Analysis of the medical response to November 2015 Paris terrorist attacks: resource utilization according to the cause of injury
The majority of terrorist acts are carried out by explosion or shooting. The objective of this study was first, to describe the management implemented to treat a large number of casualties and their flow together with the injuries observed, and second, to compare these resources according to the mechanism of trauma.
This retrospective cohort study collected medical data from all casualties of the attacks on November 13th 2015 in Paris, France, with physical injuries, who arrived alive at any hospital within the first 24 h after the events. Casualties were divided into two groups: explosion injuries and gunshot wounds.
337 casualties were admitted to hospital, 286 (85%) from gunshot wounds and 51 (15%) from explosions. Gunshot casualties had more severe injuries and required more in-hospital resources than explosion casualties. Emergency surgery was required in 181 (54%) casualties and was more frequent for gunshot wounds than explosion injuries (57% vs. 35%, p < 0·01). The types of main surgery needed and their delay following hospital admission were as follows: orthopedic [n = 107 (57%); median 744 min]; general [n = 27 (15%); 90 min]; vascular [n = 19 (10%); median 53 min]; thoracic [n = 19 (10%); 646 min]; and neurosurgery [n = 4 (2%); 198 min].
The resources required to deal with a terrorist attack vary according to the mechanism of trauma. Our study provides a template to estimate the proportion of various types of surgical resources needed overall, as well as their time frame in a terrorist multisite and multitype attack.
Assistance Publique–Hôpitaux de Paris.
KeywordsTerrorism Disaster medicine Mass casualty Bombing Gunshot wound Emergency Surgery
We thank Dr. David Baker DM, FRCA (Emeritus consultant anesthesiologist, Department of Anaesthesiology and Critical Care, Hôpital Necker-Enfants Malades, Paris) for reviewing the manuscript.
Other investigators: Christophe Leroy, MD (Direction de l’organisation médicale et des relations avec les universités, APHP, Paris); Prof Thomas Lescot, MD, PhD (Sorbonne Université, Hôpital Saint Antoine, APHP, Paris France); Arnaud Folin, MD, Florent Femy, MD (Hôpital Européen Georges Pompidou, APHP, Paris); Kevin Kearns, MD (Hôpital d’instruction des armées Begin, Saint Mandé); Prof Matthieu Legrand, MD (Hôpital Saint Louis, APHP, Paris); Jennifer Truchot, MD (Hôpital Lariboisière, APHP, Paris); Prof Philippe Montravers, MD, Prof Enrique Casalino, MD (Hôpital Bichat-Claude Bernard, APHP, Paris); Prof Christophe Baillard, MD, Emmanuel Bloch-Laine, MD (Hôpital Cochin, APHP, Paris); Philippe Laitselart, MD, Elodie Schaeffer, MD (Hôpital d’instruction des armées Percy, Clamart); Fabrice Cook, MD, Adrien Zakine, MD (Hôpital Henri Mondor, APHP, Créteil); Marie Clément Kouka, MD, Brigitte Hennequin, MD (Centre Hospitalier Saint Denis, Saint Denis); Fatima Djamouri, MD, Christophe Quesnel MD (Hôpital Tenon, APHP, Paris); Romain Dufau, MD, Prof Frédéric Adnet (Hôpital Avicenne, APHP, Bobigny); Laurence Martineau, MD, Claire Raquillet, MD (Centre Hospitalier Intercommunal Robert Ballanger, Aulnay sous bois); Christophe Vincent-Cassy, MD, Sophie Hamada (Hôpital Kremlin Bicêtre, APHP, Kremlin Bicêtre); Sébastien Beaune, MD (Hôpital Ambroise Paré, APHP,Boulogne Billancourt); Leila Lavagna, MD (Centre Hospitalier André Grégoire, Montreuil); Paer-Selim Abback, MD (Hôpital Beaujon, APHP, Clichy); Djamal Arkoub, MD (Groupe Hospitalier Intercommunal Raincy Montfermeil, Montfermeil); Catherine Le Gall, MD (Centre Hospitalier d’Argenteuil, Argenteuil); Catherine Philipoteau, MD (Centre Hospitalier Intercommunal de Créteil, Créteil); Olivier Ganansia, MD (Hôpital Saint Joseph, Paris); Marc Andronikof, MD (Hôpital Antoine Béclère, APHP, Clamart); Patrick Deschamps, MD, (Centre Hospitalier René Dubos, Pontoise); Cécile Garot, MD (Clinique Floréal, Bagnolet); Julien Aguilar, MD (Hôpital Privé de l’ouest Parisien, Trappes); all in France.
