Trauma Care In Civilian Mass Shootings

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MANY moons ago, I wrote a composition for my English class in college. The main theme was that the middle schools in the US should have instruction on very basic emergency medical techniques (opening airway, controlling bleeding etc.) I said that there would be plenty of EMTs around if the teachers didn't want to get trained to do it. (Later, I even went to my twin sons' grade school {I was an EMT} on parent day and, with the aid of a training model that I got at my EMS service, I showed the kids how to check and safely open an airway as well as putting pressure on an open bleed. The kids were very attentive and I got a lot of very positive responses from the kids, the parents and the teacher. :cool:)

I also said that there should be a full course on first responder level emergency medicine in every high school and the students should have to pass this class in order to graduate.

I got a great grade on the paper but that is about as far as it went.

Imagine the number of lives that would be saved every year in this country if there was this type of program in existence? I'm not talking about just mass shootings, which is the theme of this thread, but everyday living emergencies. Just my .02.

PS - I even was given the opportunity to give a bunch of my fellow employees (Oscar Mayer) a quick and dirty lesson on basic emergency medical treatment, on company time I might add.
 
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7 of them had wounds that would have been survivable had they had there been level 1 trauma care available.
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Thank you for the link, it seems level I trauma care is what is provided by a level I trauma center, and the link describes what a level I trauma center is, and that is a major hospital.

which makes the quoted statement somewhat confusing to me.

Unless there is another list somewhere stating what Level I trauma care IS, and that is different from a Level I Trauma care center. IF level I trauma care is what you get at a major hospital, then its NEVER available "on scene" (unless the shooting happens in the hospital). SO, isn't it always "available"??? The only difference would be the transport times to get the victim from the scene to the level I trauma center.

SO, shouldn't the statement be
7 of them had wounds that would have been survivable had they had there been level 1 trauma care available before they died. or 7 of them had wounds that would have been survivable had they had there been level 1 trauma care available immediately on scene. Or something like that??

tell me what is the good of some doctors saying, in effect, "we could have saved these people if they had been shot at the operating room door..."

I feel I must be missing something, some difference in definition between "level I trauma care" as used in the quote and what my net searches turned up, which was always "level I trauma centers".

If you know what the difference is (if any) please enlighten an old soul, because if there isn't any difference then those docs are spouting bullcrap.
 
Imagine the number of lives that would be saved every year in this country if there was this type of program
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Blackwidowp61---are you saying the average person might be able to do something USEFUL???

Haven't we been indoctrinated that to put a bandage on a wound would take years of medical, legal and psychological training in order to TRULY help the person? Don't we need to leave these things to the PROFESSIONALS?

Here's an old article (from England) about 1st responders being forbidden to wade into a 3 foot deep lake to rescue someone because they didn't have the training to do it.
https://www.dailymail.co.uk/news/ar...d-wade-3ft-deep-lake-health-safety-rules.html

Yeah I'm being sarcastic, but the link above is real.

I totally support the idea of first aid training in high school.
 
Level 1 trauma care basically means that specialized care for that certain individual can be provided due to the resources available at that hospital. The resources could be a neurosurgeon, a cardio thoracic surgeon or some other specialized trained medical team. For example in my hospital when we had a patient with severe life threatening burns, the patients brought in would bypass the ER and go directly to the burn unit where the burn unit team was ready to receive the patient and provide care.

General surgeon can provide great care and immediate life saving care but if the more specialized care like listed above is needed their knowledge and expertise is limited and the facility or hospital may not have the specialized resources needed for long term specialized care. This is the difference between a major level one hospital and the others.

I worked at a level one Trauma Center and provided support at the emergency room at Brooke Army Medical Center for many years. When ever we received a trauma patient that needed specialty care the general surgeon would request that the appropriate doctors with their specialized skills and training be called, if not everything was handled by them. The emergency room all it does is stabilize the patient further until proper immediate and long term care for their specific needs are met. The EMT guys do a fantastic job of stabilizing the patients enough to get them to the ER. The real heroes are the EMT guys in my opinion.
 
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Just an example of not being allowed to do what you need to do which actually happened to me. It was one of the first calls I had after becoming an EMT.

I was on one night at the Town of Madison EMS. The crew had turned in for the night when, about 2am, the pagers went off for a shooting. We were on-scene within 10 minutes but were told by PD to stay a couple of blocks away until they called us in.

