[The urologist confronted with a mass killing].

Area of Science:

• Trauma Surgery
• Urological Surgery
• Emergency Medicine

Background:

• The 2015 Paris attacks highlighted the French hospital system's need to manage mass casualties with severe injuries, particularly hemorrhagic shock.
• Casualties often self-direct to the nearest facility, regardless of its suitability for mass casualty incidents.
• Unpredictable terrorist attacks necessitate that all surgeons, including urologists, prepare for mass casualty response.

Purpose of the Study:

• To outline the role and responsibilities of urologists in managing mass casualties with hemorrhagic injuries.
• To describe the principles of damage control (DC) surgery, focusing on damage control laparotomy and genitourinary lesion management.

Main Methods:

• A systematic literature review was performed.
• Databases searched included PubMed, Embase, and Google Scholar.
• The review covered literature published between January 2000 and June 2021.

Main Results:

• Urologists can apply damage control principles at all stages of mass casualty management, beyond a coordinator role.
• Damage control laparotomy principles are detailed, including strategies for managing associated genitourinary injuries.
• Visceral surgical expertise enables urologists to contribute significantly to damage control efforts.

Conclusions:

• Urologists must be knowledgeable in damage control principles, regardless of their specific role (e.g., sorter, organizer, technician).
• Damage control laparotomy (Stage 1) emphasizes speed and hemostasis/urostasis for patient stabilization, deferring primary reconstruction.
• Definitive surgical management (Stage 3) is planned for after the initial stabilization period (Stage 2).