30 seconds to assess an injured person and a DNA bank: how do emergency services work in a disaster like the one in Adamuz?

BarcelonaThe rescue and emergency teams working in Adamuz (Cordoba) in the serious train accident On Sunday, fatalities were found "hundreds of meters" from the point where the trains collided. This was explained on Monday morning by the Andalusian president, Juanma Moreno Bonilla, who added that, in all likelihood, more bodies will be found as the extrication work progresses in the currently inaccessible carriages. At this point, there are still "tons of iron" that must be moved and "broken down" to allow access for heavy machinery, and subsequently, a complex task will begin: the recovery and identification of the bodies. These efforts are the focus of work on the ground now that the first group of injured, 117 adults and five children, has been attended to, 41 of whom are hospitalized (four of them minors). In tragedies like the one in Adamuz—with at least forty missing and forty dead—emergency teams initially work against the clock, in a situation where the "disproportion" between the number of people affected and the impact is evident, explains Juanjo Verge, deputy head of the Medical Emergency System (SEM) in Tarragona and Terres de l'Ebre, who is also responsible for managing mass casualty incidents. When asked about the greatest difficulty in such a catastrophe, he replies: "The initial moment is very complex; there's a chaotic situation where everyone is calling for help. Naturally, you're overwhelmed, and you have to keep a cool head." Following protocols shared with other emergency services, one of the first things SEM teams do upon arrival is deploy medical infrastructure to treat the victims while firefighters begin rescue operations.

In terms of logistics, they also have to ensure that ambulances can arrive, park, and leave for hospitals without blocking each other. "Perhaps this is the biggest challenge, because a healthcare worker who sees someone in pain immediately rushes to their aid. Here, we have to take a step back, assess the situation, and organize."

Reaching the "hot zone"

Aside from the specialized psychological support teams that assist families of victims and those with minor injuries, the SEM (Emergency Medical Service) also has specialized rescue and intervention teams. "They sound like firefighters," says Virgen, referring to the equipment they use. These specialized teams, operating in Catalonia, are not widespread among other teams in Spain, and they are trained to enter "the hot zone" or hard-to-reach places alongside firefighters to provide initial assistance to victims trapped in locations inaccessible to a standard unit. Whether victims are trapped in difficult locations or not, a preliminary triage is performed before beginning assistance. "It's done very quickly. In 30 seconds, you can determine the severity of a person's condition." Virgen explains that they primarily assess whether the person can walk and respond to simple commands or questions, such as whether they can state their name or remember what happened. Sometimes, this initial assessment is left to the firefighters if, for some reason, the SEM team has not yet been able to reach the scene.

With this initial assessment, the injured are classified using a four-color code: green for minor injuries, yellow for serious injuries, red for critical injuries, and black for those with life-threatening injuries. Once the injured person is in the healthcare area set up at the beginning, a more thorough triage is performed.

Identify the fatalities

While rescue efforts continue in Adamuz, a team of 27 forensic experts mobilized from six Andalusian provinces are working to recover the bodies and perform autopsies on the deceased in a room at the Córdoba City of Justice with a capacity for 45 bodies. However, measures have been put in place to increase capacity by up to 20 more spaces. The number of autopsies and identifications of the deceased was released this Monday at the end of the day through an Integrated Data Center (CID), similar to the one established in the Valencian Community after the floods caused by the DANA storm of October 2014. DNA analysis is being carried out by comparing the genetic material of the victims with that provided by their relatives. To expedite these identifications, the Civil Guard has set up five locations—one in Madrid, one in Seville, one in Cordoba, one in Malaga, and one in Huelva—where those missing a relative who was on board one of the trains can leave their information and DNA samples to facilitate identification.