Interview with Dr. Federico Moro, physician with the USAR team Emilia-Romagna and among the protagonists of the intervention at the Porto Sant'Elpidio collapse: what USAR is, how to get there, and why this discipline deserves more attention than it receives.
On June 6, 2026, at dawn, an explosion caused by a gas leak destroyed a two-story building in Porto Sant'Elpidio, in the Marche region. Three people lost their lives, two were seriously injured. Among the responders activated that morning was the USAR team from Emilia-Romagna, in its first full operational deployment: 44 operators, 38 Firefighters and 6 medical personnel, technical and medical components integrated into a single response module.
USAR stands for Urban Search and Rescue. In Italy it is still a little-known reality outside the Fire Service and a narrow circle of emergency professionals. The role of the medical component within it is almost completely unexplored in public debate, yet it represents one of the most challenging frontiers of prehospital medicine: working under the rubble, side by side with technicians, in scenarios where the rules of ordinary emergency response are no longer enough.
Just a few weeks before the Porto Sant'Elpidio intervention, in Pisa, the Italian USAR teams ITA-01 and ITA-02 had obtained INSARAG certification from the United Nations, respectively as Medium and Light teams, confirming the maturity of the Italian system in the international landscape.
For this interview I asked Federico Moro, physician with the USAR team Emilia-Romagna and among the protagonists of the Porto Sant'Elpidio intervention, to tell us what it means to be a doctor under the rubble: how you get there, what changes compared to ordinary rescue, and why this discipline deserves more attention than it receives.
1. What is USAR
Federico, for many colleagues in Italy "USAR" is an acronym they associate exclusively with the Fire Service. What really is a USAR team and what is the role of the medical component within it?
USAR stands for Urban Search and Rescue. In Italy it is an acronym rightly associated with the Fire Service, because the organization and management of the USAR system are the responsibility of the National Corps, and because the technical component is the heart of the intervention: search, securing, access to rubble, extrication and recovery of victims.
That said, a USAR team is not just a technical squad. It is a multidisciplinary team, designed for complex scenarios such as collapses, earthquakes, explosions or confined spaces, where technical and medical skills must truly work together.
For me the central point is the change of perspective: there is no longer "us medical personnel" and "them Firefighters." There is a single USAR team, with different roles and a common objective.
The real peculiarity is that the USAR medical personnel do not remain outside the complex area. Traditionally the red zone, that is the area of rubble or direct danger, was effectively off-limits to medical personnel. In the USAR team, however, trained doctors and nurses can enter together with the Firefighters, when conditions allow, to assist the trapped victim already during access and extrication.
In addition, the medical component manages the medical post at the base camp and protects the health of the entire team, including the dogs of the canine units. When needed it can also perform technical support roles, such as sentinel or gate attendant. So it doesn't simply accompany the Firefighters: it is part of the team.
2. The Path to USAR
Your curriculum spans from Intensive Care to HEMS, from Mountain Rescue to advanced training in trauma both at hospital and prehospital level. How did you arrive at USAR and what drove you to undertake this path?
My interest in prehospital care comes from way back. Ever since I was younger I have always been attracted to trauma and everything that happens before arrival at the hospital: the dynamism, the continuous change of context, the unpredictability, the logistics and the human factor. The hospital has enormous difficulties, obviously, but outside the hospital these variables have a different weight.
Over the years I have tried to build my path around a fairly simple idea: bringing high-quality medical care outside the hospital, especially in trauma. Working in an urban setting, in a large city and in a very high-level 118 system, you have many resources, relatively rapid times and a very structured network.
At a certain point I felt the need to combine this experience with two other passions: harsh environments and major emergencies. Because the same patient, with the same clinical problems, may require completely different choices depending on the scenario. What in the city is correct or almost automatic, in a harsh environment or among the rubble can become difficult, impractical or even dangerous.
USAR represented exactly this transition: bringing advanced medical skills into a technical, hostile and unconventional scenario. So, when the Emilia-Romagna Region opened selections for medical personnel of the nascent regional USAR Squad, I didn't need to be told twice. It seemed like a natural step, but also a new challenge.
3. INSARAG Certification
In May 2026, the Italian USAR teams ITA-01 and ITA-02 obtained INSARAG certification from the United Nations in Pisa. Can you explain what this certification means in practical terms and what standards it requires?
INSARAG certification, International Search and Rescue Advisory Group, is the international accreditation according to United Nations standards for USAR teams. It is not a symbolic certificate: it is a very rigorous verification of the ability to operate in complex scenarios such as earthquakes, explosions or collapses.
In practice it means demonstrating that the team knows how to work with procedures recognized globally: activation, logistics, self-sufficiency, search, access to victims, extrication, coordination and interoperability with other rescue systems.
For the medical component it is an important step because it also evaluates the ability to provide advanced care in the USAR scenario, therefore also in confined environments or among rubble, stabilizing and treating the critical patient during rescue phases.
The certification obtained in Pisa in May 2026 by ITA-01 and ITA-02 confirms the quality of the Italian system and the integration between the Fire Service and the National Health Service. Congratulations go to the emergency services of Tuscany, Lombardy, Lazio and Veneto, involved in ITA-01, and to Piedmont, involved in ITA-02: organizations that have opened and consolidated this path in Italy, and which we look at with great admiration.
4. The International Landscape
How does the Italian USAR model fit into the international landscape? Are there foreign systems from which we have learned or that look to us as a reference?
The Italian model fits within the international landscape defined by INSARAG, therefore in a global network of teams that share standards, operational language, procedures and interoperability criteria. In major disasters it is not enough to be effective in one's own national context: you must know how to work with teams arriving from different countries.
I believe that Italy has learned a lot from international comparison, as is right in a system based on shared standards and continuous improvement. At the same time, without making rankings, we can be proud of the level achieved.
