Hatzalah

This article is about the emergency medical services organization. For the holocaust rescue organization, see Vaad Hatzalah.

Hatzolah ambulance in Crown Heights, Brooklyn, New York City

Hatzolah/Hatzalah ("rescue" or "relief" in Hebrew: הצלה) is a volunteer emergency medical service (EMS) organization serving mostly 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, Hatzalah, and Hatzola. It is also often called Chevra Hatzolah, which loosely translates as "Company of Rescuers."

History

The original Hatzolah 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, religious Hasidic community. The idea spread to other Orthodox Jewish neighborhoods in the New York City area, and eventually to other regions, countries, and continents. Hatzolah, as an organization, is 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 250,000 calls each year with private vehicles and a fleet of more than 70 ambulances.

Hatzalah members were among the first responders to the World Trade Center on September 11, 2001. Alongside other rescue workers, Hatzalah volunteers risked their lives to rescue, treat, and transport countless victims of the terrorist attack. In the process they earned great respect from their peers in the emergency service community.

Hatzolah organizations now function in Israel, Australia, South Africa, Mexico City, Belgium, Switzerland, several provinces of Canada, Russia the United Kingdom, and at least five states in the US.

In Israel, the largest Hatzalah organization is called Ichud Hatzalah (Hebrew: איחוד הצלה), Hebrew for, "United Hatzalah." Ichud was founded in the aftermath of Israel's Second Lebanon War in 2006 when its founders decided they would like to improve unified central rescue response. A prior organization, Hatzolah Israel, also exists, and is of comparable size.

Operations

Hatzolah 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 more 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., F-100 was Flatbush unit number 100, a"h). 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, Hatzoloh 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.

Response times

Hatzolah's model provides for speedy first responder response times. Hatzolah of Borough Park, Brooklyn daytime response time averages under 2 minutes, with overall night-time averages of 7–8 minutes, regardless of the severity of the call. Each Hatzolah neighborhood's response time varies. For example, the Hatzolah organization in Los Angeles boasts a sixty to ninety second average response time. Overall, NYC branches claim 2-4 minute response.

Organization

Hatzolah is not a single organization. Each chapter operates autonomously, or in some cases, with varying levels of affiliation with neighboring Hatzolah chapters.

In New York City's Hatzolah, 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 Hatzoloh, 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 Hatzolah organizations pattern themselves after the Williamsburg and Central models (see operational descriptions below).

Formally, the New York City-area "Central Hatzolah" is called Chevra Hatzalah of New York. It combines dispatch and some other functions for over a dozen neighborhood organizations, including Williamsburg, Flatbush, Boro Park, Canarsie, Lower East Side, Upper West Side, Midtown, Washington Heights, Queens, Rockaway/Lawrence, Seagate, Catskills, Staten Island, Riverdale [1], and others. As each of these areas is otherwise independent, each has its own fundraising, management, garages, ambulances, and assigned members. Rockland County, NY 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 cooperation among them. Together, the combined New York State branches have grown to become the largest all-volunteer ambulance system in the United States. The volunteers are trained EMTs or paramedics.

Israel's Ichud/United Hatzolah's founder and director is Zeev Kashash, though the regional organization predate Ichud. Eli Beer, originally from the United States, is the volunteer Senior Coordinator for all of Ichud, which fields over 1300 volunteer medics, paramedics and doctors throughout Israel. Ichud is larger than Chevra Hatzolah of New York, though it is smaller than the combined New York City/Rockland region.

Outside of New York and Israel, there are many small Hatzolah organizations, and a few sizable ones. Each of these operates as a self-contained unit, with no centralized organization or coordination. However, where there are other Hatzolahs nearby, there is often a great deal of cooperation.

Community involvement

Hatzolah 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..

Hatzolah of Passaic/Clifton works with the local Bikur Cholim to put on a yearly Health & Safety Fair at no charge to the community, with participation from both Jewish and non-Jewish presenters, said to get a turnout possibly exceeding 25% community..

Many Hatzolahs worldwide run safety campaigns related to drinking on Purim and fires on Chanukah and during Passover preparations.

Specialization of Hatzolah EMS

Hatzolah operates similarly to many other emergency medical services, but there are also some things that are either completely unique to Hatzolah, or that are relatively unusual for EMS.

