Elsevier

The Lancet

Volume 386, Issue 10012, 19 December 2015–1 January 2016, Pages 2535-2538
The Lancet

Viewpoint
The medical response to multisite terrorist attacks in Paris

https://doi.org/10.1016/S0140-6736(15)01063-6Get rights and content

Introduction

Friday, Nov 13, 2015. It's 2130 h when the Assistance Publique-Hôpitaux de Paris (APHP) is alerted to the explosions that have just occurred at the Stade de France, a stadium in Saint-Denis just outside Paris. Within 20 min, there are shootings at four sites and three bloody explosions in the capital. At 2140 h, a massacre takes place and hundreds of people are held hostage for 3 h in Bataclan concert hall (figure).

The emergency medical services (service d'aide médicale d'urgence, SAMU) are immediately mobilised and the crisis cell at the APHP is opened. The APHP crisis unit is able to coordinate 40 hospitals, the biggest entity in Europe with a total of 100 000 health professionals, a capacity of 22 000 beds, and 200 operating rooms. It is very quickly confirmed that the attacks are multiple and that the situation is highly scalable and progressing dangerously. These facts led to a first decision: the activation of the “White Plan” (by the APHP Director General) at 2234 h—mobilising all hospitals, recalling staff, and releasing beds to cope with a large influx of wounded people. The concept of the White Plan was developed 20 years ago, but this is the first time that the plan has been activated. It is a big decision, and timing is key: it would lose its effectiveness if taken too late. On the night of Friday Nov 13 to Saturday Nov 14, the activation of the White Plan had a critical effect. At no time during the emergency was there a shortage of personnel. During these hours, as the number of victims increased, with a sharp increase after the assault was launched inside the Bataclan, we were able to reassure the public and government that our abilities matched the demand. And when we felt that it might be necessary to deal with an influx of severely injured people, two further “reservoir” capacities were prepared: other hospitals in the area were put on alert, together with some university hospitals, more distant from Paris, but with the ability to mobilise ten helicopters to organise the transport of the wounded. These other two reservoirs have not been used, and we believe that despite this unprecedented number of wounded, the available services were far from being saturated. While hospitals were receiving and directing patients to specific institutions based on capacity and specialty, a psychological support centre was set up. 35 psychiatrists, together with psychologists, nurses, and volunteers were gathered in a central Paris hospital, Hôtel Dieu. Most of them had played a similar role during the attacks against Charlie Hebdo. Most of the emergency workers and health professionals working on the evening of Nov 13 had already been involved in serious crises, were used to working together, and had participated, especially in recent months, in exercises or in updating emergency plans.

In this report, we present the prehospital and hospital management of this unprecedented multisite attack in Paris from the viewpoint of the emergency physician, the trauma surgeon, and the anaesthesiologist. This is a testimony on behalf of the health professionals involved in the night of Nov 13.

Section snippets

The emergency physician's perspective

Triage and prehospital care were the duty of SAMU. In the minutes that followed the suicide bombing at the Stade de France, the Paris SAMU unit regulatory crisis team began to send out medical workers to the emergency sites from all eight units of SAMU in the Paris region and from the Paris fire brigade (Brigade de sapeurs-pompiers de Paris), alongside rescue workers and police. The regulatory crisis team was composed of 15 individuals to answer the calls, and five physicians. Their mission was

The approach of the anaesthesiologist

Pitié-Salpêtrière Hospital is one of the five civilian level-one trauma centres in the APHP group involved in the treatment of patients after terrorist attack. It is located in the centre of Paris. The shock trauma room is included inside a post-anaesthesia care unit of 19 beds. The routine capacity of the emergency operating theatre is two operating rooms, which can be extended to three for multiple organ harvesting. After activation of the White Plan, which includes a process to call back all

The point of view of the trauma surgeon

If I had to summarise the “winning formula” in the recent tragic hours that we lived, in an orthopaedic centre of APHP, I would say that spontaneity and professionalism were the key ingredients. When I arrived in Lariboisière Hospital 2 h after the beginning of the events, I was surprised to discover that at least six or seven of my colleagues of different specialties were already there in addition to the doctors on duty that night. The on-call anaesthetists and intensive care doctors were

Conclusion

This is the legacy of history that led to the creation of the APHP hospital network as a single entity. Its huge size is regularly questioned, both internally and externally, as an obstacle to adaptation in a rapidly changing technological, medical, and social context. The decision circuits are complex, internal rivalries may develop, and changes are slow to spread. We sensed, however, that the size of the organisation could be an advantage in times of disaster. This advantage has now been

First page preview

First page preview
Click to open first page preview

References (11)

There are more references available in the full text version of this article.

Cited by (223)

  • Time to Reconsider Analgesia in Mass Casualty Incidents

    2023, Wilderness and Environmental Medicine
  • Emergency Medicine from the origins to the perspectives

    2022, Journal Europeen des Urgences et de Reanimation
  • EMS (SAMU) of the defense zone: Missions and organization in the Paris region

    2022, Journal Europeen des Urgences et de Reanimation
  • Adaptations to practice and resilience in a paediatric major trauma centre during a mass casualty incident

    2022, British Journal of Anaesthesia
    Citation Excerpt :

    Fortuitously, the rehearsal occurred just weeks before the MCI. This study supports other studies highlighting the value of such rehearsals to contribute to staff familiarisation with the MIPs.21,23–25 Disseminating the learning from such rehearsals across as wide a staff base as possible and developing a major incident preparedness curriculum for hospital staff remains a challenge.26,27

View all citing articles on Scopus
View full text