•Ensure appropriate equipment, such as tourniquets and
hemostatic dressings, is available to every law enforcement officer
•Ensure assessment and triage of victims with possible
internal hemorrhage for immediate evacuation to a dedicated trauma hospital
• Train all law enforcement officers to assist EMS/fire/
rescue in the evacuation of the injured
EMS/fire/rescue: The response must be more fully
integrated and traditional role limitations revised.
• Train to increase awareness and operational knowledge
about the initial response to an active shooter or inten-
tional mass-casualty event
Ȗ It is no longer acceptable to stage and wait for
casualties to be brought out to the perimeter.
Ȗ Training must include hemorrhage control
techniques, including the use of tourniquets,
pressure dressings, and hemostatic agents.
Ȗ Training must include assessment, triage,
and transport of victims with potentially
lethal internal hemorrhage and torso
trauma to definitive trauma care.
•Incorporate Tactical Combat Casualty Care and Tactical Emergency Casualty Care concepts into EMS/fire/
•Modify the response doctrine to improve the interface
between EMS/fire/rescue and law enforcement in order
to optimize patient care
•Establish a common language for responders, permit-ting each community to improve coordination, develop
concurrent response, and establish mutually acceptable
levels of operational risk between all public safety professionals to enhance the defense, rescue, treatment,
extrication, and definitive care of survivors
Definitive trauma care: Existing trauma systems
should be used to optimize seamless care.
•Provide trauma care to victims of an active shooter or
an intentional mass-casualty event based on available
resources and the establishment of mitigation strategies
that acknowledge community limitations
• Design, implement, and practice plans to handle a surge
in patient care demand from an active shooter or an intentional mass-casualty event
To achieve the goals of this call for action, education
of all groups is required. The core Hartford Consensus concepts should not be limited to traditional public safety responders. Everyone can and should be an
initial responder. Education should be tailored to the
level of the responder. Everyone should be taught hemorrhage control. Professional first responders should
also be taught airway management. Education for the
patient care process should focus on THREAT and
•Rapid access to hemorrhage control
Ȗ External hemorrhage control
Ƒ Direct pressure
Ƒ Tourniquet application
Ƒ Hemostatic agents
Hartford Consensus II attendees, from left: Drs. Brinsfield, Fabbri, Wade, Jacobs, Serino, Carmona, Conn,
Kamin, Eastman, Burns, McSwain, and Rotondo. Not pictured (joined by phone): Dr. Butler and Mr. Sinclair.