• Federico Solla, Joseph Carboni, Arnaud Fernandez, Audrey Dupont, Nathalie Chivoret, Gilles Brézac, Virginie Rampal, and Jean Bréaud.
• Pediatric Surgery Department, Lenval University Children's Hospital, 57, Avenue de la Californie, 06200, Nice, France. fedesolla@hotmail.com.
• Eur J Trauma Emerg Surg. 2019 Oct 1; 45 (5): 857-864.

PurposeTo 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).MethodsRetrospective 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, psychological status, and outcome at discharge were collected.ResultsEleven patients presented severe traumas including three adults. They were triaged and managed first by the Critical 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.ConclusionWe 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 clinical 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.

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