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Doctors recount treating casualties of Paris terror attacks

While terror ripped through the streets of Paris on November 13 as extremists opened fire and set off explosions at several sites throughout the capital, the city's hospitals activated an emergency response plan to treat the victims.

The attacks left 130 people dead and more than 300 injured. As of today, French Health Minister Marisol Touraine said 161 people injured in the attacks remain hospitalized, including 26 in intensive care.

The toll could have been even worse, but emergency physicians and hospital workers were prepared to handle the crisis, a group of doctors from the Assistance Publique-Hôpitaux de Paris (AP-HP) wrote in a paper released today.

In fact, of the 302 people who were rushed to hospitals that night, all but four survived.

Dr. Rémy Nizard, the head of Orthopaedic Surgery and Traumatology Service of the Hospital Lariboisière, a branch of the AP-HP, where victims were rushed to after the attack, co-wrote the report published in The Lancet.

He said that having a plan in place was vital to successfully managing patients. But also credits his colleagues' work ethic and drive to help people with much of their ability to control the situation.

"All the staff had a common goal so it was easy to manage everyone around this goal," he told CBS News. "It was so important for each of us to be a part of this history to help people. That's the core business of doctors and nurses. We like to save people and we were in the position to save people and we were so comfortable with that that we just did what the system needed."

The paper describes how medical teams across Paris operated continuously throughout the night to care for the most seriously injured.

As the attacks unfolded, several barriers existed to getting victims the treatment they so desperately needed. During long periods of shooting, many streets surrounding the attacks were blocked or dangerous for emergency teams to navigate. Seriously injured hostages in the Bataclan concert hall could not be evacuated.

The emergency protocol known as the "White Plan" -- which was developed 20 years ago and had never been used in such circumstances -- called for the mobilization of all hospitals, staff backup and the releasing of beds to cope with a large influx of wounded people.

Forty-five medical teams and the fire brigade were divided between the sites of the attacks and 15 more were on standby. "We did not know how and when this nightmare would end," the doctors wrote.

Gunshot wounds were the most common injuries. The need for tourniquets to stop bleeding was so dire, many mobile teams came back without their belts.

"Although emergency physicians have been receiving training in disaster medicine for more than 30 years, never before had such a number of victims been reached and so many wounded been operated on urgently. A new threshold has been crossed," the authors wrote.

To prevent overcrowding emergency rooms, healthcare workers conducted triage at hospital entrances.

"By the middle of the night, more than 35 surgical teams had operated on the most serious injuries," the report said. The doctors reported that even though the attacks were unlike anything seen before, at no time during the emergency did hospitals run short on personnel or supplies.

Over 30 psychiatrists were also on hand and had contact with all patients during this early period to assess their mental health and begin the follow-up for potential post-traumatic stress disorder.

"It was such a huge trauma for every one of us," Nizard said. "Our network of hospitals has many psychologists and psychiatrists and we considered that a central part to take care of the patients."

During the week after the attacks, Nizard said doctors and nurses met regularly to discuss their own emotional state. "This gives them the opportunity to express any difficulties. And it provides an important social network that allows people to go through together this important problem."

The hospital network is also making mental health professionals available to all doctors and nurses if needed.

In a strange twist of irony, earlier that same morning emergency medical physicians had participated in a training exercise with the fire brigade simulating the organization of emergency teams in the event of a multiple shooting in Paris. That night, when the same doctors were faced with the situation in reality, some at first believed it was another drill.

The authors said lessons learned from how other emergencies were handled, including attacks in Israel, Spain, England, and the U.S. -- as well as the experience of the Charlie Hebdo attacks in Paris earlier this year -- were essential to improving the disaster response.

However, they acknowledge that more improvement is still needed. Had the attacks happened during the day, when doctors and hospital staff were already at their busiest, the response might have been more difficult.

"Unfortunately, the current situation requires us to be prepared to face even more difficult situations in the future," they wrote.

While the doctors said that it is too early to determine what lessons can be learned from this event, the emergency protocols will continue to evolve.

"We already know that as terrorism becomes more lethal and violent, nothing will prevent the medical community from understanding, learning, and sharing knowledge to become more effective in saving lives," they wrote.

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