The cross-national adaptability of EMS protocols for mass casualty incidents

Adi Agiv-Berland, Isaac Ashkenazi, Limor Aharonson-Daniel

Research output: Contribution to journalArticlepeer-review


Background: On 11/3/2004, ten explosive devices detonated on board four different commuter trains in Madrid. Over 2000 casualties and 191 deaths were recorded. This study examines the adaptability of Israeli EMS protocols for Mass-Casualty-Incidents to the event. Methods: Detailed conduct of Madrid EMS during the terror attack was mapped based on interviews and published data. Three topics, in which shortfalls were described in the literature, were examined: Emergency preparedness, Leadership and Management, and Organization. Results: An event manager was not predefined, resulting in too many or no leaders on-site. Lack of familiarity with protocols led to inaccurate triage and uneven distribution of casualties among hospitals. Organizations had not exercised collaboration previously thus lacked familiarity with each others operations. Conclusions: Multi-organizational familiarity and training is of utmost importance. EMS protocols for MCIs are adaptable to the different systems worldwide. However, these must be drilled, examined and revised in order to ensure emergency preparedness.

Original languageAmerican English
Article number8
JournalJournal of Homeland Security and Emergency Management
Issue number2
StatePublished - 1 Sep 2012


  • Bombings
  • Israel
  • M-11
  • Mass casualty incident
  • Protocols

All Science Journal Classification (ASJC) codes

  • Business, Management and Accounting (miscellaneous)
  • Safety, Risk, Reliability and Quality
  • Safety Research


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