Lessons learned from Paris and Nice

Abstract

terrorists committed several attacks in Saint-Denis and the East Parisian districts. These attacks, claimed by the organization Islamic State, constitute the deadliest series of multisite attacks that France has experienced. The stake for the Etablissement Franc ßais du Sang (EFS, the French public blood service) was to face the shockwave that propagated throughout the whole establishment from the very minutes following the events, impacting all the processes and stakeholders involved in the transfusion chain, which were challenged by a massive blood donor influx as soon as 14 November 2015. This article covers the impacts of the attacks on immunohaematology and delivery activities as well as the actions that were implemented to ensure sufficient blood supply. Then, the impacts on blood component production are set out. EFS integrated organization and available stocks allowed meeting blood requirements and enabled a strong control of outdating, after unprecedented blood collections during the weeks following 13 November 2015. Lastly, the article presents EFS experience feedback of Paris attacks and of the event that occurred in Nice on 14 July 2016, which helped improve our crisis management pattern with:1 Specific steps implemented in delivery facilities located in hospitals that were flooded by a large number of victims; 2 An analysis of the postattack donor population; 3 A reflection on optimal organizational schemes to face a donation influx; 4 Actions to leverage the consequences of a 'media wave' that could potentially result in useless, excessive blood collections.

Transfusion support in mass casualty events: lessons for hospital and pathology preparedness from the Bourke Street Mall incident

“…Effective communication during MCEs is critical. It is common for many more blood components to be requested than are eventually transfused, and the overall requirement for products in these events is often lower than expected . Most blood use in MCEs occurs within the first 24 hours, particularly in the first 4 hours as the majority of severe casualties arrive within this time frame .…”

Terrorist incidents: strategic treatment objectives, tactical diagnostic procedures and the estimated need of blood and clotting products

“…A retrospective analysis of transfusion requirements following the attacks in Paris and Nice revealed that patients who required blood transfusions received a mean number of 4-8 RBC units in Paris and 3-7 RBC units in Nice as well as a mean number of 4 units of FFP and 0-4 units of platelets in both Paris and Nice [45]. Whether the percentage of patients receiving blood products, nor the range of the overall need were shown in detail.…”

Critical developments of 2018: A review of the literature from selected topics in transfusion. A committee report from the AABB's Clinical Transfusion Medicine Committee

“…A recent increase in mass casualty events from gun violence and terrorism has led to discussion on how health care teams should prepare for these disasters. [61][62][63][64][65][66] In large mass casualty events analyzed from 1980 to 2016, the 75th percentiles for units transfused per admission were 3.9 units of RBCs, 3.6 units of plasma, and 0.48 platelet doses. Most blood products were needed within the first 12 to 24 hours (medians: RBCs, 67%; plasma, 75%; platelets, 84%).…”