Evan Avraham Alpert

• Medical Doctor at Shaare Zedek Medical Center

Emergency medical services (EMS) throughout the world utilize volunteers. Magen David Adom (MDA), Israel’s EMS organization and an official member of the International Federation of Red Cross and Red Crescent Societies, has incorporated these volunteer roles on a national level and significantly expanded upon them for pandemic and disaster response...

The World Health Organization has classified Emergency Medical Teams (EMTs) into 3 types for international disaster response. They range from those that operate as daytime clinic facilities to those that have complete hospital capabilities that can provide 24/7 inpatient care. The most complex EMT (Type 3) includes a full-scale emergency department...

On October 7, 2023, somewhere around 1,500-3,000 terrorists invaded southern Israel killing 1,200 people, injuring 1,455, and taking 239 as hostages resulting in the largest mass-casualty event (MCE) in the country’s history. Most of the victims were civilians who suffered from complex injuries including high-velocity gunshot wounds, blast injuries...

Introduction: Measuring elevated post-void residual volume is important for diagnosing urinary outflow tract obstruction and cauda equina syndrome. Catheter placement is exact but painful, invasive, and may cause infection, whereas an ultrasound is accurate, painless, and safe. Aim: The purpose of this single-center study is to evaluate the accurac...

Introduction: Point-of-care ultrasound has become a universal practice, employed by physicians across various disciplines, contributing to diagnostic processes and decision-making. Aim: To assess the association of reduced (<50%) left-ventricular ejection fraction (LVEF) based on prospective point-of-care ultrasound operated by medical students usi...

Demands for whole blood (WB) and COVID-19 convalescent plasma (CCP) donations during the SARS-CoV-2 (COVID-19) pandemic presented unprecedented challenges for blood services throughout the world. This study aims to understand the motivating factors that drive WB and CCP donations in the context of the pandemic. This cross-sectional study is based o...

Symptomatic urolithiasis is a common cause of emergency department (ED) visits, with non-contrast computed tomography (NCCT) considered the imaging gold standard. According to current guidelines, POCUS is limited to the evaluation of hydronephrosis as a secondary sign of acute ureteral stones. However, the use of POCUS to detect ureteral stones may...

We sought to prospectively investigate the accuracy of an artificial intelligence (AI)-based tool for left ventricular ejection fraction (LVEF) assessment using a hand-held ultrasound device (HUD) in COVID-19 patients and to examine whether reduced LVEF predicts the composite endpoint of in-hospital death, advanced ventilatory support, shock, myoca...

Introduction Point-of-care ultrasound (POCUS) use is now universal among nonexperts. Artificial intelligence (AI) is currently employed by nonexperts in various imaging modalities to assist in diagnosis and decision making. Aim To evaluate the diagnostic accuracy of POCUS, operated by medical students with the assistance of an AI-based tool for as...

Background: The presentation of the patient with acute cholangitis (AC) ranges from mild illness to life-threatening shock. Therefore, prompt diagnosis and treatment are critical. Abdominal ultrasound (US) is the imaging of choice to locate bile duct dilatation. Other modalities include abdominal computed tomography (CT) or endoscopic retrograde c...

Background: Analgesic treatment, including with opioids, can safely be given to patients who are suspected of having appendicitis. The study examined factors which may influence the treatment of pain in appendicitis in the adult emergency department (ED). A secondary objective was to determine if analgesia affected clinical outcomes. Methods: Th...

Introduction: Disaster Medicine (DM) requires skills, knowledge, and prior experience that are rarely put to test by health care providers. Pediatric DM presents unique challenges in terms of both knowledge and practice. Methods: An anonymous survey consisting of demographic and five-point Likert scale questions was administered to physicians, n...

Background A growing body of research demonstrates that economic conditions and racial and ethnic disparities result in excessive overuse of emergency departments (EDs) by a small group of socioeconomically marginalized residents. Knowledge and understanding of these issues on the part of the healthcare team can promote equality by providing struct...

