DARA members assembled last week to celebrate the year that was and look forward to the exciting year ahead of us. For those of you that missed this year's Annual General Meeting - and for those who joined us - we recap an AGM full of engaging speakers and important updates.

A reporter from the Canadian Jewish News attended the AGM, so be sure to watch out for the article online and in print!



AGM recap - Order out of chaos: Emergency care in Canada, the U.S., and Israel

Drs. Stanley Herman, Brodie Nolan, and Larry Weiss share a laugh at AGM 2019.

Of the many lessons the Lancet affair has taught Israeli advocates, a simple one is often ignored: Israel can often stand and win its reputation on the facts. 

As you know, the medical journal and its editor, Richard Horton, shifted over the past few years from hostility to the Jewish state to mostly balanced discussion. Several factors contributed to this turnaround. DARA's engagement played a huge role, as did the efforts of other groups. Also making an impact was a visit by Horton to Israel, where he met with Israeli doctors and toured the country and its hospitals. Never mind the gray arts of hasbara; the truth sufficed.

It was in that spirit that we met at the AGM to compare and contrast emergency medical care. The trilogy of presentations, titled "Order Out of Chaos: Emergency Care in Canada, the U.S., and Israel," discussed the three systems on their terms, advantages and disadvantages included.

Emergency care in Canada

Here in Canada, said Dr. Brodie Nolan, emergency physician and trauma leader at St. Michael's Hospital and transport medicine physician with air ambulance provider Ornge, Canada's spread-out population is its chief challenge in trauma care. In Ontario, 40% of patients don't have access to a trauma centre within 60 minutes by land. Moreover, 15% of the population are not within 60 minutes of a centre by air transport.

Health care providers in the province continue to innovate and improve care. Ornge has introduced video laryngoscopy devices. In the future, aircraft will carry blood products.

South of the border

The U.S. faces its own challenges, said Dr. Larry Weiss, a DARA board member and professor of emergency medicine (adj. retired) at the University of Maryland School of Medicine. 

With no national health care system, care devolves into a hodgepodge of systems. The states manage emergency medical care, as delegated by the U.S. Constitution. Despite the disorganization, said Weiss, the system generally operates effectively.

One area that the U.S. once struggled with was pre-hospital care. Because the country lacks a national health care system, patients who could not afford care were "dumped" by private hospitals at public hospitals. As a result, some died en route.

This changed in 1986, when the U.S. Congress passed the Emergency Medical Treatment and Active Labor Act, known as EMTALA. The law requires the original receiving hospital to conduct an appropriate screening examination, stabilize the patient, and ensure any transfer to another hospital is performed appropriately.

While EMTALA has not solved all issues, it has eliminated financial discrimination against patients and continues to be interpreted by the courts.  

Israel and Magen David Adom

Israel and Canada face a common roadblock when providing trauma care: geography. While Canada's land mass dwarfs Israel's dimension, the Jewish state's southern and northern parts are isolated and response times are greater. Israel's regions compensate with effective communication

That has been the experience of Dr. Stanley Herman, corporate chief of anesthesiology, at the William Osler Health System in the Greater Toronto Area, and an international physician with Magen David Adom in Israel.

It is true, said Herman, that Israel sometimes serves as an example of trauma care for other countries. This is due not only because of its experience with terrorism but also due to its high rate of car accidents.

The country's emergency care features several anomalies.

For one, the majority of emergency medical services individuals are volunteers. They will reach a trauma site within a minute or two of the event. To care for patients, they sometimes communicate via phone with physicians.

Paramedics in Israel are also empowered to make decisions on where to transport patients - a level of autonomy that is not universal in other countries.

Since MDA is the national emergency provider, it can become an auxiliary arm of the Israel Defense Forces in times of war. There is close cooperation and training between the IDF, police and various EMS providers in Israel in conjunction with the different hospitals. In any terror attack, the police handles the scene in areas under Israeli control. The army controls the areas under military control.

One area where Israel's care could improve is the standardization of care. Accordingly to Herman, trauma hospitals in the country vary greatly in the way they care for patients. While they have taken steps to improve the situation, more needs to be done.

Update: DARA leadership changes
We are happy to announce three new appointees to the DARA board: Jocelyn Kadish, Dr. Shawna Novak, and Dr. Lisa Tarshis.

We also want to say thank you to several board members who are stepping down for the coming year: Drs. Michael Bloom, Janice Halpern, Stephen Halpern, Fred Parker, and Kusiel Perlman. Thanks so much for your dedication to DARA over the past years. The organization would not be the same without your contributions. We look forward to your continued support.