This article is about the Emergency Medical Services organization. For the holocaust rescue organization, see Vaad Hatzalah.

Hatzalah ("rescue" or "relief" in Hebrew: ) 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 and Hatzola.[1] It is also often called Chevra Hatzalah, which loosely translates as "Company of Rescuers" or "Group of Rescuers."

The original Hatzalah EMS was founded in Williamsburg, Brooklyn, New York, USA by Rabbi Hershel Weber in the late 1960s,[2] 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. Hatzalah is believed to be the largest volunteer ambulance service in the world.[3][4] 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.[5]

Hatzalah organizations now function in Argentina, Australia, Austria, Belgium, Brazil, Canada, Israel, Mexico, Panama,[6] Russia,[7] South Africa, Switzerland, United Kingdom,[8] Ukraine, and in 10 states in the US: California, Connecticut, Florida, Illinois, Maryland, New Jersey, New York, Pennsylvania and Michigan. 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: ), Hebrew for, "United Hatzalah", and Tzevet Hatzalah (Hebrew: ). While United Hatzalah is unarguably the larger of the two organizations, their volunteers are 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.

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.[9]

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., "Q-303" means "Queens unit number 303"[10]). Ambulances also have unit numbers in the same format, with the first few numbers for each neighborhood reserved for the ambulance numbers.[9] 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.[10]

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.[11]

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 12 minutes and nighttime response times are 56 minutes.[12] In the Beverly-La Brea neighborhood of Los Angeles response times average at sixty to ninety seconds.[13]

Hatzalah is not a single organization. Each chapter operates autonomously, or in some cases, with varying levels of affiliation with neighboring Hatzalah chapters.[1][14]

In New York City's Hatzalah, there is a very simple operational hierarchy. Usually, there are two or three members who are "coordinators,"[15] 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[14] Williamsburg,[2] Flatbush, Borough Park, Canarsie, 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 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.[12]

Within Israel the largest local organization is Magen David Adom.[citation needed]

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

In the United Kingdom, Hatzalah cannot use blue lights and sirens on their private vehicles [16]

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.[17]

Hatzalah of Passaic/Clifton works with the local Bikur Cholim[18] 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% of the local community.[19]

Many Hatzalahs worldwide[20][21][22] 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.

A number of items that are either unique to Hatzalah, or that are relatively unusual for an EMS include:

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.[23]

Language, religion, and culture barriers create challenges for an emergency medical service.[citation needed] 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 Sabbath 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.[citation needed] 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.[citation needed]

Hatzalah was the subject of controversy as articles in the New York Post[24] and JEMS Magazine[25] criticize the organization for its discriminatory practice of not allowing women to join. The group of Orthodox women founded an organization called Ezras Nashim, an all-female Orthodox Jewish volunteer EMT ambulance service.[26] They cited the need for modesty and sensitivity to the needs of fellow Orthodox women, with the goal of preserving womens 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.[27] 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 Orthodox Jewish mother of six.[28]

New York State Assembly member Dov Hikind announced on his radio show his support for Ezras Nashim[29] and he was criticized by Hatzalah.[30] The group received approval from their community's leading rabbis, including prominent Rabbi Yechezkel Roth of Karlsburg.[31] 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 Hatzolahs new command center in the Flatbush section of Brooklyn.[32]

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.[33]

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.

At times there have been difficulties in dealing with outside organizations, including other first-responders.[34][35]

In general, branches have excellent relations with state and local police and EMS.[36]

An example of those operating in uneven[37] or otherwise especially challenging situations[38] is Catskills Hatzolah, handling the swelling summer crowd.[39][40]

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.[41]

The Chevra NYC Central affiliates boast an excellent relationship with New York City and New York State agencies.[9]

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.[42] 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.

Hatzalah members were among the first responders to the World Trade Center on September 11, 2001.[43][44][bettersourceneeded] Alongside other rescue workers, Hatzalah volunteers rescued, treated, and transported victims.[44] In the process they earned great respect from their peers in the emergency service community.[45]

Hatzalah was not dispatched by the city's 911 system, and a printout of the 911 job from FDNY EMS does not list them as responding units.[46] However, audio recordings exist of Hatzalah's own dispatch, including members calling for help during the collapse of the first tower.[47] There are also well-known photos of destroyed Hatzalah ambulances[48][49] and the destroyed cars of Hatzalah members, in the aftermath of the attack.[50]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.

Chapters of the organization exist in Argentina, Australia, Austria, Belgium, Canada, 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 cooperation do exist between neighboring chapters.[1][51]

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