The world watched in horror as the death toll from the Paris terror attacks steadily climbed. By the time the three-hour rampage ended on Saturday and authorities put the number of those killed at 129, onlookers could only brace for worse news to come. More than 400 people received medical treatment at hospitals in the stricken city; dozens of them were listed in critical condition.
The second spike in the death toll never came. Just three of those hospitalized with grave injuries have died in the four days since the attacks.
The world-class status of the French health-care system deserves much of the credit. But a good deal of preparation, experience, and more than a little bit of lucky timing also helped save lives.
Since the Charlie Hebdo attacks in January, from which 16 people died, Paris-area ambulance crews and emergency personnel have taken part in regular exercises designed to test their readiness for possible attacks. One such exercise was held on Friday morning, the day of the latest terror attacks. In a twist of fate, the simulated emergency was a mass shooting, according to Dr. Mathieu Raux, emergency room chief at the Pitié-Salpetrière hospital in Paris.
During Friday's exercise, trauma specialists used a centralized dispatch system to set priorities and direct victims to the ER best equipped to treat their injuries. Ambulance services made sure they were ready to roll, and hospitals verified that surgeons and staff could be quickly summoned to treat arriving victims. "We tested every link in the chain," Raux said. Because Paris emergency physicians work 24-hour shifts, virtually every ER doctor on duty in the city Friday night had already taken part in the exercise earlier that day.
The training paid off at Pitié-Salpetrière, a sprawling medical complex in southeastern Paris that specializes in emergency treatment of what doctors call "penetration trauma," such as gunshot wounds. The hospital was alerted to the attacks at 9:40 p.m., 20 minutes after explosions at the Stade de France marked the beginning of the rampage. Within an hour, just as the first ambulances were pulling up, Pitié-Salpetrière had 10 operating rooms prepared and fully staffed with surgeons and surgical nurses.
Pitié-Salpetrière received 52 victims in total, 25 of which had suffered critical injuries. "Some were shot in the head, some had bullets everywhere, in the chest, arms, legs," Raux said. "I never, ever saw anything like it."
Two patients at Pitié-Salpetrière died shortly after arrival and a third victim died at another hospital in the city, according to a spokeswoman for Paris's public hospital system. No additional attack victims have died since Saturday, although 29 remained in intensive care as of Monday night.
Attack victims also benefited from the battlefield experience of veterans who now hold key positions in Paris's emergency response system. Philippe Juvin, head of emergency services at the Georges Pompidou hospital, a major trauma center, served as an anesthesiologist in Afghanistan in 2008. In interviews during the past few days, Juvin told French news media that his experience helped prepare him for the 50 victims who streamed into his ER. Juvin told the Associated Press that he saw "gun battles, explosions, buildings on fire, accidents with casualties" during his time in Afghanistan. Still, the doctor said, he had "never seen as many victims at once."
Raux is optimistic that most victims still hospitalized at Pitié-Salpetrière will survive. "These were young patients," he said, "between 20 and 40 years." That makes them strong and resilient, as well as fortunate that Paris's first responders were ready for the worst.