French civilian surgical expertise still inadequately prepared for mass civilian casualties three years after major terror attacks in Paris (2015) and Nice (2016).

BACKGROUND Three years after the terror attacks in Paris and Nice, this study aims to determine the level of interest, the technical skills and level of surgical activity in exsanguinating trauma care for a non-selected population of practising French surgeons. METHODS A questionnaire was sent between July and December 2017 to French students and practising surgeons, using the French Surgical Colleges' mailing lists. Items analysed included education, training, interest and clinical activity in trauma care and damage control surgery (DCS). RESULTS 622 questionnaires were analysed and was composed of 318 (51%) certificated surgeons, of whom 56% worked in university teaching hospitals and 47% in level 1 Trauma Centres (TC1); 44% were digestive surgeons and 7% were military surgeons. The mean score of 'interest in trauma care' was 8/10. Factors associated with a higher score were being a resident doctor (p=0.01), a digestive surgeon (p=0.0013), in the military (p=1,71 x10) and working in TC1 (p=0.034). The mean 'DCS techniques knowledge' score was 6.2/10 and factors significantly associated with a higher score were being a digestive surgeon (respectively p=0.0007 and p=0.001) and in the military (respectively p=1.74 x10 and p=3.94 x10). Reported clinical activity in trauma and DCS were low. Additional continuing surgical education courses in trauma were completed by 23% of surgeons. CONCLUSIONS French surgeons surveyed showed considerable interest in trauma care and treatment. Despite this, and regardless of surgical speciality, their theoretical and practical knowledge of necessary DCS skills remain inadequate. LEVEL OF EVIDENCE Level III STUDY TYPE: Survey.