Capital – Madrid
Land Size – 498,980
Population – 46,754,784
Language(s) – Castilian Spanish (official), Catalan, Galician, Basque

Autonomous Zones –Andalucia, Canarias, Cataluña, Comunidad Valenciana, Navarra, País Vasco, Aragón, Asturias, Baleares, Cantabria, Castilla-La Mancha, Castilla y León, Extremadura, Madrid, Murcia, La Rioja, Ceuta y Melilla


  • Decentralized, physician-led, two-tiered response system,
    • First Tier
      • BLS ambulances 2-3 EMTs (ambulancia de SVB)
      • ALS physician staffed ambulances
  • Provided by the National Health Service (NHS)
  • Managed by Servicios de Emergencias Médicas (SEM)



  • 1986–‘General Sanitary Law’ 1986
    • State financed universal coverage of ‘sanitary services’ (health services)
  • 2002– Health became decentralized into Spain’s 17 autonomous zones by January 2002
    • 1998–Andalucia the second and largest autonomous community to assume responsibility for its community’s health services under the ‘Andalucian Sanitary Law’
      • allocates public and private funding for health services



  • Decentralized, physician led, two-tiered response
  • Switchboard operators forward calls to dispatching physician?
    • MD determines appropriate level of response
      • Ground Teams
        • Non-emergency Ambulance: 1-2 EMTs/First Responders
        • BLS: 2-3 EMTs
        • ILS: emergency nurse, 1-2 EMTs
        • ALS/Mobile ICU: doctor, emergency nurse, 1-2 EMTs
        • Interhospital transfer: doctor, emergency nurse, 1-2 EMTs
      • Air Teams (HEMS)
        • Pilot, flight engineer, doctor, emergency nurse, 1-2 EMTs
  • Assisting Teams
    • Fire, police, civil defense
  • Response time goals
    • < 15 mins



  • Spanish National Health Service (SNS)
    • Composed of health services provided by 17 autonomous communities
  • Andalucian Health Service (SAS)
    •  Directs health services for Andalucia autonomously
    • 29/32 Public hospitals in Andalucia depend on the SAS
  • Public Sector Company for Health Emergencies (EPES), 2004
    • Manages, coordinates, dispatches, and transports for all emergencies in Andalucia



  • Public
    • SNS provides state based funding for health services for universal coverage so Spanish citizens
  • Private
    • Private health services are still linked to the public sector by providing health services indiscriminately to the community and receiving SNS refunds



  • Types of hospitals
    • 1. Basic General Hospitals
      • General surgery, anesthesiology, resuscitation
    • 2. General Hospitals w/ ICU
      • Same services as the basic general hospital and an ICU
    • 3. Regional Hospitals
      • Same services as above including specialty departments of neurosurgery, thoracic surgery, plastic surgery, and other specialties



  • Emergency physician
    • University degree in medicine (6yrs), master of emergency medicine (1-2yrs), medical specialty (4-5yrs) in cardiology, anesthesiology, family medicine, or intensive care medicine
  • Emergency Nurse
    • University degree in nursing (4yrs), master of emergency nursing (1-2yrs), nursing specialty (2yrs) in community nursing, or medical surgical nursing
  • EMT
    • Vocational/community college (2yrs)
  • Patient Transport Assistant
    • Private courses (4-8wks)
  • EPES formation and Research Center (FRC)
    • Emergency response strategy planning and university programs
      • 2001—organized 490 courses for medical, nursing professionals, health managers, and other emergency care groups 



  • 112—
    • Call comes in to 112 reception center
    • Forwarded to appropriate emergency service that have their own reception centers
      • Dispatcher, under close medical direction of an emergency doctor, dispatches appropriate emergency response team
  • 061—Integral telemedicine system of the government of Andalucia
    • Direct transmission of voice, image, & data between health care providers in different locations
    • Fax line for the hearing/speech impaired
    • Tele-operators manage emergency calls under close direction of doctors



  • 112—emerging universal European number for emergency response
  • 061—emergency number for Andalucia; can be accessed from 112 


  • Emergency medicine is recognized as a specialty that is completed after medical school
  • Emergency Physicians staff emergency departments and with extra training they can staff ambulances
  • Emergency Hospital Unity (EHU)
    •  Severe & multiple injuries treated by emergency physicians
      • Triage & resuscitation
      • Transferred to observation or ICU
      • Transferred to specialty providers 


Volunteer Non-profits



Carresi, Alejandro López. The 2004 Madrid train bombings: an analysis of pre-hospital management. Independent      Emergency Management Consultant, Spain 2007; pp41-66.

Quiepo de Llano E, Mantero Ruiz A, Sanchez Vicioso P, et al. Trauma care systems in Spain. Injury 2003;34(9):709-19.

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