Alexander L. Eastman
Lieutenant and Chief Medical Officer, Dallas (TX) Police Department
Special Deputy United States Marshal, US Marshals Service
Senior Medical Advisor, US Department of Homeland Security
Matthew L. Davis
Trauma Director for responses to Fort Hood, Texas active shooter events in 2009 and 2014
BLUF Box (Bottom Line Up Front)
- 1.
Our nation sits at a time of unprecedented threat from active shooter or other intentional mass casualty events.
- 2.
The frequency of active shooter/intentional mass casualty events is rising and is being seen in every region and setting, including hospitals.
- 3.
Military bases and setting have not been immune, and multiple incidents such as the Fort Hood mass shooting events have specifically targeted military bases and personnel and likely will continue to target them.
- 4.
The Hartford Consensus, a series of four documents, has helped take TCCC concepts and apply them to the civilian response to the active shooter.
- 5.
Hemorrhage control is a core law enforcement skill that all LEOs must master and be equipped for.
- 6.
In order for a seamless response, hemorrhage control must be taught to the public on a wide scale. It is the CPR of the twenty-first century.
- 7.
Fire-rescue integration must occur in a standardized way but allow for local variations in practice and operating procedures.
- 8.
Public access hemorrhage control training must be free and available and allows bystanders to be transformed into immediate responders.
- 9.
Hemorrhage control equipment should be prepositioned in large occupancy public spaces across communities, similar to the placement of automated external defibrillators.
- 10.
You must be prepared to respond in an active shooter event. Preparation and practice will prevent you from “freezing up.” Know the THREAT acronym for response to an active shooter (Fig. 40.1).
Fig. 40.1
THREAT acronym outlines the recommended actions/response for an individual in an active shooter event
In Memory of Matthew L. Davis, MD, FACS (1974–2015)
This chapter is dedicated to the memory of its coauthor, Dr. Matthew L. Davis, who was tragically killed in a climbing accident in September, 2015. The editors of this book and many of the authors had the good fortune to know Matt, and we all certainly knew of his incredible dedication to the care of the injured patient throughout his career. As the trauma director at Scott and White Medical Center in Temple, Texas, Matt led that facility’s response to two mass casualty active shooter events that occurred at nearby Fort Hood and that involved primarily military service members. Matt’s calm and professional leadership through both events was recognized locally and nationally and credited with saving a number of lives on those 2 dark days.
Matt was all about learning from these horrible events, getting better at what we do and how we care for trauma victims, and also working to prevent future similar events. He was generous and open with his knowledge, expertise, and experience and unfailingly humble about his leadership role during these events. Matt was also a great family man, father, husband, and close friend to myself and many other authors of this book. We wish that he could be here to see the final product of his contribution to this project, and he is sorely missed by everyone whose life he touched (Fig. 40.2).Courage is being scared to death and saddling up anyway.John Wayne
Fig. 40.2
Seven of the contributing authors of this book, including Matt Davis (center)
Introduction
What at first were seemingly rare events that shocked our national consciousness, a list of recent active shooter incidents or intentional mass casualty events (AS/IMCEs) reads more like a recap of recent second-page stories than a list of extraordinary incidents . It is an unfortunate fact of modern American life that communities, responders, trauma surgeons, and other must not only go about their daily jobs but also must continuously prepare themselves for the active shooter/intentional mass casualty event (AS/IMCE). I have a relatively unique perspective on these types events, as I currently serve as an officer with the Dallas Police Department in addition to being a practicing trauma surgeon. On a personal note, having recently been a responder to an active shooter event in Dallas that resulted in multiple police officer deaths, these lessons are real, poignant, and truly have the potential to improve survival with wide implementation.
The Hartford Consensus
Originally convened in an attempt harness, the power of the Tactical Combat Casualty Care (TCCC) program and formally known as The Joint Committee to Create a National Policy to Enhance Survivability from Intentional Mass Casualty and Active Shooter Events, the Hartford Consensus was originally formed by a partnership between the American College of Surgeons , the Federal Bureau of Investigation, the Major Cities Chiefs Association (Police), and the Committee on Tactical Combat Casualty Care . The HC originally met twice in 2013 and has continued to work on this topic, most recently meeting in Dallas, Texas on January 7–8, 2016. The current membership of the Hartford Consensus is listed in Table 40.1.
Table 40.1
Hartford consensus founding members
Lenworth M. Jacobs, MD, MPH, FACS |
Chair |
David B. Hoyt, MD, FACS |
Executive director, ACS |
Richard Carmona, MD, MPH, FACS |
17th US surgeon general |
Norman McSwain, MD, FACS |
Medical director, PHTLS |
Frank Butler, MD, FAAO, FUHM |
Chairman, Committee on Tactical Combat Casualty Care |
Andrew L. Warshaw, MD, FACS, FRCSEd(Hon) |
Past president, American College of Surgeons |
Jonathan Woodson, MD, FACS |
Assistant secretary of Defense for Health Affairs |
Richard C. Hunt, MD, FACEP |
Director, Medical Preparedness Policy, The White House |
Ernest Mitchell |
Administrator, US Fire Administration |
Alexander L. Eastman, MD, MPH, FACS, DABEMS |
Medical advisor, Major Cities Chiefs Association |
Kathryn Brinsfield, MD, MPH, FACEP |
Chief medical officer, US Department of Homeland Security |
William Fabbri, MD, FACEP |
Director, Emergency Medical Services, FBI
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