Experience of the Terrorist Attacks in Brussels and the Management of the Wounded and War Wounds

Summary: On March 22, 2016, the capital of Europe was hit by two terrorist attacks. As terrorism becomes more and more violent, we must learn and share our experiences to enhance our effectiveness in saving lives. The first attack hit the departure hall of the airport, which, due to its strategic role, relies upon a dedicated emergency plan. However, it focuses on airplane crashes and not on explosions in a crowded terminal. The second attack hit the subway at rush hour. An attack in such a confined environment is particularly challenging for the rescue teams as injuries are worsened, access is hindered, and numerous exits. Eleven medical teams were sent to perform triage and provide vital care. Two disaster response teams organized the medical response. Advanced Medical Posts were set up, and the mass casualty plan of all hospitals was activated. Managing war injuries for civilian teams was challenging. On-site care consisted essentially of prehospital damage control and burn care to ensure rapid evacuations for hemostatic surgery. 313 victims were dispatched to thirty hospitals. Another challenge was safety. Several threats were brought, and explosives were found on both sites. Lessons from Paris prompted a review of our multiple-site emergency plan. One single way of communication was used, and the evacuations were managed centrally. Finally, the key factor that helped limit the number of casualties was the acquaintanceship between emergency workers and non-medical teams built during exercises, allowing them to adapt and blend in as one team. Lessons from previous attacks were crucial to improving our management of the medical response. These should be shared widely, as another attack may always occur anywhere and at any time.