Desafíos en la Atención Prehospitalaria: Un análisis de escenarios no convencionales y de alto riesgo

• Autor: Merello-Tejada, José Alberto
• Formato: artículo
• Fecha de Publicación: 2026
• Institución: Fundación Instituto Hipólito Unanue
• Repositorio: Diagnóstico
• Lenguaje: español
• OAI Identifier: oai:revistadiagnostico.fihu.org.pe:article/666
• Enlace del recurso: https://revistadiagnostico.fihu.org.pe/index.php/diagnostico/article/view/666
• Nivel de acceso: acceso abierto
• Materia: Emergency Medical Services; Disaster medicine; education; medical; patient simulation; Servicios Médicos de Urgencia; medicina de desastre; educación médica; simulación de paciente

Background: Prehospital care is increasingly challenged by unconventional scenarios such as Hazardous Materials (HazMat/CBRN) incidents, tactical environments, and remote rescues, which surpass standard protocols. These settings demand competencies and operational paradigms distinct from conventional urban emergencies. Objective: To synthesize the evidence on the operational and clinical challenges in these high-risk settings and propose a framework to enhance the preparedness, safety, and effectiveness of Emergency Medical Services (EMS). Findings: The evidence highlights a critical gap between conventional training and required competencies. In HazMat/CBRN incidents, responder safety and the contaminated area, isolation and mass decontamination are paramount, creating logistical bottlenecks and high psychological stress.(1,2) In tactical environments, medical care is subordinated to threat neutralization, applying Tactical Combat Casualty Care (TCCC) principles to prioritize massive hemorrhage control.(3) In remote and rescue scenarios, the paradigm shifts to prolonged field care, requiring advanced management of hypothermia, crush syndrome, and life support with limited resources.(4,5) Continuous, realistic, simulation-based training is the most critical cross-cutting factor for improving personnel confidence, decision-making, and performance.(6,7) Conclusion: Effective response in unconventional scenarios demands a paradigm shift towards safety, environmental control, and prolonged life support. Investment in specialized, multidisciplinary training based on standardized protocols is imperative to ensure EMS resilience and personnel safety.