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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

Abstract


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.


Keywords


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

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References


Rerbal D, Dhers M, Lambolley L, et al.: Traumatic hemorrhagic shock. Prehospital care and reception in SAVE. Available at https://sfar.org/wp-content/uploads/2014/04/07_Dhers.pdf. The French Society of Anesthesia and Resuscitation (Sfar) 2014 Congress [in French]. Accessed February 2021.

Kauvar DS, Lefering R, Wade CE: Impact of hemorrhage on trauma outcome: An overview of epidemiology, clinical presentations, and therapeutic considerations. J Trauma. 2006; 60(6 Suppl): S3-11.

Frattini B, Franchin M, Klein I, et al.: Pre-hospital damage control and organization of rescue in attack situations. Feedback from the Paris events of 2015. Revue du Service de Santé des Armées. 2018; (3): 231-237.

Vardon F, Bounes V, Ducassé J-L, et al.: Out-of-hospital equipment of emergency medical services for hemorrhagic shock management: Can do better.! Ann Fr Anesth Reanim. 2014; 33(12): 621-625.

Brolliar SM, Moore M, Thompson HJ, et al.: A qualitative study exploring factors associated with provider adherence to severe pediatric traumatic brain injury guidelines. J Neurotrauma. 2016; 33(16): 1554-1560.

Lakstein D, Blumenfeld A, Sokolov T, et al.: Tourniquets for hemorrhage control on the battlefield: A 4-year accumulated experience. J Trauma. 2003; 54(5 Suppl): S221-225.

Beekley AC, Sebesta JA, Blackbourne LH, 31st Combat Support Hospital Research Group, et al.: Prehospital tourniquet use in operation Iraqi freedom: Effect on hemorrhage control and outcomes. J Trauma. 2008; 64(2 Suppl): S28-37; discussion S37.

Lapostolle F, Petrovic T, Lenoir G, et al.: Usefulness of hand-held ultrasound devices in out-of-hospital diagnosis performed by emergency physicians. Am J Emerg Med. 2006; 24(2): 237-242.

Scharonow M, Weilbach C: Prehospital point-of-care emergency ultrasound: A cohort study. Scand J Trauma Resusc Emerg Med. 2018; 26(1): 49.

Bobbia X, Hansel N, Muller L, et al.: Availability and practice of bedside ultrasonography in emergency rooms and prehospital setting: A French survey. Ann Fr Anesth Reanim. 2014; 33(3): e29-33-e33.

Government of France (Ministries of Solidarity and Health): Collective assaults by weapons of war, to be carried out by healthcare professionals. Available at https://solidarites-sante.gouv.fr/IMG/pdf/Agressions-collectives.pdf (2018). Edition DICOM, p. 230. Accessed February 2021.

Van der Weide L, Popal Z, Terra M, et al.: Prehospital ultrasound in the management of trauma patients: Systematic review of the literature. Injury déc. 2019; 50(12): 2167-2175.

Shakur H, Roberts I, Bautista R, CRASH-2 trial collaborators, et al.: Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): A randomised, placebo-controlled trial. Lancet. 2010; 376(9734): 23-32.

Roberts I, Shakur H, Afolabi A, CRASH-2 collaborators, et al.: The importance of early treatment with tranexamic acid in bleeding trauma patients: An exploratory analysis of the CRASH-2 randomised controlled trial. Lancet. 2011;377(9771):1096-101-1101.e1-2.

Guyette FX, Brown JB, Zenati MS, et al.: Tranexamic acid during prehospital transport in patients at risk for hemorrhage after injury: A double-blind, placebo-controlled, randomized clinical trial. JAMA Surg. 2020; 156(1): 11-20.

Spahn DR, Bouillon B, Cerny V, et al. The European guideline on management of major bleeding and coagulopathy following trauma: Fifth edition. Crit Care. 2019; 23(1): 98.

Cannon CM, Braxton CC, Kling-Smith M, et al.: Utility of the shock index in predicting mortality in traumatically injured patients. J Trauma. 2009; 67(6): 1426-1430.

Zhu CS, Cobb D, Jonas RB, et al.: Shock index and pulse pressure as triggers for massive transfusion. J Trauma Acute Care Surg. 2019; 87(1S Suppl 1): S159-S164.

Olaussen A, Blackburn T, Mitra B, et al.: Review article: Shock index for prediction of critical bleeding post-trauma: A systematic review. Emerg Med Australas. 2014; 26(3): 223-228.

Travers S, Lefort H, Ramdani E, et al. Hemostatic dressings in civil prehospital practice: 30 uses of QuikClot combat gauze. Eur J Emerg Med. 2016; 23(5): 391-394.




DOI: https://doi.org/10.5055/ajdm.2021.0408

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