Emergency Medical Services in Israel

Magen David Adom combines national ambulance and emergency medical responsibilities with blood banking and disaster response, and participates in home-front emergency planning alongside the Home Front Command, the National Emergency Management Authority, police, and fire services.[1] Its service areas include ambulance and mobile intensive-care-unit operations, blood processing, first-aid stations, and lifesaving training for personnel and the public.[5] The Ministry of Health has assigned MDA responsibility for managing mass-casualty events, although private and nonprofit ambulance services also operate in Israel.[3]

Emergency access and first response involve more than one organization: the government lists MDA at 101 and United Hatzalah at 1221, describing the latter as a free nationwide service staffed by trained and certified volunteer emergency medical technicians, paramedics, and doctors.[4] MDA stations provide emergency and first-aid services throughout the country around the clock, seven days a week.[4] Government guidance distinguishes these medical numbers from police at 100 and the National Fire and Rescue Authority at 102.[4]

Volunteers occupy multiple positions within the national response, including ambulance crews, automobile- and motorcycle-based on-call services, international volunteer programs, youth activities, and disaster teams.[7] MDA’s operational responsibilities also extend beyond transporting patients: it collects, tests, and distributes blood products to hospitals and the Israel Defense Forces, and collaborates with the military in supplying blood for prehospital resuscitation of injured soldiers and civilians.[6]

In 1915, Swiss Jewish ophthalmologist Dr. Moses Erlanger established an association called Magen David Adom to assist Jews captured and wounded during World War I.[2] The association expanded its work in 1918 to help people affected by disasters and emergencies, but ceased operating in 1921.[2] An early network included branches in North America, Canada, England, and Tel Aviv.[8]

The revived emergency medical society took shape in response to the 1929 Arab riots against Jewish settlements in Palestine.[2] MDA was founded in Tel Aviv on June 7, 1930, initially operating as a one-room emergency medical service; additional groups formed in Haifa in 1931 and Jerusalem in 1934.[5] In December 1934, it laid the cornerstone for its Tel Aviv headquarters, and during its first four years it provided first aid to 11,000 people.[2]

A national organization emerged in 1935 to provide medical services to the public and the Haganah, with resources that included a small truck converted into an ambulance and several dozen volunteers.[5] During the 1936–1939 Arab Rebellion, MDA opened centers throughout the country, provided medical aid to wounded people, and trained Haganah and auxiliary police personnel in first aid.[2][5] MDA members administered first aid alongside Haganah fighters during the 1930s and 1940s, and some members and volunteers later helped establish the Israel Defense Forces medical corps.[5]

In 1946, MDA support units, doctors, and nurses were sent to European countries to treat Jewish survivors after World War II and Nazi occupation.[8] The Knesset passed the Magen David Adom Law on July 12, 1950, designating MDA as Israel’s national Red Cross Society and an auxiliary of the Israel Defense Forces during conflict.[2] Its assigned responsibilities included emergency care for wounded people and war refugees, civilian emergency medicine and first aid, temporary shelter during emergencies, and operation of a civilian blood bank.[5]

Israel’s paramedic profession was established in 1979 by Dr. Nancy Caroline, then MDA’s medical director.[9] Its subsequent development included the introduction of mobile intensive-care units and changes in paramedics’ responsibilities in prehospital care.[9] A historical snapshot from roughly 2000 recorded 9,000 volunteers, 1,000 paid employees, and 600 ambulances; the workforce included physicians, paramedics, ambulance emergency medical technicians, and blood-service specialists.[10]

By December 2005, reported staffing stood at 1,200 employees and more than 10,000 volunteers serving victims of disasters, accidents, and terrorism, while working alongside the Army Medical Corps in war and peace.[11] A separate 2006 inventory recorded 95 first-aid stations in 11 geographical areas, about 700 ambulances, approximately 50 mobile intensive-care units, 22 mobile disaster units, and 18 blood mobiles.[12] These figures describe their respective reporting periods rather than a single current inventory.[10][12]

Callers seeking an MDA ambulance or emergency first-aid care use 101 and provide information that helps the dispatcher determine whether to send a regular ambulance or a mobile cardiac intensive-care unit.[4] A medically trained call taker, identified as a medic or paramedic, obtains the caller’s name, telephone number, location, and an account of what happened.[13] Available nearby teams can be assigned while the conversation continues, and the call taker can immediately guide chest compressions for cardiac arrest or use of an EpiPen for a severe allergic reaction.[13]