Background The association between COVID-19 infection and the cardiovascular system has been well described. Isolation precautions limit the use of formal echocardiography in this setting. Artificial intelligence (AI) utilization using a hand-held device in these patients can be a reliable tool for left ventricular ejection fraction (LVEF) assessme...

Introduction Point-of-care ultrasound (POCUS) is now universal in the hands of non-experts. However, the results are usually binary (normal/abnormal) but not necessarily specific. Artificial intelligence (AI) is currently used by non-experts in different imaging modalities including echocardiography to aid in diagnosis and decision making. Aim To...

On April 30, 2021, a total of 45 died and 112 were injured in a crowd crush at a religious festival on Mount Meron, Israel. Unlike a bomb blast, building collapse, mass shooting, or stampede, the incident lacked a dramatic, noticeable trigger and may be termed a “silent mass casualty incident (MCI).” This may have resulted in a slight delay in resp...

Background Medical neutrality is a normative arrangement that differentiates a zone of medical treatment disconnected from the field of politics. While medical neutrality aims to ensure impartial healthcare for all and to shield the healthcare personnel from political demands, it can also divert attention away from conflicts and their effects on he...

Background: The association between COVID-19 infection and the cardiovascular system necessitates the use of an echocardiogram in this setting. Information on the utilization, safety, and quality of point-of-care cardiac and lung ultrasound using a hand-held device in these patients is scarce. Aims: To investigate the safety, technical aspects,...

Background Improving patient experience and satisfaction in the emergency department (ED) is challenging but beneficial. Previous studies have shown an association between social and structural factors and patient satisfaction. This study examined the structural and social factors related to the ED patient experience among Jewish and Arab patients...

Objectives: Incorporating artificial intelligence (AI) into echocardiography operated by clinicians working in the emergency department to accurately assess left-ventricular ejection fraction (LVEF) may lead to better diagnostic decisions. This randomized controlled pilot study aimed to evaluate AI use as a didactic tool to improve noncardiologist...

The Centers for Disease Control and Prevention define six intervals of a pandemic: (1) investigation of cases, (2) recognition of the increased potential for ongoing transmission, (3) initiation of a pandemic wave, (4) acceleration of a pandemic wave, (5) deceleration of a pandemic wave and (6) preparation for future pandemic waves. Each of these s...

Background Strict isolation precautions limit formal echocardiogram use in the setting of COVID-19 infection. Information on the importance of the utilization of a hand-held focused ultrasound for cardiac evaluation in these patients is scarce. This study investigated the utility of a hand-held echocardiogram device in COVID-19 hospitalized patient...

Background Decreases in routine healthcare practices have been shown to occur during disasters. However, research regarding the impacts of natural disasters, pandemics, or military conflicts on emergency medical services (EMS) is scarce. Objectives This study assessed the impact of a military conflict versus the coronavirus disease 2019 (COVID-19)...

Background The association between COVID-19 infection and the cardiovascular system has been well described. Strict precautions limit the use of formal echocardiography in this setting. Information on the importance of the utilization of a hand-held point-of-care cardiac ultrasound (POCCUS) for cardiac evaluation in these patients is scarce. Objec...

Background Clinicians must be aware of the structural forces that affect their patients to appropriately address their unique health care needs. This study aimed to assess the participation of global emergency medicine (GEM) fellowship programs in formal social determinants of health (SDH) and structural competency (SC) training to evaluate the exi...

Background: Syncope is a common reason for emergency department (ED) visits; however, the decision to admit or discharge patients after a syncopal episode remains challenging for emergency physicians. Decision rules such as the Boston Syncope Criteria have been developed in an attempt to aid clinicians in identifying high-risk patients as well as...

Background The current emergency medicine literature on cardioversion for atrial fibrillation (AF), describes its performance on those who are hemodynamically unstable, present within 48 hours of the onset of the arrhythmia or are on long term anticoagulants. For patients who are not anticoagulated and present with atrial fibrillation for more than...

