SIMCES: A proof-of-concept framework for command and control in emergency medical services

Abstract

Objectives: Command and control in emergency medical services (EMS) responses to major incidents and mass casualty events is supported by multiple established doctrines; however, variability in their operational integration persists across EMS systems. The objective of this manuscript is to present the development of Sistema de Mando y Control en Emergencias Sanitarias (SIMCES), a proof-of-concept EMS command-and-control framework intended to integrate established incident management doctrines with selected conceptual and operational innovations.Methods: SIMCES was developed using a practice-based design-thinking methodology informed by the Double Diamond process (Discover, Define, Develop, Deliver). The Discover phase was informed by frontline operational experience, informal multidisciplinary feedback, and an exploratory narrative review of the literature related to EMS incident management and major incident response. During the Define phase, recurrent operational challenges were mapped to established functional domains using the Command, Safety, Communication, Assessment, Triage, Treatment, Transport framework. In the Develop phase, proposed framework components were iteratively refined through structured, scenario-based theoretical walkthroughs across representative incident types, including mass casualty incidents, hazardous materials incidents, structural collapses, high-threat scenarios, and preplanned major events. The Deliver phase consisted of consolidating the framework and applying it in structured, paper-based scenario walkthroughs to explore internal coherence and applicability across different levels of incident complexity.Results: SIMCES is presented as an integrated, EMS-oriented framework that combines established doctrinal elements with selected conceptual innovations. The framework includes a four-level incident classification system; a cordon-based approach to zoning and sectorization; a three-tiered EMS command structure with standardized commander and officer roles; the tactical coordination and support cell as an organizational construct for managing operational information and resource coordination; the COMMAND mnemonic to structure transfer of command; the 1-3-3 rule to guide initial actions of first-arriving units; and the introduction of a white triage category in evacuation triage to document discharged or self-evacuated casualties.Conclusions: SIMCES is proposed as a proof-of-concept framework intended to support structured thinking about EMS command and control during complex incidents. The manuscript does not evaluate performance or outcomes. External validation is planned to examine content validity, acceptability, applicability, workload, and feasibility before any conclusions regarding effectiveness can be drawn.