While we waited, we kept getting more details from dispatch about what was going on. The scene of the shooting was in a fast-food place (Taco Bell). Dispatch had one of the employees on the phone. The employees were locked in the office, but they could hear the employee who had been shot moaning in the store outside the office, which told us that the employee was still alive. (As time went on, we were told that the moaning stopped.)

We also learned that the reason that we were waiting off-scene was because the LEOs on-scene didn’t know if the shooter had left or not. They weren’t going to call us in until they had cleared the store.

What they didn’t tell us at the time, but we found out afterward, was that there were three different departments on-scene; Town of Madison PD (primary), Fitchburg PD (mutual aid) and the Dane County SO (in the area at the time?). They were arguing around about who was in charge and how they were going to go in and clear the store!

After what seemed like an eternity to my crew (the crew chief, another EMT and myself), the crew chief decided to call in the Madison Fire paramedics for ALS (advanced life support) when we were called in to the scene. The crew chief stayed in the ambulance talking with Madison Fire while I grabbed the jump kit and ran in the back of the store and found the victim lying prone on the floor with a pool of blood by his head and a hole about the size of a ping-pong ball in the back of his shirt. When I started talking to the kid, he actually answered me! Whew!

Anyway, I started treating the kid with the help of one of the Town officers until Madison Fire showed up, stuck an IV in the kid, loaded him in their ambulance and took off.

In another instance, I was working with a private ambulance service one day when we were sent to a racetrack for medical standby. Well, as fate would have it, there was a heck of a rollover in one of the races. Before the car had even stopped, I was running for it from the infield. When I got to the car (first one there), I looked at the engine compartment and saw small blue flames licking away on the motor. I didn’t even hesitate; I went under the back of the car to where the driver was hanging upside-down, flailing away in a panic. I started calming him down until he got his harness disconnected and I pulled from under the car.

Well, no good deed goes unpunished. I got chewed out by the rescue crew for what I had done and I wasn’t invited back. (No big deal since racing isn’t on my list of things to do.)

So, as you can see, sometimes you’re damned if you do and damned if you don’t. If somebody’s in trouble, I want to jump in with both feet if I believe that it is safe enough to do so, although my idea of what’s safe doesn’t always agree with somebody else. (sorry for the length!)


PS - The kid had been shot in the back with a shotgun slug which lodged in his shoulder, which is where the doctors left it. I was able to visit him in the hospital afterward. I asked him if he remembered me and he goes "Yeah, you were the one who kept askiing me all those questions!" :)
 
I feel that getting help sooner than later to the victims is being underplayed here. The lack of urgency of LEO to secure the site, such as what happened at the Parkland shooting, just has to be reducing the survival chances of those laying wounded on the floor.
 
davidsog said:
Last I checked there are approximately 200 Level 1 Trauma centers in the United States. Europe has even fewer. Very few hospitals are equipped to handle advanced trauma. As of 2014 only 2 Level 1 trauma centers existed in all of Europe.



https://www.ncbi.nlm.nih.gov/m/pubmed/16292062/
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Here in San Antonio Texas we have only two. We are like the 7th largest city in the Nation. We used to have three but than we lost the 3rd one Wilford Hall Medical Center when we merged the trauma care with Brooke Army Medical Center. According to the trauma surgeons in the medical community they said that the loss of Wilford Hall would not harm patient care.
 
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Last I checked there are approximately 200 Level 1 Trauma centers in the United States.
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I was at my local hospital yesterday (wife is getting wound care for a leg injury -and healing well, thanks) so I spoke with the wound care specialists about Level 1 trauma care.

They told me that, yes, level 1 care is what you get at a level 1 facility. And that there is one (1) O-N-E, one level 1 facility in our STATE! (and, its about 250 miles away from where we were)

One nurse told me the sad story of a patient brought in who had "the kind of stroke where you need neurosurgery immediately, or you die". They didn't have a neurosurgeon there, the patient died.

Apparently to be a Level I Trauma center it must have ALL the possibly needed specialists, on staff and on site, 24/7. Not on call.

The next time you hear anyone talking about how "they would have lived had Level I trauma care been available", I suggest you check and see just how "available" it is to YOU, and those places you regularly go.

there are some good hospitals near where I live, and a fair one local to me, but the only Level I Trauma Center in my state is a 90+ minute med-evac chopper flight away. Think about that, and where you live.
 
