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.


Stepping Forward or Backward? New All-Female EMT Crew is Operational in Boro Park

pinkA few years ago I read about a group of women who were petitioning the Jewish volunteer emergency medical service, Hatzalah, to accept females into their organization. The Forward had an interview with the woman lawyer and EMT spearheading this effort, Rachel Freier. Freier and others created Ezras Nashim, hoping to create a women’s EMT division in the Brooklyn branch of Hatzalah, primarily to assist with emergency home child labor.

In the late 1960’s when Hatzalah was first founded, there was a short-lived women’s division called, Hatzilu. Within three months of operation, local rabbis, fearful of inappropriate relationships happening between mixed gender emergency volunteers, ordered the female division to be disbanded. Ever since that time, the rabbis and lay leadership of Hatzalah have excluded women from participating in the service, even though half of their patients are women.

The Forward article included this interview from a woman named Miriam :

“Miriam was home alone in Brooklyn’s Hasidic neighborhood of Boro Park when she birthed her second child, her water breaking unexpectedly and the baby slipping out along with it. Moments later, seven men barreled through the door. One of them took the baby, and another asked Miriam to lie down so that he could check between her legs for the placenta. Then, the technicians — members of the volunteer ambulance corps Hatzalah — whisked her away to the hospital. Even though her male neighbor had called the men in an effort to help, Miriam said the experience was “traumatizing.”

In the ultra-Orthodox world in which Miriam lives, unmarried men and women are barred from touching, let alone exposing their bodies to one another. Though the incident occurred 15 years ago, Miriam (who asked that her name be changed to protect her privacy) remembers every detail of that uncomfortable visit. In particular, she remembers wishing that women had attended to her, instead of men.

“I think that a woman who has to give birth at home should at least have the comfort of another woman at her side,” she said.”

Rachel Freier added in a Voz Iz Neias interview:

“Women who have had a baby delivered by Hatzalah are grateful to them, but they are also embarrassed and humiliated by the experience,” said Mrs. Freier.  “If they meet that EMT or Hatzala member, they will likely cross the street to avoid him.  We are all so proud of Hatzalah.  We can’t live without them.  But the voice of the women now has to be heard.”

Hatzalah refused to change its position not to accept female volunteers, and so Ezras Nashim has been established as its own organization. They will first begin serving Boro Park and hope to expand into other areas of New York and even Israel. According to Tablet magazine:

“None of the issues they’ve faced have been enough to deter Freier or her dedicated crew of nearly 50 volunteers. In fact, they went above and beyond, with each EMT attending additional training sessions at two local hospitals, where they shadowed doctors on the emergency and obstetrics wards, and obtaining certification in neo-natal resuscitation, which requires extra hours of instruction. New recruits are signing up every day, with 10 or so currently enrolled in courses. The EMTs will at first be answering calls related to childbirth but plan to expand their focus as they solidify their practice.”

What’s interesting to me is that, aside from the usual critics who don’t feel that women are capable of responding to medical emergencies and that Ezras Nashim is taking precious financial donations and resources from the already established Hatzalah, there are those who feel that Ezras Nashim is anything but a female empowering endeavor. People have critiqued the service for promoting a hyper-tznius agenda which further separates the sexes, and could be creating a new chumra that will stop women from accepting medical treatment from men or stop men from offering medical treatment to women.

My opinion on the matter is that I think that frum female EMTs are long overdue in our communities. I think that the Hatzalah organization should be ashamed of itself for refusing to let women into their corps. Having a separate Ezras Nashim should never have had to happen – it should have been a division of the already established Hatzalah all along from the beginning. Since Hatzalah has stubbornly refused to let women into its volunteer EMT organization, forming Ezras Nashim is a necessity.

Ezras Nashim will give women more control over their care in vulnerable situations. I think it’s a terrible breach of tznius to have familiar men caring for a woman in labor who they know – especially when there have been women asking to take over this role and were told no. There is such a big difference between having a male doctor and male volunteer EMT from your neighborhood treating you. Most people I know don’t have a relationship with their OB/GYN outside of professional visits. Plus, a male OB/GYN has seen hundreds/thousands of deliveries and done hundreds/thousands of intimate exams. After awhile they become desensitized and it’s strictly professional. Doctors undergo sensitivity training in medical school on treating the opposite sex. They are graded by volunteer patients to see how they perform in this area.

Being treated and seen for an intimate exam by someone with a BLS or ALS license who you see at shul, the grocery store, parent/teacher conferences, simchas – someone who you only know socially – is quite different than being seen by a physician with whom you only have a professional relationship.

I think the critique about Ezras Nashim being a feminist step backward has to do with the emphasis on only providing labor and delivery services. In reality, these women are getting the same certification that Hatzalah members have and can treat emergencies of any nature. My opinion is that I think they are kowtowing to rabbis and those accusing them of being feminist upstarts by stressing the childbirth/doula angle. Eventually, they will incorporate all emergency services into their repertoire. I agree that it’s a waste that the women of Ezras Nashim had to recreate the wheel, but that wasn’t their choice.

I think it’s hypocritical for people to argue that the men of Hatzalah are professional and unfazed when seeing an unclothed woman they know, but women would not show the same level of professionalism when treating a man they know. How is it pikuach nefesh when a man touches and treats an unrelated woman, but a woman touching and treating a male patient would not get the same dispensation? I thought women were supposed to be on a “higher level” regarding sexual temptation? Men and women work side by side for many hours in stressful jobs every day. I don’t see how volunteer EMTs would be any more likely to develop inappropriate relationships than in most other professional work settings.

Women have a lot to offer to community emergency health services, not just as dispatchers or secretaries, but also as active EMTs and paramedics. To that end, I am very proud of these women and their determination and dedication.