Changes in Trauma Care Spurred by Frequent Mass Shootings

Changes in Trauma Care Spurred by Frequent Mass Shootings

News Oct 03, 2017

Oct. 03—When it comes to saving the life of a gunshot victim, it's all about stopping the blood loss.

Amid the horrific images from the mass shooting Sunday in Las Vegas, that may sound like a fairly obvious statement. But just in the last few years, findings from other mass shootings and from the battlefield have changed the delivery of medicine, physicians say.

Trauma researchers now recommend that emergency medical providers be brought to the scene as soon as possible—even before the threat is fully neutralized—as every additional minute of blood loss can worsen a patient's chances. Police officers are encouraged to "scoop and run," transporting trauma victims to the hospital in the back of their cruisers to minimize the loss of blood—a longtime practice in Philadelphia that is now catching on elsewhere. And tourniquets have been placed in schools, malls, and other public places, with civilians starting to get training in how to use them.

These changes stem from research showing that blood loss, while not the most common cause of death from trauma, is the most preventable, said Penn Medicine trauma surgeon Jeremy W. Cannon.

Researchers now commonly study the outcomes of past mass shootings to determine which lives might have been spared with faster action, as uncontrolled bleeding can lead to death within five to 10 minutes, he said.

"We are operating under the assumption that there must be some individuals that have potentially survivable injuries that in times past were not saved," said Cannon, who served with the Air Force in Iraq and Afghanistan. "You have to have a sense of urgency from the very beginning."

A year ago at Lincoln Financial Field, Penn trained more than 250 school nurses in the use of tourniquets, which are tightened around an injured limb to stem blood loss. In New Jersey, Cooper University Health Care has distributed the belt-like devices to police departments and schools, and it offers free classes in how to use them.

These efforts are part of a national "Stop the Bleed" campaign, at sponsored by the American College of Surgeons. The initiative was largely spurred by the findings of Hartford Hospital trauma surgeon Lenworth Jacobs after the 2012 Sandy Hook Elementary School shooting, in Newtown, Conn.

Improving survival from gunshots is not just about those precious minutes before reaching the hospital, said John M. Porter, chief of trauma at Cooper.

Years ago, trauma surgeons would try to repair all the damage from gunshot wounds in one grueling, marathon session. Now, they fix the most grievous injuries and save the rest for another day, he said, so as not to overtax the victim's already perilous condition.

Continue Reading

"Fix the main things that are going to kill the person and then stabilize them," said Porter, a former Army trauma surgeon.

But what to do when the numbers of wounded are overwhelming, such as with the hundreds injured in Las Vegas? Porter said he never saw anything on that scale during his 19 years in the reserves, which included duty in the Middle East.

The greater Philadelphia area is well-supplied with trauma centers, but in many parts of the country, a mass casualty would quickly lead to shortages of ambulances, blood, and operating rooms, he said.

Even with aggressive focus on blood loss and continued improvements in surgical techniques, the toll from gunshots and other trauma remains greater than most people realize, said Penn's Cannon. According to the U.S. Centers for Disease Control and Prevention, firearm-related deaths accounted for more than 36,000 deaths in the U.S. in 2015.

Heart disease and cancer get top billing in this country as leading causes of death, but those are diseases that strike older people. Trauma, which occurs more often in younger patients, overwhelmingly accounts for the most years of life lost, Cannon said.

Every year, an estimated 5.4 million years of life are lost due to early death from trauma, compared with 3.2 million to heart disease and 4.4 million to cancer, he said.

"These are young, vital people," he said of trauma victims, "that have their whole lives in front of them that are now not with us anymore."

The two companies have partnered to market the system that notifies hospitals of incoming critical patients in real time.
Bloomington Fire Department's improved response times have led dispatchers to call for the closest fire truck to respond to EMS calls if ambulances are unavailable, significantly increasing overtime labor costs.
Researchers concluded that ambulance usage has dropped at least 7 percent since Uber and other ride-booking services have emerged.
The Thomas Fire has spread across 238,500 acres, but firefighters have been able to contain 30% of the flames and some evacuation orders have been lifted.
Residents at retirement facilities will partner with St. Charles County Ambulance District Paramedics to ensure that pantry shelves in their community are fully stocked for those in need.
Epps has coordinated many facility and operations improvement projects that have helped improve quality, production flow, profitability and corporate communication.
Lexi Sima was 16 when she survived sudden cardiac arrest because of bystanders' CPR and use of an AED, leading her family to advocate for CPR education.
MassBay Community College's nursing, EMT, and paramedic students participated in a mock disaster drill modeled after nursing home fatalities that occurred during Hurricane Irma.
Springfield firefighters are training for intermediate to paramedic-level certificates to improve patient outcomes, learning techniques like the pit crew method.
First responders were commended for saving the lives of several heart attack victims, emphasizing the need for civilians to also know how to perform CPR and use an AED.
Aztec residents collected over 100 thank you cards for the emergency personnel and high school staff who quickly responded to the shooting that left two students dead.
The new fire station would have housed another ambulance, two more firefighters, and be able to fit modern fire trucks to fit the needs of the growing town.
For the first time since 1995, Starkville Fire Department hired a female firefighter, Bethany Allen, who is working on completing her fire academy and EMT training.
To better understand and treat the patients they revive with Narcan, firefighter-EMTs received training on opioid abuse and recovery
The collaboration supports rural healthcare providers with the goal of improving patient outcomes in Kansas through the Redivus mobile clinical decision app.