Background: The current emergency medicine literature on cardioversion for atrial fibrillation (AF), describes its performance on those who are hemodynamically unstable, present within 48 hours of the onset of the arrhythmia, or are on long term anticoagulants. This article describes a clinical pathway comparing patients presenting to the emergency...

One strategy for the containment of a pandemic is mass testing. Magen David Adom (MDA), the Israeli National Emergency Medical Services (EMS) Organization undertook this mission by operating a nationwide series of drive-through testing complexes. The objective of this study is to learn lessons from an analysis of these centers. Data from 198 statio...

Emergency medical teams (EMTs) encounter chaos upon arriving at the scene of a disaster. Rescue efforts are utilitarian and focus on providing the technical aspects of medical care in order to save the most lives at the expense of the individual. This often neglects the basic healthcare rights of the patient. The Sphere Project was initiated to dev...

The use of sonography for diagnosing inflammatory bowel disease (IBD) has been reported in the radiology literature but is not common practice in the hands of emergency physicians (EPs). We present a series of three cases where IBD was managed by an EP using point‐of‐care ultrasonography (POCUS), and discuss the sonographic features of IBD includin...

Background: Emergency department (ED) crowding is an international phenomenon dependent on input, throughput, and output factors. This study aims to determine whether patterns of potentially unnecessary referrals from either primary care physicians (PCPs) or urgent care centers (UCCs) can be identified, thereby to reduce ED visits by patients who...

Abstract Introduction Cardiopulmonary resuscitation (CPR) in patients with a poor prognosis increases the risk of perception of inappropriate care leading to moral distress in clinicians. We evaluated whether perception of inappropriate CPR is associated with intention to leave the job among emergency clinicians. Methods A cross-sectional multi-...

Objective: The scientific literature on COVID-19 is extensive, but little is written about the role of emergency medical services (EMS). The objective of this study is to describe the role of Magen David Adom (MDA), Israel's National Emergency Pre-hospital Medical Organization, in the pre-exposure period, before widespread governmental action. The...

Background Empyema necessitans is a rare complication of pleural empyema characterized by the dissection of pus through the soft tissues of the chest wall and eventually through the skin. The skin manifestation may appear as a superficial abscess. Case Report A 63-year-old woman presented to the Emergency Department (ED) with a chief complaint of...

Background: The potential excess flow of patients into emergency departments and community clinics for testing and examination during a pandemic poses a major issue. These additional patients may lead to the risk of viral transmission to other patients and medical teams. To contain the spread of coronavirus disease-2019 (COVID-19), the Israeli Min...

Background: The potential excess flow of patients into emergency departments and community clinics for testing and examination during a pandemic poses a major issue. These additional patients may lead to the risk of viral transmission to other patients and medical teams. To contain the spread of coronavirus disease-2019 (COVID-19), the Israeli Min...

Epidemics such as novel Coronavirus 2019 (COVID-19) can be contained and the rate of infection reduced by public health measures such as epidemiologic inquiries and social distancing. Epidemiologic inquiry requires resources and time which may not be available or reduced when the outbreak is excessive. We evaluated the use of Google Maps Timeline (...

Throughout history, earthquakes have caused devastation and loss of life. Emergency medical services (EMS) plays a vital role in the response to any mass-casualty incident or disaster. Magen David Adom, Israel’s premier EMS organization, has a unique strategy known as the ABC approach to earthquake response. It involves thousands of salaried worker...

Emergency medical services (EMS) provides a critical role in the rapid treatment, stabilization, and transfer of patients in the prehospital setting. The national EMS provider for Israel has developed a robust and unique organization of volunteers with advanced telecommunication strategies to activate and direct them in order to improve these proce...

Objectives: To determine the prevalence of clinician perception of inappropriate cardiopulmonary resuscitation (CPR) regarding the last out-of-hospital cardiac arrest (OHCA) encountered in an adult 80 years or older and its relationship to patient outcome. Design: Subanalysis of an international multicenter cross-sectional survey (REAPPROPRIATE)...

