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

Raux, Mathieu; Carli, Pierre; Lapostolle, Frédéric; Langlois, Michel; Yordanov, Youri; Féral‐Pierssens, Anne‐Laure; Woloch, Alexandre; Ogereau, Carl; Gayat, Étienne; Attias, Arié; Pateron, Dominique; Castier, Yves; François, Anne Isabelle; Ludes, Bertrand; Dolla, Emmanuelle; Tourtier, Jean-Pierre; Riou, Bruno

doi:10.1007/s00134-019-05724-9

Cited by 39 publications

(51 citation statements)

References 38 publications

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“…The planning of hospital beds for intensive care as well as for other specialties is usually based on planning models that include relevant information such as demographic data, average length of stay, admission rates, and bed occupancy rates [ 33 ]. In many situations (e.g., terrorist attacks or the COVID-19 pandemic), intensive care resources may be needed beyond existing capacity, and therefore capacity of these critical services has to be expanded to meet the increased demand [ 3 , 34 , 35 ]. Hospitals are urged to utilize existing response plans or modify them to address health-care demands.…”

Section: Discussionmentioning

confidence: 99%

“…This pandemic demonstrates the consequences of situations where the need for health care is greater than the health-care capability. However, other situations can also confront the health-care system with similar problems such as mass casualties after terrorist attacks, as was the case in Paris in 2015 [3]. With regard to COVID-19, several European countries have been at the center of the pandemic since the beginning of 2020 [4], with Italy, Spain, and the UK having among the highest numbers of reported cases and deaths worldwide as of May 2020.…”

Section: Introductionmentioning

confidence: 99%

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Access to intensive care in 14 European countries: a spatial analysis of intensive care need and capacity in the light of COVID-19

et al. 2020

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Purpose: The coronavirus disease 2019 (COVID-19) poses major challenges to health-care systems worldwide. This pandemic demonstrates the importance of timely access to intensive care and, therefore, this study aims to explore the accessibility of intensive care beds in 14 European countries and its impact on the COVID-19 case fatality ratio (CFR). Methods: We examined access to intensive care beds by deriving (1) a regional ratio of intensive care beds to 100,000 population capita (accessibility index, AI) and (2) the distance to the closest intensive care unit. The crosssectional analysis was performed at a 5-by-5 km spatial resolution and results were summarized nationally for 14 European countries. The relationship between AI and CFR was analyzed at the regional level. Results: We found national-level differences in the levels of access to intensive care beds. The AI was highest in Germany (AI = 35.3), followed by Estonia (AI = 33.5) and Austria (AI = 26.4), and lowest in Sweden (AI = 5) and Denmark (AI = 6.4). The average travel distance to the closest hospital was highest in Croatia (25.3 min by car) and lowest in Luxembourg (9.1 min). Subnational results illustrate that capacity was associated with population density and national-level inventories. The correlation analysis revealed a negative correlation of ICU accessibility and COVID-19 CFR (r = − 0.57; p < 0.001). Conclusion: Geographical access to intensive care beds varies significantly across European countries and low ICU accessibility was associated with a higher proportion of COVID-19 deaths to cases (CFR). Important differences in access are due to the sizes of national resource inventories and the distribution of health-care facilities relative to the human population. Our findings provide a resource for officials planning public health responses beyond the current COVID-19 pandemic, such as identifying potential locations suitable for temporary facilities or establishing logistical plans for moving severely ill patients to facilities with available beds.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Access to intensive care in 14 European countries: a spatial analysis of intensive care need and capacity in the light of COVID-19

et al. 2020

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“…The population lockdown was announced on the 17th of March 2020 for eight weeks until the 11th of May 2020. The hospital workload from patients in the emergency department (ED) can vary during exceptional events of various natures in Europe (terrorist attacks (1,2)) and the world (natural disasters (3,4)). While there is precedent for large disasters of natural or human origin in recent history, such as pandemics like H1N1 (5), none have been as long-lasting or as global as the COVID-19 pandemic.…”

Section: Introductionmentioning

confidence: 99%

Impact of the Covid-19 lockdown period on adult musculoskeletal injuries and surgical management: a retrospective monocentric study