The excellent feedback obtained by the Medium USAR team in the mission to Turkey in 2023, after the earthquake, and the results of the recent INSARAG certification in Pisa confirm very solid preparation, both on the technical level and on that of medical integration. I would not speak of a model "better" than others, but certainly of a mature, credible system capable of comparing itself with the best international experiences.
5. Porto Sant'Elpidio
On June 6 you were among the members of the USAR team Emilia-Romagna activated for the Porto Sant'Elpidio collapse. Without going into details that could compromise privacy, can you tell us how the intervention developed from a medical and organizational point of view?
First of all it was my birthday, so when at dawn I received the activation call it caught me a bit off guard. But then everything kicked in very quickly: in a short time we gathered the personnel, configured the medical and logistics module and left for the Marche region.
Upon our arrival in Porto Sant'Elpidio, important work was already underway by the local Light USAR squad, the Firefighters and colleagues from the local 118. Our arrival as a Medium USAR team made it possible to add structure, logistics and systematicity, integrating with what had already been deployed.
From a medical and organizational point of view, the task was to insert ourselves into a complex scenario, with high evolutionary risk, guaranteeing advanced medical support to the rescue operation and contributing to the overall management of the intervention. The search activities among the rubble, the continuous securing of the area, the use of canine units and drones made it possible to identify and evacuate all victims, unfortunately some of whom were deceased.
It was a strong intervention also on an emotional level. However, it showed well the value of integration between technical and medical components: in such scenarios it is not only the competence of the individual that counts, but the ability of the system to activate quickly, speak the same language and bring order to a very complex situation.
6. Medicine Under the Rubble
What are the specific clinical challenges of working in a structural collapse scenario? How is medicine under the rubble different from "traditional" emergency care in an ambulance or helicopter?
The main difference is that under the rubble medicine can never be separated from the scenario. In an ambulance or helicopter, usually, the patient is reached, assessed, treated and transported according to fairly defined pathways. In a collapse, however, access can be difficult, partial or very slow, and every maneuver must be compatible with structural safety and with the work of the Firefighters.
The approach to the buried victim is one of the most complex situations. Sometimes the first assessment occurs with cameras, voice contact or small operational stratagems. Even when you reach the patient, it may be impossible to bring backpacks, immobilization devices, advanced equipment or work with multiple rescuers. You often operate in the dark, in tight spaces, with noise, dust and instability.
In addition, the patient from rubble can present specific problems, less frequent in ordinary urban rescue, such as crush syndrome, which requires study, knowledge and dedicated treatments. In extreme cases, an entrapped and non-evacuable patient, for example with a trapped limb, can lead to dramatic decisions such as amputation directly in the rubble.
Even procedures that would normally be indicated can become impractical. A patient with severe head trauma, who in an ordinary context we might sedate, intubate and ventilate for neuroprotection, in rubble might not be safely manageable if we then cannot guarantee ventilation, oxygenation and monitoring until extrication.
Put simply: under the rubble it is not enough to know what would be correct to do in theory. You need to understand what you can really do there, at that moment, without putting the victim and the team at risk.
7. Synergy with the Fire Service
In a USAR scenario, the doctor works side by side with the Firefighters in a much more integrated way compared to ordinary emergency response. How does this synergy work concretely? How are moments managed when technical and medical priorities conflict?
It's a very good question, because it touches on one of the aspects that struck me most: integration with the technical component of the team. It is something different from what happens in ordinary emergency response, when you find yourself working with the Firefighters on a road accident or another event.
In my opinion this synergy arises above all from joint training, which lasts over time and is repeated during the year, from sharing objectives, strategies and language, but also from mutual knowledge. We are not professionals meeting for the first time on the scene: we are a team that has trained together before arriving there.
In a multiprofessional team it is normal that, at certain moments, technical priorities prevail and, at others, medical ones. This is why I really like the concept of fluid leadership: the lead passes to the component that at that moment has the most relevant competence for team safety and for the good of the patient.
There can be moments when priorities come into tension. Common training, drilling and work on non-technical skills, that is non-technical competencies such as communication, situational awareness, decision making and teamwork, serve precisely for this: to avoid sterile conflicts and choose together the safest and most effective path.
8. How to Approach USAR
If a colleague, doctor or emergency nurse, asked you "how can I approach the USAR world?", what would you concretely advise them?
I would tell them first of all to study a lot and train extensively. It may seem trivial, but to work in extra-ordinary scenarios you need to have very solid foundations in ordinary rescue. Only with good preparation in territorial emergency response, in trauma, in the critical patient and in prehospital management can you think of bringing those skills into contexts like rubble.
Then I would advise them to work on non-technical skills: communication, leadership, ability to work in a team, stress management, situational awareness and decision making. In USAR it is not enough to be technically good: you need to integrate into a multiprofessional system, with different roles and priorities that change rapidly.
Finally, no use denying it, physical preparation is also needed. These are tiring, uncomfortable and often long scenarios, in which the body is tested as much as the mind. And I would add a very practical thing: understanding before finding yourself in a small dark tunnel, full of dust and debris, whether you suffer from claustrophobia is not at all a bad idea.
Federico Moro is an Anesthesiologist and Intensivist at the Bologna Trauma Centre (AUSL Bologna) and HEMS physician at the Bologna helicopter rescue base. He is a physician with the National Alpine and Speleological Rescue Corps (CNSAS) in Emilia-Romagna and member of the Medium USAR Squad of Emilia-Romagna. ATLS and ETC instructor, he is Social Media and Digital Representative for Trauma & Emergency Medicine of the European Society of Intensive Care Medicine (ESICM) and member of the Coordination Board of the Major Emergencies and Hostile Environment Section of SIAARTI.
