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In the minutes after the terrorist assault on Paris Friday night, city health officials activated a coordinated response to deal with the mass carnage long before the full extent of it became clear.

That set into a motion a flurry of heightened emergency activity that lasted nearly a full day: Medical workers mobilized to the scenes of the attacks. Hospital staff shuffled beds. Doctors rushed shooting victims into surgery.


That local response, called the “Plan Blanc,” was part of France’s national emergency response plan. Here’s what you need to know to understand what happened:

How did the emergency response work?

Paris’s hospital authority triggered its “Plan Blanc” at about 10:30 pm local time Friday, according to the Wall Street Journal, just over an hour after the attacks began. That meant getting medical personnel to work, ambulances on the road, and beds readied ahead of the flow of several hundred wounded and dying patients pouring into hospitals across the city.

The official state of emergency lasted in the city’s hospitals until afternoon on Saturday. At that point, authorities said, the death toll had reached 129 and “several dozen” bodies had been identified.


Friday’s attacks coincided with a planned strike by union-organized doctors and nurses against health-care payment legislation, according to The Connexion, an English newspaper in France. However, the French newspaper Le Figaro reported that the doctors called for ending the strike in “solidarity” with the victims of the attacks.

What’s next for Paris hospitals?

As of Saturday afternoon local time, the city’s hospitals had discharged 53 people, but seven hospitals in Paris were still treating 300 people injured in the attacks. Among them, 80 were in “absolute” critical condition and 177 were in “relatively” critical condition, according to the Wall Street Journal. The hospitals may no longer be in an official state of emergency, but the frenzied activity necessary to treat so many seriously injured patients is far from over.

How well did the hospitals respond to the attacks?

Emergency response specialists in the United States said it was too early to tell. We’ll likely get a clearer picture the coming weeks as more information becomes available about survival rates. It’s clear, though, that this crisis was on a larger and grimmer scale than the most recent instance in which France activated its national emergency response plan, during last winter’s flu season.

How does France’s response plan compare to the US?

On a local scale, American hospitals have emergency plans similar to the “Plan Blanc” blueprints in France. But those plans operate relatively independently compared to France, where a local “Plan Blanc” is part of a more coordinated nationalized strategy for emergency response, known as the Orsan plan. That’s in line with other systems in Europe, according to Dr. Paul Biddinger, who led the emergency department response at Massachusetts General Hospital after the Boston Marathon bombings in 2013.

In both the US and European systems, though, the same elements are essential for a successful response, Biddinger said: a staggered mobilization of staff, an efficient means of command and control, and the ability to detect patients most in need of immediate care, especially when they have life-threatening internal injuries that might not be readily apparent.

What can we learn from Paris?

Biddinger told STAT that terrorist attacks resulting in mass carnage like that in Paris can put to the test competing philosophies of treating patients before they get to the hospital. One approach calls for a “forward-leaning” response emphasizing immediate treatment at the scene to avoid overburdening the hospital, while the opposing model calls for just stabilizing the wounded at the scene and then taking them to the hospital for a larger share of their care. In the 2004 train bombing in Madrid, for instance, different ambulance services deployed different approaches.

France typically favors the forward-leaning response, Biddinger said, though he cautioned that at this point we can’t know for sure to what extent it was deployed on Friday night. Once data on mortality outcomes in the Paris attacks becomes available, researchers may be able to look to it to assess the two approaches, Biddinger said.

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