Hatzalah

Hatzalah () ("rescue" or "relief" in ) is a volunteer emergency medical service (EMS) organization serving mostly areas with Jewish communities around the world. Most local branches operate independently of each other, but use the common name. The Hebrew spelling of the name is always the same, but there are many variations in transliteration, such as Hatzolah, Hatzoloh, and Hatzola. It is also often called Chevra Hatzalah, which loosely translates as "Company of Rescuers", "Group of Rescuers", or "Rescue Squad".
History.
The original Hatzalah EMS was founded in Williamsburg, Brooklyn, New York, USA by Rabbi Hershel Weber in the late 1960s, to improve rapid emergency medical response in the community, and to mitigate cultural concerns of a Yiddish-speaking, Hasidic community. The idea spread to other Orthodox Jewish neighborhoods in the New York City area, and eventually to other regions, countries, and continents. Hatzalah is believed to be the largest volunteer ambulance service in the world. Chevra Hatzalah in New York has more than a thousand volunteer EMTs and paramedics who answer more than 70,000 calls each year with private vehicles and a fleet of more than 90 ambulances.
Hatzalah organizations now function in Argentina, Australia, Austria, Belgium, Brazil, Canada, Israel, Mexico, Panama, Russia, South Africa, Switzerland, United Kingdom, Ukraine, and in 10 states in the US: California, Connecticut, Florida, Illinois, Maryland, Michigan, New Jersey, New York, and Pennsylvania. Hatzalah branches are currently being organized in other states as well.
In Israel, there are two Hatzalah organizations operating on the national level: Ichud Hatzalah (), Hebrew for, "United Hatzalah", and Tzevet Hatzalah (Hebrew: צוות הצלה). While United Hatzalah is inarguably the larger of the two organizations, in the past their volunteers were limited to direct response on-scene care, versus Tzevet Hatzalah volunteers, which are additionally licensed and authorized to provide emergency transport utilizing Magen David Adom ambulances. Currently Ichud Hatzalah - "United Hatzalah"- has a wide deployment of actives ambulances and several Mobiles Intensive Care Units (always staffed by a specialist doctor and a paramedic) distributed in the greatest cities of Israel, which allows them to transport sick and injured to the nearest suitable medical center, for free
Operations.
Hatzalah uses a fly-car system, where members are assigned ad-hoc to respond to the emergency. The dispatcher requests any units for a particular emergency location. Members who think they will have best response times respond via handheld radios, and the dispatcher confirms the appropriate members. Two members will typically respond directly to the call in their private vehicles. A third member retrieves an ambulance from a base location.
Each directly dispatched Hatzolah volunteer has a full medical technician "jump kit" in their car, with oxygen, trauma, and appropriate pharmaceutical supplies. Paramedic (EMT-P) members carry more extensive equipment and supplies, including EKG, IV, injection, intubation, and other pharmaceuticals. Each volunteer is called a "unit" (as in, a crew of one) and is assigned a unit number that starts with a neighborhood code, followed by a serial number for that neighborhood (e.g., "Q-120" means "Queens unit number 120"). Ambulances also have unit numbers in the same format, with the first few numbers for each neighborhood reserved for the ambulance numbers. Some neighborhoods have begun to assign 3-digit unit numbers to their ambulances, using numbers out of the range assigned to human member units (e.g., 900-numbers).
In some areas there may be periods where coverage is not strong enough, for example on a summer weekend. When this happens, coordinators may assign an on-call rotation. The rotation may still respond from their houses, or they may stay at the garage through their shift. In such periods, Hatzalah functions closer to a typical EMS crew setup, though the dispatchers may still seek non-on-call members to respond, and there will still often be a non-ambulance responder as first dispatched, even if that responder starts from the base.
In Israel, United Hatzalah relies upon mobile phone technologies which include an SOS app and a special emergency phone number, 1221, with messages to news organizations distributed by WhatsApp.
Response times.
Hatzalah's model provides for speedy first responder response times. Each Hatzalah neighborhood's response time varies. For example, in Borough Park, Brooklyn, daytime response in life-threatening emergency are between 1–2 minutes, and nighttime response times are 5–6 minutes. In the Beverly-La Brea neighborhood of Los Angeles, response times average at sixty-to-ninety seconds.
In Israel, the response time is under 3 minutes.
Organization.
Hatzalah is not a single organization. Each chapter operates autonomously, or, in some cases, with varying levels of affiliation with neighboring Hatzalah chapters and under a central association.
In New York City's Hatzalah, there is a very simple operational hierarchy. Usually, there are two or three members who are "coordinators", managing all operations aspects of the chapter.
As Orthodox Jews, many volunteers see each other daily during prayers, and especially on Shabbat. This allows them to remain organized, despite the lack of an extensive formal hierarchy.
The coordinators are responsible for recruitment, interaction with municipal agency operations (police, fire, and EMS), first-line discipline, and day-to-day operations. The coordinators often are responsible, directly or via delegation, for arranging maintenance crews, who are often called service members or service units, and for purchasing supplies, ambulances, and other equipment. There is also an administrative function, often separate from the coordinator function. The chief administrator is often called a director or executive director, and this is sometimes a paid position. All other positions in Hatzalah, including coordinators, are held by unpaid volunteers.
