Professionalism in the face of terror

It is with great sadness that November will be remembered for the worst attack on France since World War II and the deadliest in the European Union since the Madrid train bombings in 2004. On Friday 13 November, multi-site terrorist shootings in Paris left 130 people killed and over 300 in intensive care. A state of emergency was declared by President François Hollande, and temporary border checks introduced. While the outcome of the attacks left the country devastated, it is worth highlighting the proficiency at which Paris organised an effective medical response to the attacks, which ensured that many lives could be saved.

Triage and pre-hospital care for victims of the attacks was organised by the emergency medical services (service d’aide médical d’urgence, SAMU). SAMU were mobilised immediately following discovery of the attacks, and the crisis cell at the Assistance Publique-Hôpitaux de Paris (APHP) was opened. The APHP crisis unit has the ability to coordinate 40 hospitals with a total of 100 000 health professionals, a capacity of 22 000 beds and 200 operating rooms (Hirsche et al, 2015).

Remarkably, it was reported that there were only four deaths (1%) among the 302 injured patients, including two deaths on arrival at hospital (Hirsch et al, 2015). While it is expected that additional deaths will occur among the severely wounded in the upcoming weeks, it remains an extraordinarily low figure. What is clear from reading about the medical response to the attacks is that professionalism and preparedness lay at the heart of the successful patient outcomes.

Since the terrorist attack on the satirical newspaper Charlie Hebdo on 7 January 2015, it is noted that France had become very aware that a multi-site shooting was a possibility. As a result, the pre-hospital teams of SAMU and the fire brigade had been developing treatment protocols for victims of gunfire wounds, and three field exercises had mobilised doctors to practise pre-hospital damage control. Hirsch et al (2015) even report that on the morning of the day of the attacks, SAMU and the fire brigade participated in an exercise simulating the organisation of emergency teams in the event of a multiple shooting in Paris. The consequence was that in the evening, when faced with the situation in reality, many of the staff believed it was another simulation exercise. Hirsch et al (2015) also mention the role that scientific publications played in the improvement of medical strategies. Accounts of the Madrid bombings on 11 March 2004 (Gutierrez de Ceballos et al 2005) and the London bombings on 7 July 2005 (Aylwin et al, 2006) allowed Paris to learn from these tragedies and develop an effective medical response.

The latest terrorist attacks highlight the importance of effective and unified emergency medical services in mass-casualty situations. While Paris will be in mourning, the staff involved in the medical response must be commended, as their bravery and professionalism ensured that many lives were saved.

References
Aylwin CJ, König TC, Brennan NW (2006) Reduction in critical mortality in urban mass casualty incidents: analysis of triage, surge, and resource use after the London bombings on July 7, 2005. Lancet 368(9554): 2219–25. doi: 10.1016/S0140-6736(06)69896-6

Gutierrez de Ceballos JP, Turégano Fuentes F, Perez Diaz D, Sanz Sanchez M, Martin Llorente C, Guerrero Sanz JE (2005) Casualties treated at the closest hospital in the Madrid, March 11, terrorist bombings. Crit Care Med 33(1 Suppl): S107–12. doi: 10.1097/01.CCM.0000151072.17826.72

Hirsch M, Carli P, Nizard R (2015) The medical response to multisite terrorist attacks in Paris. Lancet. Published online first. doi: 10.1016/S0140-6736(15)01063-6

Taken from Journal of Paramedic Practice, published 4 December 2015.