Concept to action
On April 2, representatives from a select group of public safety organizations including law enforcement,
fire, pre-hospital care, trauma care, and the military
convened in Hartford, CT, to develop consensus regarding strategies to increase survivability in mass-casualty shootings. A concept document resulted and
became known as the Hartford Consensus. It includes
an acronym to describe the needed response to active shooter and intentional mass-casualty events.
The acronym is THREAT:
• Threat suppression
•Rapid Extrication to safety
•Assessment by medical providers
• Transport to definitive care
Within the framework of THREAT, there exists
the opportunity to improve survival outcomes for the
victims of active shooter and intentional mass-casualty
events through mutual collaboration and reinforcing re-
sponses. The Hartford Consensus stipulates that medi-
cal training for external hemorrhage control techniques
is essential for all law enforcement officers. They should
play a key role as the bridge between the law enforce-
ment phase of the operation and the integrated rescue
response. The interval from wounding to effective hem-
orrhage control can be minimized by law enforcement
officers trained in hemorrhage control. This principle is
central to the findings of the first Hartford Consensus.
The purpose of the Hartford Consensus Conference II,
which took place July 11 in Hartford, was to develop
strategies for focused actions to achieve the objectives
of the first Hartford Consensus.
To maximize survival from an active shooter or an
intentional mass-casualty event there must be a continuum of care from the initial response to definitive
care. The essence of this continuum involves the seamless integration of hemorrhage control interventions.
This process starts with the actions of the uninjured
public or minimally injured victims and extends to
the first responding law enforcement officers, then to
EMS/fire/rescue personnel, and ultimately to defini-
tive trauma care. These concepts must be scalable to
facilitate implementation in communities of all sizes.
The law enforcement response has evolved from the
original concepts of “surround and contain” to a more
modern and aggressive response. EMS/fire/rescue must
be involved earlier in the care of these victims. They
should have direct contact with the law enforcement
personnel on the scene.
Call to action
No one should die from uncontrolled bleeding. Preventable death after an active shooter or an intentional
mass-casualty event should be eliminated through the
use of a seamless, integrated response system. Each
group in the following categories should perform the
actions necessary to accomplish this goal:
Public: Uninjured or minimally injured victims
can act as rescuers. Everyone can save a life.
•Recognize that the initial response to an intentional
mass-casualty event will be from uninjured bystanders
and minimally injured victims
•Design education programs and implement training
for a public response to an active shooter or intentional
•Pre-position necessary equipment in appropriate locations
•Recognize that in an active shooter event the education message should include the concept of “Run, Hide,
Law enforcement: External hemorrhage
control is a core law enforcement skill.
•Identify appropriate external hemorrhage control training for law enforcement officers
Preventable death after an active shooter or an intentional mass-casualty event should be eliminated through the use of a seamless,
integrated response system.