As the ambulance hurtles through the streets of Tel Aviv, Shmuel breathes erratically through an oxygen mask, which occasionally has to be repositioned further up his nose.

It’s an improvement on his condition a few minutes earlier. When the Magen David Adom emergency team I am shadowing arrived at the old age home, the octogenarian was unconscious, with what appeared to be a blockage in his airway. His carer had been feeding him soup when he started choking.

After placing him on a stretcher and introducing a Combitube, the team of three paramedics, including the driver, manage to remove much of the blockage. Later, the chief paramedic on the shift would explain he was reluctant to try a full tracheal intubation, given the age of the patient and the risk of the adverse effect it could have on his lungs.

By the time the ambulance reaches the hospital, Shmuel is awake and responsive, reacting when his name is called. He is wheeled into A&E, where a few minutes later his son arrives, kissing Shmuel on the head. He will be fine, God willing. Thanks to Magen David Adom.

On the 70th anniversary of MDA UK’s establishment, the JC has been invited to observe the life-saving work undertaken by Israel’s emergency medical service on a daily basis.

In national terms, MDA is Israel’s first line of medical defence. The organisation itself predates the creation of the state of Israel by almost two decades. Unlike the police or the fire service, it does not receive a running budget from the government. It operates a fleet of more than 1,100 ambulances, 700 bikes (and helicopters in the north and south of the country).It has well over 1,000 full-time staff, but with a staggering 22,000 volunteers, it is the country’s largest volunteer organisation.

At MDA’s national dispatch centre on the outskirts of Tel Aviv, no information is more than a few clicks away. Unassuming passers-by would have no inkling that this squat, unprepossessing building has such an important role.

Descending several levels, we emerge into a bright, well-lit area housing around 50 workers, seated at banks of gleaming computer terminals. Ido, the MDA spokesperson, tells me there are currently “198 ambulances on call, 93 of them intensive care units [ICUs]. There are 106 engaged, 40 of them ICUs.” Each unit on call can be tracked on screen.

“At the moment, the average [arrival] time of a BLS [basic life support] ambulance is nine minutes and four seconds. Average time of answering a call anywhere in MDA, 3.46 seconds.

“Emergency call-outs which have been treated so far today — 656, quite low,” Ido continues. “Total call-outs — 1,644.” Non-emergency call-outs can be hospital transfers, for instance.

The Tel Aviv nerve centre has required significant adaptation to meet changing times. A few years ago, a rocket attack on the area would have left the national dispatch service inoperable. Now the space is sheathed in steel, with full air filtration. If there was an alert, “they would close this section off and continue to operate as normal”, Ido says.

Under the MDA’s command structure, Israel (including the West Bank, where the organisation works with the Palestinian Red Crescent) is split into 11 regions, from north to south, with 167 operating stations and launch posts. As well as the national centre, every region has a local dispatch. As the systems at each are the same, a dispatcher from anywhere in the country “could sit down here, open up a line, and begin operating calls”.

Unlike many other emergency response systems worldwide, “every dispatcher for MDA is medically trained. They can, within the first few seconds, provide medical assistance.”

Each region faces its own challenges. “Around Gaza, there is a constant threat of mortars and attacks,” Ido explains. “Tel Aviv and Jerusalem have more traffic accidents. Coastline [personnel] have to deal with drownings in the summer.” MDA ICU ambulances contain monitored defibrillators which are hooked up to patients.

The life signs from each can be viewed at the dispatch centre, where theoretically, “every patient can be overseen by a senior paramedic or physician who can provide advice on treatment or sign off on a certificate of death”.

MDA always endeavours to have operators on call who can speak other key languages — Arabic, English, Russian, French and Amharic. It is continually working on technology upgrades to improve response times, employing 50 full-time programmers. One example is its My MDA app, developed for civilians.

“In 2020, we’ll be able to see the location of 70 per cent of callers,” one tech savvy MDA staffer explains. “But three out of ten people will call and we’ll have no idea where they are. I can order a pizza and it can tell them my exact location. But I can’t call an ambulance and it can see my location? It’s ridiculous. People die because they [the operators] didn’t know their location.”

By contrast, if a call is made through the My MDA app, “it sends the location automatically. There’s also another function where we can send a link either by text or Whatsapp — the person opens the link and it sends their location.”

The app also allows users to locate their nearest blood donation centres, and to input their medical information. It is additionally used by MDA staff to check schedules and receive call-out requests.

Another new development is a defibrillator pilot scheme, with each sold to medical companies featuring GPS or wifi to assist location. And MDA’s driving simulators allow trainee ambulance operators to log considerable amounts of supervised practice time.

Innovations are not limited to electronic technology. In Jerusalem, I am taken to the country’s first Milk Bank. Soon to launch, it will allow nursing mothers to donate excess milk for babies without access to it.

Dr Asher Mozer, the paediatrician who spearheaded the project, says that until now, those seeking breast milk for a baby would have to do so via a “black market”. For example, “a woman will post at her synagogue that she needs milk for her baby and another woman will donate. But it wouldn’t go through any checking or processing. It may be contaminated.”

He recalls that on joining the organisation three years ago, he warned of a “big hole in the understanding of how we save lives for babies. I want to bring this into MDA. There’s a lot of MDA money invested here. We didn’t get much government support.”

