death everywhere, fear everywhere. Being an emergency medical
staff member is always stressful, but 2004 was particularly
tough in Israel. Workers sometimes spent their shifts collecting
body parts. Ambulances made frequent trips to the morgue.
In the midst of it all, an Israeli newspaper asked a senior
manager of the Magen David Adom, Israel’s National Society,
how his volunteers and staff were coping. “My people
are tough,” he replied. “If they are not tough,
they should not be here.”
Often seen as superhuman, emergency responders are trained
and equipped to respond to whatever awaits, be it a broken
leg or a mass-casualty accident. Their humanity makes them
strong, but it is also sometimes their greatest weakness.
Feelings of failure, guilt and sadness — in many ways
the antithesis of everything they stand for — are not
always easy for first aiders to accept.
Fortunately, the attitude is changing. Chaim Rafalowski,
director of the Magen David Adom’s emergency management
department, explains that a simultaneous drive from both the
top and the bottom is helping to create a psychosocial support
system for staff and volunteers.
“People have emotions and we need to help them cope,”
says Rafalowski. “At the same time, people in the field
are asking for a place to vent their feelings. Finally, there
is a cultural change in Israeli society. Magen David Adom
is going with the flow.”
The wheels of change were set in motion after the conflict
with Lebanon in 2006. This year, the Magen David Adom, with
support from the International Federation Reference Centre
for Psychosocial Support and the Austrian and French Red Cross
Societies, will disseminate information on psychosocial support
and increase its peer support programme. Mental health professionals
are backing the effort.
Emergency medical staff come to the scene with little knowledge
of what awaits them. This tension can also lead to stress.
Ready to respond to basic needs, they wait for, and fear,
the ‘bad’ calls. The possibility of saving a life
is often there, but things can go wrong. The worst is when
a person dies while in the worker’s care.
“It is an ego issue,” says Rafalowski. “The
saying among emergency medical staff is that ‘nobody
dies in my ambulance’. When people die it breaks the
unwritten contract — they should not die, we should
keep the patients alive. This brings about a feeling of failure,
and no one likes to fail, especially superheroes.”
Through the psychosocial support programme, Rafalowski hopes
to make it easier for staff and volunteers to accept difficult
situations. He says that especially the young volunteers,
who make up half of Magen David Adom’s volunteer force
of 10,000, need to learn this. “The younger you are,
the more ideological you are and the more adrenaline you have,”
he says. “You think you will save everyone. This is
a powerful drive if put within realistic boundaries.”
Jonathan Caspi, 17, has been a volunteer for two years. He
spends all his free time on Magen David Adom activities. He
hopes to be a medical doctor one day and is driven mainly
by the feeling of helping people.
“My friends and I have seen lots of bodies,”
Caspi says, “but nothing has bothered me that much.
Still, we will probably need psychological help. I guess it
will come back to haunt us.”
The Austrian Red Cross has provided peer support to its workers
for about ten years.
“People need to know what the system can do for them,”
says Harald Legner, a Salzburg ambulance worker for 16 yearsand
a peer supporter for eight. “The knowledge that someone
is there for you is more important than anything else. It
makes people feel safe at work.”
Barbara Juen, a professor of psychology at the University
of Innsbruck and a long-time Austrian Red Cross volunteer,
was instrumental in creating the peer support system in Austria
and is now helping the Magen David Adom to implement a similar
structure. “Setting a programme like this up is really
a way to say we care for you,” she says.
Ofer Lachme, a Magen David Adom paramedic in Tel Aviv, echoes
these sentiments. “When our leaders went on television
and said, ‘Our people are tough’, it was hard
for me,” he says. “It felt like no one thought
about us. No one cared, not even our managers.”
Juen emphasizes that implementing a peer system does not
mean banning humour
and sarcasm. “When we started there was a fear that
everything would have to be serious,” she says. “This
is not the case. Volunteers and staff can talk to the peer
supporter about their feelings and make ‘bad’
jokes about the incidents. First aiders are more sensitive
to stress reactions in others and themselves, but they may
keep their protection shields.”
While most cases are solved within the team, Legner and his
colleagues are always available. Carefully selected and specially
educated, they also link the workers to professional psychologists
when necessary. Most often, however, information and the opportunity
to talk is what is needed.
Through information sessions, the workers learn to recognize
stress signs, and increasing numbers are asking for help.
Quiet and safe places for difficult conversations are set
up, contact details are easily available and confidentiality
is guaranteed. Legner says he sees the difference.
“Before, people would leave the organization if they
experienced a bad situation,” he says. “I tell
them that they are not stupid or weak when they react to a
situation, they are only experiencing normal reactions to
an abnormal situation. We have much less turnover now.”
Juen confirms this. “Now, the older guys take care of
the younger ones,” she says. “They take more responsibility
for their colleagues.”
Need for peers
Both National Societies emphasize the value of psychosocial
support from peers. “In the acute phase, workers only
accept help from others with field experience,” Juen
says. “This is why the peer model is effective.
“The added challenge in Israel is the much higher stress
level, for both the ambulance personnel and people in general,”
she says. “The Magen David Adom needs an even better
structure to make the peer system work.”
Head of the ICRC mission in Jerusalem, Katharina Ritz confirms
that the situation in the region is difficult.
“Staff and volunteers of National Societies are at
the forefront of every emergency, often putting their own
life at risk,” she says. “Every time there is
an attack in Israel or in the Palestinian Territories, volunteers
go to assist the victims — sometimes in their own neighbourhood.
They might find neighbours, friends or even relatives among
the dead and wounded. We tend to forget that the carers also
need to be cared about. Providing psychological support to
staff and volunteers is, therefore, extremely important.”
Karin Unterluggauer, a psychologist and long-time member
of the Austrian Red Cross Crisis Intervention Team, confirms
the value of the peer support system. Ambulance personnel
call the teams when extra support for victims and relatives
is required, mostly in cases of death or traumatic stress.
“We only have bad calls,” she says.
While this means they know better what they will face on
the scene, it also means their work is challenging and support
“Once we were responding to the third incident in one
shift, the sudden death of an infant,” she explains.
“We spent four hours on the scene. It was really too
much. My colleague had to leave the house to cry and I also
had to restrain myself. I could not invite the mother to talk
with her dead child because I knew I would break down. I could
not meet my own standards.”
In conversations with the peer supporter, they worked through
their emotions. “It was only then that I realized how
hard it really was,” Unterluggauer says. “I let
down my guard during that conversation.”
Maya Dror has been a volunteer and staff member of the Magen
David Adom ambulance service for 17 years. She is pleased
the National Society is going to provide psychosocial support.
“Once, I responded to a terrorist attack,” she
says. “We collected the bodies. I remember lifting a
detached head. Blood was dripping from it. We took the bodies
to the morgue. I went home, took a shower and went on with
whatever I was doing before the call. How could I do that?
I do not feel like a superwoman, there is no reason why I
should not be disturbed.”