For almost a year, trauma surgeons, federal law enforcement personnel, and emergency responders have led an effort aimed at increasing the number of survivors of active shooter or mass-casualty incidents. An important part of this initiative calls for all law enforcement officers to be trained and equipped to control bleeding, a goal set forth by the Hartford Consensus, a collaborative group comprising leaders from the American College of Surgeons (ACS), the Federal Bureau of Investigation (FBI), the Major Cities Chiefs Association (MCCA), and the Prehospital Trauma Life Support program.
The principle of more training and equipment is central to the findings of the Hartford Consensus, according to “The Hartford Consensus: THREAT, A Medical Disaster Preparedness Concept,” an article published in the March issue of the Journal of the American College of Surgeons (JACS). A companion piece, originally published in the September 2013 Bulletin, “Joint Committee to Create a National Policy to Enhance Survivability from Mass-Casualty Shooting Events: Hartford Consensus II,” calls for a broad educational strategy and a robust evaluation of the implementation of THREAT in order to quantify its benefits in the management of active shooter and mass-casualty events. THREAT is an acronym for the needed response to mass shooting events developed by the Hartford Consensus: T–Threat suppression, H–Hemorrhage control, RE–Rapid Extrication to safety, A–Assessment by medical providers, and T–Transport to definitive care.
Driving the recommendations of the Hartford Consensus is the fact that victims of active shooter and mass-casualty events often bleed to death before medically trained emergency responders can reach the scene. Law enforcement officers are typically the first to arrive at the scene of such an incident, but they lack the medical training and equipment to treat the victims. Filling that need has become one of the central calls to action of the Hartford Consensus, which is led by the ACS Committee on Trauma and builds on guidelines developed by the U.S. military to advance battlefield trauma care.
“Controlling hemorrhage has to be a core law enforcement tactic,” said Alexander Eastman, MD, MPH, FACS, chief of trauma at the University of Texas (UT) Southwestern/Parkland Memorial Hospital, Dallas, and a Dallas Police Department Lieutenant. “We saw the dramatic impact of this tactic in the Tucson, AZ, shooting in 2011. With training and tourniquets, law enforcement officers will save lives—many lives.”
The Hartford Consensus is already having an impact. In concert with ACS and the MCCA, more than 36,000 police officers in Los Angeles, CA; Philadelphia, PA; Houston, TX; Phoenix, AZ; Dallas; New Orleans, LA; Tampa, FL; and Washington, DC, will receive bleeding control kits and training this year. The Hartford Consensus also urges cities to develop an integrated response system customized to the needs of their community and focused on the importance of initial actions to control hemorrhage.
“We can no longer wait until casualties are brought out to the perimeter,” said ACS Regent Lenworth M. Jacobs, MD, MPH, FACS, vice-president of academic affairs and chief academic officer and director, Trauma Institute at Hartford Hospital, CT. “We must prepare responders to safely intervene, control bleeding, and save lives.”
Another recommendation of the Hartford Consensus is to educate and equip the public to respond to the needs of victims. However, activating that type of response effort means that tourniquets and other equipment need to be broadly available in schools, offices, shopping centers, churches, and other public places.
“Just as automatic external defibrillators are easily usable and quickly available to the public, so should easily applied tourniquets be available in a similar manner and locations,” said Norman McSwain, Jr., MD, FACS, medical director, pre-hospital trauma life support, Tulane University School of Medicine, New Orleans. “It’s not a complicated process, and it will save lives.”
“We need to expand the pool of first responders,” added Michael F. Rotondo, MD, FACS, Chair, ACS Committee on Trauma. “With proper training, under the right circumstances anyone can act as a rescuer.”