A bit of Baltimore in Israeli hospital Trauma center copied from UMAB

June 18, 1992|By Doug Struck | Doug Struck,Jerusalem Bureau

JERUSALEM -- The walls of surgeon Avi Rivkind's consulting room are covered with pictures of Maryland MedEvac helicopters.

He trots around the hospital with a MedEvac pin on the lapel of his examining coat. His work space is a transplant from Baltimore.

"It's a mini-Baltimore shock-trauma," said Dr. Rivkind, with a creator's pride.

Dr. Rivkind studied on a fellowship for two years at the University of Maryland's shock-trauma unit, and decided Jerusalem needed one like it. In February, he opened a carefully planned copycat facility at the Hadassah Ein Karem Hospital.

"They get tired of me around here, because I'm always saying 'Maryland, Maryland, Maryland,' " he admits.

He has created a unit that is a sparkling bay of medical supplies with the latest equipment, in an area off the hubbub of the hospital's crowded emergency room. Here, victims with severe injuries are instantly the focus of a specially trained staff who have whatever they need at an arm's reach.

The point is to act fast and knowledgeably in what trauma ZTC specialists call "the golden hour" after an injury, when life often teeters with a precarious hold. It is a concept that originated in Baltimore and is now put to work saving lives in Israel by Dr. Rivkind.

Given the level of violence in this country -- both accidental and man-inflicted -- the need for such skills is quickly being proved.

"We had three people in here last week who, if they'd been at any other hospital in this country -- or many hospitals in the U.S. -- would have died," said Dr. Charles Sprung, another physician at Hadassah.

To create a shock-trauma unit in Israel, Dr. Rivkind had to travel much the same bumpy road as did R Adams Cowley, who bucked the political and medical status quo to open the country's first such unit in Baltimore in 1961.

Maryland's shock-trauma unit has been copied all over the United States and the methods of Dr. Cowley, who died last November, are recognized as pioneering in the treatment of accident victims.

Dr. Rivkind sees them spreading here. He helped bring five surgeons to Israel to establish an advanced trauma course to teach doctors and other emergency workers how to treat trauma victims. More than 1,000 have now been trained.

"It's really bingo," he said with a schoolboy's grin.

The military is looking at the treatment methods. And the Health Ministry has been presented with a plan to establish five other shock-trauma units for military and civilian use throughout Israel.

"The idea is to concentrate the equipment, the people and the knowledge in one place," said Dr. Moshe Revach, director of the Rambam Hospital in Haifa and head of the committee recommending expansion of the concept."

The 42-year-old Dr. Rivkind is unabashed about the benefits he gets from this: "Personally, I love the action," he says.

"With this work there's no discussion, no staff meetings, you don't go to the literature to read about the disease," the surgeon says. "It's like a soldier who goes to battle with everything in his pocket. The achievement is immediate: He lives, or he dies."

He is a "made-in-Israel" native, he says, tall, with curly hair, blue eyes and a inexhaustible enthusiasm for his work.

When he came to Baltimore for a fellowship in 1986 "it changed my life," he says.

He wrote to Israel's health officials, but was told, "We have everything we need. Everything is OK here," he recalls. Undeterred, he began encouraging visits to the Baltimore unit by Israeli doctors. "They came like it was Mecca," he says, and they were convinced. One of the visitors was the director general of Hadassah hospital, Israel's premier teaching facility.

Hadassah agreed to provide the facilities and help raise the $1 million needed to set up the shock-trauma unit. Half of the money came from a Swiss philanthropy. The Meyerhoff family of Baltimore donated $120,000 for a sophisticated X-ray machine.

Close to each patient are respirators, defibrillators, sophisticated monitors, blood, antibiotics and shelves-full of gloves, pads, tubes, bandages and other paraphernalia.

"I don't want to need something and not have it," says Dr. Rivkind. "A nurse only has to move like a windshield wiper to reach what we need."

A centerpiece of Maryland's shock-trauma system is fast transport of injured persons; the system's symbol is the State Police MedEvac helicopter whisking a victim to the waiting doctors. Dr. Rivkind acknowledges that Israel's emergency evacuation procedures need work. His new shock-trauma unit sometimes has problems getting the patients.

Ambulances still follow what he calls "the nearest-hospital syndrome."

He keeps a police monitor on at his home, and often radios the ambulance drivers to urge them to take severely injured patients to Hadassah. His eagerness has not won friends among the heads of other hospitals, he admits.

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