It started with a few bites of ice cream with cashew and ended with a ride in an ambulance run by an Orthodox Jewish emergency medical service.
In 2017, 2-year-old Rus Amster was on her way home with her family after Shabbat lunch in Baltimore when she began throwing up. Within minutes, her stomach was swollen with puffy blotches, and she had difficulty breathing.
Her parents called Hatzalah, a volunteer-driven ambulance company in Baltimore whose name in Hebrew means “rescue.” Within two minutes, there were several first responders at their door. They injected Rus with an EpiPen and gave her oxygen before rushing her to the hospital, where she was treated for a severe allergic reaction.
“Those volunteers are spread throughout the communities that they serve in a way that they’re able to respond unbelievably quickly,” said Rabbi Chaim Amster, the girl’s father. “For my daughter, that’s really the reason why she’s alive.”
Across the United States, independent chapters of this type of Jewish emergency response service have formed agreements with city agencies to respond, free of charge, to emergencies.
But Hatzolah, as the organization is sometimes alternatively spelled, has long struggled to gain traction in Los Angeles, where the city fire department is the exclusive provider of emergency ambulance services. The organization has applied to Los Angeles County for an ambulance license that would allow it to transport patients during non-emergencies, said Cathy Chidester, director of the Los Angeles County Emergency Medical Services Agency.
If Hatzolah receives a license, she said, it will be able to transport patients during non-emergencies anywhere in the county except Los Angeles, which requires that it apply for a second permit first. The county license would allow Hatzolah to transport non-critical patients to or from a medical facility but would prohibit it from performing more than basic life support, like CPR, or responding and transporting patients during medical emergencies, like a stroke, heart attack or shooting.
Hatzolah’s ultimate goal is to be permitted by the city to transport patients and respond with ambulances to emergency calls using lights and sirens — a practice called Code 3 — just like the fire department. But this has been met with strong pushback from the Los Angeles Fire Department and its firefighters’ union, which both point to their agency’s jurisdiction and argue that allowing another entity to respond to emergencies creates a public safety issue.
State law says county emergency medical services agencies can create “exclusive operating areas,” like the city of Los Angeles, where ambulance providers can operate. The county can either conduct a competitive process to select providers or select existing providers — such as city fire departments — that have provided these services consistently for decades. While there are 31 licensed ambulance companies in the city of Los Angeles, the Department of Transportation says only the local fire department can respond Code 3 to 911-type calls.
At Hatzolah’s licensing hearing last month at the county’s Emergency Medical Services Agency office in Santa Fe Springs — which was packed with some 80 Jewish community members — one of the hearing officers, Capt. Terry Millsaps of the Los Angeles County Fire Department, said Hatzolah’s dispatch manual would need significant revisions before Hatzolah is granted an ambulance license.
He said that most of the manual is written as if Hatzolah is operating as a 911 provider, and that Hatzolah’s current practice of alerting 911 to emergencies and simultaneously sending its own responders to a scene without authorization is in violation of the county code.
“We’re looking for an exception for a unique business model,” said Daniel Wiesel, a Hatzolah volunteer.
Hatzolah of Los Angeles, a nonprofit that began in 2001, operates in areas including Pico-Robertson, south Beverly Hills, Hancock Park, La Brea, Fairfax, West Hollywood, North Hollywood and Valley Village. Its dispatchers relay more than a thousand calls annually from its hotline to its approximately 60 volunteer EMTs, who race to reported incidents. The EMTs do respond to medical emergencies in non-ambulance emergency vehicles, and they transfer care to the fire department if a person must be transported by ambulance. Hatzolah has several ambulances but is not using them.
Chidester said the city will not give up its jurisdiction to respond to emergencies. Doing so, she said, may create confusion and competition between ambulance providers.
“They will lose that exclusivity, and the system will have a significant change to it that we would not be able to adapt to,” Chidester said. “If you have a company like Hatzolah that is responding to 911 calls, what’s to stop another ambulance company from going in and responding to 911 calls?”
But Hatzolah is intent on finding a way. Volunteers who speak Hebrew, Yiddish or Farsi sometimes act as translators for firefighters. All are trained on how to apply Jewish law when responding to emergencies on the Sabbath, when observant Jews do not work or drive, and can explain why a person is allowed to break one of that day’s rules in a life-threatening situation.
