One of the programs offered by United Hatzalah to the public free of charge is the Psychotrauma and Crisis Response Unit (PCRU). The unit is tasked with responding to any medical emergency wherein a person involved, or even a bystander is experiencing psychological or emotional stress or shock and treating them by utilizing specialized techniques to assist in stabilizing the person’s heightened emotional state.
The unit, which has several hundred volunteers countrywide, who provide both basic and advanced level care at the scene of a traumatic incident, has been in existence in Israel since 2016 and has responded to thousands of emergencies ranging from sudden infant death syndrome (SIDS) to mass casualty incidents such as Meron, Givat Ze’ev, and even to terror attacks.
Today, on World Mental Health Day, and as part of the organization’s Year of the Volunteer, three PCRU volunteers reflect as to why they became volunteer first responders dealing with mental health issues and what it means to them.
Mordechai Tzvi Noiman
Mordechai is 28-years-old and is married with five children. He lives in Tzefat and works as a maintenance manager in a factory in Tel Aviv. Mordechai has been a volunteer EMT with United Hatzalah since 2014 and was one of the first people to join the organization’s PCRU unit with the first cohort in 2016. “I feel that treating people for acute stress reactions during the scene is just as important, if not more important than treating a CPR case. The statistical success rate of having a person come back from a case of CPR and having full cognitive capabilities is extremely rare. It has a success rate of less than 4 percent. Whereas providing psychological stabilization often has a success rate of more than 90 percent and the people go from a state of complete shock and the inability to process their surroundings, to having full capability to live a normal life once again. That is not something that can be taken for granted as many people who suffered an emotional break due to a traumatic situation can be left scarred for life and can suffer from mental health issues in the future.”
Mordechai Tzvi Noiman at the scene of a mass casualty incident caused by a bus crash in which four people were killed and nearly 50 injured
Mordechai recounted a story to illustrate his point. “One year ago, a man who had come to Israel seeking specialized medical treatment suffered a cardiac arrest and died. Emergency medical personnel rushed to the scene to assist and performed CPR on the man. They were unsuccessful and the man passed away. He had been accompanied to Israel by his daughter who was in her early twenties and who was in a state of complete emotional shock, to the point where she was unresponsive. No matter what the medical personnel on the team did they couldn’t help her. They issued a request for the PCRU to come and assist. I was the first PCRU responder at the scene and I rushed over. I found the young woman in the middle of an acute stress reaction. I treated her using our specialized techniques and I spent 45 minutes with her getting her back to a normal functioning level. After the incident was over and the woman was back to a normal level of functioning and had a support network in place, I left the scene.”
“As I was leaving I noticed a man watching me intently. I asked if I could help him, he said that he was awed by what I had just done. He told me that he lost his father at a very young age in a traumatic fashion and he was just like the young woman was, in a state of complete mental disconnect. He said that it was something that neither he nor his brothers ever got over and they were never able to process the incident properly. He added that it affected their lives very harshly and that none of them led normal lives from that point onward but were always left in a heightened state of mental agitation. He said that if someone had been there to do for him what I did for the woman, then he thinks his life would have turned out differently. I was left speechless. All I could do was thank the man for his honesty. But I learned just how serious of an impact the work of the PCRU unit and its trained mental health first responders could be at the scene of a trauma.”
Ruti Prince – Ruti is a homeroom teacher in an elementary school in Beit Shemesh. She is currently on sabbatical. She is a 42-year-old wife and mother. She has been volunteering as an EMT with United Hatzalah for the past four years. Just one year after becoming an EMT she joined the organization’s PCRU unit as she saw how successful and how important the work of the unit was when responding to traumatic incidents. “I’ve personally seen many instances in the field, whether they are cases of SIDS, serious car accidents, or other major traumas, where the EMTs who responded were all focused on the patient who had physical injuries or symptoms, and there was no one working with or treating the eyewitnesses, or the family members of the injured person. They too are affected by the trauma and need assistance. The point of the PCRU unit is to send responders to help those in need of emotional stabilization. The unit comes from a place that is more relaxed and the responders are more available to treat these eyewitnesses who don’t need immediate medical attention but who need emotional and psychological stabilization. Often, this type of response takes longer than an EMS response.”
Ruti Prince after returning from an emergency
Prince continued, “Our goal is to help the person process what they saw. We in essence are restarting their resiliency and helping them return to taking an active role and helping them re-assert their sense of control over their surroundings, whereas before they were feeling helpless. This allows them to return to a normal level of functioning, in an abnormal situation.”
Prince recounted a story that illustrated for her the importance of the work of the PCRU. “I responded to an incident of SIDS in Beit Shemesh. At the time we had a school assembly for a holiday ceremony that was about to begin. I wasn’t needed for any teaching for the next hour so I asked one of the other teachers to watch over my class while I was out responding. When I arrived the EMTs and paramedics were dealing with the child, but my place was really to try to help the parents process what had just happened. One of the most important things in that instance was to provide the parents with support during the mandatory investigation that the police conduct and to be with them through the questioning. In addition to the unfathomable tragedy that they had just endured, they now had to endure questions from the police, and then the arrival of the rest of the family back at home. Once the EMS crew left, I stayed with the family to help them cope as best they could through the process, making sure that they are able to take care of the other children at home, pick up anyone they still need to, make sure they have all the supplies they need and can properly say their goodbyes. These are the types of situations where the PCRU unit is particularly useful and active. Our work isn’t just immediate, it is elongated and we accompany people through some of the toughest moments of their lives for an hour or more. It is difficult and can be emotionally draining, but our unit is terrific at providing internal support for our own responders as well. After every response that we go to we receive a phone call from another member of the unit debriefing us and making sure that we are in a good emotional state and are able to continue with what we need to do. That too is essential and keeps us from suffering secondary trauma of our own.”
Fiona Shlakman – hails from a small town near Johannesburg and immigrated to Israel in 1994. She is divorced with four children, all of whom are grown. Fiona teaches English in a number of colleges and universities. “What I do is teach, but what I do to help is volunteer in the PCRU. I find that volunteering does more for me than I do for them. Being there for someone at the worst point of their lives is a great gift, and I see it as a privilege to be able to help others.”
Fiona Shlakman
Fiona is a social worker and therapist by training and has put her training to good use in the PCRU unit. “ I find that I have more time to respond because my kids are grown up. The work is really difficult but rewarding and one of the most important aspects of this work is self-care after responding. I have my own style of personal self-care after an incident and I have shared it with many of our other volunteers. Everyone who responds to one of these calls has the support of the entire team behind them, and everyone knows that they aren’t going on their own but rather as part of a team. Even when I am the only responder at a scene, I can call a whole slew of people who can provide assistance with a myriad of issues and can help out. We have two circles of teams that are involved. There is a small team of people at any given emergency, but there is the wider envelope of the unit across the country which helps any responder who requires assistance both during and after an emergency response. If the responder has a question, isn’t sure how to handle a situation, needs advice or additional resources, the entire unit provides support during the response and that makes all the difference.”
Fiona said that she recognizes the importance of the PCRU unit every time she leaves a scene. “When the moment comes for me to leave when the person is back to full functionality and has a support network in place, (we don’t leave until both of those things have taken place) then oftentimes, the person I helped has tears in their eyes and I have tears in my eyes. I know that we made a meaningful connection, and this shows me just how important the work I have done is. One of the hardest things for me is to comply with the policy of the unit that prohibits us from contacting the person we helped again in the future unless we have known them previously. This policy has a few justifications but is incredibly difficult to follow. We have the policy in place in order to protect the person’s privacy, and in order to not inadvertently make them revisit their pain once again. We spend time with them during the worst moment of their lives, picking up from very rock bottom. The last thing we want to do is to remind them of that. But, as a caring person, all I want to do is follow up with them and make sure that they are okay and that they are being taken care of. That is why the most meaningful moment for me is when I take my leave of them and I see the look in their eye, thanking me in ways that words cannot express. I often go to my car and sit and cry for a while, letting the tragedy that I have just witnessed wash over me. Then I go through my self-care routine so that I can shake off the tragic incident and be mentally and emotionally prepared for the next one. The debriefing calls we all do for one another certainly help with this and show how much the unit and the entire organization cares for one another. United Hatzalah is one big family, and I have received more from it than I am ever going to be able to give back to others.”