As Dr Mozer explains, breast milk has “been proved many times to have much more than its nutritional value. We’re going to have a product that will save scores of babies every year.”

All the milk will be tested at the Jerusalem facility to make sure it’s safe. Staff at the bank will be female, to help donors feel at ease. Donors and recipients will be welcomed from all religions and ethnicities.

“Every bottle of milk will be traceable back to who donated it and when,” Dr Mozer adds.

He predicts that in its first year, “we’ll have at any given time in the vicinity of 20 nursing mothers donating milk on a regular basis, which will be around 300 litres a month — 3,600 a year. We will probably double that when it becomes common knowledge about how important and life-saving this is.”

MDA also finds itself having to focus not just on issues of current concern, but potential future challenges. We visit the MDA station in Beit Shemesh, which was built with MDA UK funding a decade ago. But a lot can change in a very short time, as Shuki, the station commander, points out.

“About five years ago, Beit Shemesh [including the nearby Ramat Beit Shemesh] had about 95-100,000 people living here. Now they are up to 130,000. By 2025, they’re expecting to have about 300,000. They are building everywhere.

“Besides Beit Shemesh city, the closest stations to us are in Jerusalem and Modiin. So all the little neighbourhoods outside Beit Shemesh get services from our station too — we’re overstretched.”

A new ambulance station in Ramat Beit Shemesh , “around six years in the making”, is set to open within the next six months — again, primarily down to the support of the UK branch, which has been instrumental in the building of many of Israel’s important MDA stations.

Another of these is Rahat, in the Negev, which is the main ambulance point for the 40,000-plus Bedouin population, as well as a number of Jewish villages in the area.

“At first MDA was not popular,” Ido freely admits.

“The red star of David in a Muslim community. But very quickly they understood that this was an important organisation they want to have here. And they understood that it was humanitarian and helping their own community.”

Itzik, the station head, reveals that “the first female ambulance driver from the Bedouin community is from Rahat. She’s very proud of it. She’s a model to many women in this community.”

When Itzik visits any of the Bedouin groups, he receives only positive feedback. There is a real feeling of community, so much so that the Arab MDA workers collect food for needy Jewish families prior to Pesach. The Jews reciprocate in the run-up to Ramadan.

I speak to Malek, a 26-year-old from the Bedouin community, who started volunteering for MDA at 15 and has been working as a driver-paramedic for two years. Shy as a child, he didn’t leave home much — “we didn’t have many recreational options as children here.Then one day I saw an ambulance pass by. I didn’t know there was an option to volunteer.”

Malek is now finishing a nursing degree and credits MDA for helping “make me into a better person. My personality improved, I got to know different people from outside my own community.”

Ido says MDA has become “a great [volunteering] option for the people and the youth. It’s amazing to see and hear how highly they respect MDA. Many gain entry into the medical field via MDA.”

To prove the point, as we are talking, a Bedouin woman approaches the station, asking for advice on how her son can volunteer.

The station itself, however, is in need of significant refurbishment. MDA UK is playing a big part, as is the Bedouin community. Local Sheikhs have said they would be proud to contribute.

But the biggest building project MDA is currently working on is a new HQ in Ramle, which is also where the organisation’s central blood service will be housed. Close to both road and rail links,it will enable MDA to more effectively transport the approximately 600,000 units of blood it receives a year.

Under Israeli law, MDA has to charge for its services — although the organisation has a number of different bursaries allowing those on low income to pay less, or in the case of Holocaust survivors, nothing at all.

“A lot of people in Israeli society don’t understand that MDA is not funded by the government,” Ido says.

“But over the past five years we’ve had an influx in Israeli donations. There’s an Israeli Friends of Magen David Adom. We now have stations and ambulances funded by Israelis.

“But the most important thing Israelis give to MDA is their time. Time equals money. Twenty-two thousand Israeli volunteers in MDA. That is over a million hours a year donated. Equate that to money, to crews you would have to pay a salary to — that’s an incredible amount.

“If the government was paying for all this stuff, it wouldn’t be as good a service, because it would be at the whim of other priorities. Would it be a priority for the government to build a new command and logistics centre in Ramle? Would it ever get round to doing it? Probably not.”

Fundraising for MDA brings to mind plaques on buildings, or names on the sides of emergency vehicles. Every vehicle has a story. Some have been donated by a community, others by international fellowships. Wealthy individuals have donated in remembrance of loved ones.

There is something incomparably special about seeing ambulances donated in memory of Holocaust victims helping to save lives today.

“Last year we crowdfunded 70 bikes for 70 years [since Israel’s founding],” Ido says. “Ten bikes were sourced from mass crowdfunding. So ten out of 70 weren’t just people saying ‘here’s £15,000’. It was people responding, saying ‘we’re happy to play a part in that’.

“We’re looking to educate people. It’s not just about one name on the side of one building. It’s the Israel you don’t see.

“A lot of people don’t understand why we’re asking them for money. We’re not asking for money to do the job of an ambulance service, we’re asking for money to make a difference to Israel.

“We’re saying to you: If you’re interested in Israel, the future, social cohesion, MDA is one of the ways you can make a real difference in Israeli society.”