Clinicians issue recommendations for responding to mass shootings
The number of mass shooting incidents has been increasing in recent years, rising nearly 40% from 2019 to 2021.
Photo: Jordan Vonderhaar/Getty Images
Clinicians from states affected by mass shootings, who convened at a consensus conference last fall to discuss an appropriate response to such events, have just released a number of recommendations they hope will facilitate a better response to mass shootings from the healthcare industry, including readiness training and public education.
Uniformed Services University's (USU's) National Center for Disaster Medicine and Public Health hosted a consensus conference in September 2021 to bring together clinicians from six sites in which mass shootings occurred and more than 15 people were killed or injured. The sites included Orlando, Florida; Las Vegas, Nevada; Sutherland Springs, Texas; Parkland, Florida; El Paso, Texas; and Dayton, Ohio.
Eight recommendations that the convening groups of clinicians identified were published July 18 in the Journal of the American College of Surgeons.
"We recognized that mass shootings are frequent events that occur in the United States and wondered if we could learn more about how to optimize response to these incidents," said Dr. Craig Goolsby, a professor and the vice chair of USU's Department of Military and Emergency Medicine, and the science director of the National Center for Disaster Medicine and Public Health. "We identified a group of recent mass shootings and then invited clinicians who participated in the healthcare response – EMS clinicians, emergency physicians and surgeons – to participate in our conference."
One recommendation that emerged was readiness training: Regular, multi-domain training activities that mirror the realism of actual events, to ensure readiness of the entire community system. They also recommended prior public education or immediate direction from web-based mapping programs about the appropriate hospitals to bring mass shooting patients for care.
Of prime importance, they said, was a staged and iterative triage process at the scene and emergency department, and to prioritize operative care. Effective communication between prehospital personnel at the scene and the hospitals is also key to a robust response, they said.
Clinicians suggested a patient tracking system that functions from point-of-injury through all subsequent healthcare, along with rehearsal with, and rapid availability of, alternative methods of patient care documentation and order entry.
Other recommendations included rapid implementation of organized, well-communicated family reunification and assistance services as well as tailored after-action mental health services for responding professionals.
WHAT'S THE IMPACT?
The number of mass shooting incidents has been increasing in recent years, rising nearly 40% from 2019 to 2021, according to the Gun Violence Archive. Although research has been done to identify ways to prevent mass shootings and reduce death and injury, there have not been specific details about the medical system response to such events.
While the recommendations are designed to help, preparing for a mass shooting and addressing firearm violence that happens on a daily basis require different plans to best care for patients. Conference attendee Dr. Deborah A. Kuhls, assistant dean for research and professor of surgery at Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, who was part of the response to the 2017 mass shooting in Las Vegas, said that while mass shootings make up a small percentage of the deaths occurring each year from firearms in the U.S., they are horrific events.
The more common causes of death and injury from firearms are individual homicides and suicides. But when a mass shooting occurs, it requires a different healthcare response to effectively care for the patients.
"What is really different is that with one gunshot wound patient coming in, I focus my attention on that patient. In a mass casualty event, there is a large number of people who appear at once and we have to decide who needs our attention the most, who has the greatest threat to life," said Kuhls.
She added that by properly triaging patients in a mass shooting incident, those with more severe injuries can be treated at a trauma center and those with less severe injuries can be treated at a non-trauma center. This helps ensure trauma centers don't become overwhelmed and each patient is able to get the level of care they need.
THE LARGER TREND
In June, a bipartisan gun proposal that would give grants to states for red-flag laws, provide spending for mental health treatment and school security, and give extra scrutiny for gun buyers under the age of 21 drew praise from the American Medical Association.
Ten Republican senators signed on to the Senate proposal, which means that legislation based on the proposal could get the 60 votes needed to overcome a filibuster.
Hospital costs for initial gun injury care are estimated at more than $1 billion a year. This represents about 30,000 hospital stays and 50,000 emergency room visits, Dr. Paul B. Hofmann, president of the Hofmann Healthcare Group, wrote in an AHA blog posting.
He said hospitals and health systems are taking steps on violence prevention. The University of Maryland Medical Center, for example, has a Shock Trauma program to reduce reinjury rates in recognition that those with a history of violent injury are usually 45% more likely to be readmitted with another such injury within five years.
Temple University Hospital in Pennsylvania, meanwhile, treated more than 850 shooting victims in 2021, the highest number of any Level I trauma center in Pennsylvania. It initiated a Fighting Chance program to teach community members how to provide basic first aid to victims of gunshot wounds and developed a plan focused on at-risk youth to help break the cycle of gun violence, among other programs.
Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com
