US synagogue volunteer guards learn mass casualty response from Israeli medics

Luke Tress is The Times of Israel's New York correspondent.

WESTCHESTER COUNTY, New York — A volunteer synagogue security guard struggled to wrap a tourniquet around the thigh of a “terror victim” who shouted and writhed on the ground in agony.

Another volunteer moved to pin down the victim’s flailing upper body, and an Israeli medic offered a marker that the guard could use to write the time on the victim’s forehead to inform medics when they arrived.

The volunteer applying the tourniquet, a middle-aged theater professional from New York City, tied a T-shirt around the victim’s other leg in a second, improvised tourniquet. She inserted the marker into a knot and cranked it in a circle to cinch the shirt tight.

“Listen, it’s not the right way, but it’s stopping the bleeding, and you move on to the next patient,” said another volunteer, a veteran medic. “We’re not going to have 100 tourniquets and 20 bags and this and that. Use your shoelace. Use anything.”

The Thursday drill was part of a course that Israeli first responders from Magen David Adom (MDA) taught to members of the US-based volunteer synagogue security group, the Community Security Service (CSS). CSS and American Friends of Magen David Adom, the group’s US branch, announced the partnership on Monday.

The collaboration marked an expansion of CSS’s efforts to protect American Jewish communities, drawing on lessons from terror attacks in Israel, as US Jews grapple with the threat of mass casualty incidents caused by terrorism.

CSS, a nonprofit, trains Jewish community members in security methods to protect synagogues and Jewish events around the US. The program also recently launched street patrols in Jewish areas of New York City. Magen David Adom (MDA) is Israel’s national emergency response service.

The partnership’s first two-day course for CSS volunteers was held in CSS’s headquarters in Westchester County, north of New York City. The group keeps the exact location and the identities of volunteers and some staff confidential for security reasons.

Twenty volunteer guards attended. They hailed from around the US, including the New York region, Philadelphia, Illinois, Florida and Washington, DC. CSS says its network includes more than 7,000 volunteers at more than 500 synagogues.

After completing the course, the volunteers will incorporate the lessons into training for other guards at their synagogues.

Benjamin Erbs, CSS’s senior vice president for training and security, said the program’s goal was to teach guards how to begin treating victims and preparing for first responders’ arrival in the aftermath of an attack.

“What we learned from past terror attacks is that it takes time for the EMTs, even police, or if it’s a fire department, to come on the scene, and even if they come, if the scene is still hot, they won’t engage,” Erbs said in an interview. “That means you, as the security personnel, are left with the situation on hand and you don’t have help at the beginning.”

Guards’ priority is preventing and disrupting attacks, and the medical protocol only begins after a scene has been secured, Erbs said.

He added that MDA has “a lot of experience with terrorism.”

“In Israel, things are happening daily which are out of the normal medical problems which every country and every city has,” he said. “And they produced, because of that experience, a lot of [standard operating procedures] about mass casualty incidents and how to handle them.”

Two veteran MDA medics from Israel, Raphael Herbst and Aryeh Myers, taught the course, repeatedly referring to lessons learned during terror attacks in Israel, including the October 2023 Hamas invasion.

The course was another recognition that terrorism has become a constant threat to American Jews. Terror attacks have repeatedly targeted Jews in recent years in the US and other parts of the Diaspora, including mass shootings, improvised explosive blasts, firebombings, stabbings and ramming attacks.

Antisemitic attacks last year murdered 20 people, making it the deadliest year for Diaspora Jewry in more than three decades.

American Jews have stepped up their security through an array of measures, often learning from Israeli experience and from Jewish security personnel in Europe, where terror threats have been an issue for longer. Some CSS staffers are from Israel, and the group coordinates with Jewish security outfits in Europe.

The US Jewish security effort began in earnest after the 2018 Tree of Life synagogue massacre in Pittsburgh killed 11. That was followed by deadly attacks in New Jersey and north of New York City. The push for security escalated again after the October 2023 Hamas attack.

One of the guards at last week’s course, a banker from New York, had been volunteering with CSS for 10 years, but felt that his lack of medical training was a gap.

“Having that is going to be immensely important in responding if an event ever happens. Saving lives,” he said in an interview. “Everybody gets that it’s scary, it’s disorganized, so you should be the one to come in and help organize it with whatever skills you have.”

“It sucks that we have to be doing this. But people who come to shul, they should feel confident that there are those of us that will step up when needed,” he said.