Direct Response

Most EMS rely on crews with scheduled shifts operating from a known location. Some agencies, Hatzolah among them, rely little on scheduled crews and stations, focusing on fast response from throughout the community, with EMTs responding from wherever they are, usually with all service members on call 24x7. This greatly improves response times in dense city areas. More details on this can be found in the Operations section.

Community Sensitivities

Cultural sensitives are an issue for any EMS that covers immigrant areas, especially when a given immigrant population is relatively small, speaks a unique language, and has a specialized insular culture. Hatzolah was formed in the Hasidic enclave of Williamsburg, in Brooklyn, NY, a community that matches this description. Language, religion, and culture barriers made emergency medical situations more difficult than they might be otherwise, especially as regards laws of the Jewish Sabbath and Holidays, and laws of modestly in clothing, and contact between males and females. While the primary reason Hatzolah was formed was to speed up medical response, the cultural issues play no small part. Though long established in America and elsewhere, Hasidic communities in Williamsburg and elsewhere, to this date, continue to have the same milieu found when Hatzolah was formed.

A Jew reluctant to violate Sabbath rules when receiving medical attention from an "outsider," may be more at ease and easily convinced of the medical urgency, when the EMT or Paramedic is a fellow Orthodox Jew, speaking the same patois of Yiddish, English, and Hebrew. A female worried about physical modesty and contact, knows that a Jewish provider is more aware of the details of her concerns, and will reduce the problem as much as possible.

In addition, in areas where EMS charges a fee, there is an additional factor. Lower income clientele that may lack health insurance may have a reluctance to call for an ambulance unless the evidence of urgency is overwhelming even to the layman. This may result in true emergencies not getting treatment until symptoms worsen, to avoid the cost. A volunteer service, with sensitivities to the local community, tends to reduce that reluctance; Hatzolah is well known for its willingness to handle the "check-out" case, where there is frequently no real emergency, without charge and with great patient sensitivity. 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.

Interaction With Other Agencies

Catskills Hatzolah is known to have excellent relations with state and local police and EMS, 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 Chevra NYC Central affiliates boast an excellent relationship with New York City and New York State agencies.

Their 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.

Regions

Each neighborhood or city in Hatzalah operates independently. There are some exceptions, where there is a tight affiliation with neighboring Hatzolahs, a loose affiliation of neighboring Hatzolahs, or some other basic level of cooperation.

Americas

The Hatzolah concept originated in the United States, in Williamsburg, Brooklyn, NY. The US has several regions, with different levels of affiliation within each region. There are also Hatzolahs elsewhere in North America.

New York City

By far the largest Hatzolah group is in New York City. The sixteen local divisions share rabbinic counsel, radio frequencies, central dispatch and lobbying, but have separate fundraising and management.

New York City chapters include Boro Park, Canarsie/Mill Basin, Crown Heights, Flatbush, Lower East Side, Midtown, Queens, Richmond, Riverdale, Rockaways/Lawrence, Seagate, Staten Island, Upper East Side, Upper West Side, Washington Heights, and Williamsburg.

The Catskills division is the seventeenth "neighborhood" of Central Hatzalah of New York City. While the Catskills have a year-round operation, the vast majority of their activity is in July and August, when summer residents arrive. A plurality (possibly majority) of these residents live in areas covered by NYC Hatzalah ten months of the year. A similar proportion of the Hatzalah EMTs are New York City members, carrying New York City radios, so it is logical for dispatch to use this frequency. However, there are dedicated Catskills dispatchers, who are familiar with the camp, bungalow colony, and hotel locations in the Catskills. The Catskills dispatchers use C-BASE as a radio call sign, while other NYC dispatchers use H-BASE as a radio call sign.

The Flatbush chapter corresponds roughly to "Jewish Flatbush," which is not the same as the Flatbush, Brooklyn neighborhood that runs along Flatbush Avenue. As Orthodox Jews began populating Midwood and nearby areas in the 1960s and 1970s, the name Flatbush came into common usage to describe the area, possibly in contrast to East Flatbush, a long-time large Orthodox neighborhood that was declining at the same time.

The Flatbush chapter's primary service area comprises the Brooklyn neighborhoods of Midwood, East Midwood, Madison, and Gravesend. The extended area includes Brighton Beach, Manhattan Beach, Ditmas Park, and Kensington, and occasionally Bensonhurst.

