Abstract
Purpose
To describe the most severe casualties from the July 14th, 2016 terror attack in Nice that were treated at the Lenval University Children’s Hospital (LUCH) of Nice (France).
Methods
Retrospective study about casualties treated at LUCH from Bastille Day Attack with injuries resulting in the need for surgery, resuscitation, or death. The type of lesions and surgery, duration of hospitalizations, complications, psychological status, and outcome at discharge were collected.
Results
Eleven patients presented severe traumas including three adults. They were triaged and managed first by the Critical Care Physician on duty and by emergency room nurses with no additional staff. Six pediatric casualties needed surgery; seven patients were hospitalized in Pediatric Intensive Care Unit (PICU). Five deaths were reported. The most relevant injuries were: pelvic disjunction, lower limb fracture, vascular injuries, and head or trunk crush. As soon as it was possible, two surgeons attended the emergency room (ER) to help carry out the triage. Overall we performed twenty-eight surgeries, including two neurological, one vascular, and five orthopedic. We performed closed reduction and internal fixation (CRIF) in three cases of limb fractures. A compartment syndrome was observed. Stress disorders were observed in three patients, which merited psychiatric support and treatment.
Conclusion
We faced uncommon situations with severe casualties without pre-hospital management. The presence of adult patients and unusual lesions increased the complexity. The presence of surgeons in the ER seemed useful for effective clinical decision-making. CRIF has been a valid option for damage control. Competence in vascular, neurological, major trauma surgery and psychic trauma should be available in any pediatric trauma center.
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Acknowledgements
The authors thank all the healthcare and administrative staff of LCH; Psychiatrists and private doctors Chau, Renaud, Rocher, Picon for clinical support; Doctors Lecompte, Bensaid, Demonchy, Kosok, Boyer, Richelme, Rosello, Oborocianu, Afanetti, Allia, Gastaldi, Muccioli for their hard work during and following the Bastille Day Attack; Mr. Charles Musoff and Mr. Trevor Griffiths for proofreading; and Prof. Askenazy and Dr. Haas for their scientific support.
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Federico Solla, Joseph Carboni, Arnaud Fernandez, Audrey Dupont, Nathalie Chivoret, Gilles Brézac, Virginie Rampal, Jean Bréaud declare that they have no conflict of interest.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The Institutional Board Review of Nice, France, declared no opposition and no need for formal review because formal consent is not required for retrospective study.
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Informed consent was obtained from all individual participants included in the study and their relatives. All data were anonymized.
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Solla, F., Carboni, J., Fernandez, A. et al. Severe casualties from Bastille Day Attack in Nice, France. Eur J Trauma Emerg Surg 45, 857–864 (2019). https://doi.org/10.1007/s00068-018-0901-3
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DOI: https://doi.org/10.1007/s00068-018-0901-3