This text describes the process of development of the new Spanish Prehospital Advanced Triage Method (META) and explain its main features and contribution to prehospital triage systems in mass casualty incidents. The triage META is based in the Advanced Trauma Life Support (ATLS) protocols, patient’s anatomical injuries and mechanism of injury. It is a triage method with four stages including early identification of patients with severe trauma that would benefit from a rapid evacuation to a surgical facility and introduces a new patient flow by-passing the advanced medical post to improve evacuation. The stages of triage META are: I) Stabilization triage that classifies patients according to severity to set priorities for initial emergency treatment; II) Identifying patients requiring urgent surgical treatment, this is done at the same time than stage I and creates a new flow of patients with high priority for evacuation; III) Implementation of Advanced Trauma Life Support protocols to patients previously classified according to stablished priority; and IV) Evacuation triage, stablishing evacuation priorities in case of lacks of appropriate transport resources. The triage META is to be applied only by prehospital providers with advanced knowledge and training in advanced trauma life support care and has been designed to be implemented as prehospital procedure in mass casualty incidents (MCI).

BackgroundMass Casualty Incidents (MCI) have been rarely studied from epidemiological approaches. The objective of this study is to establish the epidemiological profile of MCI in the autonomous region of the Principality of Asturias (Spain) and analyse ambulance deployment and severity of patients.MethodsThis is a population-based prospective study run in 2014. Inclusion criteria for MCI is “every incident with four or more people affected that requires ambulance mobilisation”.ResultsThirty-nine MCI have been identified in Asturias in 2014. Thirty-one (79 %) were road traffic accidents, three (7.5 %) fires and five (12.8 %) other types. Twenty-one incidents (56.7 %) had four patients, and only three of them (8 %) had seven or more patients. An average of 2.41 ambulances per incident were deployed (standard error = 0.18). Most of the patients per incident were minor injured patients (mean = 4; standard error = 0.2), and 0,26 were severe patients (standard error = 0.08). There was a positive significant correlation (p < 0.01) between the total number of patients and the total number of ambulances deployed and between the total number of patients and Advanced Life Support (ALS) ambulances deployed (p < 0.001). The total number of non-ALS ambulances was not related with the total number of patients.DiscussionPopulation based research in MCI is essential to define MCI profile. Quantitative definition of MCI, adapted to resources, avoid selection bias and present a more accurate profile of MCI. As espected, road traffic accidents are the most frequent MCI in our region. This aspect is essential to plan training and response to MCI. Analysis of total response to MCI shows that for almost an hour, we should plan extra resources for daily emergencies. This data is an important issue to bear in mind when planning MCI response. The fact that most patients are classified as minor injured and more advanced life support units than needed are deployed shows that analysis of resources deployment and patient severity helps us to better plan future MCI response.ConclusionsRoad traffic accidents with minor injured patients are the most frequent MCI in our region. More advanced life support units than needed have been initially deployed, which might compromise response to daily emergencies during an MCI.

Objective: The objective of this study was to identify the perceived problems by medical and nursing professionals that have arisen in the Spanish Emergency Medical Services (EMS) as a consequence of the first wave of the severe acute respiratory syndrome-coronavirus-2/SARS-CoV-2 pandemic, as well as the measures or solutions adopted to manage those problems and improve response. Method: This was a cross-sectional study of quantitative and qualitative methodology (“mixed methods”) using a self-administered questionnaire in 23 key informants of EMS of Spain selected by purposeful sampling, followed by the statistical analysis of both types of variables and an integration of the results in the discussion. Results: Common problems had been identified in many EMS, as well as similar solutions in some of them. Among the former, the following had been found: lack of leadership and support from managers, initial shortage of personal protective equipment (PPE), lack of participation in decision making, initial lack of clinical protocols, and slowness and/or lack of adaptability of the system, among others. Among the solutions adopted: reinforcement of emergency call centers, development of specific coronavirus disease 2019 (COVID-19) telephone lines and new resources, personal effort of professionals, new functions of EMS, support to other structures, and reinforcement of the role of nursing. Conclusion: The general perception among the respondents was that there was a lack of support and communication with health care managers and that the staff expertise was not used by policy makers to make decisions adapted to reality, also expressing the need to improve the capacity for analysis of the EMS response. Few respondents reported good overall satisfaction with their EMS response. The EMS adopted different types of measures to adapt to the COVID-19 pandemic.

Introduction: “Table-top” exercises can improve knowledge and skills related to mass casualty incidents (MCIs) with little logistical efforts. We aim to evaluate the learning process of 5th year medical school students related to MCI response using table-top simulation and measure their methodology perception. Methods: A theoretical part plus an MCI simulation board exercise was organized. Knowledge pretest and 1 mo after posttest was scored, and an assessment questionnaire with 27 questions with a Likert-type scale with 3 dimensions: methodology, knowledge acquisition, and skills acquisition was administered. Students did not receive any written or training material between pretest and posttest. Results: A total of 108 (80%) completed the evaluation questionnaire, pretest, and posttest. For the pretest, average grade was 4.25 (SD = 1.71) and 42% passed, and for the posttest, average grade was 8.33 (SD = 1.28) and 97 % pass (P < 0.0001). All variables measuring methodology perception scored more than 8, except for the duration of the exercise (7.3). Most knowledge acquisition scored above 9. Self-perception skill acquisition scores were slightly lower, although all above 7. Conclusions: “Table-top” methodology is useful for acquiring knowledge and skills related to MCI response. Retention of knowledge is very high. Students consider that this methodology can be very useful for medical studies. Active or nonactive role is a factor that only influences final results in specific items.

Objective: The objective is to identify research priorities in prehospital care in Spain. Method: This was a Delphi-type study of three rounds with a panel of experts made up of members of the Red de Investigación en Emergencias Prehospitalarias (RINVEMER; Prehospital Emergency Research Network) Network and the Sociedad Española de Medicina de Urgencias y Emergencias (SEMES; Spanish Society of Emergency Medicine) Emergency Secretariat. In the first round, each participant identified up to 15 priorities. In the second round, they scored the 30 thematic areas on a Likert scale. In the third round, they ordered and scored from one to ten the first ten priorities among those that obtained a median greater than or equal to four in the second round. After adding the assigned scores, the ten priorities with the highest total score were obtained. Results: The ten identified research priorities were: special clinical codes and time-dependent conditions; mass-casualty incident (MCI) coordination and management; innovation in Emergency Medical Services (EMS); human factor in decision making; triage, analysis, and management of calls in the Emergency Call Center; new technologies, telemedicine, and emergencies; adverse events, clinical safety, and quality in emergencies; cardiac arrest; continuous education and training (methodology, quality, and evaluation); and big data and emergencies. Conclusions: The research priorities perceived by emergency professionals are related to clinical care and organizational aspects of EMS, in addition to the need to incorporate innovative aspects and new data analysis technologies.