The Boro Park chapter's extended service area also includes Kensington and Bensonhurst, as well as Sunset Park. Boro Park also sometimes covers Ditmas Park.

The Rockaway/ Lawrence "RL" chapter [2] originally just covered the Rockaways and Lawrence. As the Orthodox neighborhood increased in numbers and area, the "RL" started to cover numerous areas other than their initial community coverage. Currently, the "RL units" coverage has increased to include the following neighborhoods; Arverne, Atlantic Beach, Bayswater, Belle Harbor, Cedarhurst, East Rockaway, Far Rockaway, Hewlett, Inwood, Kennedy Airport, Lawrence, Long Beach, North Woodmere, Rosedale, and Woodmere.

The Riverdale chapter [3] extends its coverage to parts of Yonkers, in Westchester County. "RD-Units" are also responsible for covering calls in the extended regions of the Bronx as well. Riverdale and Washington Heights share an informal mutual aid agreement on occasions where one area is short-staffed.

The Canarsie/Mill Basin chapter was originally just the Canarsie division. As the Canarsie Orthodox neighborhood declined, and the Mill Basin one grew, Canarsie started taking more calls and members from nearby Mill Basin, and is now primarily a Mill Basin operation. Canarsie/Mill Basin also covers nearby Georgetown. There are parts of the Brooklyn neighborhood of Mill Basin that border Madison/Midwood/East Midwood, so there is some overlap in coverage with Flatbush. Unusually, Canarsie/Mill Basin's radio call sign prefix is "K." At the time the chapter formed, "C" was already in use for Catskills, so the phonetically identical K was selected.

Other radio call prefixes that are not direct initials include:

• Y for Washington Heights (short for Yekkes, a reference to the German-Jewish community of K'hal Adath Jeshurun in Washington Heights.) While some think the Y is for Yeshiva University because that is where the ambulances are operated from, this is absolutely incorrect - the Y designation predates any Yeshiva University members by many years, and only 1 ambulance is based there. The call letter could not be W because that is assigned to the Williamsburg neighborhood.
• ES for Lower East Side; originally, East Side and Lower East Side were synonymous, until the later formation of the Upper East Side chapter.
• M for Upper East Side; M is for Manhattan. The reason for this is because the original dispatch system could only do 1 or 2 letter codes so M was the only thing that anyone could think of. The M area is from 34th Street to roughly 125th Street from Central Park to the East River.
• WS for Upper West Side; originally the West Side covered the Upper East side above 34th street as well. The ES covered below 34th.
• Midtown does not have a letter prefix, and is primarily a virtual chapter, relying on Upper West Side and Upper East Side response. It is an ambulance from Brooklyn that sits on 47th Street and is staffed by members that work in the diamond district area. It is used for daytime calls in Mid-town Manhattan. The ambulance is referred to as Mid-Town 1 when it is in NYC.
• Boro Park uses just B, not BP.
• Five Towns and Rockaways are a combined chapter. It started in Far Rockaway, and would have been used radio call prefix R. However, Rockland County Hatzolah was forming at the same time, and even though Rockland is not affiliated with NYC, R was considered confusing. Lawrence adjoins Far Rockaway, so the chapter is called Rockaway/Lawrence, with radio call prefix "RL." Lawrence is one of the "Five Towns" of Nassau County, and all five towns are part of the primary service area.
• SI for Staten Island covers primarily the Willowbrook area, although the response area is the entire Island. There is a separate division within Staten Island, the "R" for "Richmond". This area covers the south end of Staten Island, known in the Jewish community as where "the Yeshiva" is (referring to R' Reuven Feinstein's yeshiva). Although the R is a separate, autonomous division, they have no ambulances, and rely on the SI to "load up" ambulances for response. They also have no Paramedics for response in that area.

Catskills, the Five Towns, and Yonkers are the only areas outside of New York City covered by NYC chapters.

The New York City Hatzolah is served by a central dispatching network designed to deal with the very large volume of calls received each day. Dispatchers are highly trained teams consisting of 2 volunteers working in tandem who: answer the phones; provide immediate first aid advice where necessary; and dispatch by radio the appropriate number and level of first responders, medics and ambulances using a state-of-the-art computerized system for tracking cases and assignments. Each dispatch team works several hours on a shift, and must be capable of making quick decisions calmly under pressure, while communicating clearly with the volunteers in the field.

