Imagine you’re the CEO of a public company. You’re addressing a board meeting when you are alerted, via the two-way radio clipped onto your belt, about a medical emergency in close vicinity to your office. You’re backing your car out of the parking lot even before the dispatcher has ended the call. On this occasion the emergency is such a short distance away that you find yourself walking into the premises while the caller is still on the phone.
You will spend approximately three to eight minutes on the scene, during which time you will provide basic emergency care using the equipment you carry in the boot of your car. Depending on the emergency this may include checking the patient’s vital signs, taking their history and inserting an IV line.
Once an ambulance arrives, the handover will be swift and seamless, and you will be back in the boardroom in a matter of minutes.
This is not a scene from a Netflix series but a real situation that could occur up to seven times a day, or 2,500 times in a year, for volunteer members of a small community and faith based emergency service in South Africa’s largest city, Johannesburg. Drawn from the ranks of plumbers and electricians, doctors and nurses, teachers and students and CEOs, the 62 trained and equipped volunteer emergency responders are one reason why Hatzolah Medical Rescue’s response times measure between 30 seconds and five minutes. The other is that the service operates within a defined geographical area located to the northeast of the Johannesburg Metro in clusters of suburbs with substantial Jewish communities.
In addition to the volunteer responders there are also three fulltime advanced life support (ALS) paramedics, and six intermediate life support medics to staff the three Hatzolah ambulances. There are three fulltime dispatchers who take calls during normal business hours, and 23 volunteer dispatchers who man the phones after hours and on weekends.
And there is one feeling every member shares, says Uriel Rosen who as well as being operations manager and ALS paramedic is also a volunteer. “We care for life. It is in our culture and our religion, expressed as the idea that ‘whoever saves a life has saved the world entire’. We live our lives by that, and our volunteers are driven and sustained by a shared goal and a selflessness that knows no bounds.
“Our objective is to help people, the best and fastest way we can.”
“Best” and “fastest” were what lead to Hatzolah becoming the first emergency medical service in South Africa to receive an EMS Angels Diamond Award, a distinction they earned in quarter two of 2024. They’d been working on their stroke management for years, says Yudi Singer, medical manager, ALS paramedic and volunteer. This has included simulation training, propagating the idea that time is brain throughout the system, selecting and prenotifying the nearest stroke-ready hospital, using the Angels prehospital checklist so there’d be no delay in the transfer of information, and wherever possible taking the patient directly to CT.
It was in Johannesburg hospitals that Angels consultant Wendy Mandindi first heard about the “amazing” work done by Hatzolah – not only hospitals in the private healthcare networks, but also in state facilities such as Charlotte Maxeke Academic Hospital near the city centre.
“But they didn’t realize how amazing they were,” Wendy says. It was an uphill battle persuading Uriel and Yudi that their organization could be eligible for an award for which candidates must submit data for 30 consecutive stroke patients per quarter. When Uriel kept insisting they “didn’t have the numbers”, Wendy called in reinforcements.
Not long afterwards, Uriel received a call from an emergency medicine specialist whose unit was also vying for an EMS Angels Award.
“Join RES-Q,” they urged. “Submit your data, we need competition!”
It took another phone call and finally an ambush for Uriel to change his mind.
On 18 de marzo de 2024, Wendy and her co-conspirator turned up at Hatzolah’s headquarters, determined not to take no for an answer. Together with Uriel they studied the quarter’s spreadsheets and by 4 pm the verdict was in: Hatzolah was within striking distance of an EMS Angels Award and there was still another month to go before the quarter one deadline.
An admin oversight prevented them from winning a diamond award right away. In a couple of cases the team had omitted to note down the name of the person they’d contacted for prenotification. But there wouldn’t be a single empty data field in quarter two.
Yudi and Uriel, who are friends as well as colleagues, both heard the call of lights and sirens from early on.
Uriel’s mom tells him that he could identify ambulances by their sirens from the age of three. He eventually relayed a passion for medicine into emergency work and in 2007 moved from Israel to South Africa where his goal was to join the Johannesburg chapter of Hatzolah.
Yudi’s father and grandfather were both physicians but he knew, even before he reached high school, that he would follow an uncle into emergency medical care. He says, “I spent a lot of time ‘chasing ambulances’ while in high school. I did a first aid course as soon as I could and volunteered for the ambulance service, riding along on weekends; I found it exciting and stimulating.”
He went into training straight after school and joined Hatzolah as soon as he could. He’s always liked helping people, he says. “There’s a lot that happens behind the scenes as day after day we try to improve. It’s not just about getting the patient from a to b, but about providing comfort, dignity and care to the patients, to the public.”
There’s a lot of learning behind the scenes too – training their team, educating the community, expanding their own knowledge.
Currently enrolled as a post-grad student in emergency care, Yudi has noted that there’s more emphasis on collaboration between the providers of prehospital and in-hospital care. Having a shared goal is “extremely necessary,” he says.
The stories they share about cases that stand out have two things common – they end happily, of course, and they reflect on the relationship between hospital and EMS. Yudi recalls being a guest in the home of his parents-in-law when their domestic worker had a stroke. He instantly recognized the symptoms and drove her in his own car to “Joburg Gen” as Charlotte Maxeke Hospital was then known. The moment stands out for the outstanding treatment provided by an overcrowded state hospital. He says, “I cannot explain how impressed I was with their care.”
In Uriel’s story the shoe is on the other foot. About three or four months ago, they rushed to take care of a patient whose only symptom was blurred vision on one side of an eye and whose only history was an as yet untreated clotting issue. En route to the hospital they called ahead to let them know their patient had had a stroke.
A nurse in the emergency department scoffed at their diagnosis, but a doctor intervened, saying: “We trust you guys. If you say it’s a stroke we believe you.” After treatment for stroke the patient was discharged five days later, her vision completely restored.
Something else Uriel and Yudi have in common is the way they relax, or rather don’t. To really unwind, they have to travel to an area with no cellphone signal – because turning off their phones is simply not an option.
“We actually enjoy the work,” Yudi says. “We want to work day in and day out and find more ways to improve, ways to do things differently, more things we can do.
“Of course time away is precious. But our work is precious too.”
