Soon after terrorist attacks that led to 130 deaths and wounded more than 350 others Nov. 13 in Paris, the city activated its Plan Blanc strategy, a coordinated response to mass casualty. It was a calculated effort that was largely facilitated by the mostly municipal governance of its hospitals.
Within an hour of the attacks, hospitals in Paris called in their staffs, which remained on-site for about 26 hours. Doctors and nurses canceled a planned strike. They and other hospital workers began mobilizing beds, readying operating rooms, checking levels in blood banks and preparing to triage victims. Plan Blanc called for a deviation from the protocol to treat patients as much as possible at the scene.
The plan echoes some of the main tenets followed by U.S. providers in similar situations: efficiency and coordination. France, a country roughly the size of the state of Texas, organizes hospital response plans on a local level but within a national frame. Each region's Plan Blanc fits within the Orsan plan, a nationalized strategy to prepare for mass casualty events such as natural disasters, public health emergencies, or, twice this year, acts of terrorism.
The U.S. government provides a number of federal resources and frameworks for hospitals to consult when preparing for terrorist attacks and other disasters. But much more planning is done at state and local levels as compared to France. One major reason is that ownership of the U.S. health system is significantly different: More than 60% of French hospitals are government-run, while only 17% of American hospitals are owned by state or local governments.