Background: Colitis refers to an inflammatory process of the colon, composed of a variety of different etiologies including inflammatory bowel disease, infectious colitis, ischemic colitis, and allergic colitis. Usually, abdominal computed tomography (CT) is the gold standard in diagnosing the various forms of colitis. However, by the use of point...

Point-of-care ultrasound is ubiquitous in the hand of the clinician in many specialties, especially in the evaluation of the patient who is in shock or cardiac arrest. Two of the more common protocols are ACES (Abdominal and Cardiothoracic Evaluation with Sonography) and RUSH (Rapid Ultrasound for Shock and Hypotension). The purpose of this editori...

Background: Purulent bacterial pericarditis is a rare and potentially fatal disease. The course may be fulminant, and the presentation may pose a diagnostic challenge. Case report: An otherwise healthy 75-year-old male was brought to the emergency department in a state of general deterioration, confusion, and shock. Bedside ultrasound showed a s...

Pulmonary embolism is caused by a blood clot that travels from the deep veins through the heart and then lodges in the pulmonary vasculature. Common symptoms include pleuritic chest pain, dyspnea, or palpitations. Clinical scores such as the Wells score and Revised Geneva score can be used to assess the pretest probability of pulmonary embolism (PE...

Multi-casualty incidents (MCIs) continue to occur throughout the world, whether they be mass shootings or natural disasters. Prehospital emergency services have done a professional job at stabilizing and transporting the victims to local hospitals. When there are multiple casualties, there may not be enough professional responders to care for the i...

Background: Medical response to world disasters has too often been poorly coordinated and nonprofessional. To improve this, several agencies, led by the World Health Organization (WHO), have developed guidelines to provide accreditation for Foreign Medical Teams (FMTs). There are three levels, with the highest known as FMT Type-3 providing outpati...

ABSTRACT Introduction Cardiopulmonary resuscitation (CPR) is often started irrespective of comorbidity or cause of arrest. We aimed to determine the prevalence of perception of inappropriate CPR of the last cardiac arrest encountered by clinicians working in emergency departments and out-of-hospital, factors associated with perception, and its re...

Objective Our objective was to determine the utility of point-of-care ultrasound (POCUS) to identify and guide treatment of tamponade or clinically significant pericardial effusions in the emergency department (ED). Methods This was a retrospective cohort study of non-trauma patients who were diagnosed with large pericardial effusions or tamponade...

To the Editor The article by Goralnick et al titled “Preparing for the Next Terrorism Attack: Lessons From Paris, Brussels, and Boston”¹ highlights 3 important lessons from these tragic events. In terms of engagement of the bystander, the second lesson they discussed, Israel’s emergency medical system Magen David Adom has been at the forefront for...

Introduction: Point-of-care ultrasound (POCUS) is an important modality with many advantages. At the Shaare Zedek Medical Centre, we developed a case-based course to teach POCUS to internal medicine residents and attendings. The topics include: "Introduction to Point-of-Care Ultrasound", "Focused Assessment with Sonography of Trauma", "Basic Cardi...

Objective: To describe the contributions of on-call, volunteer first responders to mass-casualty terrorist attacks in Israel during the Second Intifada. Design: Descriptive study evaluating data obtained from postevent debriefings after 15 terrorist attacks in Israel between 2001 and 2004. Results: An average of 7.9 deaths (median 7.0, interqu...

At the time of this study, the Sheba Medical Center Emergency Department (ED) in Israel had no formal triage system in place. To evaluate the interobserver reliability of two triage scales among nurses in our ED, the time-based Australasian Triage Scale (ATS) and the resource-based Emergency Severity Index (ESI), 10 nurses participated in a worksho...

Religious fasting is associated with headache. This has been documented as "Yom Kippur Headache" and "First-of-Ramadan Headache." Rofecoxib (Vioxx®), a cyclooxygenase-2 (Cox-2) inhibitor with a 17-hour half-life, has been shown to be effective in preventing fasting headache when taken just prior to the 25-hour Yom Kippur fast. Unfortunately for fas...