American 'First-Responders' Train in Israel to Handle Terror Attacks

By Julie Stahl | July 7, 2008 | 8:13 PM EDT

Jerusalem ( - Israel has more experience than any other nation in treating terror attack victims, said medical professionals who came here to learn about Israel's techniques.

Thirteen doctors, nurses, paramedics and firefighters from the western U.S. paid their own way to Israel for a course that will help prepare them for the possibility of future terror attacks in the U.S. The five-day training session was offered at Hadassah University Hospital

The group, including a politician and a veterinarian, was organized by James Crabtree, a registered nurse and a disaster-training specialist at Los Angeles County's Emergency Medical Services Agency.

After training some 3,000 medics in his area on how to deal with chemical, biological and nuclear terrorism, Crabtree was asked to design a curriculum for Los Angeles County for the purpose of training hospital personnel, paramedics and others on how to deal with the victims of bomb blasts.

"My researching on terrorism, of course, led me to Israel and Northern Ireland," Crabtree said.

The Israeli consulate in Los Angeles responded to Crabtree's inquiries with an offer of training materials, and then it extended an invitation to Crabtree to bring a group of professionals to Israel for training.

In Israel, meanwhile, Julie Ben Benishty, a registered nurse at Hadassah University Hospital in Jerusalem, had already given a course to 300 Israeli nurses on coping in times of terror.

Ben Benishty and Dr. Yoram Klein, the attending surgeon in the trauma unit and co-author of the pilot program, had already discussed how they could share their knowledge with medical professionals in the U.S., when the request came from the U.S. group.

"[The] group wanted to learn about disaster management and mass casualties. [The] only people that really know are the Israelis," Ben Benishty said.

Most of the Americans who enrolled in the course were from California. They are all part of disaster-response teams and some were involved in disaster relief at the World Trade Center after September 11. But they voiced their appreciation for the knowledge they gained in Israel.

"I have to say that the people here in Israel have been so nice," said Crabtree, who added that after four days, he felt very comfortable in the country.

"They put together a program that covers the entire gambit of managing a mass casualty event - not just the injuries," he said.

The group had lectures on what kinds of injuries to expect, how to manage them, how to adapt an intensive care unit to absorb a sudden influx of victims, how to call in extra help and direct the help when it arrives, and how family assistance centers are set up here.

"A big part of bomb blast victims is mass casualties - going from zero people to 75 to 100 of them, and I know that that's something in Los Angeles we're not at all prepared for," Crabtree said.

Although they have many resources, Crabtree said the training offered "a lot of subtle ways to manage problems" that might not be foreseen.

"It's unfortunately - through a lot of experience...that the Israelis have become very good at it," said Crabtree.

"I'm not ashamed. I want to steal their expertise... There's one other thing about being here that's so reassuring is that the Israelis are so candid and so anxious to share."

"I think it's an outstanding learning opportunity for us, and I think the education they have to offer and the timing for us at home, they've come together in a spectacular way and their hospitality, their generosity has been extraordinary," said Larry Masterman, who has been a paramedic for 25 years and works for the Northern California Emergency Medical Services Agency, overseeing EMS for 11 counties in northern California.

"The number of high-level people that are giving up their time to come and talk with 13 people from western America is really something," said Masterman, who is also the regional disaster medical health specialist for 13 counties.

Masterman said that while many of the Israeli systems are modeled after American systems, Israel is way ahead of America when it comes to dealing with terrorism.

"There's so many refinements that they've done, and they've invented some new things to respond to [terror attacks]," he said. The program, he said, included not only dealing with incidents in a major city centers, where hospitals are well equipped, but it also included a component dealing with a rural hospital. "My whole focus is how to best take these lessons and messages home."

Kurt O. Wilson, mayor pro tem of Rialto, Calif., works with the disaster medical assistance team that is part of homeland security as an EMT and a public information officer.

As a public official in a city of 100,000 people, which operates its own fire and police departments and ambulance service, Wilson said he is interested in better understanding how things work in order to be able to set effective policies.

