Page 59 - JSOM Spring 2025

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BOX 1 Timeline of Bataclan Concert Hall Attack, 13 November 2015 maneuvers. The after-action commentary shows that when
Action Time casualties were in a safe position, the focus was “. . . stopping
Attack 21:47 external bleeding, freeing the upper respiratory tract, managing
thoracic wounds, ensuring rapid evacuations while providing
Arrival Team 1 BRI PP
(Research and Intervention Brigade of Paris) 22:32 fluid resuscitation and tranexamic acid administration, anal-
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Arrival of Rapid Response Team 22:34 gesia and preventing hypothermia.” The commentary listed
equipment as tactical tourniquets, hemostatic QuikClot Com-
Arrival of RAID (French National Police Intervention
Unit) Team 2 22:42 bat Gauze (Z-Medica, Wallingford, CT) combat gauze, and
Arrival of RAID team 1 and 2 doctors 22:58 multiple types of bandages for the BLS teams. ALS teams also
• Small armored vehicle sent – stretchers for evacuation carried pneumatic tourniquets, needles/tubes for chest decom-
via passage Saint-Pierre Amelot 23:04 pression, and perfusion kits. 4
• Entry of tactical doctors into Bataclan Concert Hall
Phase 1 Interventions
• Organization of casualties in the entrance by doctor 1 The 3 tactical physicians immediately identified more than a
• Commencement of first aid in orchestra pit by doctors hundred casualties and dozens of fatalities. RAID operators
1 and 2 then proceeded to establish the threat zones with police op-
Chain formed between pit and Level B erations and safety as the priority. RAID established the dan-
Chain formed between Level B and victims’ assembly point ger or hot area, referred to by RAID as the “exclusion zone.”
This zone was restricted to RAID and BRI operators only due
• POINT (Paris Fire Brigade on rue Oberkampf) first aid
measures commence 23:47 to the perceived explosive threat. The conventional prehospi-
• Doctor 1 and doctor 2 evacuation of level 0 completed tal response remained outside this exclusion zone. While the
Arrival of 2nd BRI doctor and 4th RAID doctor RAID police officers prepared to neutralize the threat, 2 RAID
tactical physicians performed triage in the hot area, referred
Phase 2 to in the commentary as the “combat zone.” This triage aimed
Request for Fire Brigade to provide means of evacuation of 23:50 to establish the walking casualties and direct them to a place
1st floor of safety. Established at the theatre entrance was a dressing
• Request for Fire Brigade to move victims’ assembly point
by doctor 1 23:58 station, safe from firearms but within the threat zone of explo-
• Doctor 1 joins RAID team 2 for Level 1 and above sion; this risk element restricted the entrance of conventional
Establishment of chain by ladder Balcony to Level 1 rescue teams to reach the dressing station.
evacuation of >85 persons
BRI & RAID assault 00:18 Treatments undertaken in the hot area by RAID tactical phy-
• Assault support from RAID doctor 2 and BRI doctor. 01:00 sicians were:
• Evacuation via balcony completed.
End of RAID doctor intervention. 01:20 • Fifteen casualties had tourniquets applied.
BRI = Research and Intervention Brigade; RAID = Research, Assis- • Fifteen casualties underwent wound compression with he-
tance, Intervention, Deterrence. mostatic dressings.
• Two were administered subcutaneous morphine.
emergency means.” Medical operations were undertaken so • Two received tranexamic acid (antifibrinolytic agent).
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as not to compromise the mission of the police or the safety • Two had thoracic exsufflations (treatment of pneumothorax).
of personnel.
“Salvage therapies were performed” and 50 casualties were
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Potential injuries from mass violence events RAID responds to carried out of the hot area to the dressing stations, with pri-
are from ballistic projectiles (such as those found in the Bata- ority given to the most severely compromised. Tactical physi-
clan incident), and these injuries require rapid triage, LSI, and cians instigated this tactic to move the injured out of the direct
transport to an appropriate facility. The RAID physician’s role line of fire to a less dangerous area—the dressing station—
is to overcome the time required to neutralize the threat and and closer to the conventional prehospital care providers. At
the time taken to commence early LSI. this stage, an additional 2 tactical physicians began “damage
control resuscitation” to casualties in the dressing station,
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After-action reviews showed that the presence of clinicians em- as the original 2 tactical physicians re-joined the PTG to act
bedded in the PTGs and collaboration between PTGs and con- as forward medical officers. Damage control consisted of
ventional prehospital teams led to effective/efficient treatment maintaining blood pressure at the lowest level to maintain
regimens and extrication of casualties to the cold area and, consciousness, maintaining body temperatures, and using
eventually, hospitals. The quick action taken has been credited tourniquets, vasoconstrictors, or tranexamic acid. 11
to have increased the survival rate ; the mortality rate at day
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7 was 1.3%. The 2008 Mumbai attacks, which had no or de- Multiple police officers joined the dressing station and ferried
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layed prehospital care, showed overall fatality at 42.06% and the wounded to the casualty collection point (CCP), where
on-scene mortality at 94.7%; 64.91% had bullet wounds, and conventional prehospital teams were waiting under the super-
26.31% died of blast injuries. The on-scene Mumbai mortality vision of a tactical physician. Due to the threat of explosive
due to bullet injuries was 91.85%. Weapons used in both at- devices, and despite the attackers’ neutralization, conventional
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tacks were AK-47 rifles. prehospital teams were maintained in the cold area until the
end of “mine-clearing operations’’ (ensuring there was no ex-
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Within the hot area, RAID performed essential prehospital re- plosive ordnance). Before transferring patients to the CCP, the
suscitation procedures only. These “rescue procedures” were 5 RAID physicians continued to perform damage control re-
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hemostasis, decompression of pneumothorax, and basic airway suscitation. All living casualties had already been extracted by
Enhancing Tactical Medical Responses | 57