This week’s course differed from most first aid courses, which focus on an individual’s response, in that its goal was to “teach the community how to work as a community, not as individuals,” Herbst said.

Herbst described how, as a young medic during the Second Intifada, he froze in shock when he entered a bus hit by a suicide bomber to find a disembodied hand hanging off the vehicle. A veteran medic shepherded him through the episode, he said.

The class also watched video of Druze Israelis linking arms to clear a street for ambulances after a Hezbollah rocket struck a soccer field in 2024, killing 12 youths, in an example of a spontaneous, coordinated communal response that likely helped save lives.

“This isn’t a first aid course. You’re not going to learn how to do CPR,” Myers said. “We’re going to be learning how to deal with a multi-casualty or a mass casualty situation with the bare minimum of pairs of hands and a lot, a lot of people who need help.”

The volunteer group leaned older and Orthodox and included an accountant, a talent agent and a corporate lawyer, as well as members with medical experience such as doctors, paramedics and nurses, who offered insight from their specialties and helped coach other volunteers.

At one point, Myers asked the group why tourniquets should be applied only two inches above a wound, not higher on the limb.

“Too much muscle to compress,” one of the volunteers said.

“Unnecessary tissue damage,” another added.

The course relied on MDA’s “First Seven Minutes” protocol, developed to respond to mass casualty incidents. The guards learned to handle the “balagan” — chaos — at the scene of the attack by stopping critical bleeds, communicating with dispatchers, triaging victims and identifying dangers.

Most of the immediate deaths at mass casualty incidents are caused by blood loss, so stopping bleeds was a critical priority, the instructors said.

The MDA medics taught the guards that during a mass casualty incident, applying direct pressure to an injury, such as holding a shirt on a wound, had disadvantages, because it requires constant pressure from both hands, meaning the responder cannot treat others, or other injuries to the same victim.

A first responder can apply a tourniquet, though, “turning off the tap” of blood flow, then move on to other injuries, Myers said.

“If I’ve got 10 patients and there’s one of me, I’m not going to use me to put direct pressure on any wound. That’s going to be a tourniquet,” Myers said. “Shooting situations, things like that, you’re not going to mess around with putting on direct pressure.”

Some of the volunteers practiced applying tourniquets to each other’s thighs and biceps, while others used a rubber leg with a gory, gaping wound showing broken bones protruding in its calf.

The group viewed images of terror attacks in Jerusalem, the instructors pointing out that, sometimes, a situation appeared safe to begin first aid procedures, only for another terrorist to appear. Friendly fire was another danger, they said.

A CSS instructor said that, while security work and first aid have the same goal of saving lives, they cannot work in parallel, because a scene needs to be secure before medical treatment can begin.

“We’re at a car ramming, and we have injured people on the scene. Do we immediately start taking care of people? No. We need first of all to secure the scene,” a CSS instructor told the group. “If I have a person with a knife or a gun and I start taking care of people, I’m going to turn into a victim.”

The instructors encouraged the volunteers to make multiple calls to 911 as a situation developed so those being dispatched to the scene would have a more accurate understanding of the needs and dangers as the crisis developed.

“Safety is a dynamic thing. The fact that I’ve gone into a situation and I’ve said it’s safe doesn’t mean it’s going to be safe in 10 seconds,” Myers said.

Some dangers can come from unexpected sources. In one incident, Herbst recalled, MDA volunteers began treating a victim at a suicide bombing to discover that the patient was a second bomber inadvertently hit in the first blast, and had explosives strapped to his torso.

The volunteers discussed keeping trauma equipment on their person during guard shifts, how many tourniquets and bleed control kits they should keep at synagogues, and where the first aid equipment should be stored.

The course also discussed moral quandaries.

Tourniquets can cause extreme pain and might cost someone a limb due to restricted blood flow, but save their life, for example.

“A lot of limbs were lost because of October 7, because [the tourniquets] were too effective,” Herbst said.

The trainees discussed beginning medical treatment while a scene was still “hot,” going against protocol, because their family at the synagogue had been wounded. All agreed that they would violate guidelines to treat their children.

“We’re more likely to take risks that we wouldn’t take for strangers,” one of the volunteers, a former dispatcher, told the group. “If it’s your kid with a gunshot wound, you’re going in there even if the bullets are still flying.”

Myers said that the guards needed to understand that in a mass casualty incident, “There are people who you are not going to be able to help.”

“That is a tough thing to accept,” he said.

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