Vol.:(0123456789) 1 3 European Journal of Trauma and Emergency Surgery https://doi.org/10.1007/s00068-018-0901-3 ORIGINAL ARTICLE Severe casualties from Bastille Day Attack in Nice, France Federico Solla 1  · Joseph Carboni 1,2  · Arnaud Fernandez 2,3  · Audrey Dupont 4  · Nathalie Chivoret 1  · Gilles Brézac 5  · Virginie Rampal 1  · Jean Bréaud 1,2 Received: 9 October 2017 / Accepted: 2 January 2018 © Springer-Verlag GmbH Germany, part of Springer Nature 2018 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, psychologi- cal status, and outcome at discharge were collected. Results Eleven patients presented severe traumas including three adults. They were triaged and managed first by the Criti- cal 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 clini- cal 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. Keywords Terror attack · Mass casualty incident · Children · Trauma · Pediatric hospital Introduction On July 14th, 2016 (Bastille Day), a terror attack by a lorry against the crowd occurred in Nice (France) at 10.33 p.m. [1] near to Lenval University Children’s Hospital (LUCH), which is a level 1 trauma center for children with a surgery department including five operating rooms. Pediatric sur- geons of each specialty (general, urologic, ENT, trauma- orthopedic and neurological) and operating room nurses are on call at home after 8 p.m. Due to its position close to the scene, LUCH received both adult and child casualties prior to any pre-hospital medical management [2, 3]. Once Mass Casualties Incident (MCI) was confirmed by unofficial sources, the disaster plan was triggered, recalling staff and releasing beds. Ten minutes later, four severe casu- alties arrived without pre-hospital management and were * Federico Solla fedesolla@hotmail.com 1 Pediatric Surgery Department, Lenval University Children’s Hospital, 57, Avenue de la Californie, 06200 Nice, France 2 Medical School, University of Nice, 28 Avenue de Valombrose, 06107 Nice, France 3 Child Psychiatry, Lenval University Children’s Hospital, 06200 Nice, France 4 Pediatric Intensive Care Unit, Lenval University Children’s Hospital, 06200 Nice, France 5 Pediatric Anesthesiology, Lenval University Children’s Hospital, 06200 Nice, France