The French red plan (plan rouge) is, in France, an emergency plan in case of an important number of causalties in a limited area; its aim is to organize the means of rescue to face this concentration of casualties. It is different to the French white plan (plan blanc), which is designed to face a sudden and unpredicted rise of the activity of an hospital, and to the Orsec plan (plan Orsec), which is designed to face unsufficient means of rescue: in case of a red plan, the means of rescue are sufficient, the difficulty is the coordination.

The white plan is often launched along with the red plan to face the massive arrival of casualties evacuated by the red plan.

The red plan is based on four concepts:

• a rational organization of the means: it is important to avoid that the means hamper each other, and the depletion of the means in case of another emergency situation; this implies an articulation of the different forces (firefighters, samu/emergency medical service, police), and a classification of the actions to perform (hierarchical sorting);
• a double chain of rescue, one focussed on the global management of the site, the other focussed on the care to the casualties;
• the installation of a field hospital (advanced medical post) next to the casualties, to perform triage and stabilization before the evacuation;
• a double command, one onsite that deals with the management of the rescue operations, the other in a remote site (usually the préfecture) that deals with the reinforcement, the logistics...

History

The "plan rouge" was created in 1978 by the fire brigade of Paris (Brigade des sapeurs-pompiers de Paris, BSPP), after explosions during an urban fire (rue Raynouard, Paris 16^e), that made 13 deads and a great number of casualties.

It was then extended to the whole french territory by the 28^th october 1986 the circulaire (ministerial instruction) #86-318 (ministry of Interior/french Home Office).

The name "red plan" referes to the traditional color of the french firefighters, and to the color of danger (blood/fire).

The red plan is defined by each département and thus can slightly vary from a dépertement to the other, but all the red plans are very similar.

When is the plan rouge started?

The red plan is started in case of a disaster with limited consequences (accident catastrophique à effet limité, acel), when there are — or when there might be — numerous casualties. This plan is started by the préfet of the département (or, in case of Paris and its surburbs, by the préfet de police of Paris).

These situations are various:

• fire of great intensity with immediate risks for the population
• building collapse
• road accident, train accident , or airplane accident
• criminal act (collective agression by firearm, explosives, hostage-taking , terrorist attack...)
• industrial injury
• natural disaster

The preriquisite for a plan rouge is a great number of casualties. This estimation can vary from département to département. In Paris, the following rules apply:

the situation involves a field hospital, and at least 15 person must be evacuated to a hospital.

The notion of "number of casualties" is different depending on the situation, and is evaluated from the initial assessment (the red plan must be started quickly, i.e. before all the casualties are numbered):

• for a fire, the number of casualties in the initial assessment is multiplied by 2: i.e. when 6 to 8 casualties are numbered when the rescue arrive, there are usually about 15 casualties numbered at the end of the operation;.
• for a terrorsit bombing, the multiplication factor is 3, sometimes 4 or 5;
• for the other accidents, amongst which the public transport accident, the factor is 3 to 4.

In some specific situations, the risks (risk of explosion, of intoxication etc.), or the organization constraints can lead to a red plan although there are only few casualties..

General concept

In case of a red plan, it is necessary to simultaneously:

• fight the initial disaster and its direct and indirect consequencies;
• extract the casualties from the hostile environment;
• take care of the casualties.

Due to the complexity of these three missions, two command chains are implemented, under the authority of the "commander of the rescue operations (COS: commandant des opérations de secours) : the fire-and-rescue chain, and the medical chain:

• the fire-and-rescue chain has the charge to fight the initial disaster; the rescuers are entirely devoted to this task, and participate to the search and rescue, locating the casualties, extraction/extrication of the casualties and possibly perform first aid onsite ;
• the medical chain has three fonctions:
  • the first aid onsite, casualty lifting (scoop) and movement from the disaster location to the field hodpital (called "advanced medical post", or PMA: poste médical avancé);
  • triage and conditionning the casualties for the evacuation;
  • the evacuation of the casualties to adapted care structures (hospitals).

Distribution of the responsibilities

The préfet of the département (or the préfet de police for Paris and its suburbs) is the director of rescue operations (DOS: directeur des opérations de secours). He starts the red plan; usually, the red plan is started by the firefighter or medical dispatch and then officialized by the préfet.

