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In this episode, the guest is Dr. Tuvia Buk, a reserve first sergeant, combat medic, and author of the book “Heroes of Palmar”. The episode is about the Palmar (Plugat Marpe, or Medical Company), an innovative medical evacuation unit in the IDF, and the revolution it has brought to combat medicine. Dr. Buk talks about the unit’s activity in the “Swords of Iron” war, the technologies it uses, and the human challenges its members face.
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The establishment of the Palmar and the “golden hour”
According to Dr. Buk, the Palmar is a new unit established following previous operations in Gaza, based on the understanding that the evacuation time for wounded soldiers from the battlefield needed to be shortened. The unit’s goal is to break the “golden hour,” the critical period in which life-saving treatment must be administered. He explains that the unit has succeeded in reducing the average time from the moment of injury to arrival in the operating room to less than an hour, and sometimes even to forty minutes. According to the data he presents, the unit has so far saved 2,851 soldiers in the current war, 380 of whom were evacuated by helicopter in cooperation with Unit 669.
Methods of operation and innovations
Dr. Buk says that the idea for the unit’s establishment arose from a need identified during Operation “Protective Edge”. An IDF officer, a mutual friend of his and Boris Gorelik’s, recognized that soldiers were dying from injuries that should not have been fatal, and decided to find a solution. The guiding principle is that medical treatment does not begin at the hospital, but continues throughout the entire process, from the moment of injury in the field. One of the main innovations, he says, is the use of real type O-negative blood units in the field, not just plasma. Every ambulance is equipped with blood units at the correct temperature, which aids in rapid recovery. The unit, which began as a small organic team of doctors, paramedics, medics, and combat soldiers, has grown and now comprises eight companies and serves as a new model for emergency medicine in the IDF.
Technology in the service of medicine
Dr. Buk describes a technological tool used by the unit: a digital replacement for Form 101, which allows for continuous documentation of a wounded soldier’s treatment. In a mass casualty event, a soldier records all the data on a phone-like device. The information is transmitted in real time to the evacuation helicopter and the hospital, so all treating parties can monitor the patient’s condition and prepare for further treatment. He gives an example of a case where a wounded soldier needed morphine and ketamine. The team in the field managed to administer morphine before the helicopter arrived, and the paramedic on the helicopter, who had received the data, was waiting with a dose of ketamine to continue the treatment immediately and smoothly.
The human spirit of the unit
Dr. Buk, 58, tells how he volunteered for the unit at the beginning of the war even though he had not served in the reserves since 2006. He arrived at the base without a call-up order, insisted, and was eventually enlisted. He describes the unit as a family made up of people from all corners of Israeli society: religious and secular, Jews, Druze, and Christians, all working together for a common goal. According to him, there is a strong mutual support system, including a WhatsApp group that is also used for personal matters. The unit also takes care of the students serving in it and provides them with quiet study spaces.
Medical evacuation in the northern sector
Boris Gorelik asks if the lessons from the fighting in Gaza, which is relatively close to hospitals, are also being applied in the more distant Lebanon sector. Dr. Buk, who has been serving in the north in recent months, answers in the affirmative. He explains that rapid and efficient evacuation of the wounded is also carried out there, and there is no situation where a wounded soldier is left in the field without evacuation for hours or days, as happened in the Second Lebanon War. The evacuation is carried out by helicopter to Rambam and Ziv hospitals.
Mental health support and coping with trauma
Dr. Buk notes that in every company there are two mental health officers available to soldiers 24/7. They are an organic part of the unit and hold weekly talks with the teams. He tells of difficult incidents, such as a case where a deputy company commander discovered that the critically wounded soldier he was treating was his brother-in-law. He emphasizes the importance of mental health care, both during service and in the transition back to civilian life, and notes that the support continues even when the soldiers are at home.
International recognition
According to Dr. Buk, the Palmar’s methods of operation are generating great interest in the medical world. Doctors come from abroad to learn from the Israeli experience, and he himself has been invited to lecture on the topic in Australia, Canada, the United Kingdom, and the United States. He talks about non-Jewish figures, like Colonel Richard Kemp of the British Army, who express great support for the IDF and the unit’s activities.
The original episode, in Hebrew: גיבורי הפלמ״ר