The night of January 1 descended into horror in Crans-Montana. A fire, probably accidental, trapped dozens of young people gathered in a bar in the Swiss resort. The human toll is heavy, 40 dead and 115 injured, one of the most serious that Switzerland has seen in recent decades. How, in the face of a disaster of this magnitude, is relief organized to save as many lives as possible?
A race against time from the first minutes
Dr. Gérald Kierzek, emergency physician, reminds us: when a large-scale tragedy occurs, every minute counts. As soon as the alert is received, a very structured chain is put in place. Firefighters, medical emergency services and security forces are engaged simultaneously. In Switzerland, Centrale 144 coordinates medical emergencies, while SMUR-type teams intervene on the ground, like what exists in France with the SAMU.
On site, a clear command is quickly imposed. The Rescue Operations Commander secures the area, fights the fire and prevents any further accidents. At the same time, a Medical Emergency Director organizes the health response: location of victims, evacuation circuits, distribution of teams.
“The objective is simple but vital: to avoid chaos and transform the emergency into coordinated collective action”.
Triage and priorities: saving those who can be saved
On the ground, first responders have a decisive role. Their mission is not only to provide treatment, but to assess the extent of the tragedy in order to trigger the necessary reinforcements. Very quickly, sorting is carried out according to internationally recognized color codes.
This sorting makes it possible to distinguish between victims in immediate vital distress, those requiring urgent but deferred care, the more lightly injured and the deceased. This step, sometimes difficult to understand for the general public, is essential: it allows resources to be concentrated on the victims who can be saved thanks to rapid stabilization actions.
In mountain resorts, such as Crans-Montana, the difficulty is increased. Weather conditions, nighttime, isolation and extended evacuation times further complicate the rescue task.
The advanced medical post, the heart of care
Near the disaster, but outside any dangerous zone, an Advanced Medical Post (PMA) is installed. This is where disaster medicine is organized. The medical teams provide structured first aid: airway clearance, ventilation, hemorrhage control, pain treatment, immobilization, vascular filling, sometimes damage control procedures.
Triage is refined in order to direct each injured person to the establishment best suited to their pathology: intensive care, neurosurgery, pediatrics or, as in the case of this fire, services specialized in the treatment of severe burns. The closest hospitals often receive the first victims, before organizing secondary transfers to more specialized centers.
Hospitals switch to exceptional mode
While emergency services are working on the ground, hospitals are anticipating the influx of injured people. Exceptional plans are triggered to immediately increase reception capacities. Freed beds, recalled staff, reinforced operating theaters and intensive care units: everything is done to absorb the shock.
Specific channels are set up for severe trauma, burns and psychotrauma, without completely interrupting the care of other patients. It’s a balancing act, where every resource counts.
Identifying victims: a major challenge
Beyond the medical emergency, the identification of victims is one of the most delicate aspects during a large-scale tragedy. In theory, tools exist to ensure their traceability. In France, the SI-VIC (Victim Monitoring Information System) makes it possible to identify and monitor the injured from the field, from the sorting carried out by the emergency services until their admission to hospital, particularly during the ORSEC-NOVI systems. Identification bracelets and sorting sheets facilitate this monitoring and help anticipate the influx of patients into health establishments.
“But on the ground, the reality is often more chaotic. Faced with the vital emergency, the seriousness of the injuries and the panic, the priority remains saving lives”. Victims are sometimes evacuated without identity, unconscious or without papers, subsequently complicating their census and informing families. An additional difficulty which illustrates the complexity of disaster management.
When European solidarity becomes essential
Faced with such a heavy toll, local and national capacities may be overwhelmed. This is where international solidarity comes into play. Switzerland was able to rely on European support via a mechanism little known to the general public, allowing any country to request coordinated aid when the situation requires it.
Mass medical evacuations are then organized to other regions or countries. They are carried out by helicopter or by ground medical means, with continuous resuscitation support during transport. Specialized teams are pre-mobilized, available places identified in suitable departments, particularly for severe burn victims.
In the case of Crans-Montana, this anticipation made it possible to prepare transfers to French and European hospitals with the necessary technical platforms, illustrating essential cross-border cooperation when the emergency crosses borders. “Switzerland has requested the reception of eight additional wounded in France. Their reception is in preparation”the Quai d’Orsay announced today. “We have reserved 15 adult beds and four pediatric beds in French hospitals so the capacity is there.”
An invisible but vital organization
Behind each figure, each victim, lies an extremely rigorous organization, often invisible to the public. As Dr Gérald Kierzek points out, these devices do not eliminate the tragedy, but they help prevent it from being even more deadly. In these moments of chaos, coordination, anticipation and solidarity, local, national and European, become the best weapons to save lives.