In December 2012, the world witnessed the unspeakable—the fatal shooting of 20 children and six teachers and administrative staff at Sandy Hook
Elementary School in Newtown, CT. The nation was
shocked by this senseless act, but in many ways Sandy
Hook was a tipping point. Several individuals and
organizations began to consider ways to improve survival from these horrific situations.
Among those organizations was the American College of Surgeons (ACS), which has since launched a
significant effort to improve survivability from mass
casualty situations. This article summarizes the College’s role in this ongoing effort and provides an update
on the initiative.
Shortly after the Sandy Hook shooting, the ACS Board
of Regents approved the establishment of the Joint
Committee to Create a National Policy to Enhance Survivability from Intentional Mass Casualty and Active
Shooter Events. The committee first met April 2, 2013,
and early control of hemorrhage was identified at this
meeting as critical to improving survival.
After the Boston Marathon bombing later that
month, the committee’s efforts were expanded to
focus on improving survival, not just from active
shooter events, but all intentional mass casualty events. In early 2016, the mission was further
expanded to include all causes of bleeding, such as
unintentional, everyday accidents.
The committee has met four times, and its recommendations are collectively known as the Hartford
1-4 The chief tenet of the Hartford Consensus
is that no one should die from uncontrolled bleeding.
In October 2015, the White House launched the
Engagement of law enforcement
Stop the Bleed® campaign, and the Hartford Consen-
sus played a foundational role in this initiative.
goal of the Stop the Bleed campaign is to promote
national resilience by empowering the general public
to acquire the skills and confidence to control bleeding
in emergency situations—from mass casualty inci-
dents to everyday events—where bleeding control can
In the past, law enforcement’s exclusive duties in active
shooter and other intentional mass casualty incidents
were to subdue the perpetrator and preserve evidence
at the crime scene. Once the police declared the scene
to be safe, emergency medical services (EMS) personnel were permitted to enter the area and provide care
Needless to say, victims in these situations could
bleed to death waiting for medical attention. Modification of operational strategies was needed for
hemorrhage control to become a core responsibility
of law enforcement.
To achieve this objective, law enforcement leaders had to be willing to consider this modification.
A member of the Hartford Consensus, Alexander
Eastman, MD, FACS, a trauma surgeon and police
lieutenant from Dallas, TX, propagated the idea to the
Major Cities Chiefs Association (MCCA). The MCCA
is a professional organization of police chiefs and sheriffs from the largest cities in the U.S., Canada, and
the U.K. It serves as a forum for police executives to
share matters related to policing large urban areas.
An additional purpose of this group is to influence
national law enforcement policies.
6 The MCCA was
critical in bringing about the policy change so that
hemorrhage control is now viewed as a responsibility
of police officers.
Once law enforcement leaders accepted this change,
an educational and an operational strategy had to be
implemented to achieve the hemorrhage control objective. An educational course was developed, which was
The chief tenet of the Hartford Consensus is that
no one should die from uncontrolled bleeding.