It bears repeating that, particularly in the U.S., one EMS system is one EMS system. It's a rare solution that, upon working in one small corner of the EMS world, can be adopted wholesale in another and produce the same kind of benefit, without modification to that system's own unique circumstances.
So answers that work well for Israel aren't any more automatically applicable to your area than the answers of any other system. No one has it all figured out.The Israelis have certainly been through some trials, with the mass-casualty events and nonconventional threats. Maybe you can adapt some parts of their solutions to your benefit; maybe not. There's value to be had just by listening and finding out.
"The Israelis have had the misfortune to experience so many of these events we hope will never happen in the United States," says Hick. "I think they set an extremely good example in their willingness to take the time to share their experiences and what they've learned, so that those of us who are less likely to face those situations will have the benefit of their experience. It's a good reminder to us that we need to be sharing information, sharing our experiences, and trying to make sure best practices aren't held on to by individual communities. This is not an area for competition."
In that vein, here are some final thoughts about potential lessons, solutions and strategies based on the Israeli experience.
If there's a hospital or EMS service in America that can pull off major comprehensive monthly exercises around different threats, we'd like to hear from you. Most of us can't, but that doesn't mean we can't tap into some similar benefits.
Lesson No. 1 for all training, regular and special-event, is to incorporate a strong feedback loop. Debrief participants, take their input to heart, and keep working to improve performance.
"I think that's one of the reasons the Israelis are successful at this," says Stein-Spencer. "They debrief right away, they include everyone, and everyone's comments are important. They take feedback as a positive and use it to improve. We don't necessarily do that."
Related to that is this: Training's about learning. Don't be afraid to fail--that's how you improve.
Says Heilicser: "Lots of our drills are to satisfy requirements for funding. Lots of our drills are to look good for the media. Lots of our drills are to look like we're doing it the right way. I'd prefer to have a drill to learn what I don't know, as opposed to show off what I do know. Drills should be done at 3 in the morning on a Sunday, when you don't have the staff you'd normally have. Your weakest link is your most dangerous point. Let's show what we need to learn, as opposed to flaunting what we can do."
Finally, training need not be limited to regularly scheduled drills and exercises. Many services squander smaller opportunities every day.
"The opportunity to train our staff in bits and pieces is, I think, very readily available," says Hick, "whether that's by a small column in the department newsletter, or Web-based training, or incorporating disaster medical aspects into annual mandatory training, or just offering some special training on shift for 10 or 15 minutes. In the end, those are the trainings that really matter. You can shove people into a class at the start of their employment, but unless you're doing small bits of refresher training on a frequent basis, or unless it's something they're doing with daily practice, they're not going to remember it when the time comes."
We're not getting a single national EMS service or standardized coast-to-coast emergency healthcare system in our lifetimes. But that doesn't mean we can't achieve some of their benefits. We'll just have to work harder for them.