[And if it happened to children? Adapting medical care during terrorist attacks with multiple pediatric victims].
In light of the recent terrorist attacks in Europe, we need to reconsider the organization of rescue and medical management and plan for an attack involving multiple pediatric victims. To ensure quick surgical management, but also to minimize risk for on-site teams (direct threats from secondary terrorist attacks targeting deployed emergency services), it is crucial to evacuate patients in a swift but orderly fashion. Children are vulnerable targets in terrorist attacks. Their anatomical and physiological characteristics make it likely that pediatric victims will suffer more brain injuries and require more, often advanced, airway management. Care of multiple pediatric victims would also prove to be a difficult emotional challenge. Civilian medical teams have adapted the military-medicine principles of damage control in their medical practice using the MARCHE algorithm (Massive hemorrhage, Airway, Respiration [breathing], Circulation, Head/Hypothermia, Evacuation). They have also learned to adapt the level of care to the level of safety at the scene. Prehospital damage control principles should now be tailored to the treatment of pediatric patients in extraordinary circumstances. Priorities are given to hemorrhage control and preventing the lethal triad (coagulopathy, hypothermia, and acidosis). Managing hemorrhagic shock involves quickly controlling external bleeding (tourniquets, hemostatic dressing), using small volumes for fluid resuscitation (10-20ml/kg of normal saline), quickly introducing a vasopressor (noradrenaline 0.1μg/kg/min then titrate) after one or two fluid boluses, and using tranexamic acid (15mg/kg over 10min for loading dose, maximum 1g over 10min). Prehospital resources specifically dedicated to children are limited, and it is therefore important that everyone be trained and prepared for a scene with multiple pediatric patients.
SMUR pédiatrique Robert-Debré (SAMU 75), hôpital Robert-Debré, AP-HP, 48, boulevard Sérurier, 75019 Paris, France; Service d'urgence pédiatrique, CHU Sainte-Justine, 3175, chemin de la Côte-Sainte-Catherine, H3T 1C5 Montréal, Canada. Electronic address: alix.laurence@gmail.com.
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Alix-Séguin
SMUR pédiatrique Robert-Debré (SAMU 75), hôpital Robert-Debré, AP-HP, 48, boulevard Sérurier, 75019 Paris, France.
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Lodé
Département d'anesthésie-réanimation, université Paris-Descartes, hôpital universitaire Necker-Enfants-Malades, AP-HP, 149, rue de Sèvres, 75015 Paris, France.
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Orliaguet
SMUR pédiatrique Robert-Debré (SAMU 75), hôpital Robert-Debré, AP-HP, 48, boulevard Sérurier, 75019 Paris, France.
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Chamorro
SMUR pédiatrique Robert-Debré (SAMU 75), hôpital Robert-Debré, AP-HP, 48, boulevard Sérurier, 75019 Paris, France.
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Kerroué
SMUR pédiatrique Robert-Debré (SAMU 75), hôpital Robert-Debré, AP-HP, 48, boulevard Sérurier, 75019 Paris, France.
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Lorge
SMUR pédiatrique Robert-Debré (SAMU 75), hôpital Robert-Debré, AP-HP, 48, boulevard Sérurier, 75019 Paris, France.
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Moreira
D000465:Algorithms; D001930:Brain Injuries / Q000628:therapy; D002648:Child; D004189:Disaster Planning / Q000458:organization & administration; D004632:Emergency Medical Services / Q000458:organization & administration*; D060447:Emergency Shelter / Q000458:organization & administration; D005602:France; D006470:Hemorrhage / Q000628:therapy; D006801:Humans; D054527:Mass Casualty Incidents; D018635:Rescue Work / Q000458:organization & administration*; D023481:Terrorism; D014218:Triage