in conflict zones to share their experiences and to identify areas where mutual cooperation can be initiated and developed.

What, in your view, are the main obstacles the PRCS EMS has to face every day in the field?
The main impediment to PRCS work during the current situation is access. Access not only for our emergency medical services, but for the other humanitarian services we provide such as primary health care, rehabilitation and social welfare services.

Why has the EMS become so emblematic of the PRCS and the Palestinian people outside the Palestinian Territories?
As the national emergency service provider, the PRCS has over 30 stations and substations throughout the West Bank and Gaza. Our EMS teams can be dispatched to provide assistance to even the most remote areas. The PRCS has been particularly visible since the conflict began in September 2000. It has increased the number of trained EMTs and ambulances, in addition to establishing substations in remote areas. Emergency mobile teams and the 101 hotline have also been part of this expansion in response to the needs of the population. The professionalism of the medical crews in the field and their commitment and sacrifice to save lives embody the humanitarian mission of PRCS.

What lessons have been learned since the launching of the EMS?
Crews’ safety and commitment to work according to protocols and regulations are high on our priority list, in addition to proper planning and monitoring. Providing continuous training and refresher courses for the EMS teams are also very important.