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Civilians Urged to Save Lives in Mass Casualty Events
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One of the casualties admires his supposed injuries as he waits for the mass casualty incident to begin.
   
Friday, November 10, 2023
 

STORY AND PHOTOS BY KAREN BOSSICK

Shots rang out in the parking lot of the Sun Valley Inn this past week. They were quickly followed by cries for help.

Two dozen first responders attending the Saint Alphonsus Ski and Mountain Trauma Conference at Sun Valley Resort ran into the parking lot, looking for signs of the shooter or shooters as they neared victims sprawled out on the asphalt, blood spilling from their bullet wounds.

Sirens filled the air, contributing to the confusion.

 
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One of the casualties admires his supposed injuries as he waits for the mass casualty incident to begin.
 

The mass casualty simulation, organized by Saint Alphonsus and the Idaho National Air Guard, was meant to give first responders attending the conference hands-on practice should they ever be called to the scene of such events, which are becoming all too common in the United States.

But it was also meant to emphasize that bystanders can be important participants in saving lives since a person can bleed out in two to five minutes.

The gunman who fired 1,100 rounds into those attending the 2017 Harvest Country Music Festival in Las Vegas killed 59 people and wounded 596, said Dr. Parker Fillmore, trauma medical director at Saint Alphonsus. Many of those who were killed could have survived had bystanders stopped the bleeding.

“In mass casualty events, it’s crucial to recognize life threatening bleeding and stop it,” he added. “Someone is bleeding and bleeding fast and if you don’t do something they will bleed out and they’ll be dead by the time emergency medical services arrive. We’re not trying to make civilians soldiers or put them in harm’s ways. But in mass casualty events, credentials go out the window.”

 
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One of those attending Saint Alphonsus Ski & Mountain Trauma Conference attends to Kelly O’Dell.
 

Mass shootings are on the rise. There were 690 incidents in which four or more people were killed or injured in 2021 and 647 incidents in 2022. The United States had 476 such incidents by late August and is on pace to set a record.

It doesn’t always happen elsewhere. Two people were killed and five injured at the Boise Town Center Mall a few years ago, and some of the National Guardsmen taking part in this training responded to a knife attack in Boise in which a man killed a child and wounded others.

“There were eight incidents during the past year where the shooter wore body armor and used an AR-15,” Fillmore said. “This is not a fear mongering session. It’s reality.”

Bystanders need to be careful they don’t put themselves in harm’s way, Fillmore said. But the average shooting lasts just three to five minutes, enabling rescuers to attend to the wounded quickly.

 
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A medic sets up a central gathering place for victims who are able to move to it.
 

Don’t worry about the person’s air circulation until you control severe bleeding, Fillmore said. Once you stop the bleed, you can check respiratory breathing, circulation and shock.

If you notice the victim is not breathing as you try to control the bleeding, move on. Do not perform CPR as you will not get that person back. And, while you’re attempting CPR, someone else is dying, said Idaho Air National Guardsman David Nguyen.

  • Begin with a blood sweep, spending 30 seconds running your hands down the entire length of the body. Check your hands for blood as you do so.
  • Try to control bleeding with direct pressure. Pack the wound while continuing to apply pressure with gauze if you have it. Use a shirt if you don’t.
  • If you get the bleeding under control, delegate pressure control to other bystanders while you assess others.
  • Use a tourniquet in cases where pressure isn’t working. Place the tourniquet two to three inches above the wound. Apply it two inches above the knee if it’s a lower leg wound and two inches above the elbow if it’s a lower arm wound.

    If you don’t have a tourniquet, improvise with a shirt or belt. Wrap it around the person’s limb and pull tight. Use a stick or pencil to twist the tourniquet even tighter.

     
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    A victim creates her wound ahead of the simulation.
     

    “It’s supposed to hurt,” Nguyen said, adding that tourniquets not applied tight enough will not stop the bleeding.

    Tourniquets should not be applied around the neck or groin. If one tourniquet doesn’t stop the bleeding, apply a second one.

    Do not pack severe chest wounds with gauze. Cover sucking chest wounds with such things as credit cards.

    An increasing number of public places now have bleeding control kits. When possible, delegate someone to go in search of one.

    Watch for shock, signified by rapid breathing; loss of focus; sweaty, clammy skin and pale or gray skin.  Put those in shock at the front of the line when EMS arrives, Nguyen said. If the patient is hypothermic—characterized by shivering, slow breathing, drowsiness and slurred speech or mumbling—cover them with your coat, blankets and available sleeping bags.

    Make sure someone takes charge during a mass casualty event to corral all the craziness. And have  someone set up a place to move those who can be moved for triage. That location needs to be relayed to rescuers.

    Cover the dead so rescuers don’t keep checking on them. But don’t move their body because the coroner needs to see the scene as is.

    “We’ve just taught you everything you need to know in 30 minutes,” Fillmore said. “It’s really very simple, and it doesn’t take hardly any equipment.”

    M.A.R.C.H.

    Responders follow the acronym M.A.R.C.H. when responding to a mass casualty or even a car accident where significant bleeding is involved:

  • Massive hemorrhage—Control life-threatening bleeding.
  • Airway—Establish and maintain the patient’s airway.
  • Respiration—Decompress suspected pneumothorax, seal open chest wounds and support ventilation as required.
  • Circulation—Recognize and treat shock.
  • Head injury/Hypothermia—Prevent/treat hypotension and hypoxia to prevent worsening of traumatic brain injury and prevent/treat hypothermia.

EVERY MINUTE COUNTS

During mass casualties, a shot is fired every 4 to 15 seconds with a hit rate of 50 percent to 70 percent.

In 15 seconds, an average shooter can kill 17 to 34 people with a standard handgun.

Most victims are shot in the first 3 minutes.

Fifty percent of active shooter events are over in 5 minutes.

The average time to bleed out from a major arterial injury is between 2 and 5 minutes.

The survival rate of an active shooter event drops between 7 percent and 10 percent every minute.

EMS notification averages 5 minutes after a gunshot.

EMS dispatch service takes approximately 12 minutes.

Police response time averages 15 minutes.

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