title: Management and analysis of out-of-hospital health-related responses to simultaneous railway explosions in Madrid, Spain.
abstract: OBJECTIVE
  On 11 March 2004, 10 simultaneous explosions at four different locations of the rail network in Madrid caused 198 deaths and 2312 persons were injured. The aim of this manuscript is to describe the prehospital health-related activities from the Emergency Medical Service of Madrid and to analyze the responses, the major conclusions, and the lessons learned.
  
  
  METHODS
  Three meetings were held with professionals from the Emergency Medical Service of Madrid who were involved in the catastrophe. Two experts in quality management chaired the meetings. Detailed data were gathered on what occurred at the sites following the explosions. Additional data were gathered from professionals from the Coordination Service of Urgencies and from those who assisted relatives and friends of victims in the days following the bombings. All of the data were collected and were included in the final report.
  
  
  RESULTS
  We describe the activities carried out by the Coordination Service of Urgencies at each site immediately after the explosions and during the 11 days following the catastrophe. The successful performances and those that need to be improved at the four sites and elsewhere are detailed.
  
  
  CONCLUSIONS
  The main reasons for the 'positive responses' are the number of resources that acted, the professional abilities, and the flexibility of the services. The 'areas to be improved' are communications, the establishment of the top of the command at each site, and the organization of supplies for catastrophic assistance. From the analysis, we describe the main lessons learned and we present proposals for improvement, should a future catastrophe occur.
authors.affiliation: Madrid Health Service, Mostoles, Madrid, Spain. amiquel.gapm08@salud.madrid.org
authors.forename: Ana Miquel
authors.initials: AM
authors.lastname: Gómez
authors.forename: Cristina Jiménez
authors.initials: CJ
authors.lastname: Domínguez
authors.forename: Carmen Ibarguren
authors.initials: CI
authors.lastname: Pedrueza
authors.forename: Rosa Ruiz
authors.initials: RR
authors.lastname: Calvente
authors.forename: Vanessa Martín
authors.initials: VM
authors.lastname: Lillo
authors.forename: José Mayol
authors.initials: JM
authors.lastname: Canas
mesh_terms: D003299:Cooperative Behavior; D004189:Disaster Planning / Q000592:standards*; D004631:Emergency Medical Service Communication Systems; D004632:Emergency Medical Services / Q000458:organization & administration*; D004638:Emergency Treatment / Q000295:instrumentation; D004864:Equipment and Supplies / Q000600:supply & distribution; D005107:Explosions; D006801:Humans; D007373:Interinstitutional Relations; D011890:Railroads; D013030:Spain; D023481:Terrorism; D017749:Total Quality Management