Same problem – different solutions: Spanish Model


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Carmen LEIS

SAMUR-Protección Civil. Madrid. Spain

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Same problem – different solutions: Spanish Model

  1. 1. SAME PROBLEM-DIFFERENT SOLUTIONS: SPANISH MODELCarmen Camacho LeisEmergency DoctorChief of Education UnitSAMUR – Protección Civil
  2. 2. CITY OF MADRID 604,2 Km2 3.265.038 Hab. >50 %Two types of resources: ALS Units (doctor, nurse and ALS Technicians) BLS Units (2 ALS Technicians).670 professionals2100 volunteers trained as AdvanceEmergency Medical Technicians140.000 assistances / yearArrival time 2010 - 7´12´´ 8025 Km2 6.489.680 Hab. COMMUNITY OF MADRID
  3. 3. THE SPANISH MODELPre-hospital Emergency Medical System •Different structure than Armed Forces. •Managed by Physician - Nurse - EMT teams. • Quick response to the victims. • Provide high quality medical assistance.
  4. 4. •Pre-hospital CBRN incident planning • Coordination with Fire Department, Police and National Security Forces. • Decontamination of victims is performed by EMS • Medical management of the victims performed by EMS
  5. 5. •Decontamination line
  6. 6. •Decontamination line
  7. 7. •Medical management of the victims• Immediate response• Deployment of the installations for valid and invalid victims decontamination
  8. 8. •Emergency Medical teams must have theproper training in order to use the PPEsand to perform decontamination tasks.
  9. 9. •CBRN Incidents inside the hospital• Hospitals should respond to the CBRN incidents: – Fitting out a properly equipped area for arriving contaminated victims. – Providing materials to the installations. – Teaching and training the staff in the use of the CBRN materials. – Adjusting work procedures for these special situations.
  10. 10. •City of Madrid: A SAMUR-PROTECCIÓN CIVIL model 1. Immediate response 2. Personal protection equipment in all units. 3. Staff teaching and training on a regular basis. 4. Work procedure is coordinated and trained every month
  11. 11. 1. Immediate response• One rapid deployment vehicle with a decontamination line equipment• Decontamination line is made of independent elements.• Assembly work below 20 minutes.
  12. 12. •Water is supplied through a 25 mm gaugehoses, the same to the ones used by firefighters.
  13. 13. •SAMUR decontamination line
  14. 14. 1. Immediate response• Two experts in detection of chemical industrial products, chemical warfare agents and released radiation, on duty 24 hours a day and 365 days a year.
  15. 15. 2. Protection equipmentTwo types of resources: • ALS Units (doctor, nurse and paramedic) • BLS Units (2 paramedics)670 professionals (doctors, nurses andparamedics) All units are equipped with PPE
  16. 16. 2. Protection equipment in all units•3 Protective masks with vapor and particlesfilters. •3 autofilter elements for particles FFP-3•3 pairs of chemical protection gloves
  17. 17. •Protection equipment In all units•3 pairs of shoe covers•1 roll of tape to seal•3 isolating protective anti-splashing garments (level I)
  18. 18. N-II garment to be used for decontamination tasks
  19. 19. N - III garments to be used in the hot zone
  20. 20. 3. Education and training 400 350 300 250 Doctors 200 Nurses 150 Technicians 100 50 0 Practical sessions for all professionals Three hours updating session for team per year
  21. 21. 3. Education and training•Specialized training•Training courses are suitedto the needs of ourprofessionals.•A 50- hours course for 30students.•Updating every year with 8hours course
  22. 22. 3. Education and training•We have completed several editions, so we havetrained 450 people since 2005
  23. 23. 3. Education and training•Specialized training
  24. 24. •Decontamination training session
  25. 25. 4. Work procedure is coordinatedand trained every month
  26. 26. Periodical drills with police and othersemergency medical services •114 drills with 751 peoples in 2011
  27. 27. 4. Work procedure is coordinated and trained every month•We have started working with hospitals andArmed Forces.
  28. 28. •Smoke detection
  29. 29. •Gases detected in fire 250 200 150 100 50 0 CO NH3 PH3 OE HCN CH4 CL SO2 NO2GASES 221 89 80 105 75 46 8 11 5
  30. 30. •Chemical detectionWarfare agents andindustrial toxic detector.
  31. 31. •Interventions - Chlorine spill (swimming pools) - Vapors by decomposition of plastic - Transport of dangerous products - Burns produced by acids (diphoterine is used in thiscases) - Suspicious packages in embassies and consulates - Dead bodies founded a long time after death -Smoke detections. Cianokit. 4.715 activations of especialist in CBRN in 2011
  32. 32. •Use of new technologies
  33. 33. CBRN SAMUR PROCEDURE• The interventions of CBRN incidents need a specific procedure of performance, in which it the following aspects are considered: 1. Zoning 2. Protection 3. Action Available in protección civil/procedimientos
  34. 34. Zoning• Hot zone or area of exclusion:– The presence of medical teams is necessary along the exterior limit of this zone, where those injured and/or those affected can be treated immediately. This point is defined as a Safe Point or Safe Zone.– EMS tasks: • Evaluation of victims / triage • Supervision of rescue activities and mobilization. • First medical attention to critical victims All the participants in this zone must wear protective gear defined in the Table of Security; initially protection level III
  35. 35. Zoning • Warm zone or contamination reduction zone• In this zone, lines are established for decontamination.• The participants who are employed at the lines receive those affected in the, as well as the workers who have been employed in the hot zone in different tasks.Working in this zone requires a Level II protection, ifanother measure is not determined under the SecurityTable
  36. 36. Zoning• Cold zone or assistance• This is an agent free zone.• Here the medical tasks are carried out and the Medical Advanced Position is set up.• All the teams of control and intervention assistance are located in this zone.Working in this zone requires a Level I protection, ifanother measure is not determined under the SecurityTable
  37. 37. •Changes from 2004 to 2012 2004 2012• First response with 4 self- • First response with 10 self- contained breathing. contained breathing, 2• 500 level I garments professionals equipped with• 100 level II garments level III, 8 with level II and everyone on duty with level I.• 42 Level III garments • One decontamination line around the clock assembled• One decontamination line in 20 minutes or less. assembled in 1 hour • LIDERAdecontamination line around the clock assembled• Procedure SAMUR-Protección in4 or 6 minutes Civil • Procedure jointed firefighters and National police .
  38. 38. Thank you for your attention Victims 11-M Monument ( Atocha Station. Madrid-Spain)