Planning for Injuries from an Active Shooter Emergency - Part Two
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September 26, 2019
By Lisa Limper, MS, CSCS, ATC and Scott Lee, MS, CSCS, FF/P
In this series, we take a closer at what Athletic Trainers (ATs) need to know to be prepared for an active shooter emergency in schools. In part two, we take a closer look at treating injuries sustained from an active shooter event.
Uncontrolled bleeding is a major cause of preventable deaths. According to N. Curry, S. Hopewell, C. Doree, C. Hyde, K. Brohi and S. Stanworth in “The acute management of trauma hemorrhage: a systematic review of randomized controlled trials” published in Critical Care in 2011, approximately 40 percent of trauma-related deaths are due to bleeding, making it the most common cause of preventable death in trauma. A person who is bleeding can die from blood loss within five minutes.
No matter how quickly paramedics and police arrive on the scene of an active shooter emergency, it is likely that ATs and school staff will be the first on scene to rapidly respond to injury. Those nearest to the traumatic injuries are best positioned to provide the first care.
One resource for education on uncontrolled bleeding training comes from The American College of Surgeons bleeding control program, also known as the “Stop the Bleed Course.” This is an hour long, free program designed to teach the public the fundamentals of how to recognize and intervene upon severe bleeding. It was created after the tragic shooting at Sandy Hook Elementary School and is intended to encourage the general public to become trained, equipped and empowered to help in a bleeding emergency before paramedics or the police arrive.
The Fundamentals of the Stop the Bleed Course
Either call 911 yourself or have someone else call. Ensure your own safety before attending to a victim. If at any time the scene becomes unsafe, remove yourself and the victim, if possible, from danger and find a safe location. Protect yourself from blood-borne pathogens by wearing gloves, if available. Look for life-threatening bleeding, such as loss of all or part of a limb, blood that is spurting out of a wound or pooling on the ground or clothing, or bandages that are soaked with blood. The key point in treatment for severe bleeding is to compress the damaged blood vessel in order to stop the bleeding.
Open or cut the clothing over the bleeding wound. Wipe away any pooled blood. Stuff or pack the wound with bleeding control/hemostatic gauze (preferred), plain gauze, clean cloth, or as a last resort, with any available cloth, even if it is not clean. Apply steady pressure with both hands directly on top of the bleeding wound, pushing down as hard as you can. Continue to hold pressure until relieved by medical responders.
Wrap the tourniquet around the bleeding arm or leg about two to three inches above the bleeding site (DO NOT place the tourniquet over a joint – place it above the joint). Pull the free end of the tourniquet to make it as tight as possible and secure the free end. Twist the windlass until bleeding stops, then secure the windlass to keep the tourniquet tight. Write the time the tourniquet was applied on the tourniquet or on the patient’s skin with a Sharpie marker. Note that when a tourniquet is applied correctly, it will be painful, but it is necessary to secure it very tightly to stop life-threatening bleeding.
Programs available to the public are useful information, but not eligible for Athletic Trainers to maintain their certification. If you would like to take a course to prepare yourself to assist injured people following a traumatic event, you can look for classes in the following places:
- The Department of Homeland Security
- Bleeding Control
- First Care Provider
- Contact your local public health department, hospitals, emergency medical services, or fire and police departments to see if they offer these or similar trainings
Trauma and Emergency Response Kits
According to Scott Lee, a 20-year veteran paramedic and firefighter in Tennessee, when preparing a trauma or response kit for an active shooter situation, there are a few things to consider:
- Whether there will there be enough supplies.
- The logistics of getting the supplies to where they are needed.
- The ease of use of the supplies.
The normal AT response bag for a sporting event may not be adequate for an active shooter emergency, and depending on the number of victims, it may be taxed very quickly. One approach, besides having multiple conventional AT bags, is making multiple single use bags from gallon-size zip lock bags filled with trauma supplies. Once stocked, many of these bags can be placed in a tote and stored in a known and marked location (such as a concession stand or press box) and are readily deployed. The multiple bag system works well for a number of reasons. Once the tote gets carried to the scene, the individual kits can be grabbed several at a time because they are small and lightweight. The kits can also be easily handed out to lay people to use, thus getting more help to even more people. The smaller or portable kits also keep others from fighting over one bag when trying to retrieve supplies.
Suggested List of Supplies for Individual Gallon Bag Kits
The below list and quantities are simply a recommendation and can be modified based on the size of the bags and the budget allotted for the kits but should be adequate to stabilize wounds and get the patient to a triage area.
- 10-20 4x4 gauze pads or abdominal pads
- Two to four rolls of roller gauze - elastic wraps
- Three triangular Bandages (also can be used as a tourniquet)
- Arm board\splint
- Trauma shears
- Laminated emergency action plan and map of facilities
- Permanent marker
After stabilizing the patient, if they can safely be moved, move them to a triage area and away from the active shooter zone. This would be a designated safe place that the first responders can arrive to and start triaging the patients for transport to the hospital. In this area, it is best to have one person designated to talk to the first responders so they don’t get bombarded with information from several people at once, which will only delay the triage and transport of patients.
Curry N, Hopewell S, Doree C, Hyde C, Brohi K, Stanworth S. The acute management of trauma hemorrhage: a systematic review of randomized controlled trials. Critical Care. 2011;15(2):R92.
Tourniquet instructions are from the Bleeding Control - Save a Life booklet. You may download the free booklet from https://www.bleedingcontrol.org/resources/how-to-stop-the-bleed
Pons PT and Jacobs L. Save a life: What everyone should know to stop bleeding after an injury. Chicago, IL: American College of Surgeons; 2016.