disaster preparedness
mass casualties

How to Cite

LEFORT, H., Travers, S., 1, M., Mihai, I., Béguec, F., Calamai, F., Hersan, O., Tourtier, J., & Carpentier, J. (2021). EMERGENCY RESPONSES IN CASE OF MASS CASUALTIES’ DIFFERENT BIG BANG INCIDENTS: THE PARIS FIRE DEPARTMENT PREHOSPITAL MEDICAL CARE APPROACH. Mediterranean Journal of Emergency Medicine, (21), 3-9. Retrieved from https://mjemonline.com/index.php/mjem/article/view/32


Introduction: Taking into consideration the natural disasters, the industrial and terrorist attacks had changed significantly with time. The idea of terrorist threats such as chemical biological radiologic or nuclear (CBRN) have determined the authorities to change and adjust their approach.

Methods: Through the experience of the Fire Brigade of Paris (BSPP), we focus on the emergency services organization during a major event and on the triage of the victims, whether of a natural disaster or exposed to the CBRN.

Results: The new approach is based on a very clear and very well organized emergency care support, a very well organized commanding network, and last but not least a very well prepared logistic support.

Conclusion: The willingness and the necessity to anticipate the occurrence of such risks is materialized by the systematic well organized and clearly assigned functions: transport, triage, medical care, and evacuation of the victims. All of which are coordinated by the medical rescue direction.



Jenkins JL, McCarthy ML, Sauer LM, Green GB, Stuart S, Thomas Tl et al. Mass-casualty triage ; Time for an evidence-based approach. Prehosp Disaster Med 2008; 23:3-8.

Dudaryk R, Pretto EA. Resuscitation in a multiple casualty event. Anesthesiol Clin 2013; 31:85-106.

Hinton Walker P, Garmon Bibb SC, Elberson KL. Research Issues in Preparedness for Mass Casualty Events, Disaster, War, and Terrorism. Nurs Clin North Am 2005; 40: 551-64.

Dara SI, Farmer JC. Preparedness lessons from modern disasters and wars. Crit Care Clin 2009; 25:47-65.

Kilner TM, Brace SJ, Cooke MW, Stallard N, Bleetman A, Perkins GD. In ‘big bang’ major incidents do triage tools accurately predict clinical priority?: A systematic review of the literature. Injury 2011; 42:460-8.

Adnet F, Maistre JP, Lapandry C, Cupa M, Lapostolle. Organisation des secours lors de catastrophes à effets limités en milieu urbain. Ann Fr Anesth Reanim 2003; 22:5-11.

Ramesh AC, Kumar S. Triage, monitoring, and treatment of mass casualty events involving chemical, biological, radiological, or nuclear agents. J Pharm Bioallied Sci 2010; 2:239-47.

Macintyre AG, Christopher GW, Eitzen E, Gum R, Weir S, DeAtley C et al. Weapons of mass destruction events with contaminated casualties: effective planning for health care facilities. JAMA 2000; 283:242-9.

Laurent J, Richter F, Michel A. Management of victims of urban chemical attack: the French approach. Resuscitation 1999; 42:141-9.

Baker DJ. Critical care requirements after mass toxic agent release. Crit Care Med 2005; 33:S66-74.

Tucker JB. National health and medical services response to incidents of chemical and biological terrorisme. JAMA 1997; 278:362-8.

Duncan EA, Colver K, Dougall N, Swingler K, Stephenson J, Abhyankar P. Consensus on items and quantities of clinical equipment required to deal with a mass casualties big bang incident: a national Delphi study. BMC Emerg Med 2014; 14:5.

Okumura T, Takasu N, Ishimatsu S, Miyanoki S, Mitsuhashi A, Kumada K et al. Report on 640 victims of the Tokyo subway sarin attack. Ann Emerg Med 1996; 28:129-135.

Okumura T, Hisaoka T, Yamada A, Naito T, Isonuma H, Okumura S et al. The Tokyo subway sarin attack - lessons learned. Toxicol Appl Pharmacol 2005; 207s:471-6.