And that facility treats 80,000 patients thru the ER each year and treats 4,000 patients thru its outpatient clinics each day.....per the website.

8500 staff members.
 
Trauma patients after triage will move thru a pipeline to the level of trauma care that is appropriate. Part of an casualty event is identifying the available facilities. If a victim requires level 1 care a plan to get them to an appropriate facility must be in place. That is the responsibility of responding agencies.

Yes, the nearest level 1 trauma center is briefed and the responding agencies are aware of their current status. Only saw one three letter agency drop the ball on that once.

If an agency does not have that information and pipeline established, they are simply wrong.

The golden hour is very important and responding LE must be aware of it. Life, limb, and eyesight must be their immediate priority. Clearing and securing an objective such as school does not take that long. Agencies must be proficient in multiple team, multiple room, and multiple building operations.
 
Your post is kind of babbling and I am not sure what you are talking about.
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What I'm babbling about was my quest to understand this statement..
Out of the 44.6 people, 7 of them had wounds that would have been survivable had they had there been level 1 trauma care available.
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I did not know what level 1 trauma care was, nor where it was available. This made me wonder, WHY level 1 care was not available to those 7 people who "would have survived" if it had been. Based on what I found out, it seems the most likely answer to that question is that level 1 care was too far away, and the victims simply didn't live long enough to get there.
 
Which pretty much means, if you are one of those seven people, you're pretty much SOL, so the statement that there were 7 who could have survived is pretty much like saying you could survive being hung if the rope broke.

I have a level 1 hospital just on the other side of town, but there would still be no guarantee that I would get there in time. The medics could also take me to one of the two level 3 hospitals in the city (which are closer), not realizing that I needed level 1 care right away.
 
Ok

Teaching trauma medicine is far beyond the scope of the thread. Stabilization and transportation is a thing and works so it is not at all like saying “being hung and blah blah with the rope”.

You MUST have good well trained first responders with proper equipment to work the ABC’s in the golden hour. That is what that statement says....

7 people died because they did not have trained and equipped first responders in the golden hour.

For example...

One my colleagues shot in the face with a 7mm magnum survived the hour and a half trip to level 1 trauma ONLY because the medic did an immediate cut down of his carotid artery and controlled the bleed manually for that hour and a half.
 
davidsog, I am happy to hear that your buddy survived and that the high initial and continued level of care necessary for his survival was available, but in most cases, that level of care will not be available for most people.

Since I was an EMT (up to intermediate level and was in paramedic training when a family problem interrupted), I can fill you in on that side of it.

First of all, most people are not cut out for emergency medical training of any sort. They don't/can't bring themselves to be near people who are in pain, bleeding or have open wounds etc.. There is also the money and time involved in being trained and the continuing education required after the initial training. In some states, you need to belong to an ambulance service in order to qualify for EMT training. A large amount of money and time is involved as well.

Even trained, certified EMS people have their problems. I had a trained, licensed EMT freeze up when he saw a pool of blood by a patient who had been shot. When I was a crew chief, I had an EMT on my crew tell me that she would not be able to help on a SIDS call (sudden infant death syndrome) because she had had a baby die that way. The first person I never trusted after that, but the second I thanked for telling me beforehand so I wouldn't put her in a situation which would put her in a highly stressful position.

There are many different levels of EMS:

There is first responder level of trained people (Red Cross, Boy Scouts, etc.) who are trained in just the basics of emergency treatment, or the basic ABCs (airway, breathing, circulation). They can clear an airway by pulling the tongue or a foreign object out of the area of the mouth or perform the Heimlich maneuver. They can control bleeding to a certain extent and they can perform CPR (oops, it's now CCR I guess).

Here are the levels of emergency medical responder training levels of various states around the country:

Minnesota
Emergency Medical Responder*
EMT-Basic
AEMT
EMT-Paramedic*
Community Paramedic
Registered Nurse-EMT
Registered Physician Assistant-EMT

Pennsylvania
BLS
Emergency Medical Responder (EMR)
Emergency Medical Technician (EMT)
ALS
Advanced EMT (AEMT)
Paramedic
Prehospital Registered Nurse (PHRN)
Prehospital Physician Extender (PHPE)
Prehospital Physician

Texas
Emergency Care Attendant
EMT-Basic
Advanced EMT (formerly EMT-Intermediate)
EMT-Paramedic
Licensed Paramedic (paramedic with a college degree)

