French Hospitals Respond to Terrorist Attack
Through a friend in Paris, I was able to speak briefly with a medical lab scientist at the American Hospital of Paris. I was interested in getting an overview of how the hospital, particularly the lab, responded in the hours directly after the massacre and perhaps see if their protocols were similar in any way to what we are used to in the United States.
Yes, hospitals do have mock codes and disaster drills as we do. About 22 30h (10:30p) on Friday the government declared a Plan Blanc (Code White) which immediately put all hospitals on alert and informing them to prepare for dealing with a mass casualty. Unlike our individual hospital plans here in the US, in France Plan Blanc is a city-wide (sometimes nation-wide) plan where all hospitals prepare jointly, share resources and share communication in an emergency.
Phillipe (who unfortunately does not want to be identified by name since he was speaking off the record) said it started as a pretty routine shift for him. The Plan Blanc was announced about an hour after the shooting but he actually heard about the attack shortly before the Plan Blanc. Immediately hospital staff: administrators, laboratorians, nurses and others opened floors, mobilized additional beds, readied operating rooms, mobilized ambulances, inventoried the blood bank and pharmacy and called in additional staff.
Because the metro was slowly being shut down, ambulances had to transport staff from their homes and sometimes moved staff among 7 hospitals in the same vicinity. No staff member was allowed to leave and many worked until Saturday around noon, sleeping when they could.
The terrorist attack coincided with a planned strike by unionized doctors and nurses (this is France, after all). Luckily the doctors called off the strike and decided to work.
Because of the fluid situation, most patients were transported to the hospital in contradiction of the French tradition of treating patients as much as possible at the scene of the accident. This time even the walking wounded were all brought to the hospital for security. Needless to say there was severe overcrowding and confusion.
By Saturday, communication went out that 53 patients had been treated and discharged but another 400 or so were hospitalized (at the various hospitals) with 200 classified as critical or serious.
The most common tests requested were basic metabolic profile and a hemogram. Several patients were given type-specific uncrossmatched blood. They did as many immediate spin crossmatches . It was not clear from the conversation which was their protocol in emergencies.
By noon on Saturday, thousands of Parisians were standing in line to replenish the blood bank supply.
In a tragic twist, Phillipe found out on Sunday that a friend of his was killed in the attack on Le Stade de France. Another colleague had been brought in to his hospital but he was not aware at the time, since many were identified initially by arm bands with colors and numbers. He ruminated about the possibility he might have performed tests on his friend's sample.
It is interesting and heartening that wherever you are in the world, healthcare providers including medical laboratorians run towards the injured, and often place their own physical and psychological needs second while they save lives.
Ours is a noble profession and we should never forget it.