Le 13 octobre 2023, un attentat terroriste survient dans la cité scolaire Gambetta à Arras, exposant environ 2 000 personnes, majoritairement des adolescents, à une effraction traumatique majeure. Dès les premières heures, la cellule d’urgence médico-psychologique (CUMP) met en place un poste d’urgence médico-psychologique (PUMP). Cependant, une proportion importante des impliqués ne bénéficie pas d’évaluation ni d’orientation initiale, soulevant la nécessité d’un dispositif complémentaire. Un Guichet Unique Santé (GUS) est créé en novembre 2023, financé par l’Agence régionale de santé (ARS) Hauts-de-France, afin d’assurer la prise en soin médico-psychologique des élèves et personnels. Initialement centré sur des consultations, le dispositif évolue rapidement vers une organisation multimodale et multiniveau combinant : consultations spécialisées, interventions mobiles médico-psychologiques, actions de psychoéducation, dépistages systématiques à cinq et quatorze mois, formation graduée des professionnels en trois niveaux (sentinelles, évaluateurs, soignants spécialisés) et accompagnement institutionnel (commémorations, communication). Ce modèle global s’inspire de la stratégie nationale de prévention du suicide, transposée au champ du psychotraumatisme, et repose sur cinq axes : accessibilité universelle, repérage et suivi proactif, soutien institutionnel, maillage des ressources et communication. Le GUS a permis de prévenir la désorganisation des services de soins de droit commun, de structurer une réponse coordonnée et de réduire le risque de chronicisation des troubles psychotraumatiques. Cette expérience constitue un modèle de prise en soin post-immédiate dans un contexte d’attentat scolaire, susceptible d’être répliqué dans d’autres situations de psychotraumatisme institutionnel.

On October 13, 2023, a terrorist attack occurred within the Gambetta school complex in Arras, France, resulting in the death of a teacher and injuries to three others. Approximately 2,000 individuals — mainly adolescents — were present at the time of the attack and were exposed directly or indirectly to the traumatic event. The school-based setting, the prolonged lockdown situation, the uncertainty regarding the persistence of the threat, and the rapid dissemination of violent images through media and social networks contributed to a major traumatic breach at both individual and institutional levels. In the immediate aftermath, the Emergency Medical-Psychological Unit (Cellule d’Urgence Médico-Psychologique, CUMP) of the Pas-de-Calais, reinforced by the neighboring department, intervened promptly and established a Psychological Emergency Unit (Poste d’Urgence Médico-Psychologique, PUMP) within the school premises for seven days. As per its mandate, the CUMP provided early psychological care, assessment, and orientation during the post-immediate phase. However, a significant proportion of those involved were not assessed during this period, highlighting the limits of post-immediate emergency interventions in a large, predominantly adolescent, institution-based population. Several contextual factors contributed to this gap: many students and staff did not return immediately to the school in the days following the attack due to primary needs for safety, proximity to relatives, and protection, while teaching activities resumed only gradually. In addition, the CUMP framework does not include systematic, proactive, or long-term institutional follow-up. These elements underscored the need for a complementary, structured, and proactive system dedicated to medium-term psychological care.

This article describes the conception, implementation, and outcomes of an innovative post-immediate care system — the Health Single Access Point (Guichet Unique Santé, GUS) — designed to ensure coordinated, proactive, and multimodal psychological care following a school-based terrorist attack. The aim is to present a transferable model for managing institutional psychotrauma beyond the emergency phase.

The GUS was launched in November 2023 with funding from the Regional Health Agency (ARS) Hauts-de-France and integrated into the CUMP organizational framework. Initially designed as a consultation-based service, it provided centralized access to psychological care for students and staff through telephone triage and specialized psychotrauma consultations delivered within the local branch of the Regional Psychotrauma Center (CRP). Due to limited spontaneous engagement — particularly among adolescents — the system was restructured in January 2024 into a proactive, multimodal, and multilevel intervention. This evolution was based on the recognition that adolescents face specific barriers to care-seeking, including developmental factors, self-sufficiency biases, and stigma. The restructured GUS combined several complementary components: 1. Mobile medical-psychological interventions conducted on-site by binomial teams (psychologist and psychiatrist or psychiatric nurse), aimed at informal clinical assessment, psychoeducation, early identification of distress, and facilitated referral to care. 2. Psychoeducational sessions delivered in all classes at 5 and 14 months post-attack, addressing trauma-related symptoms, coping strategies, risk behaviors, and available resources. 3. Systematic screening for post-traumatic stress disorder (PTSD) using validated self-report scales (CRIES for middle school students and PCL-5 for high school and higher education students), followed by proactive parental contact and clinical orientation when indicated. 4. Individual consultations for assessment, guidance, or specialized treatment within the GUS or referral to external services. 5. A three-level training program inspired by the national suicide prevention strategy, involving: (a) Level 1: Sentinels (school assistants) trained in identification and referral; (b) Level 2: Evaluators (school physicians, nurses, psychologists) trained in clinical assessment; (c) Level 3: Specialized mental health professionals trained in evidence-based PTSD treatments. 6. Institutional support , including coordination with victim assistance services, regular interprofessional meetings, and structured accompaniment of commemorative processes. 7. Communication and prevention strategies , including the development of an audio psychoeducational resource disseminated through the school's digital platform.

Between November 2023 and November 2024, 126 individuals accessed the GUS, resulting in 737 consultations. Among those followed, 39% met diagnostic criteria for PTSD. Mobile interventions were conducted throughout the school year, totaling 24 sessions and more than 200 informal clinical encounters. Psychoeducational sessions reached all 70 classes (n = 1,672 students). At 5 months post-attack, systematic screening identified PTSD-positive scores in 28.9% of middle school students and 3.3% of high school students. Proactive follow-up calls to families led to 18 specialized care orientations. At 14 months, a second screening identified 4.6% of students with positive scores, including delayed or reactivated PTSD symptoms, leading to nine additional care referrals. In parallel, 105 professionals were trained across the three levels of prevention, strengthening local capacity for identification, assessment, and treatment of psychotrauma. During the first anniversary of the attack, a coordinated institutional support and monitoring system was implemented, including an on-site reception unit and intensified mobile interventions, allowing timely orientation of individuals experiencing symptom reactivation.

The GUS model builds on two complementary bodies of expertise: the long-standing experience of CUMP teams in crisis intervention and disaster response, and the operational principles of the French national suicide prevention strategy. Both fields emphasize the central role of crisis, proactive outreach, continuity of care, and coordinated multi-actor responses. By transposing a public health–oriented prevention framework to psychotrauma, the GUS addressed not only individual clinical needs but also collective and institutional dimensions, including containment, meaning-making, and prevention of secondary traumatization or symptom chronicity. While the effectiveness of the system requires further quantitative evaluation, qualitative feedback from professionals and institutional indicators — such as rapid resumption of school functioning and absenteeism comparable to previous years — support its perceived relevance and acceptability.

The Health Single Access Point represents an original and structured response to the post-immediate phase of a school-based terrorist attack. By integrating clinical care, proactive screening, professional training, and institutional support within a coordinated framework, it enabled a controlled transition from emergency response to routine care. This model may serve as a replicable framework for managing institutional psychotrauma in similar contexts and could be reactivated during subsequent critical periods, such as judicial proceedings. Further research is needed to assess its long-term impact on mental health outcomes.