Sometimes, when the rockets are coming down and the sirens are blaring and his phone is ringing, Shimon Lugasi isn’t quite sure which way to run. The veteran first responder and head of United Hatzalah’s Ashkelon regional branch helped respond or send volunteers to almost 70 events during the 48-hour barrage from Gaza at the beginning of the week, but the calls were often coming in too quickly for him to take a breath.
Terror groups in the Gaza Strip launching using massive volleys with dozens of rockets fired simultaneously in an apparent bid to overwhelm the Iron Dome defense system. The tactic seems to have succeeded on a number of occasions, notably in an attack on the city of Ashkelon that left one dead and 13 injured.
Palestinian terrorist groups in the Gaza Strip fired approximately twice as many rockets and mortar shells at communities in southern Israel on Monday and Tuesday than on even the heaviest day of fighting in the 2014 Gaza war.
Emergency first responders and police are trying to figure out how to respond to a large number of simultaneous events.
“Sometimes we’ll have four instances at once, and we don’t even know where to go [first],” said Lugasi, who oversees 27 volunteers for United Hatzalah in the Ashkelon region, including the city and 28 surrounding towns. “Do you go to the closest event? The one with the most injuries?”
Both Magen David Adom and United Hatzalah add additional dispatchers to help direct an efficient flow of volunteers when there is a large-scale situation such as sustained rocket attacks in the south. Magen David Adom spokesman Zaki Heller said dozens of MDA paramedics from across the country volunteered to come down south to take extra shifts in order to relieve local staff and volunteers.
Whenever a rocket makes contact with the ground or a building, the first people on the scene are the Israel police bomb sapper’s unit, to ensure there is no additional unexploded ordnance and the site is safe for emergency workers. The police and Home Front Command give the all-clear for emergency workers to enter a site and check for any injured people. But sometimes, additional sirens go off while emergency workers are already responding to instances.
“It was really dangerous to try and take care of people and there are also sirens going off and you’re not quite sure what to do,” said Lugasi, who has worked as a paramedic and first responder for the past 32 years.
“The worst part is this lack of certainty, you don’t know when it will stop or start again. It’s really difficult.”
Paramedics can respond to as many as ten events surrounding a single rocket, explained Heller. For example, after a rocket hit an apartment building in Ashkelon, paramedics responded to five incidents in the same neighborhood outside of the building that was hit, including people injured by shrapnel or exploding glass, people who fell and hurt themselves while running to the bomb shelter, and a pregnant woman who went into early labor from the stress of the nearby explosion.
Magen David Adom treated 65 people during the rocket barrage against the south this week, including one fatality, three people who were critically injured, and 30 people with minor injuries ranging from shrapnel to smoke inhalation, said Heller. Paramedics also treated 31 people for shock.
“We are not just responding to the place where things fell,” said Heller. “There could be instances of shock or injuries in all parts of the city.”
“With physical injuries, they heal after a month or a few months,” Heller added. “But dealing with shock, this sometimes stays with them for their entire life.”
Lugasi said he also dealt with many people experiencing shock in Ashkelon. “In at least three instances [on Monday], we saw people in total shock, crying to themselves,” he said.
Lugasi said when first responders locate someone in psychological shock, they treat it exactly like a physical injury, triaging patients to more professional services. The role of first responders is to survey the situation and provide first aid and triage. They try to arrive first on the scene, and provide support until professional services can take over, whether it be an ambulance to take someone to the hospital or emergency social workers that are trained to deal with shock victims on the site.
While a first responder waits for professional help to arrive, they try to talk to the victims to bring them back into reality by asking pointed questions with simple answers, Lugasi said. This helps the person in shock break out of the mental loop of the trauma and start thinking about new things by forming an answer.
“We show them they are not alone, we try and identify if they are concentrating on something specific,” said Lugasi. “We ask them questions like, How long have you been here? Where is your car? Do you want to go somewhere?”
United Hatzalah also has a separate unit of emergency psycho-trauma support volunteers called Hoshen, which operates nationally and responds to terror attacks and other events where their services might be needed, including accidents or rocket attacks.
“It’s important to remember that when you hear on the news that 10 people were treated for shock, it doesn’t mean nothing,” said Lugasi. “It can really affect their lives, their work, their ability to function.”
First responders also try to monitor if the psychological shock starts manifesting physical symptoms, including hyperventilation or fainting, that could require immediate medical attention.
Lugasi said another challenge that emergency workers face is hearing the siren and leaving their families behind in the bomb shelters and protected areas. “During a siren, we run to the bomb shelter and then we wait to hear a ‘boom’ that either means a rocket has fallen or there was an explosion [with Iron Dome intercepting the incoming rocket],” said Lugasi. “We wait to hear where the direction of the fall was and then we wait for the United Hatzalah hotline to tell us where to go.”
Lugasi said that for most people, the sound of the siren means they run for cover. But “when I hear a siren, I go outside to take care of people,” he said. That can sometimes mean leaving the bomb shelter immediately after the siren, even if his children and grandchildren are shaken and terrified.
“The hardest part is that we are trying to calm down all the kids, and we’re also really shocked and scared but we have to show the kids we are okay and we are strong,” said Jackline Lugasi, Shimon’s wife, who is also a nursery school teacher and at times has to help 40 children in her care run into the bomb shelter. “We tell the kids, okay, that was a siren, we should just sit and read tehillim [psalms]. You should hear the kids, they are yelling and crying out, ‘Master of the Universe, protect us, save us!’”
“Our people have families and children in the bomb shelters, and they leave them in order to take care of other people,” Heller said. “This could be a mother who leaves her children in order to climb into the ambulance and respond to a situation. When there is a siren, the paramedics go outside.”
Lugasi said oftentimes, after difficult events, the United Hatzalah volunteers don’t go straight home. Instead, they gather outside their volunteer clubhouse, lounging on the concrete sidewalk outside the Karl Berg supermarket in an industrial area of Ashkelon. They smoke cigarettes and talk about what they’ve seen, even telling jokes while reliving the experience, and try to lower their adrenaline levels so they can return to their lives. Blowing off steam before they go home means they don’t carry the trauma of emergency response back to their families, said Lugasi.
When Lugasi is not volunteering with United Hatzalah, he is known as “The Singing Rabbi,” a cantor who performs weddings, bar mitzvahs, and baby naming ceremonies for girls. He trades his bright orange paramedic vest for a traditional white robe, and estimates that he has married thousands of couples over the past decades. “Sometimes it’s not an easy transition from trauma to simchas,” he said.
Lugasi said he is conscious that emergency workers, dealing with the double stress of responding to emergencies while simultaneously worrying about their families, also need psychological support. “We see terrible things,” he said. “I can’t even tell you the things I have seen over the past two days…. All of us emergency workers also need social support.”
Judah Ari Gross contributed to this report