Carmen LEIS SAMUR-Protección Civil. Madrid. Spain

1. SAME PROBLEM-DIFFERENT
SOLUTIONS: SPANISH MODEL
Carmen Camacho Leis
Emergency Doctor
Chief of Education Unit
SAMUR – Protección Civil

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 professionals
2100 volunteers trained as Advance
Emergency Medical Technicians
140.000 assistances / year
Arrival time 2010 - 7´12´´
8025 Km2
6.489.680 Hab.
COMMUNITY OF MADRID

3. THE SPANISH MODEL
Pre-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. •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. •Decontamination line

6. •Decontamination line

7. •Medical management of the victims
• Immediate response
• Deployment of the installations for valid and invalid
victims decontamination

8. •Emergency Medical teams must have the
proper training in order to use the PPEs
and to perform decontamination tasks.

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. •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. 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. •Water is supplied through a 25 mm gauge
hoses, the same to the ones used by firefighters.

13. •SAMUR decontamination line

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. 2. Protection equipment
Two types of resources:
• ALS Units (doctor, nurse and paramedic)
• BLS Units (2 paramedics)
670 professionals (doctors, nurses and
paramedics)
All units are equipped with PPE

16. 2. Protection equipment in all units
•3 Protective masks with vapor and particles
filters.
•3 autofilter elements for particles FFP-3
•3 pairs of chemical protection gloves

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. N-II garment to be used for decontamination tasks

19. N - III garments to be used in the hot zone

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. 3. Education and training
•Specialized training
•Training courses are suited
to the needs of our
professionals.
•A 50- hours course for 30
students.
•Updating every year with 8
hours course

22. 3. Education and training
•We have completed several editions, so we have
trained 450 people since 2005

23. 3. Education and training
•Specialized training

24. •Decontamination training session

25. 4. Work procedure is coordinated
and trained every month

26. Periodical drills with police and others
emergency medical services
•114 drills with 751 peoples in 2011

27. 4. Work procedure is coordinated
and trained every month
•We have started working with hospitals and
Armed Forces.

28. •Smoke detection

29. •Gases detected in fire
250
200
150
100
50
0
CO NH3 PH3 OE HCN CH4 CL SO2 NO2
GASES 221 89 80 105 75 46 8 11 5

30. •Chemical detection
Warfare agents and
industrial toxic detector.

31. •Interventions
- Chlorine spill (swimming pools)
- Vapors by decomposition of plastic
- Transport of dangerous products
- Burns produced by acids (diphoterine is used in this
cases)
- 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. •Use of new technologies

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 www.madrid.es/emergencias/samur
protección civil/procedimientos

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. 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, if
another measure is not determined under the Security
Table

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, if
another measure is not determined under the Security
Table

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. Thank you for your attention
Victims 11-M Monument
( Atocha Station. Madrid-Spain)