The Downside of Hatzalah in Smaller Communities

911*Identifying details have been changed in the examples to protect the privacy of those involved.

Growing up in America, from the time we are young children we are taught to dial 911 in an emergency.  This number is so ingrained in our psyche that even elderly people suffering from early dementia sometimes remember to call 911, even when they can no longer remember their own telephone number (and even when a 911 call isn’t warranted).

In an emergency, how quickly help is asked for and received can make the difference between life and death.  How then is the situation improved or diminished based upon a change of protocol, such as having to make a quick choice between dialing 911, a lifelong standby, or dialing a 10 digit number for Hatzalah?  What are the factors that go into the decision between calling one number over the other?  What are the factors that delay the decision over who to call?

When Hatzalah opened a branch in Chicago a few years back, it was to better serve the community’s needs when it came to medical emergencies.  Some people complained that 911 ambulance calls took too long to arrive at the scene, the city being underserved with emergency vehicles and EMT staff.  Another large complaint was that the ambulances took patients to hospitals closest to the community, which are generally smaller and not as reputable, instead of the major hospitals slightly farther away that give more extensive care and have their personal physicians on staff.  With Hatzalah, if the medical situation permits, they will take patients to the hospital of their choice.  Additionally, there was the added benefit of having care with a personal touch, by volunteers who likely know their patients and therefore, will give them the best care possible.  Aye, there’s the rub!

I happen to know a few Hatzalah volunteers, and have seen firsthand how dedicated they are to their cause.  Aside from the training and hours of experience needed for EMT certification, they must sacrifice time away from their families, their tranquility and peace on Shabbos and Yom Tov, and much needed sleep for nighttime emergency calls.  Their families also sacrifice their time with their husbands and fathers in order to allow them to perform this mitzvah.

However, the personal touch is not what everyone wants from an EMT.  There is a certain comfort in being anonymous in a patient/caregiver situation – particularly in emergency situations where we are at our most vulnerable and exposed.  Confiding intimate healthcare problems, or undergoing examinations that could be experienced as embarrassing is often made more bearable for many by knowing that the caregiver is not someone you are ever likely to meet at a birthday party, or synagogue, or at parent teacher conferences.  Not true with Hatzalah in a smaller town.

It doesn’t matter how discreet and professional the men of Hatzalah are, the fact is that they are neighbors, friends, and relatives who don’t normally see their patients in a state of undress or in a mess of bodily fluids.

For example, two local elderly brothers waited to call Hatzalah until the younger brother, who had suffered a fall and couldn’t get up, could clean himself up to greet the emergency workers.  The older brother recounted that his younger brother was weak and disoriented after falling.  He also suffered from occasional incontinence, and in the shock of the fall had soiled himself.  They had thought about calling 911, but knew they wouldn’t be taken to the hospital where his doctors were on staff, so they attempted to get him up to go to the bathroom, clean off, and change clothes. In the attempt to lift him up, his brother fell again and hit his head on a dresser, which later required stiches.  They finally managed to get him to crawl to the bathroom, where he readied himself for the volunteers who were sure to recognize him, and only afterwards did they dial Hatzalah for assistance.

Added to the mix of lack of anonymity is the overarching international policy of the Hatzalah organization that only men are allowed to be volunteers.  I have written about this topic before, and also about how men and women are very different when it comes to modesty in medical care.  While certainly there are women who prefer male doctors and medical workers over female, many women specifically choose female health care workers, especially for any care requiring intimate examinations or exposure.  While some national Hatzalah volunteers have been quoted in the press as saying that as long as there is a positive outcome, their patients are happy and satisfied, many women will tell you that an embarrassing health care experience is something that stays with you, regardless if the health outcome was good.  This is especially true in segments of the frum community, where women place a high emphasis on tznius.

For example, one son told of how his elderly mother called him in the middle of the night in a panic.  She was suffering from chest pains, and she couldn’t decide whether to call 911 or Hatzalah.  She had been lying in bed about to go to sleep when the pains hit her.  She had her phone by her bedside, but she was simply in too much agony to get out of bed, much less put on clothing and a sheitel.  She couldn’t stand the thought of frum Jewish men coming into her home and seeing her without her hair covered.  At the same time, she felt Hatzalah would give her better care than calling 911, so she also hesitated to dial 911.  She simply didn’t know what to do.  Finally, she called her son to ask his advice, and he promptly called 911 and headed to her house.  By the time he arrived, the ambulance had arrived, but his mother’s heart had already stopped.  The medics had to resuscitate her on site and put her on a portable ventilator.  She never regained consciousness.

