Enhancing organizational resilience of emergency medical services through a designated intervention program

Background: Emergency medical services (EMS) in conflict-affected settings face compounding operational demands, making organizational resilience (OR) a critical institutional asset. Israel’s EMS have operated under ongoing security pressures for decades, intensified dramatically following the 7 October 2023 attacks. Despite growing recognition of OR as a measurable and modifiable property, longitudinal interventional evidence in pre-hospital settings remains sparse. This study reports the development and three-time-point evaluation of a targeted intervention program designed to enhance OR within Israeli EMS. Methods: A three-time-point quasi-longitudinal interventional study was conducted within a single EMS: T1 (pre-intervention baseline; n = 196), T2 (post-intervention; n = 205), and T3 (six-month follow-up; n = 172). OR was measured using the validated seven-domain Organizational Resilience Questionnaire (ORQ). The 70-hour intervention - comprising structured training (30 h, 4 weeks) and organizational embedding (40 h, 24 weeks) - was delivered by internal Resilience Trustees. OR changes were examined using one-way ANOVA with Bonferroni-corrected comparisons (Cohen’s d) and independent-samples t-tests (α*=0.005). Sequential multivariable regression (pooled n = 573) and ANCOVA identified independent OR predictors and examined OR changes after covariate adjustment. Results: Composite OR increased significantly from T1 to T2 (Δ=+0.20; p = 0.018; d = 0.27), with a Bonferroni-corrected significant gain in situational awareness (Δ=+0.25; p < 0.001), with additional gains in adaptive capacity (Δ=+0.21; p = 0.006) and learning processes (Δ=+0.23; p = 0.006) reaching conventional but not Bonferroni-corrected significance. OR continued to rise at six-month follow-up (T1 mean = 3.86; T2 mean = 4.06; T3 mean = 4.09; Δ T1→T3 = + 0.23; p = 0.007; d = 0.32). The time effect remained significant after full covariate adjustment (ANCOVA: F = 7.41; p = 0.001; ηp²=0.026), with paramedics showing greater gains (+ 0.27) than other staff (+ 0.05; Time × Profession: p = 0.046). Transformational leadership, employee well-being, and technological advancement were the dominant OR predictors (pooled R²=0.770; β = 0.458, 0.274, 0.208, respectively; all p < 0.001). Conclusions: A structured, domain-targeted OR program was associated with significant, domain-coherent resilience gains that progressively consolidated under protracted conflict conditions. The ORQ and the Resilience Trustee model — for which the present study provides preliminary effectiveness evidence — together offer a promising framework for OR strengthening in EMS organizations confronting chronic operational disruption, with implications for national and global emergency health policy.