A 2017 Ministry of Health director-general circular directed public emergency calls through MDA’s national responders’ center, which was to dispatch the nearest immediate-response responders regardless of organizational affiliation. It also required non-MDA responders to carry a telephone running an adapted MDA application connected to the center.[14]

A 2026 study evaluated medically experienced dispatchers using MDA call data from 2019, comparing their preliminary diagnoses with paramedics’ working diagnoses.[15] The primary analysis found sensitivity of 48.8%, specificity of 97.3%, positive predictive value of 53.0%, and negative predictive value of 98.0%.[15] Grouping diagnoses by body system produced sensitivity of 78.6% and specificity of 88.4%; the study identified a need to examine a wider variety of diagnoses.[15]

For 2023, MDA reported 1,447,000 team dispatches, an average of one every 21.7 seconds, while its 101 center received a call every 9.5 seconds and answered in an average of one second.[16] Its report for Hebrew year 5786 recorded 1,911,412 emergency-team dispatches and 2,020,218 calls, with average intervals of 16.5 seconds between dispatches and 15.9 seconds between calls received.[17] The latter report gave an average answering time of two seconds or less and listed 213 stations and dispatch points.[17]

An August 2024 fleet account listed about 2,000 MDA ambulances nationwide, including roughly 400 yellow vehicles equipped for full intensive care and about 40 bullet-resistant ambulances.[18] It also recorded approximately 600 motorcycles, 250 small Picanto vehicles, 50 electric vehicles, and specialized mass-casualty, four-wheel-drive, and all-terrain vehicles.[18] A November 2025 account listed more than 2,000 ambulances and intensive-care units, five helicopters, more than 650 emergency motorcycles, 250 rapid-response vehicles, and two boats.[19]

The 5786 inventory included 652 motorcycles, 275 rapid-response vehicles, 117 four-wheel-drive ambulances and mobile intensive-care units, 27 mass-casualty vehicles, and five intensive-care buses.[17] It also listed 104 ambulances, mobile intensive-care units, or command vehicles with ballistic protection.[17] The reporting dates distinguish these inventories from earlier snapshots of the fleet.[17][18]

MDA’s intensive-care bus was originally developed to move groups of patients during the COVID-19 period.[18] It can treat and transport 13 patients simultaneously, including two lying down, and carries oxygen and intensive-care equipment; its intended capacity substitutes for 11 ambulances and two intensive-care units.[18] A volunteer crew member described evacuating dozens of people after driving south on October 7, 2023.[18] Later uses included evacuating patients from Soroka Medical Center after it was hit, moving infants from inadequately protected hospitals in Haifa, and assisting during a Jerusalem Hills fire.[19]

Specialized vehicles support access where ordinary ambulances cannot travel.[18] Unimog four-wheel-drive trucks can carry four patients lying down and were used to reach 70 passengers stranded in a train tunnel where ambulances and all-terrain vehicles could not travel along the tracks.[18] Two adapted John Deere vehicles have been used in Jerusalem’s Old City to move casualties through narrow or crowded areas to an ambulance rendezvous point.[18]

In 2023, MDA worked with Hatzalah Air to operate an intensive-care aircraft and three helicopters equipped for advanced intensive care; together they treated and airlifted 336 patients and injured people to hospitals.[16] Its sea services include an intensive-care ambulance on the Sea of Galilee and a sea-ambulance boat off Eilat, which together attended 153 incidents in 5786.[17] A mobile ECMO unit operated with Shamir Medical Center treated nine patients that year, connecting five to a heart-lung machine during field resuscitation.[17]

MDA’s 2023 workforce report counted about 34,500 volunteers, employees, national-service members, and civil-service members, including 14,490 teenagers, alongside about 18,000 “Life Guardians” volunteers.[16] Volunteers contributed more than 4.7 million hours during the year, and the reported average volunteer age was 26.[16] Volunteer roles include ambulance work, on-call automobile and motorcycle response, international participation, youth volunteering, and service within the national disaster response team.[7]

