Just days before the terrorist attacks in Paris, many doctors and firefighters had taken part in an exercise to simulate the organization of emergency responders in a multiple shooting attack like the one that actually occurred. When the real events began to unfold, some of the emergency responders thought it was another simulation.

As the terrorist attacks took place on multiple fronts, health officials put their “White Plan” into action, a disaster response plan to treat the injured developed two decades ago for such an event. While 302 people were rushed to hospitals, only four died according to the journal Lancet. The coordinated attacks across the City of Lights claimed 130 victims, but most died immediately and never made it to the hospital.

A team of 20 doctors and crisis experts organized the medical response, sending three person teams into the field and setting up triage operations at the hospitals. More than 40 medical teams, comprised of a doctor, nurse and driver and the fire department were divided between the attack sites with 15 more teams on standby. Most of the victims had gunshot wounds, which caused health care workers to run short of tourniquets to stop the bleeding. Many emergency response teams returned to the hospital without their belts.

The mobile teams treated patients in the field and reduced crowding in the emergency rooms. Their field assessments enabled patients to be sent to the appropriate hospital for care of their injuries. The White plan included a fast track service for patients with gunshot wounds and victims of “war arms.”

Doctors were able to operate as quickly as possible on the injured and were never short of supplies. The fact that all but one of the victims was under 40 years old helped to make it possible to care for so many patients. The youth and good health of most of the patients helped them to survive according to Dr. Philippe Juvin, head of the emergency department at Georges Pompidou hospital.

When doctors reviewed what happened that night, they found that all of the upper limb fractures were devastating and had to be treated externally because the broken bones pierced the skin or there was extensive bone loss. The doctors said that the response would have been more difficult if the attacks had occurred during the day since the hospital would have been busy. They anticipate that they must continue to be vigilant and prepared for more attacks in the future.

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