11 March 2004 Madrid Bombings A Prehospital Analysis

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11 March 2004 Madrid Bombings A Prehospital
Analysis
Alfredo Serrano Moraza, M.D. María Jesús Briñas
Freire, E.M.D. Andrés Pacheco Rodríguez,
M.D. Alejandro Pérez Belleboni, M.D.
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Scientific approach
Evidence-based disaster medicine

• Analytical work
• Systematic sources acquisition and register
• Exhaustive methodological evaluation
• Ethical principles
• Patiens and relatives confidentiality
• EMS teams work respect
• Useful and exportable approach
• Look for and design an evaluation-tool for
  similar MCIs

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The key

• While Police and Fire-Rescue Emergency could
  finish on focus
• EMS Emergency
• does NOT finish on scene
• Critical-bed needs coordination
• has impact on pts. morbi-mortality

No references yet
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NY 9-11 vs. Madrid March-11
9/11 McKinsey report9/11 Commission full report
No official report

• Approx. one / multiple focus
• Critical patients almost absent / overload
• EMT-Parameds. EMS / Phys. based EMS
• No victims between Emergency teams
• Others

ED red labels 233
...when they arrived
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Advanced support
María Jesús Briñas Rescue Jeseník 2004
Total approx. 80
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Atocha
María Jesús Briñas Rescue Jeseník 2004
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Santa Eugenia
María Jesús Briñas Rescue Jeseník 2004
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El Pozo
The face of death
María Jesús Briñas Rescue Jeseník 2004
Dead 67 Total victims 56 SUMMA/SAMUR
4 critical SAMUR 2 critical SUMMA
45 almost unknown ambulances
Work time approx. 1 h 15 min.
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Téllez St.
María Jesús Briñas Rescue Jeseník 2004
Confussion for ½ hour
Original IC is not available
Dead 64 Total victims 83 perhaps 2
deceased in place ?? 7 critical
rest is confusing Work time
approx. 2h 25 min.
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Hospital data
Hard severe
Discharged
Wounded
Slight injuries
Critical
Severe
Dead
224 9
Consejería de Sanidad March 11, 21 h
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Closest hospital overcrowd
Red labels
5
17
1
1
14
5
91
15
30
1
38
2
12
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Different EMS-ED dataWhy ?
Deceased 191 minus 20
Red labels
SAMUR 44 to 49 1 fallecido de camino
SUMMA 21 plus 20
On-scene deceased 14 to 20
85-90
143 ?

• Different classification systems
• Ex ED no yellow labels

• Difficult focus data collection

official data estimated
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In MCI, are most victims evacuated to hospitals
by EMS?
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Lessons learned 80 accuracy
Enormous citizens collaboration
SUMMA Communications irregular failing
Enormous Firefighters, Police and public-private
efforts
SUMMA Planification deficiencies
EMS good job
SAMUR on-scene good organization
SUMMA Dispatch Center good job
ED and Hospitals good job
Impact on morbi-mortality ?
80 accuracy
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Thank you
Madrid, my friends, Madrid, my brothers
You cannot see my tears - I have no more
but can you really hear my words crying for you?