Most of the New York State branches have some centralized administration and dispatch functions, known as "Central Hatzalah", or, simply, "Central". The neighborhood organizations under Central are nevertheless independent. Most Hatzalah organizations pattern themselves after the Williamsburg and Central models (see operational descriptions below).
Formally, the New York City-area "Central Hatzalah" is called Chevra Hatzalah of New York. It combines dispatch and some other functions for over a dozen neighborhood organizations, including Williamsburg, Flatbush, Borough Park, Canarsie, Crown Heights, Lower East Side, Upper West Side, Midtown, Washington Heights, Queens, Rockaways & Nassau County, Seagate, Catskills, Staten Island, Riverdale, and others. As each of these areas is otherwise independent, each has its own fund-raising, management, garages, ambulances, and assigned members. Rockland County, NY and Kiryas Joel (Town of Palm Tree) branches have a centralized dispatch system as well, but their central organization is separate from the other New York State centralized functions, and they have a looser relationship with their New York State brethren, though there is a great deal of co-operation among them. Together, the combined New York State branches have grown to become the largest all-volunteer ambulance system in the United States.
For the first time, NYC Hatzoloh, one of the largest volunteer ambulance corps in the country, will receive funding from the city council.
Within Israel, the largest local organization is Magen David Adom.
Outside of New York and Israel, there are many smaller Hatzalah organizations. Each of these operates as a self-contained unit as members of a single association, but with no centralized coordination. However, where there are other Hatzalahs nearby, there is often a great deal of co-operation.
In Baltimore, Hatzalah's response area straddles two jurisdictions; Baltimore City Fire Department and Baltimore County Fire Department. Members in Baltimore often work side by side with crews from both services.
Legal status.
In the United Kingdom, Hatzalah cannot use blue lights and sirens on their private vehicles.
In England, all Hatzalah chapters are CQC registered, and they have MoU with local police forces with regards to use of blue lights and sirens, if certain criteria are met. Like any other emergency service, this does not mitigate if a collision occurs, and the service and its members can be prosecuted if deemed to be in the public interest. 
In New York, Hatzalah usually use red and blue lights and sirens, like normal unmarked emergency vehicles. In New Jersey, Hatzalah usually use blue lights. 
In Toronto, Hatzalah use green lights, having the same legal status as volunteer firefighters who also use green lights in their vehicles.
Community involvement.
Hatzalah organizations are often involved in other community activities, on top of their primary mission of emergency medical work. Many neighborhood chapters sponsor and participate in community events, both within the local Jewish community and in the broader community.
Flatbush Hatzalah frequently plays softball against teams from local police precincts, firehouses, and hospitals.
Many Hatzalahs worldwide run public relations campaigns related to safe drinking on Purim, and fire safety on Chanukah and during Passover preparations. Chevra Hatzolah in New York works closely with the FDNY on this matter.
Specialization of Hatzolah EMS.
A number of items that are either unique to Hatzalah, or that are relatively unusual for an EMS, include:
Direct response.
Most EMS rely on crews with scheduled shifts operating from a known location. Due to its members and the communities they serve usually living in proximity, Hatzolah relies little on scheduled crews and stations, and, rather, has all service members on call 24/7 and members responding from wherever they are.
Cultural sensitivities and discrimination.
Language, religion, and culture barriers create challenges for an emergency medical service. Hatzalah is built to consider these challenges, especially with regard to Halacha (Jewish law) and communities that only speak Yiddish or Hebrew.
A Jew reluctant to violate Shabbat rules when receiving medical attention may be more at ease and easily convinced of the medical urgency when the EMT or paramedic is a fellow Orthodox Jew. A female worried about physical modesty and contact is helped by knowing that a Jewish provider is aware of the details of her concerns, and will act to reduce the problem as much as possible.
Hatzalah was the subject of controversy as articles in the "New York Post" and "JEMS Magazine" criticize the organization for its discriminatory practice of not allowing women to join. A group of Orthodox women founded an organization called "Ezras Nashim", an all-female Orthodox Jewish volunteer EMT ambulance service. They cited the need for modesty and sensitivity to the needs of fellow Orthodox women, with the goal of preserving women's modesty in emergency medical situations, especially childbirth: "This is a woman's job. Historically, women have always delivered babies in traditional Jewish values, pointing to the Hebrew Bible Book of Exodus, where the first midwives were women, Shiphrah and Puah. "In our community, women also have a very strong motivation to seek female doctors", said their lawyer, Rachel Freier, a Brooklyn Civil Court Judge and Haredi Orthodox Jewish mother of six.
