Paris Terrorist Attacks: From Black Friday to White Plan

Jean-Bernard Gervais

November 17, 2015

PARIS — The devastating series of attacks that struck Paris and Saint Denis on the evening of Friday, November 13, at six different locations, with 132 dead so far and more than 250 injured, had an immediate effect: the indefinite suspension of the strike movement by private practice physicians, called Black Friday. On Friday evening, Dr Jean-Paul Ortiz, president of the Confederation of French Medical Unions (CSMF), used Twitter to ask "all doctors to halt the strike and give priority to emergency care."

The MG France union, the main general practitioners union, also used Twitter to call for a halt to the strike: "the private practice physicians, in solidarity with the victims and the population, are stopping their strike and protest movement."

Suspension of the Strike

Even before the tweet by the president of the private practice physicians main union, numerous physicians had voluntarily come to the accident and emergency (A&E) departments to offer their help, as recalled on November 14 by Dr Jacques Lucas, from the National Council of the Order of Physicians, on Twitter: "the doctors did not wait for instructions when the attacks occurred, and the Order pays tribute to them."

Immediately afterward, the French Fédération de l'Hospitalisation Privée (FHP), which earlier on that same Friday had announced that 80% of clinics were on strike, also issued a press release to announce the suspension of the strike movement: "The Private hospitals Federation (FHP) asks the clinics to suspend with immediate effect the protest movement against the health bill, in order to give priority to emergency care, in the wake of the attacks which this evening plunged the capital into mourning."

White Plan

In the space of just a few hours, the medical world made the transition from Black Friday to the White Plan, triggered on Friday evening by the Paris hospitals authority (Assistance Publique–Hôpitaux de Paris [AP-HP]). The White Plan has been enshrined in law since 2004 and enables additional means and human resources to be mobilized, nonessential activities to be rescheduled, and additional beds to be opened.

Source: Pourya Pashootan, MD

"All the personnel are mobilized, in particular the [Service d'Aide Médicale Urgente] and A&E teams. The necessary staff are called in directly by the hospitals," the AP-HP stated in a press release Friday evening. All the emergency services of the largest university hospital in France were mobilized. The victims of the attacks were mainly distributed among Saint-Louis Hospital, La Pitié Salpêtrière Hospital, Georges Pompidou European Hospital, Henri Mondor Hospital, Lariboisière Hospital, Saint-Antoine Hospital, Bichat Hospital, and Beaujon Hospital.

On Saturday, November 14, at least 300 people were being treated in Paris hospitals, with 80 of them being considered absolute emergencies and 177 relative emergencies, plus 43 additional persons — either witnesses or family members.

AP-HP issued the somber warning that "most of the patients are in a state of shock and suffering from various and sometimes multiple injuries, which could require very long-term medical attention." By late afternoon on Sunday, November 15, about 415 people, or about 100 more than the previous day, had been admitted to the hospitals for psychological shock. Of the 80 absolute emergency cases, 35 had been downgraded, but an additional three had died, raising the death toll from the attacks to 132. Of the 415 persons receiving treatment, 218 were discharged on Sunday evening.

Blood Donors

In addition to the medical community, the residents of the Paris area as a whole made a commitment to the medical effort. Although blood reserves were announced by AP-HP as being sufficient on Friday evening, large numbers of the population nonetheless lined up to give blood. The French blood bank noted that "this mobilization needs to be a long-term one: 10,000 blood donations are required every day, and all blood groups are needed." The Ministry for Health, for its part, stated that the ministry's health emergency center had been immediately activated, along with the health emergencies preparation and response facility. "Medico-psychological emergency units...were set up on a number of Paris sites, in order to treat the victims and their families," the ministry added.

Psychological Care

On Monday, November 16, Dr Christophe Prudhomme, the spokesman for the Association des Médecins Urgentistes de France union of A&E physicians, told Medscape France that AP-HP had resumed a normal pace of work and that, given the capacity of the region, the hospitals were not in a disaster situation.

Last Friday, in barely 1 hour, the staffing levels had been doubled. The triage system also enabled the injured to be evenly distributed, with the largest hospitals taking several dozens of the injured, which was not a strain on the hospitals. Even if treatment of the injured at the time went smoothly, Dr Prudhomme is concerned that the hospitals could be submerged by those suffering from the psychological shock: "We could see thousands of people suffering from psychological distress, and we do not necessarily have the resources."

Tribute

With the weekend barely over, tributes had been sent to medical personnel by the Ministry for Health, as well as by the National Council of the Order of Physicians, which, in a news release, said it wished to "pay tribute to the exceptional mobilization by all the health professionals, hospital workers, A&E staff, and interns who, as soon as the tragedy became known, provided first aid to the victims of these attacks." It also paid tribute to the unions of private practice physicians and the SOS Médécins association, which immediately responded to council's appeal to suspend the ongoing protest movements.

Two joint hospital physician unions, the Confédération des Praticiens des Hôpitaux and Avenir Hospitalier, also issued a press release to "salute the memory of the victims murdered in so cowardly a fashion on Friday 13th November" and "the engagement by the Paris hospital community and the [Service d'Aide Médicale Urgente] services from the provinces."

Because of the meeting of the two Houses of Parliament convened in Versailles on Monday, November 16, by President François Hollande, the examination of the health bill, which was to begin Monday in the National Assembly, has been postponed to today.

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