Evaluation of the Hospital Response to a Mass Casualty Incident: Lessons learned from a simulation exercise at Hospital Universitario La Paz, Madrid

César Carballo Cardona , Julio Cobo Mora, Arturo Cantero Campos, Isabel Arroyo Rico, Ignacio Fernández Fernández, Beatriz Mañero Criado, Renzo Tejada Sorados

INTRODUCTION. Hospital mass casualty incident (MCI) drills are essential tools for improving institutional preparedness for emergency situations. Evaluating their impact allows the identification of operational strengths as well as areas for improvement in clinical protocols, interdepartmental coordination, and overall organizational response. The objective of this study was to analyze hospital response capacity during an MCI simulation, using structured assessment and qualitative analysis to identify operational strengths and opportunities for improvement.
METHOD. We conducted a scheduled MCI simulation jointly by SAMUR–Protección Civil and Hospital Universitario La Paz (Madrid, Spain). SAMUR conducted the prehospital operation (activation, on-site care, and transport), and the hospital worked as the receiving node, allowing simulated patient offloading and transfer under realistic conditions. More than 100 professionals participated, including physicians, nurses, nursing assistants (TCAEs), admissions staff, security personnel, and emergency medical technicians (EMTs) from both hospital and prehospital settings, as well as actors portraying victims with varying levels of severity. A mixed-methods approach (quantitative and qualitative) was used, including direct observation, semistructured interviews, and a structured evaluation tool completed by 6 independent observers. The tool included a total of 20 items categorized into 5 thematic domains (activation, triage, coordination, logistics, and communication), scored on a 1–5 scale. Response times and qualitative staff perceptions were also analyzed.

RESULTS. The highest scores were obtained for items related to centralized triage and ambulance flow management. The lowest scores corresponded to protocol activation and initial internal communication. Qualitative analysis highlighted the efficacy of clinical leadership, the need to digitalize activation systems, and the importance of improving patient traceability. Structural weaknesses were identified in institutional communication and in the integration of external teams.
CONCLUSIONS. The simulation enabled the identification of relevant strengths in initial clinical management and logistical coordination, as well as key areas for improvement. The usefulness of a mixed-methods approach for achieving a comprehensive and reflective evaluation is emphasized. These findings underscore the need for ongoing training, periodic protocol review, and the development of digital tools to facilitate communication and coordination among care nodes during MCIs.