IBERO Protocol: A Multi-agency Coordination Framework for the Tactical Emergency Casualty Care Spanish System

Abstract

Introduction:Despite Spanish experience in counterterrorism, jihadism means new modus operandi, based on active mass casualty incidents, involving new injury patterns as mass bleeding ones. Therefore, the environment is completely different to first responders' structure. This change forced the revision of the tactical response model, led by the Spanish Association for Emergency Medicine's Tactical Care Secretary, who provides a discussion forum to its members, reaching a joint framework document, IBERO, adapted to Spanish tactical emergency capabilities.Method:Methodology was based on three parameters: 1)Literature revision, selecting three sources: Books and academic papers, TCCC and TECC guidelines, and Hartford Consensus, and AARs from the main active incidents with similarities to jihadist ones.2)Formation of discussion groups: Threat definition, tactile response, and prehospital care, triage and evacuation systems.3)A final group formed by representatives of each discussion group wrote the final document.Results:The protocol defines a staged plan of action, adapted to Spanish legislation and institutions, following the acronym IBERO: 1)Information: threat intelligence and information transmitted to responders from the incident location and dispatchers.2)Block the threat by perimeter, zonification and suppression of the threat.3)Escalation of resources. Definition of areas of action according to direct threat, indirect threat and safe areas of action.4)Response and Rescue. Extrication to safe areas, including different stages of triage and protection against secondary attacks.5)Order and evacuation. Access to other emergency services, and psychological first aid.Conclusion:The document proves the need for a coordinating framework of the Spanish emergency system to be fully adapted to these new threats. The discussion groups have identified the need for regular training on threat identification, zonification setting, mass bleeding control, extrication, and evacuation techniques during hostile situations. To achieve this goal, realistic training is mandatory.