The Hartford Consensus: THREAT, A Medical Disaster Preparedness Concept

Abstract

Mass murder through active shooter and explosive events has been at the forefront of our news. Despite improvements in both law enforcement tactics and emergency trauma care, additional integration of the core functions of the public safety response to these events has the potential to maximize survivability. From the mass casualty shooting at Columbine High School in Littleton, CO, through the shootings at SandyHook Elementary School in Newtown, CT, an examination of events will demonstrate some improvement. However, we must continue to hone our response. Perhaps no incident has changed both law enforcement and fire/rescue/emergencymedical services (EMS) response like the Columbine High School shooting. At that time, traditional law enforcement response doctrine dictated waiting for tactical personnel to arrive to secure the school. During this waiting time, some of the fatalities and some of the morbidity among survivors were due to unchecked hemorrhage and shock. Nearly 8 years later, a clear transition in active shooter response was evident on the campus of Virginia Tech University, where the initial response included 2 tactical medics who provided care, predominantly hemorrhage control and airway management, long before the scene was secured. The mass casualty shooting incident at Foot Hood military base resulted in 13 dead and 31 wounded. An officer was able to stop the shooter, but sustained bilateral thigh wounds with significant hemorrhage from the left lower extremity. An Army medic