Case Study: The Madrid Train Bombing of March 11, 2004

Abstract

Madrid, the capital of Spain, is a highly Westernized metropolis with a well-developed and modern emergency system that has extensive experience responding to terror attacks. Nevertheless, the March 11, 2004 (M-11) train bombings resulted in a mass casualty incident (MCI) that produced a casualty load of 2062 victims, almost immediately overwhelming the medical emergency response system. Local ambulance services and hospitals were severely challenged by the multiple casualties, cadavers, inrush of both families and media representatives, etc. The M-11 train bombing stands as an important marker to prepare for similar catastrophic events and to prevent systemic failures in the response. This case study briefly presents the main lessons learned of this event and provides recommendations for improving emergency system readiness. One of the authors (IA) participated in post-event assessments of the response; the case study includes his personal observations as well as those of published post-incident reviews.