As the deadly terror attacks rippled across the French capital on Nov. 13, crisis teams of doctors, nurses and first responders were immediately mobilized to prepare for the wounded. Now, a group of doctors who treated the victims are sharing details of how they coped that night.

Their accounts, published Tuesday in The Lancet, detail the coordinated response from the Assistance Publique-Hopitaux de Paris (APHP), which is the public hospital system of Paris and its surrounding suburbs.

Within minutes of a suicide bomb blast near the Stade de France, APHP enacted a "White Plan," which coordinates 40 hospitals in the event of a major emergency situation.

The plan, which oversees 100,000 staff and 200 operating rooms, was first developed 20 years ago. However, this was the first time it was put into action.

A total of 35 surgical teams from 10 different hospitals operated on the most seriously injured.

Below are the stories of that night from the perspective of an emergency doctor, an anesthesiologist, and a trauma surgeon.

Emergency doctor

According to the emergency doctor, 45 crisis medical teams were dispatched to the scenes of the attacks, and 15 teams were kept on reserve in case they were needed later in the night.

These pre-hospital teams were tasked with treating patients at the scene, and controlling the "damage" as much as possible, before transporting the victims back to hospital for additional care.

As most of the injuries were related to gunfire, the teams' main priorities included maintaining blood pressure, ensuring consciousness, and treating victims with medications and tourniquets.

The doctor noted that the need for tourniquets was so high that medical teams often had to improvise. "The demand for tourniquets was so high that the mobile teams came back without their belts," the doctor said.

The doctor also said that, despite the "appalling" death toll, the attacks did not come as a surprise. Since the start of 2015, all state departments had known that a multi-site shooting could happen, and had been preparing for such an attack.

And, in a "cruel irony," many of the same crisis teams had participated that very morning in a training exercise on what to do in the event of a multiple shooting.

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

Despite receiving training for such emergency situations, the medical teams had never before been confronted with such a high number of victims that required care, the doctor added.

"A new threshold has been crossed."

Anesthesiologist

The anesthesiologist said the number of patients that were admitted to their hospital was "far beyond" what any of the staff could imagine they could treat. However, the hospital never required additional resources.

The doctor said several factors contributed to this relative success in treating the wounded. These include:

  • Groups of injured patients arriving at hospital quickly and in small groups;
  • The establishment of a rapid triage outside the entrance of the ER;
  • The cooperation and dedication of all the staff.

On this last point, the doctor noted that each staff member was determined to do their very best for the wounded.

"Another key element was related to the dramatic characteristic of the event – each participant wanted to do more than his or her best for the victims, and they did it," the doctor said.

The doctor said that, within 24 hours of the attacks, all emergency surgeries had been completed.

Trauma surgeon

The trauma surgeon said it was a combination of "spontaneity and professionalism" that allowed hospital staff to efficiently operate on the wounded.

The doctor said, without being asked, many staff members came to work to help treat the victims.

All the extra staff allowed the hospital to open six operating rooms, and the first of the seriously injured were being operated on within 30 minutes of admission, the doctor said.

The surgeon said that the teams worked continuously through the night on Nov. 13, and by Nov. 15, the hospital's usual services resumed.

On Nov. 16, the staff met to review what had been done over the weekend, and one common observation was that all but one of the victims admitted to hospital were less than 40 years old. The staff also noted that all of the patients had suffered high-energy ballistic trauma, and nerve damage was "frequent."

The doctors conclude that all of the hospitals working in concert allowed each to efficiently treat the wounded victims.

"We sensed that the size of the organization could be an advantage in times of disaster. This advantage has now been demonstrated. No lack of coordination has been identified. No leakage or delay has occurred. No limit was reached," they said. "What happened strengthens our belief that size can be combined with speed and excellence."