What is it like to work in a hospital when your city is being terrorized by gunmen and suicide bombers?

The team of doctors who treated the wounded victims of the November 13 Paris attacks answer that question in The Lancet today.

Paris's public hospital system had been bracing for a terrorist attack since January, when gunmen massacred the staff at the Paris-based political satire journal Charlie Hebdo.

The Paris doctors said they'd developed a plan for how to respond to an influx of gunshot victims and, in an eerie coincidence, had been simulating that response on the morning of the November 13 attacks. "In the evening, when the same doctors were confronted with this situation in reality, some of them believed it was another simulation exercise," they wrote.

After the three explosions in the capital and shootings at four sites, more than 300 patients flooded into 10 hospitals across the system. But actually getting patients into the hospitals wasn't easy:

"During long periods of shooting, the streets surrounding the attacks remained difficult and dangerous for emergency intervention teams. Seriously injured hostages in the hands of terrorists or obstructed by fire could not be evacuated."

Of the 302 patients who turned up, two were dead on arrival, and two later died in hospital. (More than 130 people died in the attacks.) Most of the patients were under the age of 40, the doctors note.



Thirty-five surgical teams had to operate through the night to meet the unprecedented demand:

"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 doctors say that planning and professionalism helped them get through the night, but that solidarity made the extremely challenging work "harmonious."



They finish their piece warning that this attack is probably only the beginning for the medical community: