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An international effort to assist, counsel Fla. Collapse responders

Dov Maisel advises on 5 elements of disaster response as United Hatzalah’s Psychotrauma and Crisis Response Unit team responds to Florida


A month after responding to domestic and terror-related MCIs in their own country, the Psychotrauma and Crisis Response Unit (PCRU) from United Hatzalah of Israel deployed overseas to provide their expertise to the tragic building collapse in Surfside, Florida.

Photo/United Hatzalah of Israel

A month ago, they responded to domestic and terror-related mass casualty incidents in their own country. Now, they’ve deployed overseas to provide their expertise to the tragic building collapse in Surfside, Florida. Members of the Psychotrauma and Crisis Response Unit (PCRU) from United Hatzalah of Israel flew into Miami to provide psychological support and stability to the families and neighbors of those injured, killed or affected by the tragedy.

The team of psychological first aid experts, deployed at the request of the Jewish Federation of Miami, was led by Dov Maisel, Hatzalah’s vice president of operations, alongside Einat Kaufman, one of Israel’s top cognitive psychotherapists, who also serves as the clinical operations director of the PCRU. The team also has a K9 element in the shape of King Charles Spaniel, Lucy, herself a veteran of MCI responses, tasked with providing comfort to victims and responders alike. In addition to the physical presence on the ground, the team also offered the community a sense of solidarity from the residents of Israel in this devastating situation.

Most recently, Maisel and Kauffman led the PCRU and United Hatzalah’s medical team in providing support at the Meron tragedy in Israel, to the injured, the bereaved and to the first responders themselves who were present at the incident and were traumatized as a result. Maisel, a well-known speaker on the U.S. conference circuit, is a veteran of both home-based domestic response and of disaster relief deployments to Nepal, Haiti and Japan.

The PCRU’s role is not one of conducting the physical aspect of urban search and rescue, but, as Maisel describes, “it picks up from the point where other first responders no longer have the tools to cope with the emotional fallout that a highly triggered person may exhibit. We haven’t come to replace any of the services that are currently available here to the family members of those missing in the collapse, or those who escaped but are injured. We came to complement these efforts and add the tools that we have in our repertoire that have been accumulated throughout the years from our previous missions abroad, or by responding to terror attacks and mass-casualty incidents in Israel.”

Elements of crisis response

Not classic USAR, nor is the role of the PCRU pure peer support that we are only now, as a profession, becoming used to. Maisel shared a few thoughts on both the PCRU’s operation and the Surfside deployment.

  • Scene size-up. In a process developed by Hatzalah over many responses, the deployment began as many other do, with a visit to the site. Maisel notes that after arrival, “I need my team to get a picture of what they are going to be working with and understand the magnitude of the tragedy – they need to get a feel of what the survivors’ families and rescue workers went through.” Thereafter, the team proceeded to a briefing with community leadership and social services, and then on to the reunification centers armed with the operational picture and situational awareness.
  • Intelligence gathering. A key role in the early stages of an incident such as the Champlain Towers collapse is the development of intelligence and information from survivors and family members to assist with both locating and identifying those missing. The PCRU team arrived at the same time as the globally respected Israeli Defense Force (IDF), Home Front Command USAR Team which specializes in building collapse. Their task was to conduct debriefing using blueprints of the building to map every apartment to understand the layout to direct rescue and recovery. Questions also move onto identification of those within the building, where they may have been at the time of the incident, clothing, distinguishing marks, birthmarks, tattoos – all clues to locate and identify victims. All information gathered is entered into an IDF program that creates a 3-D image of the building and the accompanying victim information which may direct subsequent rescue and recovery efforts.
  • K9. The addition of animals to assist in therapy has extra benefits. The PCRU team believes that the benefit of animal-involved therapy is that the patient feels no judgment, only acceptance of their current state without any preconditions. By nature, humans are judgmental. Therefore, a patient who struggles with creating a connection or trusting another person can more easily connect with an animal. This allows the initial stages of therapy to be easier and the patient can approach the therapy with a stronger sense of personal security.
  • Caring for the caregivers. Maisel believes that a big takeaway from incidents such as this from the team perspective is to ensure that the caregivers are cared for. PCRU members may interview and counsel up to 30 patients or relatives and inevitably will take some of their personal stories on board, which can weigh heavily. Self-care is, therefore, a priority and at the end of each shift or operational period, no matter the time of day, the last event of the day is to conduct a debrief and “vent” session to allow staff to decompress to either stand down or return the next day to the mission at hand.
  • Role of the chaplaincy. Maisel noted a definite need for chaplaincy and ministry on the scene of any lengthy major incident. He observed chaplains on the site of Champlain Towers were there to support both family members and rescuers alike. Chaplaincy is not about simply religion, but comfort and reassurance. The chaplain occupies a unique place in public safety, in that they sit outside the chain of command and are therefore immediately approachable by one and all. At the same time, they can direct caution or concerns into the ears of leadership and can act as the honest broker, ensuring pastoral care is delivered and morale is both measured and maintained.

The nature of Hatzalah’s dedication to helping those in need, no matter whether they are in Nepal, Haiti, Florida or the West Bank, means they will be in action again soon and the years of experience they have gained are worth of studying and possibly consulting. Sadly, the rule of disasters, either natural or man-made is, it’s not a case of if, but when!

Rob Lawrence has been a leader in civilian and military EMS for over a quarter of a century. He is currently the director of strategic implementation for PRO EMS and its educational arm, Prodigy EMS, in Cambridge, Massachusetts, and part-time executive director of the California Ambulance Association.

He previously served as the chief operating officer of the Richmond Ambulance Authority (Virginia), which won both state and national EMS Agency of the Year awards during his 10-year tenure. Additionally, he served as COO for Paramedics Plus in Alameda County, California.

Prior to emigrating to the U.S. in 2008, Rob served as the COO for the East of England Ambulance Service in Suffolk County, England, and as the executive director of operations and service development for the East Anglian Ambulance NHS Trust. Rob is a former Army officer and graduate of the UK’s Royal Military Academy Sandhurst and served worldwide in a 20-year military career encompassing many prehospital and evacuation leadership roles.

Rob is a board member of the Academy of International Mobile Healthcare Integration (AIMHI) as well as chair of the American Ambulance Association’s State Association Forum. He writes and podcasts for EMS1 and is a member of the EMS1 Editorial Advisory Board. Connect with him on Twitter.

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