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Conference Agenda

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Session Overview
MON5.8: Mass casualty incidents – lessons learned
Time: Monday, 27/Aug/2012: 2:40pm - 4:10pm
Session Chair: Chaim RAFALOWSKI, Magen David Adom
Location: Sertig

Session organized by Magen David Adom

Session Abstract


Mass casualty incidents – lessons learned


1Magen David Adom, Israel, State of; 2German Red Cross, Frankfurt Branch, Germany; 3SAMUR-Protección Civil. Madrid. Spain

Multi Casualty Situations are one of the most important challenges Emergency Medical Services prepare for and are required to respond to. In recent years terrorist attacks in Madrid, London, Israel have created major operational challenges to the EMS organizations, challenging the "historical" response schemes.

The lessons learned from those operations clearly demonstrate the complexity of creating a clear real time operational picture of the casualties, their severity and location. Project SOGRO on electronic triage addresses this issue and provides a state of the art solution to this issue.

Objectives: (1) To present the lessons learned by the EMS services in – Madrid, London, Israel from their response to terrorist attacks, and identify common lessons learned. (2) To present the results of project SOGRO offering a solution to creating a real time picture of the number of casualties, their severity and location, in order to facilitate right distribution to the hospitals and resource management.

C. Session structure:

1. 3 presentations 15 minutes each followed by 5 minutes of questions and answers – lessons learned from: Madrid, London, Israeli terrorist attacks.

2. Presentation of SOGRO project results – 20 minutes.

3. Panel discussion – 10 minutes.

Hospital & EMS – real time information SOGRO


1Public Health Authority Frankfurt am Main; 2German Red Cross Frankfurt am Main

In the framework of a research project called SOGRO, funded by the German government, we run a full scale exercise with 550 „casualties“. The goal was the evaluation of medical disaster management supported by electronic triage.

Today's threat level makes it absolutely necessary, to gain first information of the accident scene and to transfer these data´s immediately to hospitals nearby. With the technology provided by SOGRO it allows the hospitals in real time to follow the MCI and get rapidly prepared as needed.

The technique is based in PDAs and RFID wristbands. In terms of data transmission, is redundant and therefore almost certainly fail safe. The project shortens the preclinical and clinical interface in many ways. Several exercises, with as much as 560 casualties have now demonstrated the enormous time savings for the hospitals to get prepared. By „seeing” the developing scene on sight, they are starting to become a part of the rescue chain. Where ever a complete concept of emergency preparedness and response is wanted/needed, it is imperative to further develop the EMS and hospital set up between the two and to establish interfaces. SOGRO´s part is sharing of information in two-way direction - injury with triage status directed to the hospital and dynamic reporting of available hospital beds back on sight, even during a running MCI.

The use of electronic registration of casualties in major disasters is possible and the hospitals are even faster and more targeted to treat the injured. It can be determined by the real-time information sharing to achieve a maximum increase in resources in hospitals and thus ensure a quick and high professional medical care of patients. SOGRO has been able to prove this concept in an exercise with more than 500 patients and 16 participating hospitals.

Lessons Learned from Multi Casualty incidents response by Magen David Adom Israel


Magen David Adom Israel

Magen David Adom, Israel's National EMS, is in charge of the medical response to multi casualty incidents. Those incidents include transportation accidents (busses and trains), structural fires, and one large wild fire, terrorist attacks (mainly suicide bombers).

MCI doctrine has been revised and operational debriefings are routine.

1. Declaring the MCI – In order to minimize time, the authority to declare a MCI should be delegated to the "grass root" and they must have the support in case of a "non -justified" activation.

2. Check lists – the first minutes of a MCI are very chaotic. In order to support the field personnel "checklists" have been created.

3. "Bomb squad" procedures. The "normal" procedure of waiting for "clearance" from bomb squad technicians to enter the explosion site has proven non feasible.

4. Managing within the chaos. MDA philosophy is that there is little sense in trying to organize the chaos, and the better solution is to learn to work within the chaos.

5. Surge capacity – there is a need to bring additional personnel and equipment fast to the scene, on top of those available in the ambulances responding to the incident.

6. Incident commanders need to be well identified. Each commander needs an assistant dealing with communications.

7. Coordination and cooperation between the different organizations is essential. In many cases organizations work side by side and not jointly, previous personal acquaintance of commanders is extremely important.......

Terrorist Train Bombings in Madrid. Learned Lessons

Carmen LEIS

SAMUR-Protección Civil. Madrid. Spain

SAMUR is the pre-hospital emergency medical system in Madrid. Samur-PC runs Basic Life Support Units and Advanced Life Support units. On March 11, 2004, ten bombs placed on four different trains detonated during the terrorist attack in Madrid. 192 people were killed (173 people on scene, 2 people died during transport and 17 deaths in the hospitals) more than 1,800 injured.

The magnitude of the attack called for the massd mobilisation of resources. This resulted a regional and national response – something which has previously never happened.

The lessons we learned are resumed in the next points:
- Response to multi site incident needs to be global
- Coordination between commanders and dedicated communications channel
- Dedicated radio channels (between bases)
- Commander's identification
- The arrival and exit of the workforce must be controlled
- Casualty organization on site – by severity.Triage cards are not always useful. Colors triage was not used (though avilable)- possibly because severity was evident.
- Field Hospital improved quality of care and use of ALS resources. Phyisicans presence improved care.
- Personal protective equipment is requires. Safety a major consideration. “In unsafe site, rescue should predominate over the stabilization”
- Discipline in these incidents is the key to an adequate organization
- The mass casualty incident procedure should be improved to address the needs of incidents with multiple focus. SAMUR-PC mass casualty incident protocol was modified including CRBN preparedness
- Periodical training with simulation exercises (interal and inta-institutional) is very helpful. The collaboration between all the proffesionals) was extraordinary
- The capacity to increase the human and mobile resources is necessary. In two hours and twenty five minutes all the incident sites were evacuated.
- Distribution of patientes to hospitals – homogenus

Pillars for catastrophe preparedness: training, material resources and Simulation programs

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