Several international recommendations advise adapting military healthcare response models to intentional mass casualty incidents (IMCIs) in civil environments. The IMCI experience and associated published research from the United States, where these situations are frequent and properly analyzed more often, are, unfortunately, not directly applicable to the Spanish model of emergency medical services (EMS), where each autonomous region has its own competencies and protocols. However, there is a series of common elements that served as a reference for the development of an effective, evidence- based, IMCI consensus response plan called Victoria I. In this plan, we have tried to define each intervening role during an IMCI, from the occasional first responder to the final hospital staff at the reference trauma centers. We believe that each professional role in this response chain, on and off the scene, must have a clear mission and function to improve victim survival.