On March 22, 2016, the capital of Europe was hit by two terrorist attacks. As terrorism becomes more and more violent, it is critical to learn and share experiences in order to enhance effectiveness in saving lives.

A field perspective and experience feedback from the Emergency Medical Response.

The first attack hit the departure hall of the airport, which, due to its strategic role, relies upon a dedicated emergency plan. However, it focuses on airplane crashes and not on explosions in a crowded terminal. The second attack hit the subway at rush hour. An attack in such a confined environment is particularly challenging for the rescue teams, as injuries are worsened, access hindered, and exits numerous.

Eleven medical teams were sent in order to perform triage and provide vital care. The medical response was organized by two disaster response teams. Advanced Medical Posts were set up and the mass casualty plans of all hospitals were activated. Managing war injuries for civilian teams was challenging. On-site care consisted essentially in prehospital damage control and burn care in order to ensure rapid evacuations for haemostatic surgery. 313 victims were dispatched to thirty hospitals. Another challenge was safety. Several threats were apparent and explosives were found on both sites. Lessons from Paris had prompted a review of our multiple sites Emergency Plan. One single way of communication was used and the evacuations were managed centrally. Finally, the key factor that helped limit the number of casualties was the acquaintanceship between emergency workers and non-medical teams built during exercises, allowing them to adapt and blend in as one team.

Lessons from previous attacks were crucial to improve our management of the medical response. These should be shared around, as another attack may always occur anywhere and at any time.