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Analysis of the medical response to November 2015 Paris terrorist attacks: resource utilization according to the cause of injury

Intensive Care Medicine volume 45, pages 1231–1240 (2019)Cite this article

Abstract

Purpose

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.

Methods

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.

Results

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].

Conclusion

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.

Funding

Assistance Publique–Hôpitaux de Paris.

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Acknowledgements

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.

Funding

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.

Author information

Authors and Affiliations

  1. Sorbonne Université, INSERM, UMRS1158, Paris, France

    Mathieu Raux

  2. Assistance Publique Hôpitaux de Paris (APHP), Department of Anaesthesiology and Critical Care Medicine, Groupe Hospitalier Pitié Salpêtrière, Paris, France

    Mathieu Raux & Emmanuelle Dolla

  3. Université Paris Descartes, Paris, France

    Pierre Carli & Bertrand Ludes

  4. APHP, SAMU 75, Hôpital Necker-Enfants Malades, Paris, France

    Pierre Carli

  5. Université Paris 13, Bobigny, France

    Frédéric Lapostolle

  6. APHP, SAMU 93, Bobigny, France

    Frédéric Lapostolle

  7. Service Médical du RAID, Bièvres, France

    Matthieu Langlois

  8. Sorbonne Université, INSERM, UMRS1136, Paris, France

    Youri Yordanov & Dominique Pateron

  9. APHP, Department of Emergency Medicine, Hôpital Saint Antoine, Paris, France

    Youri Yordanov & Dominique Pateron

  10. APHP, Department of Emergency, Hôpital Européen Georges Pompidou, Paris, France

    Anne-Laure Féral-Pierssens

  11. Department of Emergency, Hôpital d’Instruction des Armées Bégin, Saint-Mandé, Paris, France

    Alexandre Woloch

  12. APHP, Department of Emergency, Hôpital Saint-Louis, Paris, France

    Carl Ogereau

  13. Université Paris Diderot, Paris, France

    Etienne Gayat

  14. APHP, Department of Anesthesiology and Critical Care, Hôpital Lariboisière, Paris, France

    Etienne Gayat & Yves Castier

  15. APHP, Department of Anaesthesiology and Critical Care Medicine, Hôpital Henri Mondor, Créteil, France

    Arié Attias

  16. APHP, Division of Vascular Surgery, Hôpital Bichat, Paris, France

    Yves Castier

  17. Etablissement Français du Sang, Paris, France

    Anne François

  18. Institut Médico-légal de Paris, Paris, France

    Bertrand Ludes

  19. Brigade des Sapeurs-Pompiers de Paris, Paris, France

    Jean-Pierre Tourtier

  20. Sorbonne Université, INSERM, UMRS1166, IHU ICAN, Paris, France

    Bruno Riou

  21. APHP, Department of Emergency, Groupe Hospitalier Pitié Salpêtrière, Paris, France

    Bruno Riou

Authors
  1. Mathieu Raux
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  2. Pierre Carli
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  3. Frédéric Lapostolle
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  4. Matthieu Langlois
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  5. Youri Yordanov
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  6. Anne-Laure Féral-Pierssens
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  7. Alexandre Woloch
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  8. Carl Ogereau
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  9. Etienne Gayat
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  10. Arié Attias
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  11. Dominique Pateron
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  12. Yves Castier
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  13. Anne François
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  14. Bertrand Ludes
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  15. Emmanuelle Dolla
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  16. Jean-Pierre Tourtier
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  17. Bruno Riou
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Consortia

the TRAUMABASE Group

  • Christophe Leroy
  • , Thomas Lescot
  • , Arnaud Folin
  • , Florent Femy
  • , Kevin Kearns
  • , Matthieu Legrand
  • , Jennifer Truchot
  • , Philippe Montravers
  • , Enrique Casalino
  • , Christophe Baillard
  • , Emmanuel Bloch-Laine
  • , Philippe Laitselart
  • , Elodie Schaeffer
  • , Fabrice Cook
  • , Adrien Zakine
  • , Marie Clément Kouka
  • , Brigitte Hennequin
  • , Fatima Djamouri
  • , Christophe Quesnel
  • , Romain Dufau
  • , Frédéric Adnet
  • , Laurence Martineau
  • , Claire Raquillet
  • , Christophe Vincent-Cassy
  • , Sophie Hamada
  • , Sébastien Beaune
  • , Leila Lavagna
  • , Paer-Selim Abback
  • , Djamal Arkoub
  • , Catherine Le Gall
  • , Catherine Philipoteau
  • , Olivier Ganansia
  • , Marc Andronikof
  • , Patrick Deschamps
  • , Cécile Garot
  •  & Julien Aguilar

Contributions

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.

Corresponding author

Correspondence to Mathieu Raux.

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The members of the TRAUMABASE Group are listed in the Acknowledgements and in the electronic supplementary material.

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Raux, M., Carli, P., Lapostolle, F. et al. Analysis of the medical response to November 2015 Paris terrorist attacks: resource utilization according to the cause of injury. Intensive Care Med 45, 1231–1240 (2019). https://doi.org/10.1007/s00134-019-05724-9

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  • DOI: https://doi.org/10.1007/s00134-019-05724-9

Keywords

  • Terrorism
  • Disaster medicine
  • Mass casualty
  • Bombing
  • Gunshot wound
  • Emergency Surgery