Disaster management is a major concern for almost every government across the globe. Agencies, institutions, and jurisdictional responsibilities are rapidly increasing in preparation for unforeseeable emergencies. Different countries have different emergency management systems. The increasing threats to national security in many parts of the world have resulted in calls for unified and well-coordinated command and emergency systems (Hambridge, Howitt, & Giles, 2017). National emergency services are top priorities for many governments. The United States and Israel are among nations that face threats of disasters and terrorism. The world is in a state of anticipation and preparedness for any emergency response. The incidence command system is the skeleton upon which every emergency service is framed. Therefore, training and retraining are part of each government’s policy on incident command systems through such agencies as the National Incident Management System (NIMS) and Federal Emergency Management Agency (FEMA). The National Emergency Authority (NEA) and the Ministry of Home Front Defense of Israel are the equivalents of the Department of Homeland Security. A nation’s political system, policies, culture, infrastructure, reflects the type of emergency service and response.
Overview
The U.S. created a federal agency to manage emergencies and prepare against threats. FEMA was formed in 1978, as a focal point for states and local governments during disasters or other incidences of national concern. The primary function of FEMA is the provision of policy guidelines, directives, training, and coordination of national and state emergency services. One of the major reasons for its creation was to eradicate the different entities that were impeding incident response by having a central command and training agency. An assortment of organizations that were merged to form FEMA/DHS involved institutions with different professional training, policies, ethics, roles, and responsibilities (.U.S. Department of Homeland Security, n.p). It is the responsibility of FEMA to prepare and respond to natural and human-made disasters in America. Several emergency programs have been developed and tested. According to FEMA (n.d) “;in March 2003, FEMA joined 22 other federal agencies, programs and offices in becoming the Department of Homeland Security.” (n.p). This inclusion came after the September 11 attack in 2001. The Homeland Security Act of 2002 introduced the National Incident Management System (NIMS) as an improved standardized disaster management approach that is composed of all levels of government irrespective of incident size, nature, and complexity (U.S. Department of Homeland Security, n.p). Since its mandate, every state governments and organizations have adopted NIMS principles and concepts at various levels of success.
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The United States emergency line, 911 is a centralized line that is regulated by the Federal Communication Commission. The Department of Transportation oversees the national 911 system, and it links with the National Emergency Numbers Association, which is a representation of public and private companies involved in emergency services. Each state and county manage its 911 emergency center. The 911 calls are to connect with the police, fire, and emergency medical service (EMS) divisions closest to a caller’s location. In the U.S, the first responders are the police, fire, and emergency, medical team. The 911 line was designed with landline telephone infrastructure that now requires upgrade (Kelly & Keefe, 2017). It has experienced challenges with new cellular technology. Private telecommunication operators are gradually upgrading their systems to assist the transition and integration of smartphones into the 911 emergency line.
The digital shift is one of the problems encountered in America’s emergency service. As noted by Kelly and Keefe (2017), “Your chance of 911 getting a quick fix on location ranges from as low as 10% to as high as 95%, according to hundreds of pages of local, state and federal documents” (n.p). Often, private telecommunication tower addresses what is seen in the call center centers because of the routing of calls. Some callers might be in another county or jurisdiction, but the emergency line is not able to locate them because of the network provider’s tower location. Thus, jurisdictional challenges caused by routing, and the need to overhaul the cellphone capabilities of the centers across the country.
The Israeli police, Magen David Adom (MDA), the Ministry of Health, the IDF, Army Medical Corps, Israel Fire and Rescue Authority are functional institutions concern with an emergency. A public-private partnership exists in Israel’s emergency services. The government regulates emergency agencies and departments. The ministry of health regulates the MDA while the ministry of Public Security regulates the Police and Rescue and Fire Departments. In Israel, there is no single or common emergency line like 911. Different agencies have their respective emergency lines, and they have about six emergency lines to call for specific issues (Hason & May, 2014). There are command call centers that are operated by soldiers.
The MDA is the largest medical emergency organization in Israel with an emergency number 101. The national police number is 100, and the Fire and Rescue number is 102. Other agencies have numbers that citizens can call. For example, United Hatzalah uses 1221 to provide emergency services to people that it can access and assist. Government agencies such as the National Fire Authority have Command centers that connect with the Home Front Command, the Police, and other emergency networks to improve response time (Hason & May, 2014). There is a system in Israel called the Nitzan that incorporates all emergency agencies into one communication system. It enhances the responsiveness to an emergency.
