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On the morning of Friday, Nov. 13, firefighters and emergency medical workers in Paris simulated how they might respond to a mass shooting event. They had no idea that they would be putting their skills into practice that same night.

Those kinds of drills, instigated even before the shooting at the French satirical newspaper Charlie Hebdo, were just one way that the French medical system tried to ready itself for such an attack, according to a report published Tuesday in The Lancet. Written by doctors who responded to the latest crisis, in which terrorists set off explosions and fired weapons at six locations across the French capital, the article is a chilling examination of what it was like to be treating the victims that night.

The attacks left 129 dead and over 300 injured. No simulation could have prepared medical professionals for that kind of carnage — in fact, when the attacks began, some doctors thought it was another drill. But even so, the response was remarkable. Doctors and nurses spontaneously appeared at hospitals to help, and the extra personnel meant that at a single medical center, six operating rooms were performing surgeries at once. The operations continued all night and into the next day.

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So many victims were left bleeding that emergency responders ran out of tourniquets, and had to use their belts.

The effectiveness of the response is in part due to an emergency protocol called the “White Plan.” It was developed 20 years ago, but Nov. 13 was the first time it was ever put into practice. The plan involved readying hospitals for an unprecedented influx of patients by freeing beds and making sure staff was on site.

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The medical system also kept other hospitals ready as backup, in case there were further attacks, or in case those centers launched into action by the White Plan weren’t sufficient. But “at no time during the emergency was there a shortage of personnel,” write the authors of the report, and those extra medical services were not needed.

They also note that “never before had such a number of victims been reached and so many wounded been operated on urgently. A new threshold has been crossed.”

Another response to the attacks came from Alain Fuchs, president of the French National Center for Scientific Research, Europe’s biggest public research institution. He announced that the organization, known by its French acronym CNRS, would be fast-tracking funding to certain research projects that deal with the issues surrounding these attacks. In his request for proposals, he called intelligence and knowledge “our most potent weapons.”