Missile alerts flash on the phones of Israelis in those zones, as well as on the devices of MDA staff and volunteers, followed by sirens sounding in parts of the country. Soon after come the calls—about those directly injured, others hurt while rushing to shelter, people trapped in safe rooms, or drivers involved in accidents amid the confusion.

MDA is Israel’s national emergency medical service organization, with 36,000 volunteers, 3,000 employees, nearly 2,000 ambulances and 650 motorcycles. The entire fleet is tasked with being ready for deployment within two hours of the start of a war.

Moshe Shteren oversees the national first-responder dispatch operation and monitors MDA vehicles en route to war-related and routine incidents alike.

“A [ballistic missile]fragment can be the size of a bus. A fragment can destroy half a building, as happened in Beit Shemesh,” he told JNS.

During JNS’s visit, Israeli President Isaac Herzog and first lady Michal Herzog came to the compound to show appreciation to MDA volunteers. President Herzog shared words of encouragement on the volunteers channel using one of the walkie talkies. The president also addressed world Jewry during the visit.

Herzog called on Jewish communities worldwide to remain “vigilant and cautious” as Israel continues its war against the Iranian regime and its regional terrorist proxies.

“We’re very much aware both of the support and the challenges of the Jewish communities and the Jewish world at large,” Herzog told JNS.

“In these trying times, where there is war here, where we are in the bomb shelters, we know that Iran doesn’t rest only on the fact that it’s attacking Israelis,” he said. “It’s been seeking for generations already to attack Jews around the world.”

Herzog added that despite the danger, the Jewish people “will always be as strong as ever,” citing the resilience found in Jewish history and tradition.

“The lessons of Purim and other Jewish traditions are that we never give up and we will grow from strength to strength,” he told JNS.

Any emergency hotline dispatcher anywhere in Israel can answer a call from anywhere in the country and immediately access all relevant information. The closest ambulance is then automatically assigned through artificial intelligence.

“We oversee it,” MDA paramedic Ori Lazarovich told JNS. “The initial response is automated by AI, making our response time as short as possible. We don’t want calls to be forwarded and then assigned. It’s not absolute, but it assigns the first Basic Life Support ambulance, and we can change or modify it if needed,” he said.

MDA’s average response time for first responders—such as motorcycles, rapid-response vehicles or ambulances—stands at under five minutes, while a standard ambulance dispatched to transport patients typically arrives within seven minutes. In places such as Tel Aviv, where more resources are available, response times are even shorter.

MDA’s operations department determines resource distribution, based on factors such as population density and age demographics.

What makes the war more difficult, Lazarovich said, is the intensity over time. “Being fully prepared for 24 hours is easy; being fully prepared for a week is manageable. But being fully prepared for two years is very difficult,” he said.

With 90% of MDA’s personnel serving as volunteers—many of whom have full-time jobs or run businesses—maintaining operational readiness can be challenging and costly, he added. While the government determines work guidelines, MDA’s ambulances and stations are funded entirely by donors.

“The government only pays for specific services, such as having a paramedic stationed at the Knesset,” Lazarovich said. “They don’t pay for our services or salaries.”

Training programs

MDA offers a range of training programs for those interested in joining, from a 60-hour basic first-responder course—open even to ninth graders—to paramedic certification.

Lazarovich moved to Israel from the United States when he was in sixth grade. He began volunteering with MDA as a ninth grader, served as a combat paramedic in the army, and eventually joined the organization professionally. He has been with MDA since 2012.

“The work and the organization are part of our DNA, part of what we believe in. We come in the morning and we save lives—it’s very special. It’s not a job; it’s a lifestyle,” he said.

MDA operates in coordination with the IDF Home Front Command, the police and the fire services. Technology indicates where rockets and missiles are projected to hit, while MDA maintains mapping data on the estimated number of residents in each building, allowing it to calculate how many ambulances may be needed.

“If we have a building with 100 people, we could start sending 40 ambulances within the first five minutes,” Lazarovich said. “The first responders arriving let us know whether we need more—if additional buildings were hit—or fewer if only a fragment of a missile struck.”

“We urge civilians to stay inside their safe rooms, and we do the opposite,” he added. “When we urge people to go in, we go out.”

On Oct. 10, 2023, Bin already instructed personnel to prepare for a multi-front war. “In 2023, we were preparing for 2025,” Lazarovich said. “We knew the multifront war would come at some point, and that the missiles would be on a larger scale.

“We didn’t yet have hands-on experience with it, but we were prepared. When you’re well prepared, things fall into place. We knew it wouldn’t be 40- or 50-kilogram missiles, but rather 200- or 300-kilogram ones. Once you know the size of the weapons, you know how to prepare,” he added.

Elchanan Elon, another MDA paramedic, told JNS that people being unable to leave their safe rooms—due to the force of a blast, blocking debris or a defective door—are common. He emphasized, however, that safe rooms remain the safest place to be, even if the door becomes stuck, until MDA staff arrive to assist.

He also warned people against rushing to bomb shelters after receiving the initial Home Front Command alert. “There is enough time between alerts today to move calmly to sheltered areas,” he said. “Make sure the path is clear, bring in the children and take everything needed before entering.

“If you are going down to an underground building shelter, do not run on the stairs. It can make the difference between someone getting injured and someone reaching the shelter safe and sound,” he said.

Between the initial alert and the missile siren, people have between eight and 10 minutes to find shelter.