Mass Shootings in America: Consensus Recommendations for Healthcare Response.

BACKGROUND: In 2021, 702 people died in mass shooting incidents (MSIs) in the US. To define the best healthcare response to MSIs, the Uniformed Services University's National Center for Disaster Medicine and Public Health hosted a consensus conference of emergency medical services (EMS) clinicians, emergency medicine (EM) physicians, and surgeons who provided medical response to six of the nation's largest recent mass shootings. STUDY DESIGN: The study consisted of a 3-round modified Delphi process. A planning committee selected 6 MSI sites with the following criteria: the MSI occurred in 2016 or later, and must have resulted in at least 15 people killed and injured. The MSI sites were Orlando, FL, Las Vegas, NV, Sutherland Springs, TX, Parkland, FL, El Paso, TX, and Dayton, OH. Fifteen clinicians participated in the conference. All participants had EMS, EM, or surgery expertise and responded to 1 of the 6 MSIs. The first round consisted of a 2-part survey. The second and third rounds consisted of site-specific presentations followed by specialty-specific discussion groups to generate consensus recommendations. RESULTS: The 3 specialty-specific groups created 8 consensus recommendations in common. These 8 recommendations addressed readiness training, public education, triage, communication, patient tracking, medical records, family reunification, and mental health services for responders. There were an additional 11 recommendations created in common between 2 subgroups, either EMS and EM (2), EM and surgery (7), or EMS and surgery (2). CONCLUSIONS: There are multiple common recommendations identified by EMS, EM, and surgery clinicians who responded to recent MSIs. Clinicians, emergency planners, and others involved in preparing and executing a response to a future mass shooting event may benefit from considering these consensus lessons learned.

From the battlefield to main street: Tourniquet acceptance, use, and translation from the military to civilian settings.

Throughout history, battlefield medicine has led to advancements in civilian trauma care. In the most recent conflicts of Operation Enduring Freedom in Afghanistan/Operation Iraqi Freedom, one of the most important advances is increasing use of point-of-injury hemorrhage control with tourniquets. Tourniquets are gradually gaining acceptance in the civilian medical world-in both the prehospital setting and trauma centers. An analysis of Emergency Medical Services (EMS) data shows an increase of prehospital tourniquet utilization from 0 to nearly 4,000 between 2008 and 2016. Additionally, bystander educational campaigns such as the Stop the Bleed program is expanding, now with over 125,000 trained on tourniquet placement. Because the medical community and the population at large has broader acceptance and training on the use of tourniquets, there is greater potential for saving lives from preventable hemorrhagic deaths.

Building community resilience: A scalable model for hemorrhage-control training at a mass gathering site, using the RE-AIM framework.

BACKGROUND: In a decade, the US military reduced deaths from uncontrolled bleeding on the battlefield by 67%. This success, coupled with an increased incidence of mass shootings in the US, has led to multiple initiatives intent on translating hemorrhage-control readiness to the civilian sector. However, the best method to achieve widespread population-level hemorrhage-control readiness for civilians has not yet been elucidated. This study evaluates the implementation of American College of Surgeons Bleeding Control training at a National Football League stadium as a prospective model for general mass gathering site implementation. METHODS: The American College of Surgeons' Bleeding Control Basic layperson hemorrhage-control training was implemented at Gillette Stadium in Massachusetts. The five domains are as follows: reach (demographics of study participants), effectiveness (correct tourniquet application after intervention), adoption (investigator, leadership, and participant efforts for sustainability of intervention), implementation (course details), and maintenance (correct tourniquet application at retention testing at 3 to 9 months). RESULTS: A total of 562 employees were included in the study. Of those included employees, 58.7% reported having taken first-aid training and 17.3% reported having taken hemorrhage-control training. There was an increased mean likelihood to help (4.39 vs 4.09, P < .01) and comfort level to control hemorrhage (4.26 vs 3.60, P < .01) after training compared with before training, on a Likert scale (1-5). The stadium operations team located hemorrhage control kits with automatic external defibrillators, integrated layperson immediate-response awareness into its Web site, and developed a public safety announcement. The training, performed by physicians, nurses, and emergency medical technicians, consisted of a 30-minute lecture and a 30-minute hands-on skills-training course, with a class size of 24. The total number of sessions was 24. CONCLUSION: Achieving initial hemorrhage-control readiness and maintenance at a mass gathering site through American College of Surgeons Bleeding Control training is feasible but requires significant commitment from training staff, site leadership, and financial resources.

A Retrospective Review of Screening Labs for Medical Clearance in a Military Population.

STUDY OBJECTIVE: We determine the incidence of clinically significant findings within mandatory screening studies during medical clearance of patients for psychiatric care. METHODS: This is a retrospective review of emergency department patients medically cleared for psychiatric care over 11 months. All patients evaluated for behavioral health-related issues are recorded on a daily report which was used to locate subjects. Laboratory studies were reviewed during that visit for the presence of abnormalities. If abnormalities were noted, the individual chart was reviewed. Our primary outcome was the incidence of clinically significant findings that warranted admission to a medical or surgical unit. RESULTS: 204 psychiatric patient reports were reviewed. 191 of these patients had screening studies performed. Seven patients were admitted to a nonpsychiatric unit. These admissions were all for elevated ethanol levels. These patients were admitted until their ethanol level decreased, and then transferred to a psychiatric facility. The total screening lab cost during this study period was $27,893. CONCLUSIONS: Routine screening has limited utility in this population and comes at significant cost. Further research should be directed to determine which patients may benefit from screening studies.