De Ceballos JP, Turégano-Fuentes F, Perez-Diaz D, Sanz-Sanchez M, Martin-Liorente C, Guerrero-Sanz JE. 11 March 2004: The terrorist bomb explosions in Madrid, Spain - an analysis of the logistics, injuries sustained and clinical management of casualties treated at the closest hospital. Crit Care 2005; 9:104-11.

Redhead J, Ward P, Batrick N. The london attacks-response: Prehospital and hospital care. N Engl J Med 2005; 353:546-7.

Lockey DJ, Mackenzie R, Redhead J, Wise D, Harris T, Weaver A et al. London bombings July 2005: the immediate pre-hospital medical response, Rescuscitation 2005; 66:ix-xii.

Horne S, Vasallo J, Read J, Ball S. UK triage – An improved tool for an evolving threat. Injury 2013; 44:23-8.

Bogle, LB, Boyd JJ, McLaughlin KA. Triaging multiple victims in an avalanche setting: The avalanche survival optimizing rescue triage algorithmic approach. Wilderness Environ Med 2010; 21:28-34.

Travers S, Bignand M, Raclot S, Domanski L, Tourtier JP. Difficulties of triage in mass casualties incident. Injury 2013; 44:1965-6.

Lyle K, Thompson T, Graham J. Pediatric mass casualty: triage and planning for the prehospital provider. Clin Ped Emerg Med 1999; 10:173-85.

Potin M, Sénéchaud C, Carsin H, Fauville JP, Fortin JL, Kuenzi W et al. Mass casualty incidents with multiple burn victims: rationale for a Swiss burn plan. Burns 2010; 36:741-50.

Vinson E. Managing bioterrorism Mass casualties in an emergency department: Lessons learned from a rural community hospital disaster drill. Disaster Manag Response 2007; 5:18-21.

Aylwin CJ, König TC, Brennan NW, Shirley PJ, Davies G, Walsh MS et al. Reduction in critical mortality in urban mass casualty incidents: analysis of triage, surge, and resource use after the London bombings on July 7, 2005. Lancet 2006; 368:2219-25.

Dorandeu F, Blanchet G. Chemical warfare agents and terrorism. Med Catastrophe Urg Collectives 1998; 1:161-70.

Schumacher J, Weidelt L, Gray SA, Brinker A. Evaluation of bag-valve-mask ventilation by paramedics in simulated chemical, biological, radiological, or nuclear environments. Prehosp Disaster Med 2009; 24:398-401.

Ophir N, Ramaty E, Rajuan-Galor I, Rosman Y, Lavon O, Shrot S et al. Airway control in case of a mass toxicological event: superiority of second-generation supraglottic airway devices. Am J Emerg Med 2014; doi: 10.1016/j.ajem.2014.08.067.

Castle N, Bowen J, Spencer N. Does wearing CBRN-PPE adversely affect the ability for clinicians to accurately, safely, and speedily draw up drugs? Clin Toxicol (Phila) 2010; 48:522-7.

Castle N, Owen R, Hann M, Clark S, Reeves D, Gurney I. Impact of chemical, biological, radiation, and nuclear personal protective equipment on the performance of low -and high- dexterity airway and vascular access skills. Resuscitation 2009; 80:1290-5.

Castle N, Pillay Y, Spencer N. Insertion of six different supraglottic airway devices whilst wearing chemical, biological, radiation, nuclear- personal protective equipment: a manikin study. Anaesthesia 2011; 66:983-8.

Wedmore IS, Talbo T, Cuenca PJ. Intubating laryngeal mask airway versus laryngoscopy and endotracheal intubation in the nuclear, biological and chemical environment. Mil Med 2003; 168:876-79.

Leslie CL, Cushman M, McDonald GS, Joshi W, Maynard AM. Management of multiple burn casualties in a high volume ED without a verified burn unit. Am J Emerg Med 2001; 19:469-73.