MR and BR conceived and designed the study. MR, ED, YY, ALF, and AA collected, anonymized, and prepared the data. MR and BR analyzed and interpreted the data. MR, PC, JPT, and BR wrote the initial draft. All authors subsequently critically edited the report. All authors read and approved the final report. MR had full access to all the data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis. MR and BR obtained funding and supervised the study.
Assistance Publique–Hôpitaux de Paris provided a grant to pay for data collection. The TraumaBase group was supported only by institutions. Assistance Publique–Hôpitaux de Paris was not involved in analysis, interpretation of the data nor writing the report or decision to submit the paper for publication.
Compliance with ethical standards
Conflicts of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
- 9.von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP (2007) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. PLoS Med 4:1623–1627Google Scholar
- 10.Gregory TM, Bihel T, Guigui P, Pierrart J, Bouyer B, Magrino B, Delgrande D, Lafosse T, Al Khaili J, Baldacci A, Lonjon G, Moreau S, Lantieri L, Alsac JM, Dufourcq JB, Mantz J, Juvin P, Halimi P, Douard R, Mir O, Masmejean E (2016) Terrorist attacks in Paris: surgical trauma experience in a referral center. Injury 47:2122–2126CrossRefPubMedGoogle Scholar
- 27.Gauss T, Balandraud P, Frandon J, Abba J, Ageron FX, Albaladejo P, Arvieux C, Barbois S, Bijok B, Bobbia X, Charbit J, Cook F, David JS, Maurice GS, Duranteau J, Garrigue D, Gay E, Geeraerts T, Ghelfi J, Hamada S, Harrois A, Kobeiter H, Leone M, Levrat A, Mirek S, Nadji A, Paugam-Burtz C, Payen JF, Perbet S, Pirracchio R, Plenier I, Pottecher J, Rigal S, Riou B, Savary D, Secheresse T, Tazarourte K, Thony F, Tonetti J, Tresallet C, Wey PF, Picard J, Bouzat P (2019) Strategic proposal for a national trauma system in France. Anaesth Crit Care Pain Med 38:121–130CrossRefPubMedGoogle Scholar
- 28.Sollid SJ, Rimstad R, Rehn M, Nakstad AR, Tomlinson AE, Strand T, Hemdal HJ, Nilsen JE, Sandberg M (2012) Oslo government district bombing and Utøya island shooting July 22, 2011: the immediate prehospital emergency medical service response. Scand J Trauma Resusc Emerg Med 20:3CrossRefPubMedPubMedCentralGoogle Scholar
- 29.Klassen AB, Marshall M, Dai M, Mann NC, Sztajnkrycer MD (2018) Emergency medical services response to mass shooting and active shooter incidents, United States, 2014–2015. Prehospital Emerg Care 34:1–8Google Scholar
- 31.Gates JD, Arabian S, Biddinger P, Blansfield J, Burke P, Chung S, Fischer J, Friedman F, Gervasini A, Goralnick E, Gupta A, Larentzakis A, McMahon M, Mella J, Michaud Y, Mooney D, Rabinovici R, SweetD Ulrich A, Velmahos G, Weber C, Yaffe MB (2014) The initial response to the Boston marathon bombing: lessons learned to prepare for the next disaster. Ann Surg 260:960–966CrossRefPubMedPubMedCentralGoogle Scholar