First responders remember Paris terror attack, one year on • FRANCE 24 English

Key Concepts

• Mass Casualty Incident (MCI): An event that overwhelms the available resources of emergency medical services.
• First Responder: An individual trained to provide immediate medical care in an emergency situation.
• Triage: The process of sorting and prioritizing patients based on the severity of their injuries and the likelihood of survival.
• Pre-hospital Care: Medical treatment provided to patients before they reach a hospital.
• Mobility: The ability of a first responder to move quickly and efficiently with essential equipment.
• Clinical Choices: Decisions made by medical professionals based on their training and the available resources in a critical situation.

Bataclan Concert Hall Response

Dr. Dunis Safon, Head Doctor of the BRRI (French Search and Intervention Brigade), was the first medical professional to enter the Bataclan Concert Hall on November 13th, 2015, during a terrorist attack. He described the scene as one of mass casualties, with entangled corpses and dozens of severely wounded individuals. The immediate priority was evacuation.

Challenges and Procedures:

• Environmental Hazards: The lobby was covered in a centimeter and a half of broken glass, making movement difficult.
• Patient Handling: Many women had lost their shoes, necessitating them being carried to prevent further injury from the glass.
• Psychological Impact: Some individuals were in a state of panic upon seeing the deceased, requiring their eyes to be covered.
• Equipment Limitations: Dr. Safon, as a first responder, carried essential but limited equipment, emphasizing mobility over sophisticated medical tools. His gear included a flashlight and a thigh pack with emergency supplies.
• Resourceful Treatment: In such extreme circumstances, "sophisticated medicine" was not feasible. Treatment focused on critical decision-making, particularly regarding evacuation order. Dr. Safon highlighted the utility of his scissors for cutting clothing to diagnose wounds. In cases of severe bleeding without adequate compression pads, he would improvise by cutting up a t-shirt, crumpling it, and instructing a friend of the wounded to apply pressure until evacuation.

Street-Level Triage in Paris

Christian Puare, a doctor with France's firefighters, was on call the night of the attacks and was the first medical professional to arrive outside large restaurants where many wounded and dead were located. He likened his experience to being on a "dinghy that's in rough shape, going from port to port, from one wounded to another, from one dead to another."

Triage Methodology and Ethical Considerations:

• Prioritization: Dr. Puare explained his triage approach: if faced with three victims, one in cardiac arrest, he would not perform chest compressions on that individual. Instead, he would attend to the other two victims. His reasoning was that focusing on the person in cardiac arrest would likely result in the death of the other two, leading to three casualties.
• Clinical Justification: He emphasized that these are "clinical choices" that must be stood by, implying a lack of guilt associated with these difficult decisions, as they are made to maximize survival rates.

The Impact of Victim Age

A profound aspect of the night's events for both doctors was the age and youth of the victims. While death is a part of their profession, the loss of a 20-year-old to a terrorist bullet in Paris was described as "hard to conceive" and "not normal" or "fair."

Continued Service

• Dr. Dunis Safon: At 78 years old, he has no plans to retire, wishing to remain available to make life-saving decisions should future tragedies occur.
• Christian Puare: He continues to serve as a doctor for firefighter brigades, now in the south of France.

Conclusion

The transcript details the harrowing experiences of two French medical first responders during the 2015 Paris terrorist attacks. It highlights the extreme challenges of mass casualty incidents, including environmental hazards, psychological trauma, and severe limitations in equipment and resources. The accounts underscore the critical importance of rapid, decisive triage and the emotional toll of treating young victims in such violent circumstances. Both doctors demonstrate a commitment to their duty, with one continuing his service despite his age and the other having adapted his role.