This part of the Mass Attacks Defense Chain refers to the steps that bystanders, police, firefighters, EMS, and other people can take to mitigate injuries and loss of life. The medical response to the scene might happen in tandem with other parts of the Mass Attacks Defense Chain (e.g., law enforcement response); medical response can also happen through a partnership among police, fire, and EMS agencies.
Firefighters, EMS, police, venue management and security, and hospitals must work together in the planning of, preparation for, and response to incidents of mass violence. Our interviewees highlighted the following:
- There is a lack of mass violence treatment training for emergency room physicians.
- Where EMS are separate from fire agencies, EMS need to be an equal partner in planning, preparation, and response.
- Having "go bags" for responders containing tactical medical response supplies and placed in strategic places in high-risk locations (or deployed with responders) is valuable.
- Having strong relationships and communication with major private-sector partners (where these incidents might occur) can facilitate an effective medical response.
Beyond interagency planning and coordination, our experts highlighted the importance of
- the Stop the Bleed initiative in educating both practitioners and bystanders about using pressure and, if necessary, tourniquets to save lives by stopping the bleeding from wounds (Stop the Bleed, undated)
- the work of the Committee for Tactical Emergency Casualty Care in determining guidance for treatment for mass casualty events, ranging from what active bystanders can do to advanced life support personnel (Committee for Tactical Emergency Casualty Care, undated a)
- recent changes in guidance on triage for mass casualty events from the U.S. Department of Health and Human Services (HHS) (HHS, Office of the Assistant Secretary for Preparedness and Response [ASPR], Technical Resources, Assistance Center, and Information Exchange, 2019). Key points include the following:
- Standard triage needs to be expanded to include assessing for truncal-penetrating wounds and other life threats.
- Stable (yellow) patients need to be regularly checked because the initial assessment might have missed life-threatening injuries, and seemingly stable patients can deteriorate quickly.
- The focus should be on getting patients to medical facilities quickly rather than conducting on-scene formal triage.
- Patient distribution is key: Critical patients must be distributed to trauma centers, which implies that other patients might need to be sent outside of trauma centers.