The Israeli Defense Force has a division called the Home Front Command that focuses on emergencies. It states on its website, "In times of crisis or war, the Home Front Command operates to its fullest capabilities, using all its resources to instruct the civilian population on how to cope with the threats facing Israel.” (IDF, n.d). The Home Front Command is a specialized department of the IDF, focused on emergency, search and rescue operations for Israelis and overseas emergency engagements. Each ministry ensures that during an emergency, everything required within its jurisdiction is available in time as part of a coordinated, unified system. The law enforcements, fire, transportation, media, the IDF, and other agencies are critical in emergency service control and resolution. The readiness against disasters is demonstrated by institutions that are involved in emergency services in Israel (Rambam Health Care Campus, 2014). Thus, the nation’s command and oversight structure incorporate different agencies in its emergency coordination.
The ministry of health and Defense work in close cooperation in Israel's emergency services. The supreme health authority or committee of the department of health is responsible for emergency management in any disaster. During an emergency, this supreme power is the commander of the medical system. The supreme health authority has representatives from other health care agencies or organizations. The frequency of their meetings depends on the state of the nation’s intelligence reports. The purpose of this inclusivity is to ensure that every health facility is open to victims and incident responders.
How the U.S Conducts Emergency Services
The U.S is a federal state with great inter-government relations. This political structure influences the way organizations, and agencies implement policies. NIMS is the U.S emergency management concept. The U.S is made up of fifty states, counties, local governments, tribal entities, municipalities, and districts. The DHS/FEMA is responsible for NIMS compliance by relevant participating agencies in emergency responsiveness and preparedness. The agency also offers training to other tiers of responders as well. States and local governments are required to be NIMS compliant to get federal preparedness funding, but non-governmental organizations and private industry do not rely on these funds. Thus, emergency is business-focused in the U.S. (Hambridge, Howitt, and Giles 2017).
The U.S. government is assisting individuals and organizations in understanding their level of exposure to risks through programs such as the National Preparedness system and the National Preparedness Goal, initiatives that are based on risk assessments. Many organizations have their primary missions that are unrelated to emergency services. The delay in restructuring the 911 system to adapt to cellular technology is an example. Thus, redirecting their funds to implement NIMS concepts is a challenge in America’s context. Collaboration and consistency are important in how emergency services are performed. The U.S emergency response system is improving in collaboration with different jurisdictions because of the benefits that are associated with it. Collaboration in planning, execution, training, administration, and costing make responses efficient (Hambridge, Howitt, and Giles 2017).
There is a weak institutional status of emergency management outside first responders. Though fragmentation of responsibilities is being reduced, weak political constituencies and budgetary cuts are affecting emergency service delivery. Hambridge, Howitt, and Giles (2017) note that “Ideally, a robust emergency response, especially when involving multiple organizations and jurisdictions, requires effective collaboration so that the tasks of response can be carried out with necessary urgency,” (p.4). The municipal emergency-response systems are disparate thus making a uniform emergency service difficult. Different states operate their ambulatory services differently. Infrastructure, fiscal issues impede technological upgrade and overhaul. A relationship between the public and private agencies is not very robust, and the best emergency response systems will come from such partnerships.
Cost and Efficiency
In the U.S, health care cost is increasing. This increase is reflecting on the emergency services as well. The private network operators charge callers that use its networks to call 911. For example, Vonage charges a fee of $0.99 for a line. Vonage (n.d) notes, “This fee is for providing 911 service, as required by the Federal Communications Commission (FCC), including costs for supporting computer software and hardware upgrades that allow public safety answering points (PSAP) to send assistance to the registered location of a 911 caller.” (n.p). This bill is almost an average in the country.
Institutions, volunteers, private ambulance companies, fire departments, municipal EMS, and agencies offer ambulance services. However, depending on the transporter, part of the state, and who is responsible for payment, the ambulatory cost in the U.S range from $224-2,204. According to Rosenthal (2013) “Part of the inconsistency in pricing stems from the fact that ambulance services are variously run by fire departments, hospitals, private companies and volunteer groups.”(n.p). The business-oriented nature of ambulance services has impacted on the cost in the U.S. efficiency is related to the arrival time which is dependent on the nearness to a center as well as 911 dispatch time. Mostly, it is efficient because the quality of infrastructure is high and the competency of personnel is reasonably adequate.
