DIAGRAM No. 1 Victims’ pathway (simplified diagram) 1. Circular relative to the national doctrine concerning the use of emergency and medical care resources in the event of a terrorist attack involving radioactive materials. IN PRACTICE What are the action priorities in emergencies involving a large number of victims? In situations with large numbers of victims, the civil security and urgent medical aid response is organised on the site of the event in order to treat as many victims as possible. The on-site response organisation is governed by Interministerial Circular No. 800/SGDSN/PSE/PPS of 18 February 20111. It is divided into three separate zones: an exclusion zone, a controlled zone and a support zone. The victims must be prioritised by triage. • Front-end triage, before going to the Victim Assembly Area for Chemical, Radiological and Nuclear risks (VAA CRN). If many people are involved, triage is vital in order to rapidly assess the condition of each victim and determine decontamination and initial treatment priorities. An Advanced Medical Post (AMP) may be set up, depending on the severity, the number of victims and the scaling of the emergency response services. • Organisation of victim transfers: the medical regulation by the Emergency Medical Assistance Service (SAMU) organises the transfers to the healthcare facilities capable of continuing the resuscitation strategy initiated in the field (1st line healthcare facilities, and notably the Regional Reference Hospital for the RN risk (RRH RN), or even the National Reference Hospital (NRH RN). Only the casualties identified as EU are evacuated to a 1st line healthcare facility without full decontamination, subject to the approval of the SAMU and the receiving facility. SEE SHEET 18 Once the victims are in a safe place, the appropriate treatments must be provided at each stage of the care process: symptomatic treatments, (assisting a vital function, complementary therapies, etc.), specific treatments (chelating agents). Provide appropriate treatment as quickly as possible 5 + - - - - - - + Victims in Extreme Urgency condition MEDICAL AND RADIOLOGICAL TRIAGE RECEPTION CENTRE FOR UNINJURED PERSONS (RCUP) HEALTHCARE FACILITIES VICTIM ASSEMBLY AREA (VAA) DECONTAMINATION LINE Event ADVANCED MEDICAL POST (AMP) 1 2 3 EVACUATION Exclusion zone (contaminated zone) Controlled zone (triage, stabilisation, decontamination) Support zone (clean zone) Non-contaminated victims Contaminated victims MEDICAL RESPONSE STRATEGY Action priorities along the response pathway SHEET 03 MEDICAL RESPONSE IN NUCLEAR OR RADIOLOGICAL EMERGENCY 17
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