This being Israel at a time of war, many of the emergency responders carry pistols on their belts alongside their tourniquets and stethoscopes.
“We believe we have the best and most advanced emergency service in the world but tomorrow we will be better,” says Elli Bin, MDA’s swashbuckling director general.
Since the start of Operation Rising Lion - the military name given to Israel’s attack on Iran - and the declaration of a state of emergency last Friday, his crews have responded to strikes that have killed at least 23 and injured more than 700, many with life-changing blast injuries.
“The size of the impacts is what makes this different,” said Israel Weingarten, MDA’s deputy director of disasters.
“With the rockets from Gaza and even Lebanon it was contained. Here the blast radius can go to 300m or more.
“It means the numbers [of casualties] are higher and it’s much more difficult to get to people. We also see many more internal blast, burn and crush injuries.”
Yesterday (NZT), the blast doors of the MDA dispatch centre slammed shut on the dot of midnight as, with the rest of the country, the centre was alerted to the night’s first barrage of missiles launched from Iran.
As people across Israel dashed for bomb shelters - most in basements - screens lit up across the room with live feeds from news and static cameras across the country.
Through these and other means, the centre is able to estimate probable and actual impact points, giving it vital extra minutes to get emergency crews to the scene.
“Speed is everything,” said Ori Lazarovich, 26, a senior paramedic and head of MDA international relations for Europe.
“If you want to save someone haemorrhaging or trapped in a fire every second counts”.
Earlier this week, Lazarovich was among the first to arrive at the massive Bat Yam missile strike near Tel Aviv, where he worked with others to pull survivors from the burning buildings.
“Normally you would wait for the first services to arrive but we were first and had to deal with it,” said the paramedic who first trained with the Israeli Defence Forces.
The first batch of missiles yesterday was taken down by Israel’s air defence system.
But just as the room paused to catch its breath, a second salvo was launched, sparking another seven to eight minutes of frantic activity as the projectiles arched high above Iraq and Jordan before hurtling down towards Israel.
And again, the air defence systems locked on, shooting them out of the sky before they could impact.
The MDA centre breathed again.
For the first three nights of this conflict, several missiles got through from Iran, the size of the barrages seemingly overwhelming Israel’s air defences.
There was significant damage done to both industrial and civilian infrastructure, with the destructive force of the blasts catching many Israelis by surprise.
An oil refinery in the north was set ablaze and shut down, and while Iran had aimed at military sites outside of major cities in the attacks launched in April and October last year, now it was hitting major population centres.
The Iron Dome and its related air defence systems, which have given citizens a very real sense of protection, were not “hermetic”, the Government went on air to stress. Only an underground safe room could really provide protection.
After the second strike, there was a long pause before a third barrage hit.
Two, nearly three, days of successful interceptions had built confidence that the Iranian capacity to get through was fading.
So much so that lockdown regulations had been relaxed to allow many more businesses to reopen on Thursday .
But at 7.12am local time, another 20 missiles started to hit, three of them getting through to cause very significant damage.
A major hospital, the Soroka Medical Centre in Beersheba in the south of the country, was hit, as were two densely packed housing areas south of Tel Aviv, one at Holon and one at Ramat Gan.
The Telegraph raced to Holon where the devastation was immense, and it was a miracle no one was killed. If you had to guess where pictures of the scene came from, many would say Gaza.
The missile hit one ageing five-storey block directly, completely demolishing it and leaving the four immediately adjacent buildings without windows and structurally unstable.
A 12-floor high-rise had its cladding and glass stripped away from top to bottom on two sides, and even 400m away on surrounding streets, the blast had blown-out doors and windows.
The local synagogue was badly damaged, and a school and three local kindergartens were strewn with rubble. Had they been open, the carnage would have been unimaginable.
Professor Alon Ben Nun, a prominent surgeon and medical director of the fire brigades, was early at the scene helping people from their shelters and out of the rubble.
“I would say there were a 100 walking wounded and four seriously wounded,” he said as drones with thermal cameras buzzed overhead searching for unconscious survivors.
Gill Vaknin, 57, said he had just got into his building’s shared bomb shelter when the missile hit. There was no “whoosh” of warning, just an “incredibly loud and powerful blast”.
“It’s hard to describe,” he said, “the whole building shook. If we were not in the shelter, I would not be talking to you now”.
Barch Angel, a retired machinery operative, 55, was out when the blast hit, but it very nearly killed his wife Dalia.
She received an alert on her phone and reached the entrance to the shelter with only seconds to spare.
The blast exploded through the plate glass front of the couple’s apartment, shredding the main living area and kitchen.
Anyone who had been there would almost certainly have died.
Dalia could not speak for emotion, while Barch surveyed the damage philosophically.
“I’m fine”, he said, “what’s there to worry about. We are safe. The rest is only money.”
His son Itzic said the housing estate in Holon was a “family community ... peaceful, a very sleepy place”.
“Everyone in Israel has been affected by the war [since October 7, 2023] but this is the closest it has ever got to this neighbourhood physically,” he added.
The MDA paramedics at the scene were still busy helping people with minor injuries and logistical issues, when the Telegraph left.
First responders with MDA, like Batya Tugendhaft, 20, originally from London, were visibly exhausted but determined to carry on.
“It’s the young that basically run this nation. We are cheap labour, but we do it for a sense of duty to our country and love. This is a true national service,” she said.
Even in the darkest of times as a paramedic, “there are tiny pockets of human connection” that make it worthwhile.