How Israel Conducts Emergency Services
Soldiers operate the command centers. Israel operates a centralized government. The country has a multiparty, parliamentary system of government that is democratic. It has a robust and functional emergency service. The pillars of its emergency response system are contingency planning, command and control, coordination, cooperation, and capacity building (Hason & May, 2014). The degree of awareness of possible threats causes Israel to anticipate and prepare in readiness for an attack as the example of Rambam Health Care Campus underground facility. Israel creates standard operation procedures for potential disaster. This development of operating systems is done together with a national stocking of vital emergency necessities such as medical equipment and supplies. They also maintain their critical infrastructure such as decontaminant locations. The law in Israel grants the national police the powers and responsibility for coordinating the activities of the municipal officials, EMS, fire department, or first responders. Therefore, in Israel, the command and control are under the national police. The military may offer assistance in certain situations if the defense ministers and the minister of internal security, agree. The military may assume control of a situation depending on an agreement between the two departments.
Depending on the complexity of the incident, coordination is accomplished through a centralized, top-down hierarchy structure consistent with the incident command system. If casualties are involved, it will be according to instructions circulated by the Israeli health ministry. The cooperation is realized through shared information and intelligence systems. Also, continuous training activities are carried together with doctor posting to health facilities during disasters. They have a unified terminology, which improves emergency management. Their capacity building is a thorough all-inclusive training for medical staff in emergency preparedness. Individual performance is assessed by competent staff of a medical institution or the ministry of health and observations sent to the health department. Thus, capacity building is taken seriously as a national policy. The Israeli command call center operates within a linguistic range of seven languages (Arutz Sheva TV, 2014). Though struggling with a fragmentation of locations, the absence of a unified central command is affecting the operations of the services. It has a targeted and known caller identity feature that helps in service delivery. The Israeli emergency system is digitized and functions effectively with cellular phones.
Cost and Efficiency
In Israel, the cost of emergency services depends on socioeconomic status, distance to the emergency department, time of the day, and organization involved. Emergency services in Israel have been stable with a cost containment policy that is implemented efficiently. Risk sharing between the government and providers/consumers of emergency services through the health plan initiative promote access to emergency services while keeping costs at manageable levels. Private ambulance in Israel operates according to the market forces. Their prices are not as high as those in the U.S, but they also have volunteers as providers of ambulance services. Therefore, prices range from zero to the starting price for the government controlled organizations such as MDA at $100.59(NIS 357), for 20km to NIS 1,500, for a distance of 100km.
Israel is known to have efficient emergency services. The country's emergency is impressive in many aspects. The quality of duty is excellent in community-based services. Specialized care is concentrated in community settings. Also, it has an enhanced primary care service. Community-based and home emergency care became alternatives to hospital emergency. The health insurance system is one that encourages universal coverage so that many can access essential emergency services. Rosen, Waitzberg, and Merkur (2015) state that "the Israeli health care system has functioned well with relatively few resources, which may indicate a good level of efficiency overall. However, there continue to be various pockets of inefficiency, and various barriers to efficiency improvement, which should be addressed.” (p.188). Most Israelis can access emergency services because of the level of preparedness.
Israel’s Emergency Approach
The national police are the first line of command and control in emergency services in Israel. The Home Front Command, Israeli Defense Forces (IDF), and the national supreme health authority act as an integrated emergency preparedness and management system. There are a few differences between the Israeli emergency services and that of the United States. Although, both countries, share similarities in some extent. The political structure of the two nations and size contributes significantly to these differences. Most emergencies are hospital-bound, so the national police and the ministry of health through the supreme health authority are usually in command alongside the Fire and Rescue department.
One of the key distinctive features of Israel's emergency services is the compulsory training for medical institutions, first responders and the regular drills performed by personnel involved in disaster or incident management. In these training and drills, standard terminology, close synergistic effort between the civilian and military, police, local, regional, and national authorities are harnessed. There is a flexible system for emergency response, formulated from an evaluation of past incidences.
Emergency response in Israel makes use of bystanders and witnesses. Almost every Israeli is trained and empowered to offer first aid and calm a chaotic situation. They are made the first responders in an incident operational structure. Before the arrival of government authorities, citizens are allowed to respond to situations. Israel's military service is compulsory for both men and women. Therefore, most people in the streets and neighborhood have gained experience in military training to transform a disturbing, crisis scene to one that is orderly. In cases of mass casualties, the Israelis are prepared to assist in restoring order and saving lives.
