[Archived from February 20, 2009]
[by Shiela Steinman Wallace]
For a nephrologist (a doctor who treats people with kidney disease) in the United States, the practice of medicine usually moves at a deliberate pace with ample time for diagnostic tests and consultations. However, as Dr. Sanford Reikes discovered when he participated in Western Galilee Hospital’s (WGH) Emergency Response Group (ERG) training, if there is a mass casualty event, priorities change, and even nephrologists have to work differently.
During an emergency simulation drill at WGH, the ERG participants experienced lifelike scenarios. “We’re used to the western medicine model,” Dr. Reikes said, “where we take things stepwise – thoughtfully – and call in consultants. There, they stress bare bones procedures. Save this person and move on to the next. They don’t have the luxury of time to wait for the x-rays to come back. They have to prioritize to save lives.”
Dr. Reikes first heard about ERG at a Partnership with Israel presentation by the Jewish Community Federation at Jewish Hospital East when that facility first opened. “I thought, this is a very interesting thing,” he recalled, noting at the time, “Too bad I’m not a trauma surgeon or emergency physician. I want to take advantage of this, but I don’t know what a nephrologist could do to help out.” So he dismissed the idea.
Then, last April the Reikes family participated in trip to Israel that included a stop in the Western Galilee, Louisville’s Partnership region, and Judith Jochnowitz, WGH’s international liaison gave them a tour of the hospital.
“I was very impressed with the hospital and what they have accomplished there,” Dr. Reikes said. They learned about the security at the hospital, the underground facilities and the story of how the hospital was under siege during the 2006 war.
“It was suggested that I might benefit from coming to the ERG program,” he continued. “By that time, I was in Israel, and saw this as a way of making friends there and making ties with Israel and this region. I checked my calendar and found that I had already scheduled one week off at the time of the next program, so I felt it was bashert (preordained).”
While the focus of the ERG program is teaching medical personnel to handle mass casualty events, it also includes the opportunity to network with others who work in the same specialties, to observe their techniques, to teach and to explore Israel.
The ERG program had participants from several communities in the Partnership’s Central Area Consortium, a group of 14 Midwestern communities paired with the Western Galilee, of which Louisville is a member, as well as people from New Jersey and Hungary. “It was a large mix of people,” Dr. Reikes observed, “doctors, health administrators, surgeons, a podiatrist, neurosurgery specialists and me.”
After spending Shabbat in Jerusalem, the group traveled to Nahariya for orientation, instruction and drills.
“A lot of what this week was about was reorienting our perspective away from one patient at a time. We had to look at what we would do when there are large numbers of people” – with a wide variety of physical injuries, from trauma to chemical. In addition, patients who suffer psychiatric trauma after witnessing events must be treated.
Dr. Reikes spent a day with other nephrologists, during which he observed the Israeli model. “There was good sharing of information about how I do things and how they do things,” he said. “I gave a little presentation to their trainees about what being a nephrologist in the U.S. is like, and I got to tour their facilities.”
“I was very impressed with the caliber of people they have at this hospital,” he observed. “They are very up to date, and they have very skilled physicians with a lot of talent.”
Dr. Reikes was also very impressed with the mass casualty drill at WGH. “We got to see everything in action. Actors come in in ambulances and are triaged.”
The exercise was also recorded and participants and administrators took notes – “something they do on a regular basis,” he said.
“I’ve never been involved in anything like this,” he continued. “We have emergency procedures and drills, but never something that involved everyone in the hospital; and everyone took it seriously, as this is a place where these same procedures have been enacted. In 2006, they were on the firing line … and it was not just a theoretical exercise.”
The real key to the exercises is the evaluation after the drills. “They use the drills to continue to refine what they do. That is a useful model to take away. They see where the problems arise and change the procedures so when it’s the real thing, they don’t stumble all over themselves.”
Dr. Reikes also noted that the hospital uses checklists rather than memorization of procedures so when modifications are made, people don’t have to worry about relearning things, and in time of real crisis, they don’t have to rely on people’s memories to do things properly.
Connecting with Israelis was an important part of this trip. “We had some home hospitality and had dinner with people from our specialties,” he said. “The Israelis were very interested in where I live, my commute, what I like to do, what weekends are like and why I came to Israel.”
The interest was mutual. Dr. Reikes got to see where the Israelis lived and to ask questions about what life was like during the Lebanon War. “Driving was the scariest thing,” he observed. “Nobody wanted to stop for a red light because they felt like sitting targets.”
At the same time, he noted the people in Nahariya initially thought they wouldn’t be targeted because about half of the city is Arab, “but that wasn’t the case.”
He also pointed out that at WGH, Arab or Jew, every patient “is treated exactly the same.” The staff, too, is of mixed heritage, and “Dr. Barhoum, the head of the hospital, is Arab.
“As a physician, it is very inspiring to see, but not surprising,” he said, and he would expect nothing less in the U.S.
While the program ended on an up note with a dinner and reception, there was yet one more meaningful experience in store for the ERG participants.
When they arrived in Tel Aviv, right before their departure, they stopped at the Meir Medical Center and observed a chemical exposure drill. “The army ran it,” he reported. “The actors came in and were treated as if they had been exposed to toxic chemicals. They had permanent showers set up in the parking lot. When the casualties come, they get triaged, they cut off their clothes and hose them off, then move them to the safe area.”
“It’s a shame they have to have it,” Dr. Reikes said, “but it really opens your eyes. You realize that this is a national project. Security is something every citizen is involved in. … Our health system has a lot we can learn” from the Israelis. In fact, he would like to see the ERG program a model in the U.S. and around the world.
“On a personal and professional level,” he concluded, “I feel much more connected to that region of Israel. … I feel ownership in the hospital and can’t imagine not stopping there when in Israel. I will keep in touch by e-mail.” He is grateful for this opportunity and plans to encourage other doctors to do the ERG program.
Dr. Reikes is originally from northern California, and went to medical school and did his nephrology training in St. Louis. He came to Louisville in 2002 and joined Nephrology Associates of Kentuckiana.
He serves on the National Kidney Foundation Board and is a member of the Board of Kentucky Physicians Health Foundation.
He is married to his high school sweetheart, Robin, and they have two children, Hannah, 15, and Michael, 13. Their children attended Eliahu Academy, and they are members of Adath Jeshurun.
Partnership with Israel, a program of the Jewish Agency for Israel (JAFI), is designed to foster individual relationships between Israelis and American Jews. The Louisville Jewish Community Federation has been an active participant in the program since its inception. The Federation is part of the Central Area Consortium of Midwestern Federations partnered with the Western Galilee region of Israel.
Through Partnership programs, Louisville has benefited from numerous exchanges in medicine, art, music, education and business.
The program is flexible, so if a Louisvillian has a specific interest he/she would like to pursue with counterparts in the Western Galilee, it is often possible to develop a suitable program.
Kathy Karr is Louisville’s Partnership chair. Dr. Phil Rosenbloom is the chair of the Partnership Medical Task Force.
For more information about Partner-ship opportunities, contact Federation Executive Director Alan Engel.