David Applebaum

BMJ 2003; 327 doi: (Published 18 September 2003) Cite this as: BMJ 2003;327:684

Israeli emergency physician and a specialist in treating the victims of suicide attacks

When David Applebaum failed to answer his pager alert five minutes after it was sounded last week, Shaare Zedek Medical Centre's emergency department staffers immediately became alarmed. They knew that when called, the 50 year old department director, who was one of the pioneers of efficient and humane urgent medical care in Israel, always dropped everything he was doing, day or night, and rushed in to help.

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Applebaum was one of seven people who were killed in a suicide bombing at Jerusalem's Hillel café. Fifty-seven people–many of them rushed to Shaare Zedek–were wounded in the explosion.

“It was clear to me from very early on that when David didn't show up and hadn't called, a terrible tragedy had occurred,” said the director general of the Jerusalem medical centre, Professor Jonathan Halevy. “Confirmation of my suspicions came shortly.”

Applebaum's 20 year old daughter Nava, who was doing a year's national service working with children with cancer, also died in the attack. The pair had been chatting in the café less than 24 hours before Nava was to be married.

Earlier that day, Applebaum had flown home from the United States, where he had given a lecture to hundreds of doctors at New York University Hospital on how Israeli trauma and urgent care experts have coped with Palestinian suicide attacks. The last slide he presented said: “Everybody always says: ‘You don't know what's going to happen next in the ER [emergency room].’ In Jerusalem, it's for REAL.”

Applebaum, who was raised and educated in Cleveland, Ohio, United States, received a bachelor's degree in psychology and a master's degree in biological sciences before being ordained as an Orthodox rabbi. While he could have been a brilliant Talmud scholar, he decided to study medicine. After his residency in internal medicine, Applebaum received American board certification in emergency medicine. He and his wife, Debra, moved to Israel with their eldest children in 1981 and settled in Jerusalem, where Applebaum rode Red Star of David (Magen David Adom or MDA) ambulances and initiated injecting heart attack patients with streptokinase before local cardiologists had heard of it. After becoming medical director of MDA's mobile intensive care unit, he spent three years as a physician at Shaare Zedek.

“He once flew to Miami for one day just to make sure that a patient who needed a liver transplant was in good hands,” recalls University of Miami Medical School transplant surgeon Dr Andreas Tzakis. “He insisted on staying until he found me. Only after a lengthy discussion, where he investigated everything from the quality of care to the skills of the surgeon and the estimated wait time for the new organ did he agree to take a short nap before catching the flight back to Israel.”

Coming from the United States, Applebaum was shocked two decades ago by the long queues and frequent chaos in Israeli emergency rooms. Too many people with broken arms, heartburn, infections, and mild injuries were waiting in line for care when they could have been treated more cheaply and efficiently in an urgent care centre, he declared. Battling against the medical establishment, he purchased Jerusalem's MDA station and set up TEREM, the country's first private urgent care clinic. Applebaum trained a cadre of urgent care doctors and nurses, some of them Arabs whom he wanted to work on the Sabbath and on Jewish holidays.

Although health ministers could not understand the need for this 24 hour a day clinic and health insurers first balked at covering the treatment costs, Applebaum proved that it was a necessity. Nearly 95% of all TEREM patients were treated and sent home, with only a tiny minority having to be referred to an emergency room. Emergency rooms were therefore able to focus on really sick patients. On Saturday nights, when many Orthodox Jewish patients arrived to be treated after waiting for the end of the Sabbath, he hired a clown to entertain children.

Last year, Professor Halevy asked Applebaum to head his hospital's emergency department; Applebaum agreed on condition that he could continue to head TEREM. He felt it was a challenge to upgrade and humanise urgent care in both places. He introduced a computerised board on the ER's wall that kept tabs on all patients, their symptoms, doctors, test results, and how long they had waited. Selected doctors also had real time access on their computer monitors to all ER patients' conditions and records. During a break in last week's New York University appearance, he logged on to a computer and told Professor Halevy with pride: “You see, even without me, our emergency department is functioning like clockwork. The average wait to see a doctor is 16 minutes.”

He leaves Debra, five children, and a granddaughter.

David Applebaum, emergency physician Jerusalem, Israel (b Detroit, Michigan, 1952; q Cleveland, Ohio, United States, 1978), died in a suicide bombing on 9 September 2003.

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[Judy Siegel-Itzkovich]

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