Every health care provider can render services anywhere in the country without restrictions once certified. This freedom provides smooth reinforcement in any event of staff shortage in a particular location. The three public emergency agencies; fire department, the police, and the emergency medical services (EMS) are national institutions (Hason & May, 2014).. A select committee constitutes each incident that requires a response and task force of government appointees made up of experts. People serving on these committees do so voluntarily and are not compensated. The recommendations from the committee or task force are passed down for implementation as policy. The Israeli government has developed a system that can be activated easily. There is no violation of jurisdictional responsibilities or roles because any of the national agencies can be activated at any time. Bystanders can become responders in any delayed response. All medical centers are required to create space for a 20% surge of emergency in their emergency department. Israel utilizes technological innovation, social media to gather information on hospital admission and patients’ treatment progression.
The U.S Approach
The U.S approach to emergency services is not so different from the Israeli except for a few structural organizations. The differences are systemic because of the political system (Peleg & Kellermann, 2009). The U.S 911 call centers are state-based response units with subdivisions within states. The federal emergency management agency makes use of integrated data system from the states. It also creates its information dissemination pathway to states as a bidirectional data relay system. The police manage the 911 calls in the U.S. even with a non-uniform data system (Kelly & Keefe, 2017). Besides, police, the fire service, EMS are part of the first responders in emergencies. Different states operate emergency management according to their capabilities and readiness. Military training is not compulsory and not every medical staff train for emergency preparedness, though the government is ensuring that institutions evaluate their readiness. The federal agencies are collaborating with medical institutions and professionals to train them for emergency preparedness.
Thus, Israel and U.S have similar emergency services, but institutional and policy differences exist between the two countries. These differences are more of political, institutional settings, and social orientations. They apply the "all hazards" approach to disaster or incident management. In addition, both countries have a prolong emergency department length of stay and crowding even though it happens at different hours of the day. The U.S similar to Israel has learned from its past incidences of emergency response and preparedness. The two nations have a national agency that oversees the response readiness of its nation.
The government of Israel is a unitary government where the national police, fire department, emergency medical services, are national institutions. Licensure laws in the U.S are restrictive while in Israel a licensed medical professional can practice anywhere and anytime in an emergency. The first responders in U.S are not the same with those of Israel. Non-official residents, bystanders can become first responders in Israel.
Emergency service is a major concern for almost every government across the globe. Agencies, institutions, and jurisdictional responsibilities are rapidly increasing in preparation for unforeseeable emergencies. Different countries have different emergency management systems depending on the nature of threat anticipated. Even with these differences, Israel and the United States have many similarities regarding education, training, technology, and equipment, connected to disaster management. A nation’s political system, policies, culture, infrastructure, reflects the type of emergency service and response that it implements.
References
Arutz Sheva TV. (2014). Visiting the homefront command call center. Retrieved from YouTube: https://www.youtube.com/watch?v=TD9CbKB3J8Q
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Emergency Management Institute (EMI) | EMI's History. (n.d.). Retrieved from https://training.fema.gov/history.aspx
Hason, G. & May, A.(2014). Technology and Information Systems as the Backbone of the Israel Fire & Rescue Authority. Retrieved from http://www.102.gov.il/english/news%20and%20resources/articles/pages/techbackbone_ie_17.aspx
Israel Defense Forces. Home front command . (2015). Retrieved from https://www.idfblog.com/about-the-idf/idf-units/regional-commands/home-front-command/
Kelly, J., & Keefe, B. (2017). 911's deadly flaw: lack of location data . Retrieved from https://www.usatoday.com/story/news/2015/02/22/cellphone-911-lack-location-data/23570499/
Hambridge, N. B., Howitt, A. M., & Giles, D. W. (2017). “Coordination in Crises: Implementation of the National Incident Management System by Surface Transportation Agencies.” Homeland Security Affairs 13, Article 2. Retrieved from https://www.hsaj.org/
Peleg, K., & Kellermann, A. L.(2009). Enhancing hospital surge capacity for mass casualty events. JAMA.302 (5):565–7.
Rambam HCC. (2014). Underground drill . Retrieved from YouTube: https://www.youtube.com/watch?v=9T-M8DtrKLk
Rosen B, Waitzberg R, Merkur S. Israel: health system review. Health Systems in Transition,17 (6):1–212.
Rosenthal, E. (2013). Think the E.R was expensive? Retrieved from http://www.nytimes.com/2013/12/05/health/think-the-er-was-expensive-look-at-the-ambulance-bill.html?mcubz=2
U.S. Department of Homeland Security. (n.d.). Emergency services sector . Retrieved from https://www.dhs.gov/emergency-services-sector
