Tactical emergency medicine: lessons from Paris marauding terrorist attack.

On the evening of 13 November 2015, three terrorists equipped with military-grade firearms and explosive jackets penetrated Bataclan, a Paris music hall containing 1500 people [1]. The terrorists started a massive execution of the people located in the orchestra pit. Terrorists then moved to the upper circle to take 400 people hostage. Immediately, RAID (Research, Assistance, Intervention, Deterrence), the French national police counter-terrorism team, and the BRI (Research and Intervention Brigade) were engaged. As previously reported [2, 3], these units encompass police operators and tactical emergency medical physicians, the latter being in charge of rescue planning and care delivery in a tactical environment. At the first look, the three tactical physicians identified more than a hundred casualties, including dozens of fatalities. A terrorist then detonated his bomb, killing himself. First, RAID police officers and tactical physicians proceeded to zoning. Priority was given to police operation and safety [2]. They delimited a danger zone, referred to as an “exclusion zone”, of which access was strictly limited to RAID/BRI operators because of an explosives threat. Conventional prehospital medical rescue teams remained located outside this police exclusion zone. While police operators were getting into position within the theater and thus repelling terrorists, two RAID tactical physicians performed triage in the combat zone [2, 4]. They identified about 100 fatalities. Most of the living casualties were identified as invalid. This tactical triage did not aim at identifying relative or absolute emergencies but rather at organizing immediate transfer of the non-invalid patients by themselves to a safe place. A dressing station was located in the theater entrance, far from firearms but still under the threat of explosives. This precluded any conventional rescue team support. In the combat zone, RAID tactical physicians applied tourniquets to 15 invalid patients [5]. A further 15 patients underwent wound compression with hemostatic