Of course, not every incident is as dramatic as those described above.  One woman who had used Hatzalah’s services for herself in a non-life-threatening emergency situation, said that while the care was excellent and she was appreciative, she felt extremely uncomfortable to be examined by men she knew.  She had also hesitated at first about which emergency service to call.  She was worried that she would be required to partially disrobe in order for Hatzalah’s EMTs to examine her, but ultimately, the desire to be transported to her hospital of choice overrode her fear of potential embarrassment. After finally choosing Hatzalah, she was relieved that her back pain didn’t require her to remove her shirt or lift it too high.  The EMT’s were very conscious of her desire for modesty and took pains to keep her covered as much as possible.  Nevertheless, reliving the embarrassment of two of her husband’s friends coming into her home and putting hands on her is something that has stayed with her, despite their professionalism and discretion.

The last thing an injured or ill person should have to worry about is embarrassment, but when the caregiver is a personal acquaintance and/or a member of the opposite sex that you know out of context from the health care angle, it is an issue.  How many people waffle between whether to call 911 or Hatzalah because of the lack of anonymity?  How many lives are put at risk because people have one too many options regarding who to call in an emergency?  How many times do social or religious reasons override health reasons in reaching out quickly for medical care?

My goal in writing this post is not to disparage Hatzalah, whose volunteers save lives on a daily basis and deserve our gratitude and admiration.  Rather, I wanted to discuss an unintended impediment to achieving Hatzalah’s mission of rapid response.  There is already a general hesitation in medical emergencies over whether or not a trip to the hospital is warranted.  Once the decision is made to go to the hospital, precious lifesaving minutes could be further wasted in the possible hesitation over which emergency service to call.  Hatzalah needs to find a way to ameliorate the hesitation and embarrassment inherent in calling upon friends and neighbors for assistance in private and potentially humiliating situations.  In a small community like Chicago, where everybody knows everybody, the anonymity larger communities can expect when calling Hatzalah is difficult to achieve.

Advertisements

6 thoughts on “The Downside of Hatzalah in Smaller Communities

  1. Elderly people feel this embarrassment more. My father, in his final days was very embarrassed at having a nurse help him in the bathroom. As for a woman doctor – no way. And he wasn’t Jewish and didn’t know the women.
    May I suggest a way that, while it may involve an extra expense, would solve this problem in your community?
    Call 911 for immediate care and go to the closest hospital for emergency treatment. Then, when the patient is stabilized, transport them to the bigger hospital of their choice with their doctor for continuing treatment. I did this once for my daughter.

    • That’s what used to happen fairly regularly before Hatzalah came about.

      I think people don’t hesitate to call when it involves children. I also think most men don’t hesitate. I can’t say how widespread of an issue this is, but if even one person hesitates to call, like the woman who was concerned about hair covering, and ends up with a bad outcome that could have possibly been prevented, it is an important issue.

  2. I suggest that the pros and cons of favoring Hatzalah over other services (as discussed in this post) be presented in schools, shuls, and the Chicagoland Jewish press, and the community urged find their balance between pikuach nefesh and privacy BEFORE the crisis hits.

    I’ve shared this with my daughter, who was an EMT for over a decade in the Detroit area. She’s told me that when starting out, she deliberately chose to work for a service that didn’t serve our part of town–so she wouldn’t be ministering to patients she knew personally. Alas, working for Hatzalah offers no such alternative.

    • People in the Chicago area don’t seem to feel this is a problem or crisis. The thought is that the life saving measures that the organization provides far outweigh any cons – and people are always free to dial 911 if they want privacy. I don’t think they considered people who waste time trying to decide who to call in their crisis. I’m sure some people who spend time deciding who to call end up dialing 911, so Hatzalah never even sees those patients and the further harm that might have been done by the delay. Even in the cases of those who do end up choosing Hatzalah, the patients don’t always give an accurate medical history, so Hatzalah doesn’t realize there was further injury because of patient ambivalence. For example, the elderly man who further injured himself trying to get up to clean himself reported to the first responders that his head injury happened during his initial fall. Hatzalah never knew there was a delay or further injury because the man was trying to preserve his dignity in front of the volunteers. These aren’t things patients are likely to tell them.

  3. I don’t mean to be rude or disparaging BUT embarrassment comes last after Pikuach Nefesh. OY. it is very very sadly ignorant to clean yourself up ( causing another fall) before calling emergency responders. Hatzalah or 911 is NOT, I repeat, not a taxi to the doctor situation. The issue seems more ‘pronounced’ with the elderly so their families need to talk to them about the issue and be smart / on the lookout for them.

Talk Amongst Yourselves!

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s