Simcha Mandelbaum, a member of Hatzolah, said that people sometimes “turn to us and say, “I don’t know if I’m sick enough to go on a Sabbath to a hospital.”
“Many, many times we have encouraged people to get adequate care follow-ups that they are afraid to do on one of the [Jewish] holidays,” he said.
On Jan. 17, LAFD Chief Ralph Terrazas sent a letter to Chidester that said allowing Hatzolah to dispatch its own ambulances to emergencies without permission from the city fire department creates a “significant public safety risk.”
In a separate letter, Freddy Escobar, president of United Firefighters of Los Angeles City, said the union has received many complaints from its members about unauthorized Code 3 responses by groups like Hatzolah.
Asst. Chief Ellsworth Fortman said that Hatzolah does not currently meet his agency’s standards for responding to medical emergencies.
“One day it might get there,” he said. “To be OK with anyone else stepping in and doing it, at the minimum, they would have to provide the same level of service.”
But Rabbi Shmuel Manne, Hatzolah’s chairman, said the California Highway Patrol, which has certified Hatzolah as an ambulance company, allows them to currently drive Code 3 to a call. In a statement, CHP said it has licensed three ambulances and nine other vehicles that can respond Code 3. It said its license authorizes private ambulances to transport patients but that each city and county may institute additional regulations.
Manne said the ability to transport patients to hospitals is important partly because people may be reluctant to pay for a city ambulance. In those cases, he said, “We could get them to the hospital and get them seen.”
“Obviously, we don’t want to replace the fire department… Other cities have worked it out,” he said.
Hatzolah members also say they’re trying to bridge the gap between the fire department’s response time and what they can do as responders who live minutes away from their calls.
“We’re getting resistance to something that is totally benevolent,” said Mandelbaum.
Hatzolah volunteers currently use some of the vehicles licensed by the California Highway Patrol. Letters dating back to 2005 from Mayor James Hahn and City Councilman Jack Weiss backed Hatzolah’s application for licenses from the CHP to respond Code 3 to emergencies. Hahn wrote that Hatzolah volunteers in Hancock Park had been instrumental in capturing a sexual predator, and Weiss described how Hatzolah was on scene when a small plane crashed into an apartment building in Fairfax.
Chidester explained that Hatzolah is in a unique spot because it has not been licensed yet by the county. Nothing stops it from responding to emergencies like any private citizen.
“They found this little niche in the system where they have people call them and they call their volunteers and have the volunteers respond,” she said. “They’re very confusing because of that. Nothing addresses that in the law.”
Hatzolah has tried to apply for ambulance permits from the city before. In 2008, the Department of Transportation told Hatzolah that private ambulance companies must charge people for their services, which the group does not want to do. In a subsequent letter, the agency said the LAFD is the city’s recognized 911 provider and that it could not approve any private ambulance company providing that same service. At the time, then-Fire Chief Douglas Barry wrote a letter supporting Hatzolah’s application.
At last month’s hearing, Danielle Zemel, a mother of four, said she has Hatzolah’s number saved on her cellular and house phones. Several years ago, her daughter Nina, then 3, severed her finger after getting it stuck in a folding chair on Shabbat. The fire department, which arrived after Hatzolah, told her she needed to take Nina to the hospital, but they did not have an ambulance available. Zemel, who was not home at the time of the incident, ended up borrowing a car from a friend.
“Hatzolah came within minutes, but they couldn’t transport us,” she said.
Rabbi Eliezer Gross, dean of Yeshiva Gedolah of Los Angeles, an all-boys Orthodox Jewish high school, said “there’s a certain sense of security” that comes with seeing a member of one’s own community arrive to provide emergency services, as Hatzolah has done at his school.
When Hatzolah volunteers respond to calls on their two-way radios, they know they may soon find themselves in the home of a close friend, a member of their synagogue, or someone they have greeted before with a “Shabbat Shalom.”
That was the case with Aharon Sabbagh when he responded over a year ago to an incident in a Pico-Robertson home where a friend’s baby was choking. After doing chest thrusts, he partially unblocked the 6-month-year old’s airway and told the city paramedics who arrived later that they needed a tongue depressor. A little red plastic ball flew out of the boy’s mouth.
“That kid is like my nephew,” Sabbagh said. “The call comes out and we respond. All of a sudden it’s your friend’s kid or someone that you know.”