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Enhancing Tactical Paramedicine Response

Efficiency and Effectiveness

Lessons from the Bataclan Concert Hall Incident

Steven Robertson, MHlthSC, MPhil

ABSTRACT
The 2015 Bataclan Concert Hall attack in Paris highlights the RAID and Service d’aide médicale urgente (SAMU) system
role of the tactical emergency medical physicians embedded with Australia’s paramedic-based emergency response system.
within France’s Research, Assistance, Intervention, Deterrence The outcomes include key lessons and actionable recommen-
(RAID) Police Tactical Group (PTG). France’s use of high-level dations for enhancing Australia’s response efficiency, clinician
physicians in hot zones contrasts with Australia’s reliance on deployment, and patient outcomes.
paramedics. This study evaluates the skillsets, effectiveness,
and efficiency of Australia’s paramedic response to intentional The findings show that basic lifesaving interventions (LSIs) are
mass violence incidents (IMVI) compared to France’s Service needed in IMVIs at the point of injury and as early as pos-
d’aide médicale urgente (SAMU), which deploys physicians sible. Further, deploying the highest clinician into the threat
and integrates seamlessly with hospital care. Findings reveal area wastes valuable resources and is not cost effective. Thus,
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that trained Australian paramedics can deliver the minimal Australian paramedics are adequately skilled to respond to
lifesaving interventions (LSIs) required at the point of injury; threat zones if supported by integral organizational policies,
meanwhile, physicians can manage complicated cases in cold procedures, selection, and training programs.
zones. Deploying highly trained clinicians into threat areas, as
with the Queensland Ambulance Services (QAS) High Acu- French EMS – SAMU
ity Response Unit (HARU), may waste resources better allo- The French emergency medical system (EMS), known as
cated to the cold zone. Embedding clinicians within tactical SAMU, operates with medical physicians and does not rely on
groups may enhance survival rates, operational success, and paramedics. Medical experts continuously monitor dispatch-
cost-effectiveness. ing and can choose from various response options, such as
general practitioners or other clinical services, basic emergency
Keywords: Bataclan Concert Hall; tactical emergency medical and cardiac resuscitation from fire services, or dispatching a
physicians; Research, Assistance, Intervention, Deterrence; mobile intensive care unit (MICU) led by physicians.
Service d’aide médicale urgente; Police Tactical Groups;
intentional mass violence; tactical paramedicine; emergency MICUs employ various techniques, including general anesthe-
response sia, advanced airway and ventilatory management, intrave-
nous line placements, CPR, defibrillation, and thrombolysis.
Protocols are followed by the responding physician, who ex-
ercises medical judgment for interpretation. SAMU’s model
Introduction
incorporates validated approaches to EMS, offering a compre-
Background hensive framework for emergency medical care. 3
Intentional mass violence incidents (IMVIs) demand highly
coordinated emergency medical responses. On 13 November The Parisian prehospital service is a two-tiered response sys-
2015, a sophisticated and well-choreographed Islamist terrorist tem. The first tier operates at a basic life support (BLS) skillset
attack occurred at multiple sites across Paris (Figure 1). While and is served by 200 teams of 3–5 professional rescuers re-
there have been numerous case studies on the response to these sponding from 77 firefighting stations. The second tier con-
attacks, none have compared the skillsets of Research, Assis- sists of 44 advanced life support (ALS) crews made up of an
tance, Intervention, Deterrence (RAID) physicians to those of emergency physician, a nurse, and a BLS responder who is the
Australian advanced care paramedics (ACPs), which are the base driver. 4
level professional stream practice in Australian Paramedicine. 1
Bataclan Attack: Paris Attack Statistics
This paper analyzes the Bataclan Concert Hall attack as a case During the Bataclan concert hall attack, there were 90 deaths
study to compare the responses of France’s physician-based and over 200 injuries. This tragic event was part of a series of
Correspondence to srobertson51@bigpond.com
Steven Robertson is a higher research student with Queensland University of Technology, Brisbane, Queensland, Australia.

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