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American Trauma Society is the lead TIIDE partner in the development of the Bombings Injury Patterns and Care: System Preparedness course. Working closely with CDC/NCIPC/Division of Injury Response, international experts in medical response to terrorism, and other TIIDE partners, ATS developed a course that deals with the systems issues related to response to terrorists' use of explosives and other mass casualty events with an immediate impact.
On March 11, 2004, ten detonations on four trains in Madrid, Spain killed 191 people and injured more than 2,000. Similar to the Oklahoma City experience in 1995, more than half of the casualties went to the two hospitals closest to the scene, although 15 hospitals were available. Over 300 casualties were managed at one 1,800-bed hospital, Gregorio Marañón University General Hospital - 272 within 2 ½ hours. The overwhelming majority of casualties were not critically injured. Observations included lack of communication with EMS, uncontrolled casualty distribution from the scene, and casualty surge at the hospitals.
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These bombings, like the bombings in London a year later, and like our own tragedies on 9/11/2001, were an inflection point. With hundreds of casualties occurring in a matter of minutes, prehospital services and hospital emergency departments were stretched to the limits of their capacity to respond.
What occurs in the first minutes of a mass casualty event (MCE) with immediate impact is critical to the success or failure of the emergency response. The purpose of this course is to examine the systems issues that affect emergency medical response and to make recommendations for preparatory action.