A described volunteer training route consists of 60 hours of theoretical and practical first aid, covering CPR and emergencies involving road crashes, drowning, electrocution, infants, and children.[5] Graduates may serve on ambulance crews or at MDA stations, with the program specifying at least eight hours of service monthly and a minimum volunteering period of two years.[5] Youth volunteers aged 15–18 have served as assistant medics and dispatch-center workers.[5]

One Haifa-based international volunteer cohort included 17 participants who completed an EMT course in their first two weeks and passed an examination, including a participant who had no previous medical training.[20] They then worked three eight-hour ambulance shifts each week, attending calls such as road crashes and kitchen accidents and transporting patients to hospitals.[20] Volunteer responsibilities were also expanded during the COVID-19 pandemic and for disaster response.[7]

Training extends to local residents who may provide care before an ambulance arrives: a 2025 account described MDA instruction for residents outside local security squads in immediate first medical aid.[19] Routine workload includes both injuries and obstetric emergencies; in 2023, teams treated 59,121 road-crash casualties and transported 16,283 pregnant women to hospitals.[16] Of those women, 1,062 gave birth with MDA teams at home or en route.[16]

MDA is Israel’s national blood collector, responsible for collecting, testing, and distributing blood products to hospitals and the Israel Defense Forces.[6] Civilian and military casualties are treated in the same hospitals, creating requirements both to sustain stocks in peacetime and to expand supplies during emergencies.[6] MDA and the military also cooperate in providing blood products for prehospital resuscitation of injured civilians and soldiers.[6]

Around 2000, MDA supplied all blood used for transfusions by Israel’s armed forces and more than 85 percent of the country’s blood requirements.[10] A 2006 account reported annual collection of about 280,000 blood units, with the National Blood Service collecting, processing, testing, and distributing blood to hospitals throughout Israel.[12] Donations are voluntary, and pandemic restrictions prompted collection teams to visit neighborhoods and towns when large donor clinics were impractical.[4][21]

Ambulance evacuation can involve charges rather than being universally free.[4] Ministry of Health guidance entitles HMO members transported to hospital by a regular ambulance or mobile intensive-care unit to full reimbursement if admitted, against a receipt.[22] Mobile intensive-care evacuation without admission qualifies for 50 percent reimbursement, while regular ambulance transport without admission generally does not.[22] These rules apply to MDA and private ambulances, with additional provisions for certain patients aged 80 or older, oncology and dialysis patients, and people who die before hospitalization.[22]

Patients are advised to contact their HMO promptly with the evacuation report and receipt; if payment is not arranged within 60 days, the ambulance company may require full payment before reimbursement is sought.[22] General government guidance also identifies maternity transport as usually covered.[4] In 2026, the National Insurance Institute announced a proposed legislative change allowing licensed ambulance companies other than MDA to receive payment for transporting women in labor.[23] The proposal addressed arrangements dating from 1953, when MDA was the only ambulance evacuation provider, and sought to improve availability where immediate response is difficult; the announcement concerned a bill, not an enacted change.[23]

During COVID-19, MDA operated nationwide stationary and mobile drive-through testing complexes and collected samples from people in home isolation.[21][24] An early pandemic account described six drive-through centers in five large cities and the Wadi Ara region.[21] Call centers that ordinarily handled several thousand calls daily experienced surges of up to 100,000 calls a day, prompting the opening of emergency call centers and training of additional volunteers.[21]

A study of 198 testing complexes operating between March 20 and October 17, 2020, analyzed sampling of 931,074 people.[24] Stationary sites accounted for 46.9 percent of samples and mobile sites for 53.1 percent.[24] An operational improvement program reduced sampling time from 128 to 98 seconds per patient and cost from $6.55 to $6.27 per patient; estimated home-testing cost was $74.50 per patient.[24]

A nationwide analysis examined 1,242,225 MDA responses between January 1, 2019, and July 31, 2022, comparing six pandemic waves with historical control periods.[25] Responses involving fever and respiratory symptoms increased during the first two waves, while responses for major trauma and motor vehicle accidents declined.[25] Later waves showed a gradual return to an overall increase in response volume relative to control periods.[25]

MDA was the principal prehospital responder to the April 30, 2021 crowd crush at Mount Meron.[26] Advance planning, medical infrastructure, and an on-site mass-casualty drill supported coordinated treatment and evacuation by ambulance and helicopter.[26] Volunteers participated, and a “rolling reinforcement” ambulance system supported care and transport at the scene while retaining staff at stations elsewhere for routine emergencies.[26]

