# The framework and best practices of emergency medical teams: lessons learned from Israel’s international field hospital response

## TL;DR

This paper outlines best practices for emergency medical teams based on Israel's experience in international disaster response.

## Contribution

The paper presents a framework for professional and flexible emergency medical response, derived from Israel’s field hospital operations.

## Key findings

- Israel’s EMT-3 field hospital was the first globally recognized under the WHO’s EMT initiative.
- Professionalism and flexibility are key to successful disaster medical response.
- The framework includes three types of EMTs with increasing complexity and capabilities.

## Abstract

In 2010, a devastating earthquake struck Haiti, killing over 200,000 and injuring over 250,000. Dozens of countries sent medical teams, with Israel’s being one of the first to arrive. These teams saved lives and salvaged limbs. However, other responses were not as professional, resulting in criticism in the medical community of “Disaster Tourism.” For example, certain physicians attempted to perform procedures or surgeries that they were not certified to perform. There was a call to develop a framework for disaster response. The World Health Organization spearheaded this project by initiating the formation of Foreign Medical Teams, which later became known as Emergency Medical Teams (EMTs). The EMT Initiative involves a vision of saving lives in the context of transparency and global cooperation. It includes an emphasis on safe care, ethical care, and an accountable, coordinated response to disasters. There are three general types of teams, with an additional group of specialized care teams. An EMT-1 is similar to a clinic and open only during the day. An EMT-2 adds operating room and inpatient capabilities. EMT-3 which is the most complex, includes a minimum of 40 inpatient beds, four intensive care unit (ICU) beds, and the capacity to treat 100 outpatients a day. The Israel Defense Forces Field Hospital was the first in the world to be recognized as an EMT-3. The Israeli EMT-3 includes an emergency department, inpatient services, surgical capabilities, and an intensive care unit. Pediatric services, infectious disease care, and women’s health are integral parts of the EMT-3. Logistical and ancillary services also play a key role in the success of the field hospital. The Israeli field hospital responded to recent disasters in Haiti (2010), the Philippines (2013), Nepal (2015), and Turkey (2023). The main lesson learned is that the success of the Israeli EMT-3 is based on professionalism and flexibility within the framework of the EMT initiative. The staff consists of highly trained professionals, including board-certified physicians and nurse specialists who convert their everyday skills into those used in the disaster setting. Flexibility includes having these professionals take on logistical responsibilites. Operational flexibility includes the last-minute decision to implement a hybrid versus a standalone model, to using local supplies to quickly adapt to an urgent need. While the lessons here are from the perspective of an EMT-3, they can be applied to other response teams to improve outcomes for disaster victims throughout the world.