Page 99 - 2020 JSOM Winter

FIGURE 1. Iteration flowchart.

TABLE 1 Professional Categories stimulate local organizations to undertake measures to offer a
Profession Percentage Workplace Percentage rapid medical response without compromising security in tacti-
Nurse (nonmilitary) 43.6% ALS ambulance* 47.3% cal environments. This equilibrium involves providing the nec-
Physician (nonmilitary) 20% Commanders* 16.4% essary medical training to the police (e.g., massive hemorrhage
control), as well as providing the necessary police knowledge
Tactical operator 12.7% Hospital* 10.9%
(medic)* to the medical teams. In essence, the objective is to combine
Tactical operator both operations to give rise to a single one in which the tactical
(nonmedic) 12.7% Dispatch center 5.5% operator begins the chain of survival while the medical team
Paramedic advances from its classic position (i.e., safe area) to a more ad-
(nonmilitary) 7.3% BLS ambulance 3.6% vanced one (i.e., indirect threat care) and under the protection
Psychologist 1.8% Other 16.3% of the police to continue such care at a more advanced level.
Firefighter 1.8% — —
*No distinction between physicians and nurses. Our results suggest that advancing a medical team with the
ALS = Advanced Life Support; BLS = Basic Life Support. skills, training, and equipment, in coordination with a special-
ized assault team, is a feasible solution to the problem of offering
quality health care in areas under indirect threat. This is already
TABLE 2 Experience in Mass Casualty Incidents (MCIs) being done in Spain with EMAET teams such as SAMUR-PC
Number of Times Involved in Number of Times Involved in
Response to an MCI Response to an IMCI Madrid, EBAZ Zaragoza, or UIS in Catalonia (personal com-
0 16.4% 0 58.2% munication as of 31 March 2020). However, these skills, train-
ing, and equipment are not within the reach of all emergency
<5 43.6% 1 23.6% response systems. Thus, while the EMAET approach seems to
5–10 21.8% 2 5.5% fit well in large cities with specialized police response teams and
10–20 9.1% 3 3.6% relatively short isochrones, in more remote areas where the re-
>20 9.1% 4 1.8% sponse time may be long, this may not be a solution. 30
— — 5–10 1.8%
— — >10 5.5% This conclusion was also reached by the Arlington County
Police Department (Virginia) and its fire paramedic service—
hence, their developing the Rescue Task Force concept. This
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solid consensus regarding specifically sections 5 and 6, as shown model’s main advantage is the shorter response time through
in Table 4. With these results, and by virtue of the consensus learning, training, and coordinating with the police first re-
obtained, the review process was concluded according to the sponders (i.e., police patrol officers). However, when the po-
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Delphi methodology, and a third iteration was not necessary. lice response is specialized (e.g., SWAT), their degree of training
may not be adequate to the operational needs of the team. In
this second case, it has been found more appropriate to use an
Discussion
EMAET team, which in addition to providing care to victims
The classic approach to emergencies in MCIs has been forced is also an active part of the ongoing intervention, with strict
to change because of the increase in intentional incidents in medical competences integrated into the priorities of police. 32
recent years. These are defined by combining two apparently
incompatible factors: safety on the scene and early medical Considering that public agencies’ response is limited to the
response. context of each area (and its economic capacity or executive
priorities), choosing one model or another must be left to the
Existing literature such as the 2018 IPSA Study grant re- competent authority’s discretion. However, the optimum re-
port, the Hartford Consensus, and the Victoria I Consensus sponse model involves the EMAET team, although when this
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