One thing that impressed him, Wilson said, was how Israeli disaster medicine and daily care are integrated, whereas in the U.S. the two systems are separate.

"I've learned, if possible, to integrate the day-to-day functions with disaster functions," said Wilson. "In the states, what happens is we have our traditional system of medicine and that's how we handle our day-to-day events.

"We have wonderful care but in the event we've had some kind of a mass casualty event, that system is completely overwhelmed. It's no longer able to function...We then come in when the local resources are overwhelmed," he said.

"Here they're not two separate things. Here it's one system that is able to adapt, which is much more efficient than having two separate systems," he said.

"We haven't integrated those two systems. I didn't know it was possible to do it, until I came here and now I see it is possible to have one system that has that type of flexibility," he added.

Dr. Lorna L. Lanman, an assistant state veterinarian for the Arizona Department of Agriculture, is part of the veterinary response team that deals with explosives detection and search dogs at disaster sites, including the World Trade Center after 9-11.

"We have recognized the need for veterinarians to understand mass casualties," said Lanman, the only member of the group not from California.

"They are dealing with the medical response to human mass casualties. We can extrapolate the same information for animals... also the mental health significance because of the strong human, animal bond," she said.

Search and recovery dogs, which are highly trained, can be exposed to toxins or press or blast injuries, she said. "We just want to make sure we're as well educated as we can [be]."

Lanman said she was also interested in how Israel protects its food supply and agricultural interests "because we feel like there is a very significant risk for agro-terrorism in the United States."

Dr. Mona Khanna, of Palm Springs, California, is a full time medical reporter and also devotes much of her time to disaster work.

"I think what most impressed me is that disaster medicine in terms of terror medicine has really become a science," said Khanna, who was the former medical director of Riverside County, the fourth largest county in the U.S.

"It's not as haphazard as a disaster could be. A disaster when it happens is chaos but learning how to manage it, learning how to deal with it, learning how to provide the medical care, that's very systematized at this point," she said.

While many things surrounding natural and unnatural disasters are the same, Khanna said, the emotional toll on the medical personnel is quite different.

"What's different, I think in terror medicine is the emotional toll it takes on you because you realize at some point after you get through all the chaos that this was an act that was actively perpetrated by someone specifically designed to create violence, to injure people and maim people," she said.

Khanna said her goals when she returns home are to make the public aware of the kind of training disaster workers are receiving, even at their own expense, and to educate them about "what the political, religious conflicts are here in the Middle East and how that ties into terror medicine.

"The country of Israel lives under siege every single day. It's a very low-lying threat. It's accompanied by psychological damage. It's accompanied by all sorts of things we don't know in the United States," she said.

Khanna, who said she paid about $3,000 out of her pocket for the trip, said she hoped that in the future, trips like these for other professionals will receive funding.

Barbara Sofer, director of public relations and communication at Hadassah, said that the course is not a "money-making" venture. The Israeli doctors and nurses gave their time voluntarily out of a sense of mission, she said.

"Almost without realizing it, the doctors and nurses and paramedics [here] have a acquired a certain expertise in dealing with terror mass casualties that only they have," Sofer said.

"We never thought we'd want to bring the...theory of dealing with terror [to the world] but in fact a lot has been learned here and what's been learned can be translated into saving lives," she said.

"I think [we're] very happy the first group came to us," said Ben Benishty, instead of taking the training to the U.S. "Ninety percent of how we cope with the terror is because of the people."

At their closing night ceremony, a 16-year-old girl, whose case the doctors used as an example during the course, came to meet the course participants.

The teen was eating ice cream with her friends on a Saturday evening on Jerusalem's main promenade, when two suicide bombers blew themselves up. She had 122 blood transfusions and more than 100 pieces of shrapnel in her body. She walked in dressed in overalls and a pink T-shirt, ready to go back to school in the fall, Ben Benishty said.

"They really saw what a resilient group of people we are," she added.