Acute Care Surgery in Context of Terrorist Attack: Which Organization Should be Proposed? Report of the 2019 French Association of Surgery Congress

Terrorist attack evolve with years, and recently appeared mass casualty’s terrorist attacks.
Surgery also evolves, with new technics, new approaches, development of mini-invasive surgery, and specialization of surgeons inside a specialty. With reform of post-graduate fellowship, specialization occurs very early and there is no longer a place for general surgery fellowship.
The subject of 2019 French Association of Surgeons (AFC, for Association Française de Chirurgie) national meeting was original, talking about surgery in context of terrorist attack. The report allowed us to analyse, via a questionnaire, experience of French surgeons in the area of mass casualties, and if no experience, their confidence to perform some procedures if they were facing this kind of situation
Results of this report show a certain heterogeneity in the learning, the experience and in the feeling in case of mass casualties. These results highlight a need for theoretical learning and practical training in trauma surgery, in any area, including digestive and extra digestive surgery. These results conduct to propose improvement targets, as learning, training, and organization of trauma care.
In the area of learning, we know that mass casualty events and hyper-specialization of surgeons are contradictory. Learning and training of surgeons must be considered by health authorities. Some additional courses exist already (university degree, DSTC, ASSET, military courses). In the context of reform of to post-graduate reform with hyper specialization of surgeons, health authorities called for the creation of a transversal specialized course dedicated to war and disaster surgery.
In the area of organization of trauma care, situation in France lags behind other countries, in particular Anglo-Saxon countries. Since the 1970’s these countries established “trauma systems” including network of trauma centers, regional and national trauma registries and guidelines. By standardization of learning and training and by improvement of efficiency of trauma centers and networks, these trauma systems led to improvement of management of trauma care, of research and knowledge in trauma care, and of overall survival and quality of life of injured.
Two meetings were organized in November 2017, then in December 2018. These meetings aimed to:
1.Establish networks of trauma centers and registries;
2.Structure surgical and radiological practices;
3.Structure learning and training in trauma care.
These meetings were attended by delegates of different societies involved in trauma care, and led to creation of a workgroup, named GITE (groupe d’intérêt pour la traumatologie grave).
Certain proposals were put forward in these meetings:
-Overview of trauma systems at a regional then national level, with deliverance of degrees of different levels to the trauma centers;
-The establishment of guidelines at prehospital level, intensive care, surgical and radiological level;
-The establishment of a national trauma registry, leading to utilization of epidemiologic data, in order to facilitate prevention, research and learning.
Finally, results of the survey of the 2019 national meeting of the French Association of Surgeons must alert about the preparation of surgeons to terrorist attack management. This preparation includes different learning and training courses in trauma surgery, and by establishment of trauma systems, involving many care providers among which surgeons are significant.