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Advances in prehospital hemorrhagic shock management since Paris’ terrorist attacks in 2015: A before-and-after retrospective study

Christophe Thiery, MD, Daniel Jost, MD, Isabelle Klein, MD, Frédérique Dufour-Gaume, MD, Olivier Stibbe, MD, Bertrand Prunet, MD, PhD


Background: In France, in 2015, prehospital emergency doctors were faced with civilian casualties in hemorrhagic shock resulting from terrorist attacks with automatic rifle fire and explosive weapons. The present study aimed to evaluate the impact of these attacks on the advanced life support (ALS) team’s practices and equipment and on physician training in the prehospital management of traumatic hemorrhagic shock.

Methods: This before-and-after multicenter study evaluated professional practices based on a questionnaire sent to emergency department heads and medical practitioners in 370 ALS teams in metropolitan France.

Results: We analyzed 672 responses from 209 (56.5 percent) ALS teams in 91 of 95 emergency medical services (EMS) headquarters. Of these 91, 73 (80.2 percent) had a protocol in use for managing traumatic hemorrhagic shock after the attacks, compared with 45 (49.5 percent) who had protocols in use before the attacks (p < 0.001). Ultrasound equipment was available in 49 (53.8 percent) of the EMS headquarters after the attacks, compared to 39 (42.9 percent) before (p < 0.001). Limb tourniquets were available in 90 (98.9 percent) EMS headquarters after the attacks, versus 27 (29.7 percent) before (p < 0.001). Tranexamic acid was available in 88 (96.7 percent) EMS headquarters after the attacks, versus 71 (78 percent) before (p < 0.001). During the post-attack period, training in war medicine did not affect individual practices, neither for using the shock index or the Focused Assessment with Sonography for Trauma (FAST) nor the tourniquet. However, this training was associated with more frequent use of hemostatic dressings (p = 0.002).

Conclusion: Following the attacks in Paris and Nice, ALS teams received additional equipment and training to prepare for future mass causality events.


hemorrhagic shock, prehospital, advanced life support, traumatism, terrorist attack

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