8/20/2018 WHY ARE WE HERE? WHEN CAN I USE THIS?

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Franklin Stevenson
5 years ago
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Trauma Services Bleeding is the leading cause of preventable death after injury In an

there are multiple casualties EMS services may be overwhelmed In an active shooter event,

RECENT EVENTS NATIONWIDE AND LOCAL In 2018 alone there have been 17 school shootings where

High School Spokane WA 1 dead Sept 2017 First Baptist Church Sutherland Springs Texas 27

Lounge nightclub Little Rock AR 28 hurt July 2017 Bronx Lebanon Hospital Center San

Nightclub Orlando FL 49 dead 53 wounded Social Services Center San Bernardino CA Umpqua

Marathon bombing BOSTON MARATHON BOMBING HARTFORD CONSENSUS CONFERENCES Widespread use of

occluding venous return Recent publication from Boston suggested improvised tourniquets did

1 WHY ARE WE HERE? WELCOME! STOP THE BLEED TRAINING PROVIDENCE SACRED HEART MEDICAL CENTER Sacred Heart Medical Center Trauma Services Bleeding is the leading cause of preventable death after injury In an emergency someone can bleed to death before help arrives (as little as 3 minutes) When there are multiple casualties EMS services may be overwhelmed In an active shooter event, law enforcement must focus on mitigating the threat WHEN CAN I USE THIS? RECENT EVENTS NATIONWIDE AND LOCAL In 2018 alone there have been 17 school shootings where someone was hurt or killed (as of March 23, 2018) Parkland Florida 17 dead Feb 2018 Freeman High School Spokane WA 1 dead Sept 2017 First Baptist Church Sutherland Springs Texas 27 dead Nov 2017 Mandalay Bay Resort and Casino Las Vegas, NV 58 dead Oct 2017 Power Ultra Lounge nightclub Little Rock AR 28 hurt July 2017 Bronx Lebanon Hospital Center San Francisco package facility Charity Baseball game Baggage claim Ft Lauderdale FL Pulse Nightclub Orlando FL 49 dead 53 wounded Social Services Center San Bernardino CA Umpqua Community College Roseburg OR Sandy Hook Elementary School Movie Theater Aurora CO Boston Marathon bombing BOSTON MARATHON BOMBING HARTFORD CONSENSUS CONFERENCES Widespread use of improvised tourniquets by bystanders Most ineffective, some worsened bleeding by only occluding venous return Recent publication from Boston suggested improvised tourniquets did not impact survival 260 casualties 3 deaths at scene Encouraged earlier access of EMS to scenes of mass shooting Encouraged bleeding control training including tourniquets for all EMS, Law Enforcement and bystanders 1

T-H-R-E-A-T ENHANCED LAW ENFORCEMENT & EMS

Rapid Extrication to safety Assessment by medical

Law Enforcement in bleeding control and personal

warm zones for more rapid extraction WHAT NEXT? 1.

public to enable bystanders to act in an emergency

Provide bleeding control equipment in public places

cardiac arrest ENABLING BYSTANDERS WHAT IS IN THE

Scissors Marking pen Tourniquet WHERE SHOULD WE HAVE

Schools / College Campuses Businesses Airports

2 T-H-R-E-A-T ENHANCED LAW ENFORCEMENT & EMS COORDINATION Threat mitigation Hemorrhage control Rapid Extrication to safety Assessment by medical providers Transport to definitive care Training of Law Enforcement in bleeding control and personal tourniquets Ballistic vests for EMS Access of EMS to warm zones for more rapid extraction WHAT NEXT? 1. Provide bleeding control training to the general public to enable bystanders to act in an emergency situation 2. Provide bleeding control equipment in public places adjacent to the automated defibrillators we use for cardiac arrest ENABLING BYSTANDERS WHAT IS IN THE KITS? Gloves Packing gauze Compression bandage Scissors Marking pen Tourniquet WHERE SHOULD WE HAVE THESE KITS? Schools / College Campuses Businesses Airports (SeaTac already installing) Train stations Movie Theaters Stadiums Concert Halls Courthouses (Federal courthouse installing) Shopping Malls Individual kits: Car/Home/Camping. 2

QUESTIONS? ACTIVE SHOOTER TRAINING WHAT SHOULD YOU DO?

First Baptist Church Sutherland Springs TX 11/7 27 Mandalay Bay Resort Las

14 Individual engaging in killing or attempting to kill people in a confined,

evolves quickly San Bernardino, CA 12/15 14 21 Planned Parenthood, CO 11/15 3

3 QUESTIONS? ACTIVE SHOOTER TRAINING WHAT SHOULD YOU DO? Tim Bax, MD Medical Director Trauma Services Sacred Heart Medical Center ACTIVE SHOOTER? AN EPIDEMIC IN THE US Event Fatalities Wounded High School Parkland FL 2/18 17 First Baptist Church Sutherland Springs TX 11/7 27 Mandalay Bay Resort Las Vegas NV 9/17 58 Orlando nightclub 6/ Excel Industries Kansas 2/ Individual engaging in killing or attempting to kill people in a confined, populated area Victims are selected at random Event is unpredictable and evolves quickly San Bernardino, CA 12/ Planned Parenthood, CO 11/ Umpqua Community College, OR 10/ Chattanooga military recruitment 7/ Charleston Church, SC 6/ Marysville-Pilchuck HS, WA 10/ MASS SHOOTINGS (>4 SHOT) IN

RUN/ESCAPE HIDE Have an escape route and plan in mind Leave

agree to follow Help others escape, if possible Do not attempt

the active shooter may be Keep your hands visible Call 911 when

door or block entry to your hiding place Silence your cell

ENFORCEMENT ARRIVES Fight as a last resort and only when your

Act with as much physical aggression as possible Improvise

visible at all times Avoid quick movements toward officers,

or yelling Do not ask questions when evacuating INFORMATION FOR

4 RUN/ESCAPE HIDE Have an escape route and plan in mind Leave your belongings behind Evacuate regardless of whether others agree to follow Help others escape, if possible Do not attempt to move the wounded Prevent others from entering an area where the active shooter may be Keep your hands visible Call 911 when you are safe Hide in an area out of the shooter s view Lock door or block entry to your hiding place Silence your cell phone (including vibrate mode) and remain quiet FIGHT LAW ENFORCEMENT ARRIVES Fight as a last resort and only when your life is in imminent danger Attempt to incapacitate the shooter Act with as much physical aggression as possible Improvise weapons or throw items at the active shooter Commit to your actions... your life depends on it Remain calm and follow instructions Drop items in your hands (e.g., bags, jackets) Raise hands and spread fingers Keep hands visible at all times Avoid quick movements toward officers, such as holding on to them for safety Avoid pointing, screaming or yelling Do not ask questions when evacuating INFORMATION FOR 911 Location of the active shooter RECOVERY POSITION Number of shooters Physical description of shooters Number and type of weapons shooter has Number of potential victims at location 4

5 VIDEO QUESTIONS? FQ-oxhdFjE 5

Community preparedness: M a r k G e s t r i n g, M D F A C S C h a i r, E M S C o m m i t t e e

Community preparedness: M a r k G e s t r i n g, M D F A C S C h a i r, E M S C o m m i t t e e Disclosures None Introduction Uncontrolled hemorrhage remains the single most preventable cause of death