People light candles during a vigil in Kathmandu on Nov. 15, 2015 following the deadly attacks in Paris. (Navesh Chitrakar/Reuters)

The scene at Lariboisière Hospital in Paris was one of eerie order as patients began pouring in after terrorists attacked the city in a series of brutal coordinated attacks on Nov. 13.

Doctors and nurses at makeshift triage centers in mobile medical units as well as inside the main building directed patients to the right teams. Six different surgery teams were operating simultaneously: two for abdominal injuries, two for orthopedic injuries, one for ear, nose and throat, and the last for neurosurgery. At the same time medical personnel were working to repair the victims' bodies, psychiatrists were trying to help them through the mental anguish of what they had just gone through.

The 29 patients sent to this hospital had all been shot, and doctors noticed that they were young. All, but one, were younger than 40. Some had bullet injuries in their arms and extensive bone loss. Two victims who had been shot in the legs had to be treated with plates. Many had nerve damage and were likely to face reconstructive surgery. The surgeons operated continuously on Friday and all day Saturday.

The descriptions of that night published in The Lancet on Tuesday — as told through the eyes of an emergency physician who provided triage and prehospital care, a trauma surgeon and an anesthesiologist — provide a chilling window into the aftermath of the horrifying near-simultaneous shootings and explosions that held Paris hostage. In total, the medical system was grappling at once with an almost unprecedented number of victims: 129 people dead at the sites of the attacks and 302 rushed to hospitals.

While most of the journal article is very technical and describes how personnel in the Assistance Publique-Hôpitaux de Paris (APHP) — the largest medical system in Europe with 40 hospitals and 100,000 health professionals — were deployed, it provides an emotional punch in its details.

The doctors revealed, for instance, that in "a cruel irony," the morning of the day of the attacks the city's emergency medical teams and the fire brigade had held a practice exercise simulating what they should do in the event of multiple shootings in Paris.

"In the evening, when the same doctors were confronted with this situation in reality, some of them believed it was another simulation exercise," they wrote.

The emergency physician talked "prehospital damage control" among the wounded — describing the use of war-time medical techniques.

"[T]he demand for tourniquets was so high that mobile teams came back without their belts," the doctor said. Some of those without lethal wounds were treated to maintain a blood pressure at the lowest level ensuring consciousness (60 mm Hg mean arterial pressure) to try to stop them from bleeding out.

Also buried in the account are heartbreaking reminders of how terrorist attacks are now becoming so frequent that more and more medical personnel are beginning to specialize in them. In describing a group of 35 men and women who were called in to staff a grief support center, the authors wrote: "Most of them had played a similar role during the attacks against Charlie Hebdo."

The Paris offices of that satirical newspaper had been attacked by terrorists in January. 12 journalists died in that massacre.

 


Lights in the colors of the French flag illuminate the Auckland Museum to remember victims of the Paris attacks. (Hannah Peters/Getty Images)

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