The 2017 Barcelona terrorist attack: Real-time appropriateness and lessons learned from the management of an intentional vehicle-ramming mass-casualty incident

OBJECTIVE: To describe the appropriateness of triage according to safety conditions, incident characteristics, and observed injury patterns in an intentional vehicle-ramming (VR) mass-casualty incident (MCI). METHODS: We conducted a retrospective observational study of the intentional VR-MCI that occurred on August 17th, 2017, in Barcelona (Spain). Data were collected from emergency medical services and hospital records regarding decision-making processes, triage strategies, and hospital diagnoses. RESULTS: A total of 153 victims were attended, including 14 fatalities (9%) and 139 injured patients (91%), across a large affected area of 13,608 m2. Initially, due to compromised safety conditions and the high number of casualties, a triage strategy based on expert visual assessment using surgical priority criteria (VIVE-Q) with immediate transport was implemented. Once safety in the healthcare area was established, the advanced prehospital triage model (META) was applied. Both triage strategies allowed appropriate prioritization and correct destination assignment in 98.1% of patients, with no associated in-hospital mortality. Assistance time was shorter in patients triaged with VIVE-Q vs META [19 (IQR 21) vs 28 (IQR 47) minutes; P = .001]. Regarding injury patterns, 25% of the injured patients were categorized as severe (red), with 87% presenting $ 2 injuries, predominantly involving the head and thoracoabdominal regions. CONCLUSIONS: Security compromise during an intentional VR-MCI required adaptation of emergency response and triage plans, which proved to be effective.