Hatzolah of New York also uses a mobile command center for dealing with larger events.

Rockland County, NY

The "RH" (Rockland Hatzolah) is the only other affiliate umbrella in the United States outside of NYC Central. In some ways, it is the opposite of NYC's affiliation model. Whereas NYC has a central rabbinical board and separate community fundraising, Rockland has common fundraising, but several distinct sets of rabbinical oversight.

The stratification of rabbinic oversight is primarily due to several large Hasidic communities affiliated with Rockland Hatzolah. Generally, Hasidim always follow the rulings of their sect, with authority vested in the Rebbe (Grand Rabbi of the sect) and Beis Din (Rabbinical Court of the sect).

Recently, the Village of New Square, which was previously under the auspices of the Rockland Hatzoloh administration opted to part ways and create their own organization, which is expected to eventually result in a completely separate organization, operating under its own DOH license. The dispatch would probably remain centralized, where all Monsey and New Square units would transmit and receive on the same channel in the event that mutual aide is necessary.

New Square has recently implemented an unprecedented move, in which a group of female CFR's (Certified First Responders) responds to calls which involve OB related emergencies. This provides for a more comfortable environment for the patient, considering the nature of modesty that is present in New Square.

New Jersey

New Jersey has many Hatzolah organizations throughout the State. Each NJ affiliate maintains its own emergency phone number, dispatchers, and radio frequencies. While they are not officially connected, as with NYC Hatzolah, many of them are nevertheless loosely affiliated, sharing classes or working at each others' events.

Per New Jersey law, volunteers with proper permits may equip their cars with blue flashing lights and electronic airhorns, but not red flashing lights, nor sirens. Coordinators' ("officers'") personal vehicles, and any vehicle owned by a squad with a 'No Fee' license plate, are permitted the use of red flashing lights and sirens; not all branches make use of these allowances. Paramedic (ALS) units in New Jersey are only run by hospitals, per state law. The limitation to BLS is not just for Hatzolah and other volunteer agencies: all New Jersey "911" municipal-run EMS services are also limited to BLS. However, see Lakewood below for a special exception.

• Deal/Jersey Shore: Chevra Hatzalah Jersey Shore, primarily serving the year-round Sephardic community in the Deal area (Deal, West Deal, Long Branch), but expands to cover additional Jersey Shore communities in warmer months. There are a total of seven municipalities covered by Chevra Hatzolah Jersey Shore. The only Sephardic-run Hatzalah in the United States. (Mexico City, Mexico also has a Sephardic Hatzalah.)
• Elizabeth/Hillside: Hatzalah of Union County, with "U-prefix" unit numbers. Union County is geographically and organizationally separate from Union City. With three active ambulances and one a spare, "the U" also responds to nearby towns including Linden, Union Township, Roselle and Roselle Park, and even to businesses in Newark where slow EMS response may allow the Hatzalah ambulance to complete the 12-14 minute trip from Elizabeth or Hillside before a Newark city crew arrives. Hatzalah of Union County also covers the Jersey Gardens Mall, Newark Liberty Airport, and nearby stretches of the New Jersey Turnpike and Garden State Parkway.
• Lakewood: The largest branch in New Jersey, with "L-prefix" unit numbers. Unique to New Jersey, Lakewood has a Paramedic (ALS) unit. The ALS unit is owned and run by MONOC, but the Paramedics are also Lakewood Hatzolah members, and the ambulance was donated by Hatzolah Lakewood to MONOC. This unusual arrangement meets New Jersey's strict hospital-based ALS rules, while giving Hatzolah its own ALS coverage. Also unique, Lakewood has its own Rescue (extrication) unit.
• Passaic/Clifton: Hatzolah of Passaic/Clifton EMS. The neighboring cities have a contiguous Orthodox Jewish community, with most of the community and its institutions on the Passaic side. Likewise, Hatzolah of Passaic/Clifton, with "P-prefix" unit numbers, covers both parts of the community, but is primarily based in Passaic, with some members and management in Clifton. This Hatzolah is geographically near Union City, and can provide extra coverage for them. Hatzolah of Passaic/Clifton has 30 active members, 20 dispatchers, two active ambulances and a third on standby, for a community of about 2,000 households.
• Union City: Hatzolah of Union City, is run out of Yeshivas Sanz-Klausenberg, which is the center of the Chasidic community in Union City. It is the only Chasidic Hatzolah in New Jersey. Union City is located in Hudson County, and is not related to Union County. Union City uses VHF radios, while all other New Jersey chapters use UHF radios.