Crenn

Kinani

Piétu

et al. 2020

Preprint

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Background The coronavirus disease 2019 (COVID-19) pandemic has led to the worldwide implementation of unprecedented public protection measures. On the 17th of March, the French government announced a lockdown of the population for 8 weeks. This monocentric study assessed the impact of this lockdown on the musculoskeletal injuries treated at the emergency department as well as the surgical indications. Methods We carried out a retrospective study in the Emergency Department and the Surgery Department of Nantes University Hospital from 18 February to 11 May 2020. We collected data pertaining to the demographics, the mechanism, the type, the severity, and inter-hospital transfer for musculoskeletal injuries from our institution. We compared the four-week pre-lockdown period and the eight-week lockdown period divided into two four-week periods: early lockdown and late lockdown. Results There was a 52.1% decrease in musculoskeletal injuries among patients presenting to the Emergency Department between the pre-lockdown and the lockdown period (weekly incidence: 415.3 ± 44.2 vs. 198.5 ± 46.0, respectively, p < .001). The number of patients with surgical indications decreased by 33.4% (weekly incidence: 44.3 ± 3.8 vs. 28.5 ± 10.2, p = .048). The policy for inter-hospital transfers to private entities resulted in 64 transfers (29.4%) during the lockdown period. There was an increase in the incidence of surgical high severity trauma (Injury Severity Score > 16) between the pre-lockdown and the early lockdown period (2 (1.1%) vs. 7 (7.2%), respectively, p = .010) as well as between the pre-lockdown and the late lockdown period (2 (1.1%) vs. 10 (8.3%), respectively, p = .004). We observed a significant increase in the weekly emergency department patient admissions between the early and the late lockdown period (161.5 ± 22.9, 235.5 ± 27.7, respectively, p = .028). Conclusion A pronounced decrease in the incidence of musculoskeletal injuries was observed secondary to the lockdown measures, with emergency department patient admissions being halved and surgical indications being reduced by a third. The increase in musculoskeletal injuries during the late confinement period and the higher incidence of severe trauma highlights the importance of maintaining a functional trauma center organization with an inter-hospital transfer policy in case of a COVID-19 second wave lockdown.

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“…Then, a few minutes later, seven Parisian locations (six bars and the Bataclan concert hall) were targeted by terrorists using both explosive devices and firearms. A total of 130 people died, more than 300 were injured and nearly 2 000 were psychologically impacted [1,2]. The massive influx of injured people presented an unprecedented situation in Paris and many hospitals in the area were involved [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

The attack on November 13, 2015: organisation of the medico-judicial unit of the Hôtel-Dieu Hospital in Paris

Soussy

Dufayet

Rey-Salmon

et al. 2020

Forensic Sciences Research

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The main aims of a medico-judicial unit are to ensure the examination of assault victims or persons in custody and to perform sampling necessary for investigations. Forensic examination is essential to describe the wounds and to evaluate the consequences of an assault by determining days of total incapacity for work (ITT). After the Paris attack on November 13, 2015, 121 victims were examined at the medico-judicial units of Paris. An initial forensic certificate was issued by forensic physicians with an assessment of physical ITT. A consultation with a forensic psychiatrist was systematically scheduled on the same day to obtain a forensic certificate for the psychological ITT. The average age of the victims was (33 ± 7) years and the sex ratio was 1.26. Most victims were in the Bataclan concert hall (78/121 or 64.5%). Of the 121 victims, 73 (60.3%) had projectile lesions (bullets, bolts and nuts, metal fragments, etc.) and 48 (39.7%) had non-projectile lesions (bruises, hematomas, etc.). The average physical ITT was 27 days (0; 190). The evaluation of the number of days of physical ITT was often complicated as some patients were still in medical care at the time of the initial examination. This experience enabled the Paris medico-judicial unit to anticipate the management required should any future event of this magnitude occur. It also reinforced cooperation between the medico-judicial unit and other departments, mostly emergency services and the forensic psychiatric unit. The Paris medico-judicial unit was thus able to offer a unique place of care by providing both physical and psychological examinations.

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

Cited by 39 publications

References 38 publications

Access to intensive care in 14 European countries: a spatial analysis of intensive care need and capacity in the light of COVID-19

Access to intensive care in 14 European countries: a spatial analysis of intensive care need and capacity in the light of COVID-19

Impact of the Covid-19 lockdown period on adult musculoskeletal injuries and surgical management: a retrospective monocentric study

The attack on November 13, 2015: organisation of the medico-judicial unit of the Hôtel-Dieu Hospital in Paris

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