Wisconsin
EMR (Emergency Medical Responder)
EMT (Emergency Medical Technician)
AEMT (Advanced Emergency Medical Technician)
EMT-Intermediate (Emergency Medical Technicial Intermediate)
EMT-Paramedic
Critical Care Paramedic Endorsement
TEMS (Tactical Emergency Medical Service Endorsement) Primarily for SWAT teams

As you can see, there are quite a variety of levels of treatment available. In most cases, the needed level of training to keep one of your 7 people alive until they could reach a level 1 trauma center would be probably an EMT Intermediate or above (ALS). I say that because the victim is going to need an IV started at a minimum to stay viable.

In most rural areas, the highest level of training that you are going to find on an ambulance crew will be a basic EMT. The reason is that it costs money to train these people and it costs time and money to keep up their skills. The higher the training, the more money and time involved. Most rural EMS ambulance services can't afford that kind of money. If these services need advanced care, they will ask for a perimedic service to meet them at scene/during transport or, if available, a medical helicopter.

In my earlier post, I mentioned that my service (basic EMT at the time) had a gunshot patient who wasn't seen until the building was cleared and we were called in, which took some time. Even though we had a level 1 trauma hospital within 15 minutes of where we were, and two level 3 hospitals within 5 minutes, the crew chief called in a paramedic unit because of the time situation involved.

I remember reading somewhere/sometime that medics and corpsmen weren't recognized by some states as legal emergency medical providers, even though their training was at a paramedic level or above!

I will continue to say that the 7 victims are not likely to receive the necessary initial treatment they need, nor is there likely to be a level 1 trauma center available to continue the level of treatment needed within the necessary time frame. I know that my remark about the rope breaking could offend some people, but I wanted to make the point that in most instances, those seven people were more likely to die without extraordinary means available, which isn't likely to happen in most areas of the US.

By the way, while I was an EMT, I was able to talk to some ER and ICU nurses. Most of the ones that I talked to said that they would never work on an ambulance! I thought that was pretty interesting.

Again, I am thankful that your buddy was able to get the level of care he needed to survive.
 
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Ok

Then why am I having to explain that a survivable is survivable?

You are correct and make my point that if we are to increase the number of survivable wounds that survive....

We need to increase training and have equipment available.
 
davidsog, please believe me when I say that I am not trying to be argumentative, but I will continue to point out that, for those seven victims to survive, they need immediate ALS treatment to have a chance at arriving at a level 1 trauma center. If every person in the country were trained to the level of an EMT basic, which is extremely unreasonable to believe would happen in any case, it would still be very unlikely that the seven 'survivable' victims would get the initial treatment needed to survive. The article supposes that the level of treatment needed for those seven to survive would be available every time, all the time, everywhere. It is a very unreasonable assumption on their part. It just is not possible in the real world, but it sure would be nice if it were so! :)
 
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Level I Trauma Center
Provides comprehensive trauma care, serves as a regional resource, and provides leadership in education, research, and system planning.
A level I center is required to have immediate availability of trauma surgeons, anesthesiologists, physician specialists, nurses, and resuscitation equipment. American College of Surgeons' volume performance criteria further stipulate that level I centers treat 1200 admissions a year or 240 major trauma patients per year or an average of 35 major trauma patients per surgeon.

Story about level 1 trauma centers...mass shooting in Las Vegas
https://www.usatoday.com/story/news...epend-trauma-center-capacity-plans/727100001/

https://www.nremt.org/rwd/public/data/maps

Total Nationally Certified EMS Personnel In US
BLS...EMR – 11,430.....EMT – 247,679.......................Total BLS – 259,109
ALS...AEMT – 15,604....Paramedic - 101,174..............Total ALS – 116,778
Total all levels...375,887
Population of US....327.2 million

The actual math confirms my point. At this time, there are a total of 375,887 EMS personnel and a population of 327.2 million. It gets even worse if you take the number of ALS personnel, the minimum training level needed for a victim who needs level 1 trauma care to still have a chance of arriving at that trauma center in a viable condition. If you take the number of paramedics alone, which gives you the absolute best chance of survival, your chances become extremely bleak indeed!
 
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You should be familiar with triage. A survivable wound is simply survivable.

That they did not survive indicates a failure on the part of medical care and an indication to do better.
 
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