Article (pre-submission/pre-publication): Early Medical Response in Active-Shooter Incidents. A Systematic Review of After-Action Reports
Guests:
* Dr. Dominique Wong is an attending physician the Cabell Huntington Hospital Emergency Department and chair of the hospital’s Medical Readiness Committee. She also serves as a tactical physician and medical director for police SWAT and Tactical EMS teams, trains law enforcement officers and the US military, and serves in leadership roles with the American College of Emergency Physicians, Tactical and Law Enforcement Medicine Section.
* Dr. Clay Young is a board certified emergency physician with over 25 years of clinical experience. As a former director of a flight service he has demonstrated leadership in pre-hospital emergency medicine. Dr. Young is committed to advancing public safety through the education and training of law enforcement personnel in life saving interventions and active shooter medical response. He is a graduate of the University of Kentucky college of medicine, a father of four, and an active hiker and fly fisherman.
* Dr. Beth Toppins is an emergency medicine physician practicing in her hometown of Huntington, West Virginia. A graduate of Marshall University School of Medicine, she has served as an Emergency Department physician at Cabell Huntington Hospital since 2003 and currently serves as the Emergency Department Medical Director. She previously held leadership roles in regional EMS and has worked alongside Drs. Wong and Young to provide medical training to law enforcement across West Virginia. Outside the hospital, Beth is a proud mother of four and wife to Eric, and the children’s pastor at Christ Temple Church in Huntington, where she is an active member.
Abstract:
* Background: Timely medical response can improve survivability in active shooter incidents (ASI). This systematic review evaluates law enforcement, emergency medical services (EMS), rescue task force (RTF) and tactical emergency medical support (TEMS) medical response in ASI.
* Methods: After-action reports (AARs) from U.S. ASI (1999–2022) were retrospectively reviewed. Point of injury (POI) medical response time for police, EMS, RTF, and TEMS was reviewed. Medical response type provided by law enforcement was also examined
* Results: Thirty-one AARs representing 19 ASI were analyzed. Police provided medical response in every case, most commonly (84%) casualty extrication. In 21% of incidents, law enforcement provided the full spectrum of response: direct care, extrication and transportation to a hospital. RTF victim access was frequently delayed and in 43% of incidents, RTF providers never reached casualties at the POI. TEMS medical response times varied. Barricade hostage situations delayed all medical responders.
* Conclusion: Police consistently provided early medical care in ASIs, while EMS, RTF and TEMS faced challenges accessing ASI casualties in a timely manner. These findings suggest law enforcement officers play a critical role in early medical response and may help reduce preventable deaths in AS incidents.
My additional points on this topic:
School shooting victims who could be saved with rapid transport to a hospital have died inside their schools because EMS crews are directed to wait outside until police issue an ‘all clear’ order. To address this long-standing problem, many agencies created combined EMS/police ‘rescue task force’ units or tactical EMS units with body armor to go inside and find victims…but these units take ~30 minutes to arrive and assemble. At this point, critically wounded students and teachers are already dead.
In October 2022, a teacher and student were shot with an AR-15 rifle inside CVPA High in St. Louis. They were still alive when police killed the shooter, yet EMS waited outside for 20 minutes until police gave the all clear. Teacher Jean Kuczka and 15-year-old student Alexzandria Bell both died waiting for help inside.
With military-style rifles being used by most school shooters, a school campus is like a battlefield where “the majority of combat casualties die within ten minutes of the trauma” (PubMed: Wounded in action: The platinum ten minutes and the golden hour). Instead of unnecessarily cautious policies that protect adult EMS providers against theoretical (and often imagined) dangers, we need to shift the status quo to accepting managed risks to save the lives of innocent children with critical gunshot injuries.
Here are two of my articles about this problem:
* When ‘Eddie Would Go’ so should police, fire, and EMS
* Wounded victims can die when plans are based on the ‘second shooter’ fallacy
David Riedman, PhD is the creator of the K-12 School Shooting Database, Chief Data Officer at a global risk management firm, and a tenure-track professor. Listen to my weekly podcast—Back to School Shootings—or my recent interviews on Freakonomics Radio and the New England Journal of Medicine.
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