On occasion, all five divisions have worked together to provide joint event coverage or to share training classes.

Elsewhere In the United States

The Orthodox community in Waterbury, CT, centered around the yeshiva there, has its own Hatzolah.

The Chasidic community in Kiryas Joel (Monroe), NY has a Hatzolah, known as "KY" (Kiryas Yoel) or "KJ." Unqiuely, it operates separately from all other New York State Hatzolah organizations, not affiliating with Central or Rockland.

Los Angeles has a Hatzolah [4] chapter which provides BLS level care. On August 31, 2009 they began direct transport of patients to area hospitals on board their own ambulance [5]. Los Angeles Hatzolah relies on the Los Angeles Fire Department for ALS paramedic care and transport. They cover Hancock Park/ Fairfax, Pico-Robertson/Beverlywood/Beverly Hills, and Valley Village/ North Hollywood.

Baltimore [6] started a Hatzolah in 2007 as a first-responder-only service with transport to be done by Baltimore City ambulance units. They are planning to add transport services with the blessing of the Baltimore City Fire Department, but a start date has not been publicly announced.

Hatzalah of Miami-Dade [7] began operation inn January of 2010. It provide direct BLS response, but no transport; Hatzalah relies on Miami-Dade Fire Rescue Department for ALS paramedic care and transport. The only Hatzalah service in Florida, it cover areas of unincorporated North East Miami-Dade County, as well as select portions of the city of North Miami Beach and the city of Aventura. Hatzalah of Miami/Dade operates under the auspices of the South Florida Orthodox Rabbinical Counsel. During its two-year development, it received organizing assistance from members of many other U.S. Hatzolah branches.

Hatzalah Chicago [8] is in formation stage, accepting applications for their first team of emergency medical responders. Planned coverage area includes Evanston, Lakeview, Lincolnwood, Northbrook, Peterson Park, Skokie, and West Rogers Park.

Other Americas

Mexico City Hatzalah has a sophisticated operation, run by the Syrian-Sephardic community . It has 70 full time volunteers, seven ambulances with the most advanced equipment, five bases spread out through different areas, and its own state of the art headquarters. All dispatchers are certified Medics for immediate intervention and instructions. It also has immediate access to a helicopter and air transport for certain situations. Hatzalah mostly covers the Jewish areas of Tecamachalco, Bosques, Polanco, Interlomas, and weekend resort city Cuernavaca.

In Canada, there are Hatzolah chapters in Toronto Ontario, Montreal, and the Hasidic community of Kiryas Tosh.

Throughout the world

Though North America and Israel have the vast majority of Hatzolah activity, there are scattered Hatzolah chapters throughout the world.

Europe

Hatzolah chapters are located in England (North London, Manchester and Gateshead); Antwerp, BE; and in Zurich.

Moscow has recently formed Hatzolah.

Australia

There is Hatzolah in Melbourne and Sydney.

Africa

Johannesburg, ZA has a Hatzolah.

Israel

An Ichud Hatzalah rapid response scooter parked in Geula, Jerusalem.

Hatzolah Israel is the original Hatzolah in Israel. Ichud Hatzolah is another umbrella organization, formed in 2006, mostly with chapters that had been part of Hatzolah Israel. Other regions still recognize the older organization, and a court injunction has barred United Hatzalah from certain activities.

Each of the two Israeli central organizations has many local chapters, close to 1,000 volunteers apiece, and provides coordinated response for larger emergencies or extra coverage across multiple localities.

See also

• List of Hatzolah chapters
• Shomrim and Shmira ( "custodian" or "guardian" ) citizen patrol organizations
• Chaverim (literally, "Friends") roadside assistance squads
• ZAKA Zihuy Korbanot Ason, literally: "Disaster Victim Identification")

External links

• United Hatzalah official Site
• Hatzolah Israel
• Hatzolah of Los Angeles