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EMS World Expo Quick Take: Preventable death during civilian public mass shootings


Nov 1, 2018

By Nicole M. Volpi, PhDc, NREMTB




The short answer is yes. Through evidence-based research, there is new information that suggests there are some deaths during a mass casualty that are preventable. Sarani sums up the current research findings about civilian public mass shootings:

  • Most deaths are instant – brain, torso. Case fatality ratio is 45-60 percent.

  • Banning assault weapons will not impact most deaths.

  • Tourniquets have less of a role than anticipated in preventing fatality.

  • All causes of preventable death should be addressed, not just bleeding (i.e., chest injury, airway).

  • Rapid extrication of victims may represent a better strategy overall and needs to be studied.

  • We need to engage/teach lay-citizens how to help."

Full Article HERE

Fatal Wounding Pattern and Causes of Potentially Preventable Death Following the Pulse Night Club Shooting Event.


November, 2018

Smith ERShapiro GSarani B.

Excerpt: "to obtain a goal of zero preventable deaths, the medical care must not be focused on only one cause of death, but instead should involve strategies to address all, including rapid control of external hemorrhage, simple airway maintenance, strategies to address chest/torso injury, hypothermia prevention, and rapid extrication of the wounded. "

Full Article HERE

Department of Homeland Security: 

1 October After-Action Report (Las Vegas)



Department of Homeland Security Digital Library

"Officers agreed that it would have been useful for them to have access to more robust medical kits or supplies to carry on them, since they were unable to retrieve and use the ones in their cars. Acquiring medical supplies proved to be a challenge for responding officers and special events medical personnel. Ambulances that arrived on the scene were overrun due to a desperate need for additional supplies. Responders had to improvise tourniquets, stretchers, and ways to move patients."

Full Article HERE

Tourniquets overemphasized in mass shooting response planning

February 4, 2016

By M. Alexander Otto 

MDedge News

Excerpt: “Wounding in active-shooter events differs from combat and may require different therapeutic emphasis. Although tourniquets and external hemorrhage control techniques hold value, their role in active-shooter events may be overemphasized as a means to decrease fatality. The focus on external hemorrhage is important, but it’s not enough,” Dr. Smith said."

Full Article HERE

Public use of tourniquets, bleeding control kits

May 31, 2016

By Kenny Navarro

Excerpt: "With untrained bystanders as part of the definition of a first responder, the Office of Health Affairs at the Department of Homeland Security recommends the availability of both tourniquets and hemostatic agents in the early management of severe bleeding [7]. Lay rescuers play a vital role in providing immediate bleeding control while awaiting the arrival of traditional first responders [29]."

Full Article HERE

Practical Use of Emergency Tourniquets to Stop Bleeding in Major Limb Trauma


John F. Kragh, Jr., MD, Thomas J. Walters, PhD, David G. Baer, PhD, Charles J. Fox, MD, Charles E. Wade, PhD, Jose Salinas, PhD, and COL John B. Holcomb, MC

Conclusions: "Morbidity risk was low, and there was a positive risk benefit ratio in light of the survival benefit. No limbs were lost because of tourniquet use, and tourniquet duration was not associated with increased morbidity. Education for early military tourniquet use should continue."

Full Article HERE



January 21, 2014

Eileen M. Bulger, MD, FACS, David Snyder, PhD, Karen Schoelles, MD, FACP, Cathy Gotschall, ScD, Drew Dawson, BA, Eddy Lang, MD, CM CCFP (EM) CSPQ, Nels D. Sanddal, PhD, NREMT, Frank K. Butler, MD, FAAO, FUHM, Mary Fallat, MD, FACS, Peter Taillac, MD, Lynn White, MS, CCRP, Jeffrey P. Salomone, MD, FACS, NREMT-P, William Seifarth, MS, NREMT-P, Michael J. Betzner, MD, FRCPC, Jay Johannigman, MD, FACS, Norman McSwain, Jr., MD, FACS, NREMT-P

Excerpt: "The panel believes that tourniquets used to treat severe extremity hemorrhage have a clear survival benefit, demonstrated by a large and consistent effect size across several studies. The panel discussed that direct pressure may be ineffective in the setting of major arterial injury or impractical in circumstances with limited manpower, unsecure scene, or when complex extrication or extraction is required."

Full Article HERE

The profile of wounding in civilian public mass shooting fatalities.


July, 2018

By Smith ER1, Shapiro GSarani B.

 Excerpt: "The overall and fatal wounding patterns following CPMS are different from those resulting from combat operations. Given that no deaths were due to extremity hemorrhage, a treatment strategy that goes beyond use of tourniquets is needed to rescue the few victims with potentially survivable injuries."

Full Article HERE

Mortality from Isolated Civilian Penetrating Extremity 


July, 2005

The Journal of Trauma: Injury, Infection, and Critical Care

By Dorlac, W C. MD; DeBakey, M E.; Holcomb, J B. MD; Fagan, S P. MD; Kwong, K L. MD; Dorlac, G R. MD; Schreiber, M A. MD; Persse, D E. MD; Moore, F A. MD; Mattox, K L. MD

Excerpt: "Although rare, death from isolated extremity injuries does occur in the civilian population. The majority of injuries that lead to immediate death are proximal injuries of the lower extremities. The cause of death in this series appears to have been exsanguination, although definitive etiology cannot be discerned. Intravenous access was not obtainable in the majority of patients. Eight patients (57%) had bleeding from a site that anatomically might have been amenable to tourniquet control."

Full Article HERE

Stretch and Wrap Style Tourniquet Effectiveness With Minimal Training


Military Medicine, 2012

By Piper L. Wall, DVM, PhD*; John D. Welander, MD*; Amarpreet Singh, BA†; Richard A. Sidwell, MD*; Charisse M. Buising, PhD†

Excerpt: "Despite the ease of application, specific training on stretch and wrap techniques is desirable to achieve high rates of proper application stretch. Considering its effectiveness when properly applied, ease of use, small size, light weight, and low cost, this tourniquet might prove useful in its intended arenas of care (tactical, limited supplies, or possibly first responder casualty care) with adequate user training."

Full Article HERE

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