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Victory I Consensus Document

Proposal for the Implementation of the Hartford Doctrine in the Spanish Context

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Luis Martín, RN, MSc *; Guillem Roca, RN ; Jesus Manuel Hernandez, RN ;
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Saul Fernandez, RN ; Barry Lynam, MD, MSc, EMDM 5

ABSTRACT
Several international recommendations advise adapting mili- survival rates of victims are improved. On 2 April 2013,
tary healthcare response models to intentional mass casualty healthcare representatives, police, private and armed forces,
incidents (IMCIs) in civil environments. The IMCI experience firefighters, and emergency medical services (EMS) respond-
and associated published research from the United States, ers participated in the Hartford Consensus Conference. There
where these situations are frequent and properly analyzed they had the chance to report on and analyze the current mili-
more often, are, unfortunately, not directly applicable to the tary and civil experience with respect to these types of attacks.
Spanish model of emergency medical services (EMS), where The result of this conference was the “Improving Survival
each autonomous region has its own competencies and pro- from Active Shooter Events” document that aims to promote
tocols. However, there is a series of common elements that local and national policies to improve victim survival in these
served as a reference for the development of an effective, increasingly common situations. 10,11
evidence-based, IMCI consensus response plan called Victoria
I. In this plan, we have tried to define each intervening role General Principles of the
during an IMCI, from the occasional first responder to the Victoria I Consensus Document
final hospital staff at the reference trauma centers. We believe
that each professional role in this response chain, on and off The Victoria I document takes the Hartford Consensus as an
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the scene, must have a clear mission and function to improve international theoretical framework and adapts it to Spain’s
victim survival. EMS and healthcare response reality, establishing a civil–
tactical chain of survival based on the available scientific ev-
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Keywords: Victoria consensus; Hartford consensus; terrorist idence. The key points of the document are (1) the analysis
attack; intentional mass casualty incident; Spain of current threats; (2) the proposal of a public integrated re-
sponse system that includes population, security and armed
forces, emergency response teams, and trauma centers; and (3)
Introduction the development of training strategies for each of the key par-
ticipants in the incident response.
Currently, in Spain, there is no standard intentional mass ca-
sualty incident (IMCI) response plan that coordinates the mul- The Victoria I document has been elaborated by 32 multidis-
tiple emergency medical response levels and the state security ciplinary experts who participate in six different workforces
forces. Therefore, there is a need to create a specific action within the Spanish Emergency Medicine Society and are af-
proposal. The distinct features of IMCIs require a change in filiated with 15 public institutions, ranging from prehospital
the type of healthcare response and an adaptation of the usual emergency care, hospital staff, and high-end researchers to
concepts and procedures to these kinds of scenarios. Such an police and armed forces.
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adaptation translates into a specific preparedness and training
program adapted to the rapid evolution of this type of threat. 5–8
Prevention and Action Strategies
for IMCI Response
Improving Survival Rates in Terrorist Incidents: The
Hartford Consensus as an International Reference IMCIs must be approached from the prevention perspective,
emphasizing the importance of education, 14-16 and from the
The increase in multiple active shooter incidents in the United perspective of active response in two tiers: secondary and ter-
States has resulted in the need to respond in such a way that tiary action.

*Correspondence to Luis Martín Ibáñez, San Luis 19, 04230, Almería, Spain; or lmariba@et.mde.es
1 Captain Martín is a critical care and emergency care nurse with the Spanish Legion and national coordinator of the Military Nursing Work
Group of the Spanish Society of Emergency Medicine (SEMES). Mr Roca is with Emergency Medical Services Catalunya and is a member of
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the Military Nursing Work Group of SEMES. Captain Hernandez is a nurse at Central Defense Hospital “Gomez Ulla” Spain, and is a member
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of the Military Nursing Work Group of SEMES. Captain Fernandez is with the Spanish Legion and is a member of the Military Nursing Work
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Group of SEMES. Dr Lynam is a critical care and emergency care physician with Emergency Medical Services Catalunya.
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