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Mass Shootings Trigger Change for Emergency Medicine - Emergency responders rethink what it takes to

In the aftermath of Wednesday's mass shooting at a Florida high school, the emergency medicine community is once again thinking about how to improve disaster preparedness as it waits for more details to be made available on how peers responded to the tragedy that left 17 dead.

That's not to say that medical professionals failed in Broward County: a semiautomatic AR-15 assault rifle causes "a crazy amount of damage in a human body," said Michael Redlener, MD, of Mount Sinai St. Luke's and Roosevelt Hospitals in New York City.

Still, in the past decade, the emergency medicine community has been working to overhaul responses in order to keep up with the tide of mass shootings. Notably, the American College of Surgeons and government groups created the Hartford Consensus after the 2012 shooting at Sandy Hook Elementary School in Newtown, Conn., and its recommendations for responding to an active shooter event remain the national standard.

"All of us have revised approaches to supply distribution, triage, and patient distribution over the past 2 years because of lessons learned from active shooter incidents that are fast-moving critical incidents," said A.J. Heightman, MPA, EMT-P, editor of the Journal of Emergency Medical Services.

Now bystanders are also getting involved by taking care of the wounded and, in fact, not waiting for EMS to transport critically wounded individuals, doing it themselves in their own personal vehicles, Heightman told MedPage Today.

Moreover, a new appreciation of how unique deadly bleeding can be -- realised just within the last 7 years, according to Redlener -- is making bleeding a main priority for EMS and changing how civilian responders are encouraged to help in an emergency.

Launched in 2015, the Stop the Bleed national awareness program is the emergency community's answer to teaching bystanders how to take the first steps to saving someone's life. Civilians are called on to assess the scene of an emergency, move injured victims to safety, and perform actions that limit heavy bleeding.

"It is important for communities to consider how to enable bystanders to safely assist victims with life-threatening bleeding, in much the same way as we enable them to assist cardiac arrest victims needing CPR," commented Alexander Isakov, MD, MPH, of Emory University School of Medicine in Atlanta.

"The value and importance of ensuring that as many people as possible know how to care for patients in the immediate moments following a critical injury cannot be stressed enough. The ability to quickly deliver lifesaving care does not just pertain to the aftermath of horrific tragedies, such as intentional mass casualty events. It is also crucial to survival following incidents of everyday trauma, such as workplace mishaps and motor vehicle crashes. This is about enhancing resilience," according to Matthew Levy, DO, of Johns Hopkins University School of Medicine in Baltimore.

Levy co-wrote an editorial in 2016 highlighting the importance of bleeding control kits for civilian use.

"There is an increasing body of scientific knowledge in the emergency medicine literature that suggests that in cases of mass trauma, the local availability of bleeding-control supplies can improve survivorship," agreed Robert Emery, MSPH, MSEH, DrPH, of the University of Texas Health Science Centre at Houston.

He noted that students and staff there collaborated on a project to create Stop the Bleed kits for placement alongside automated external defibrillators. The kits include tourniquets, gauze, and surgical tape, gloves, and other necessities (including instructions), and are meant to transform a bystander into a first responder.

The last few years have also taught that earlier alerting of nearby hospitals is crucial in the face of mass violence.

Redlener said that coordination before victims arrive at the hospital among EMS, police, bystanders, and hospital operations is key. Thanks to modern tools, communication can be enhanced and people triaged and taken to the operating room or ICU more quickly.

Ultimately, "I believe the biggest change in EMS has been the loss of 'it can't happen here' to 'let's be ready when it happens,'" said Corey Slovis, MD, of Vanderbilt University Medical Centre in Nashville, TN. "EMS leaders have worked within almost every system to ensure that each of us is ready.

"And yes, we in Nashville are getting all of our EMS providers equipped with ballistic vests and helmets -- something that not that many years ago, would have seemed unnecessary and overly dramatic."

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