The chief officer of the local fire and rescue department (SDIS: service départemental d'incendie et de secours ) is the "commander of the rescue operations" (COS: commandant des opérations de secours). He is assisted by the "director of fire and rescue" (DSIS: directeur des secours incendie et sauvetage), and by the "director of medical rescue" (DSM: directeur des secours médicaux). The DSM is usually the chief-physician of the firefighters or the director of samu (french EMS).

The main means are the firefighters and Samu, but other organism can contribute such as the first aid associations (e.g. french Red Cross, volunteers of the civil protection/FNCP), who can contribute for the non-medical evacuations or to deal with the relative emergencies, light wounded people and logistic for psychological aid (CUMP: cellule d'urgence médico-psuchologique).

The operational command

The commander of rescue operation (COS) coordinates the rescue means onsite (public, private or associations). He must be easily spotted and has thus a yellow chasuble-like jacket on his cloths, with the inscription "Commandant les Opérations de Secours". He has an operational head-quarter (PCO: poste de commandement opérationnel) near the site of the disaster. The OHQ has communication means with all the means and the various administratrions implied, including the police.

The director of fire and rescue (DSIS)

The director of fire and rescue (DSIS) is a firefighter officer. He manages:

• the fighting against the initial disaster;
• the search-and-rescue operations;
• in the beginning, the scoop operations, before the medical chain is fully operational (increas of the means)

He has a yellow chasulbe-like jacket with the inscription Directeur des Secours Incendie et Sauvetage.

The director of medical rescue (DSM)

The director of medical rescue (DSM) manages the medical chain described below.

He has a yellow chasulbe-like jacket with the inscription Directeur des Secours Médicaux.

The medical chain

The medical chain is organized in three parts. The personal attributed to each part are identified by a colour armband: red-white-blue. These are the colours of the french flag, and are also the symbol of:

• red: danger zone;
• white: medical zone;
• blue: secured zone (away from the disaster site).

The scoop

The scoop is the following of the extraction/extrication operations. It is under the responsibility of a firefighter officer. The casualties are transported to the advanced medical post (field hospital).

THis officer has a red chasuble-like jacket with the inscription "Directeur des Secours Médicaux", and the personal have a red armband.

This part is also called "scoop noria" (noria de ramassage) or "small noria".

The advanced medical post (PMA)

The casualties are agthered at the advanced medical post (PMA), managed by a physician chosen by the director of medical rescue (DSM). He has to manage:

• the care to the casualties;
• the triage;
• to search for a destination (hospital) adapted to the different affections (medical regulation ).

He has under his order:

• a firefighter officer (officier PMA) chosen by the commander of rescue operations (COS): he deals with the organization and logistics of the PMA
• first responders, paramedical (nurses, ambulance men) and medical staff
• a secretaryship made of firefighters, who deal with:
  • the establishment of the list of casualties;
  • filling the identification forms (FMA: fiches médicales de l'avant);
  • transmitting the list of casualties to the operational head-quarter (PCO).

In urban environment, the advanced medical post (PMA) is often placed in a public location (bar, restaurant, hall of sports…). In wilderness or on a road away from any building, it is an inflatable structure.

The advanced medical post (PMA) is organized in three zones corresponding to the triage:

• Absolute emergencies zone (UA: urgences absolues): prehospital ressuscitation unit for very serious cases : extreme emergencies (EU: extrème urgence) and grave injuries (U1);
• Relative emergencies zone (UR: urgences relatives): for the serious (U2) and light injured (U3)
• Mortuary zone (dépot mortuaire) for the deceased casualties. This zone is under the responsibility of the judicial police.

Two additional zones can be created, besides the advanced medical (PMA) post but under the responsibility of the director of medical rescue (DSM):

• a gathering zone for non-inhured people, managed by volunteer (non-professional, association) first aiders
• a zone for the psychological support under the responsibility of physicians and psychatrists (CUMP).

The chief physician of the advanced medical post has a white chasuble-like jacket with the inscription "Médecin PMA"; the firefighter officer has a white chasuble-like jacket with the inscription "PMA". The other staff memners have a white armband.

The evacuation

The mission of the evacuation part is to gather and manage the evacuation vectors, according to the needs expressed by the chief physician of the PMA. This area is managed by a firefighter officer. The vectors can be firefighter rescue vehicles, private ambulance societies, vehicles from an association, helicopters, etc. The staff take cares that the instruction given by the chief physician are obeyed.

The officer of this zone has a blue chasuble-like jacket with the inscription "évacuation", and the staff members have a blue armband.

This part is also called "evacuation noria" (noria d'évacuation) or "great noria".