Ezras Nashim applied for a BLS only ambulance certificate, full of inaccuracies like Insurance of an Ambulance + 3 cars is $4000 a year. Based on the application, Ezras Nashim expects a total of 175 transports a year. A public hearing was scheduled for 10/30/2019, where supporters of Ezras Nashim testified of the "wishes and wants" of women to be treated by EMT women due to religious needs, and, at the same time, accusing Hatzolah of emotionally raping women and traumatizing them. Therapist Rachel Schmidt testified to the need of modesty in the Jewish community, but failed to relate if she treated one women with emotional scars due to the fact she was treated by a male Hatzolah member. Rabbi Kaufman represented 49 rabbis, explaining that based on Jewish law, a man can treat a woman in cases of emergencies. Ezras Nashim failed to demonstrate they understand basics of EMS rules like Paramedics not being allowed to perform any ALS procedures because Ezras Nashim is only requesting BLS license, resulting in life-threatening emergencies being handled by 911. Dr. Sara Devorkes testified that she has requested an Ezras Nashim EMT to call Hatzolah for a patient that was hemorrhaging, but the responder refused. Dr. Devorkes called Hatzolah herself, saving the patient's life.
On November 19, 2019, REMSCO did not approve Ezras Nashim's request for a BLS Ambulance Certificate. According to the agency, the reason was failure of either side to produce a majority of 14 votes to either pass the motion or deny it. Therefore, the case will move up to the Albany State EMS Council for a Decision.
New York State Assembly member Dov Hikind announced on his radio show his support for Ezras Nashim, and he was criticized by Hatzalah. The group received approval from their community's leading rabbis, including prominent Rabbi Yechezkel Roth of Karlsburg. Until now, Hatzolah has operated under this controversial policy, despite receiving public funding, such as the nearly half a million dollars in funding to overhaul the communication system at Hatzolah's new command center in Brooklyn.
Cost.
In areas where the EMS charges a fee, lower income clientele lacking health insurance may have a reluctance to call for an ambulance, unless the evidence of urgency is overwhelming. A volunteer service, with less overhead costs, tends to reduce that reluctance. Hatzolah will often handle "check-out" cases, without charge. In this way, the true emergencies among those check-outs may be recognized and treated quickly, where the caller might have otherwise not sought treatment.
Patient advocacy.
In contrast with most other EMS agencies, many Hatzalah volunteers will remain at the hospital with the patient long after bringing them to the emergency department. This is especially true during serious cases, in order to help the patient and/or their families navigate the sometimes confusing series of events that occur during an emergency. Members will stay to explain, advocate, and sometimes help make arrangements to bring in other specialists or arrange transfer to higher care facilities.
Interaction with other agencies.
At times, there have been difficulties in dealing with outside organizations, including other first-responders.
In general, branches have excellent relations with state and local police and EMS.
An example of those operating in uneven, or otherwise especially challenging situations is Catskills Hatzolah, handling the swelling summer crowd.
Israel's United Hatzalah has shared its expertise with a group of Arab volunteers from East Jerusalem, to form an emergency first response unit called Nuran. The group since has been dismantled, and the volunteers were incorporated in United Hatzalah.
United Hatzalah's relationship with Magen David Adom, however, is strained, and MDA has banned its members and volunteers from also volunteering in other rescue organizations, including Hatzalah.
The Chevra NYC Central affiliates boast an excellent relationship with New York City and New York State agencies.
On February 20, 2013, the Federal Communications Commission granted Chevrah Hatzalah's request for a waiver to obtain calling party numbers (CPN), even when callers have caller ID blocking. Calls to 911 are exempt from CPN blocking, but calls to Chevrah Hatzalah do not go through 911. Other Hatzalah dispatch numbers, including other New York State Hatzalah groups, do not have this waiver, but some are working on it.
Notable time periods.
September 11, 2001.
Hatzalah members were among the first responders to the World Trade Center on September 11, 2001. Alongside other rescue workers, Hatzalah volunteers rescued, treated, and transported victims. In the process, they earned great respect from their peers in the emergency service community.
Hatzalah was not dispatched by the city's 911 system, and a print-out of the 911 job from FDNY EMS does not list them as responding units. However, audio recordings exist of Hatzalah's own dispatch, including members calling for help during the collapse of the first tower. There are also well-known photos of destroyed Hatzalah ambulances and the destroyed cars of Hatzalah members, in the aftermath of the attack.
The Hatzalah units were also referred to in a memoir of 9/11 by responding NYC fireman Dennis Smith in his book "Report From Ground Zero". On page 231 of the first edition, he wrote: "I met two guys from Engine 39. They brought me to EMS, the Hezbollah ["sic"] ambulance." This was corrected in later editions.
2019-2020 Coronavirus Pandemic.
Hatzalah chapters across the United States continued to service Jewish communities during the COVID-19 pandemic. The organization saw a 250% increase in emergency calls during the pandemic. In addition to medical response, Hatzalah worked with rabbis and community leaders to communicate to Jewish communities the need for self-isolation and the implementation of safety precautions. Multiple Hatzalah chapters donated ventilators and masks, as well as other vital personal protective equipment, to local hospitals in need of the equipment.
Chapters.
Chapters of the organization exist in Argentina, Australia, Austria, Belgium, Canada, Chile, England, Israel, Mexico, Russia, South Africa, Switzerland, and in the United States. The chapters in each neighborhood or city operate independently, though in many cases, affiliations and levels of co-operation do exist between neighboring chapters.