Emergency Medicine in Israel: State of the Art

doi:10.1016/S0196-0644(95)70018-8

Annals of Emergency Medicine

Volume 26, Issue 5, November 1995, Pages 640-642

https://doi.org/10.1016/S0196-0644(95)70018-8 Get rights and content

Abstract

Emergency medicine is in its infancy in Israel but is developing rapidly. Medical and government authorities such as the Israeli Medical Association and the Israeli Ministry of Health have already recognized the need for this field in Israel, although it remains for emergency medicine to be recognized as an independent medical specialty. Those involved in the intense process of obtaining formal recognition believe this will occur in the next year.

[Waisman Y, Amir L, Or J: Emergency medicine in Israel: State of the art. Ann Emerg Med November 1995;26:640-642.]

Section snippets

BACKGROUND

Israel is a small country (21,946 km²)¹ located along the eastern shore of the Mediterranean Sea. Israel has 5.5 mil lion inhabitants, of whom 81.4% are Jewish, 14.1% are Moslem, 2.8% Christians, and 1.7% Druze and other.¹ The population is mostly urban (90.5%)¹ and concen trated along the Mediterranean coast; the main urban center is Tel Aviv and its surrounding communities.

Israel has four medical schools, all in major cities: Jerusalem, Tel Aviv, Haifa, and Beersheba. Students enroll directly

THE PRACTICE OF EMERGENCY MEDICINE

There are approximately 2 million ED patient visits annually in Israel. Patients are referred to the ED from one of three sources: a family physician, who usually belongs to one of the HMO-like organizations; a community-based after-hours HMO clinic (open from 7 to 11:30 PM); or an emergency medical services (EMS) center, where the need for an ED referral is assessed by a physician or paramedic. Some patients self-refer.

From 8 AM to 4 PM, EDs are staffed by full-time attending physicians and

PREHOSPITAL EMERGENCY MEDICAL SERVICES

The EMS system (Magen David Adom [MDA], "Red Star of David") is organized on a national basis and is supported by government funds. The MDA is divided into four administrative regions with 12 dispatching centers that control more than 45 MDA ambulance stations throughout the country (personal communication, Zvi Feigenberg, MDA EMS) The system includes 500 basic ambulance units and 20 mobile ICUs (MICUs). Basic units are staffed only by an emergency medical technician/driver, whereas MICUs are

EDUCATION

Several formal training courses in trauma and emergency care are offered in Israel. Advanced Trauma Life Support has been taught by the military since 1990 and is mandatory for all military physicians regardless of specialty. Male physicians complete the course during their 5 years of compulsory service or during their obligatory 1 to 2 months of reserve duty each year; female physicians complete the course during their compulsory service because they are only rarely required to do reserve

RESEARCH IN EMERGENCY MEDICINE

Research opportunities are more limited in Israel than in many academic hospitals in the United States because ED attending physicians are expected to provide patient care on a full-time basis. No separate or protected research time exists. Funding for research is also limited, and grants are usually only a few thousand dollars each. Research grants are available from universities, foundations (national and binational) and from the chief scientist of the Israeli Ministry of Health. An emergency

ISRAELI ASSOCIATION FOR EMERGENCY MEDICINE

Emergency physicians are represented by the IAEM, which has been in existence for 2 years. Its main emphasis is to achieve recognition of emergency medicine as an independent specialty. A national conference is held annually. More than 400 physicians, nurses, and paramedics attended the 1995 conference. Other IAEM activities include continuing medical education courses in emergency medicine taught by IAEM members through Tel Aviv University and bimonthly meetings at which clinical issues,

RECOGNITION OF EMERGENCY MEDICINE AS A SPECIALTY

Medical specialties in Israel get recognition from the Scientific Council of the Israeli Medical Association (IMA). A subcommittee of the IMA gave its recommendation for a residency program in 1994 to the governing body of the IMA, but a final decision has not been made and no specific action taken.

FUTURE DIRECTIONS

Our goal is to gain official approval of an emergency medicine residency training program by July 1996. Once such a program is approved, we plan to train 10 to 12 residents a year in a 4-year program. "Fellowship" training of 1 to 2 years will be offered to physicians who are already board certified in internal medicine/surgery/critical care or anesthesia and wish to be specialty trained in emergency medicine.

Pediatric Advanced Life Support is taught bimonthly with the goal of training every

Acknowledgements

The authors thank Dr Zvi Feigenberg, medical director of MDA EMS, for submitting data for this article and for his significant contribution to the prehospital section of this manuscript. The authors also thank Dr Bruce Klein, Children's National Medical Center, Washington DC, for his editorial assistance.

References (1)

Statistical Abstracts of Israel 1994, No. 45.. Jerusalem, Israel, Central Bureau of Statistics,...

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^☆: From the Department of Emergency Medicine, Schneider Children's Medical Center of Israel, Petah Tiqwa*; the Department of Emergency Medicine, Chaim Sheba Medical Center^‡, Tel Hashomer; and the Tel Aviv University Sackler School of Medicine, Tel Aviv, Israel.^§

^☆☆: Dr Waisman is the chairman of The Israeli Association for Emergency Medicine.

^★: Address for reprints: Yeheskel Waisman, MD, Director, Unit of Emergency Medicine, Schneider Children's Medical Center of Israel, 14 Kaplan Street, Petah Tiqwa 49202, Israel, 972-3-939-3658, Fax 972-3-922-3011

^★★: Reprint no. 47/1/68844

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