Faster Medical Response During Mass Casualty Attacks Can Save Lives

Dec 11, 2013

Federal officials and medical experts say when medical personnel respond more aggressively during mass casualty events, it can save lives. The Obama administration is formally recommending that emergency medical personnel be sent into so-called “warm zones” during mass attacks to try and prevent death by controlling victims’ early bleeding.

"You don’t want the medical response team to be in line of sight of a shooter."
Dr. Lenworth Jacobs

These new guidelines are based on discussions between medical experts, law enforcement, fire and rescue, and the military that took place in Hartford earlier this year -- "Improving Survival from Active Shooter Events: The Hartford Consensus." Dr. Lenworth Jacobs, director of the Trauma Institute at Hartford Hospital, led the conversation. 

Jacobs said these types of attacks fall into two categories. One is an active shooter which has somebody who is creating harm and mayhem. The other is an intentional mass casualty event, which could be an explosion.

An example of the first would be Sandy Hook. An example of the second would be the Boston Marathon. Classically, they're usually finished in 15 minutes. The response has to be very quick at any time of day or night, and be fully coordinated.

WNPR's Diane Orson spoke with Dr. Jacobs.

Diane Orson: So what has been the protocol, and what are you recommending change?

Dr. Lenworth Jacobs: Classically, the law enforcement services want to secure the scene, which is appropriate, because if there is an active shooter, you don’t want the next person to be harmed or killed by this person. One of the problems is that can take a long time. That means if there is somebody who is injured, the first person in there has to identify: is somebody is bleeding?, and stop the bleeding. This is not small bleeding. This is massive bleeding to death, and is usually secured by a tourniquet, or something of that nature. That needs to be done right now. If your mission is really to secure the shooter and not pay attention to people who are injured, then that delays the time for care.

On what basis are you making these recommendations?

The military, over the last two wars in Iraq and Afghanistan, has totally changed their concepts to having a buddy system, where each soldier carries a tourniquet and a hemostatic dressing. They’re expected -- if a soldier/colleague is injured -- to immediately address their bleeding, which is different than the civilian sector, which would be really suppressing the shooter first. So these things have been done simultaneously in the military, and the results are very significant. The mortality from severe bleeding dropped from 7.2 percent to 2.8 percent.

Do you have concerns about the safety of these first responders?

Absolutely. That’s why you really want to be sure that the first responding team, which is to say the law enforcement or police services, are very sensitive to making sure that it is safe. You don’t want the medical response team to be in line of sight of a shooter. So you want to be behind a wall or somewhere, but in a "warm zone," not in a "hot zone." You definitely want to be as close as possible, and get to care as quickly as possible.

I think the real key to it is: since these events, whether they’re explosions or shootings, happen usually in a public place, the purpose of it is to terrorize people. They will happen, and the public will be there. So the public needs to have a very clear understanding of what the expectation is.

For instance, in Boston, the public responded phenomenally well, with makeshift torniquets. It could be a [neck]tie; it could be shirt sleeve; it could have been a belt; but those things actually saved lives. And they probably just had common sense. We need to take those principles, and educate the public.