Medical Technicians have endorsed these guidelines through the
PHTLS program. 3
Although military and law enforcement operations are unique,
the TCCC guidelines may be used to standardize TEMS protocols. 3
These principles are applicable to events that generate mass casualties where a team of responders is tasked to secure the scene and
simultaneously access and treat multiple victims. The National
Tactical Officers Association has endorsed TEMS and the TCCC
guidelines. 3 All communities should have rapid access to TEMS,
including tactical EMS personnel who are trained for the exigencies
of mass-casualty shootings. To achieve the earliest possible care,
personnel in schools and other public places should be trained not
only in evasive and protective maneuvers but also in first aid for
penetrating injuries to themselves and others.
Unfortunately, the time has come when intentional civilian
mass-casualty incidents require a military-like response. This approach will enhance rapid assessment, treatment, and triage of patients. Mass-casualty shootings should be viewed as medical scenes
where treating patients is a top priority. Although the concepts proposed here would not have saved the 26 Newtown victims, survivability of future mass-casualty shootings will be enhanced if EMS
and law enforcement personnel adopt policies and procedures for
rapid patient assessment, treatment, and transportation to definitive care.
ACS plays leadership role
The ACS has taken a leadership role in achieving the goal of an integrated response system to rapidly care for patients in these horrific
events. Recently, the ACS brought together professionals to form
the Joint Committee to Create a National Policy to Enhance Survivability From Mass Casualty Shooting Events. The committee had
representation from the ACS Board of Regents, the ACS Committee
on Trauma, the PHTLS Program, the Federal Bureau of Investigation, the Major Cities Chiefs Association, the EMS section of the
International Association of Fire Chiefs, and the Committee on Tactical Combat Casualty Care. The joint committee met in Hartford,
CT, on April 2 and produced a document titled “Improving Survival
from Active Shooter Events: The Hartford Consensus,” which is
published in its entirety on the following pages. The organizations
and agencies involved in the development of this document anticipate that it will be useful in promoting local, state, and national
policies that will improve survival from mass-casualty shootings.
1. Pearson Education. Time line of
worldwide school and mass shootings.
Available at: http://infoplease.com/ipa/
A0777958.html. Accessed February 15,
2. Haddon W, Jr. The changing approach
to the epidemiology, prevention, and
amelioration of trauma: The transition
to approaches etiologically rather than
descriptively based. Am J Public Health
Nations Health. 1968; 58( 8):1431-1438.
3. Salomone JP, Pons PT, eds. PHTLS,
Prehospital Trauma Life Support. Military
7th ed. St. Louis, MO: Mosby JEMS
4. Runyan CW. Using the Haddon Matrix:
Introducing the third dimension. Inj Prev.
1998; 4( 4):302-307.
5. Ng C, Goldman R. Two adult school
shooting survivors will be key witnesses.
Yahoo News/Good Morning America.
December 17, 2012. Available at: http://
Accessed February 14, 2013.
Unfortunately, the time has come when intentional civilian mass-casualty incidents require a military-like response. This approach
will enhance rapid assessment, treatment, and triage of patients.