During a national home-front exercise in the first week of November 2021, MDA participated in scenarios designed to improve coordination between emergency authorities.[1] These included evacuating residents of a special-needs institution under fire, routing casualties among hospitals to avoid overload, and evacuating wounded people after a rocket strike triggered a hazardous-material explosion at a factory.[1]

On October 7, 2023, MDA’s response to the terrorist attack combined extraction from areas under fire, casualty-treatment stations in safer locations, ambulance transport from those stations, evacuation from other safe areas, and helicopter transport to hospitals.[3][27] Bulletproof ambulances supported extraction, while active combat zones impeded access, endangered responders, and constrained evacuation.[3][28] An analysis of 4,097 dispatch records from the day found that 39.3 percent were directly related to the attack.[28]

A later operational account reported more than 21,700 calls to 101 that day and deployment within hours of more than 1,400 ambulances and mobile intensive-care units nationwide, including more than 300 ambulance teams in the south.[29] Treatment took place in improvised settings, including a synagogue in Netiv Ha’asara and a family home in Mefalsim; at Kibbutz Alumim, a volunteer coordinated evacuation of 10 wounded people while under fire.[29] MDA also reinforced call centers, organized blood donations, and received employees and volunteers arriving at stations.[19]

Secondary transfers relieved hospitals that had received large numbers of casualties.[27] Beginning five hours after the event started and continuing for about 12 hours while infiltration remained ongoing, Soroka Medical Center in Beersheba transferred 26 patients, five in Advanced Life Support ambulances, while Barzilai Medical Center in Ashkelon transferred 38.[27] Research on the response identified communication, national coordination of prehospital resources, evacuation management, and support for EMS personnel as priorities for resilience.[28]

MDA’s international relief activities have included medical cooperation, disaster training, supplies, and deployment of personnel.[30] In 1999, an MDA doctor worked in Kosovo on a possible blood-transfusion project under International Committee of the Red Cross auspices; in 2000, MDA organized delivery of 40 tons of relief goods to Ethiopian famine victims.[30] Six staff and volunteers attended regional disaster-response training in Turkey in 2004, and in January 2005 MDA donated a mobile clinic and sent medical personnel to establish a first-aid center in Sri Lanka.[30]

After Hurricane Katrina, MDA launched an emergency mission called “United Brotherhood” to collect donations, funds, clothing, and equipment for survivors left homeless in New Orleans.[11] Its domestic emergency responsibilities and overseas humanitarian work developed alongside efforts to obtain full participation in the International Red Cross and Red Crescent Movement.[11][30]

MDA had participated as an observer in international Federation and Movement meetings since 1957, but its emblem prevented full membership under the earlier arrangements.[30] Adoption of the red crystal emblem in December 2005 preceded its admission to the Movement in 2006, while it continued using the Star of David within Israel.[31] The 2006 admission vote was reported as 237 in favor and 57 opposed, with the new emblem allowing use of the Magen David inside it.[32] By 2024, academic literature identified MDA as an official member of the International Federation of Red Cross and Red Crescent Societies.[7]

MDA and United Hatzalah have had prolonged disagreements over emergency numbers, access to incident information, and coordination of responders.[33] A 2014 cooperation agreement proposed routing responder calls through 101.[33] Both organizations welcomed the 2017 coordination circular, although United Hatzalah emphasized its requirement to share emergency-call information.[14] A 2022 investigation continued to report competing allegations; the Health Ministry favored a single national center coordinating ambulances and responders while protecting patient privacy.[34]

A 2018 partnership between United Hatzalah and private ambulance providers sought to make additional vehicles available, while the Health Ministry warned that another emergency hotline could confuse the public and endanger lives.[35] Reporting on a 2023 court ruling recorded MDA’s argument that separate medical numbers risked confusion and United Hatzalah’s position that MDA was trying to shut down its dispatch service.[36]

In 2024, a Knesset research update criticized MDA’s provision of information about emergency evacuation preparedness and raised oversight and vehicle-protection concerns.[37] MDA responded that it operated approved responders from multiple organizations and regularly supplied activity and deployment data to the Health Ministry.[37] These exchanges represent disputes about coordination and oversight, rather than an absence of other authorized emergency medical providers.[23][37]