Our thoughts and prayers go out to all the victims and all the families and friends of victims affected in the Las Vegas shooting. I was watching footage of the shooting and kept thinking “wow, I’ve been right in that area every January for the past several years at Namescon”, and something like this could have happened at anytime.
I say this not as a deterrent to living life or changing my behavior because of terrorist or extremist attacks, but rather to be prepared and situationally aware, to know how to react should something like this happen to me.
Being better prepared for an event like this can be as simple as knowing a few life saving concepts. The first thing to consider, and one that was not easily accomplished in the Las Vegas attack, is to neutralize the threat. If you listen to the police radio traffic, several officers voice this concern while others are calling out the locations of the wounded. One of the officers summed it up great, saying we need to take this guy down before there’s more casualties.
If you can, move the patient and yourself to a position of concealment or cover as quickly as possible. Hiding behind something that won’t stop a bullet is preferable sitting out in the open, it will make it harder for you to be recognized as a target.
Another important thing to consider is the use of tourniquets. This could consists of a belt or anything that could be used to stop the flow of arterial blood coming from an extremity wound. Even if a victim has multiple gunshot wounds stopping the flow of arterial blood in the extremities will prolong survivability. For the longest time there was a stigma to tourniquet use, there was a misconception that the person might lose the limb if a tourniquet was applied. The fact of the matter is that loss of limb from a tourniquet is very low percentage and is insignificant when the alternative is complete exsanguination.
The tourniquet needs to be tight enough so that it stops the flow of blood completely. It also should be applied on the single longbone of the affected limb. Your femur and humerus are the single long bones, so any easy way to remember tourniquet placement is above the knee or above the elbow, obviously between the heart and the wound. The distal ends of your extremities have two main bones, this make it harder to compress the artery against the bone with the tourniquet.
One of the most inspiring things that happened during the Vegas attack were people helping people by loading them onto whatever they could find and taking them to a vehicle that could transport them to the hospital. The thing with regular Emergency Medical Service during an event like this, is that they will not enter the hot zone until it’s confirmed that the threat has been neutralized, and in reality most of the wounded don’t need an ambulance or even a Medic, they need to get to the operating room as fast as possible. If you stop the bleeding and control the airway the best you can, then taking the person to definitive care as fast as possible is the best treatment for them. EMS Advanced life support is limited in its capabilities when dealing with trauma. Iv’s are essentially pointless and we don’t carry whole blood. Sure, I can give you fluids to assist with blood circulation (not as beneficial as once thought in loss of blood shock as it can diminish clotting factors), decompress a tension pneumothorax or intubate the patient, but like I said, what they really need is a surgeon.
If you come across someone that is not breathing, has no pulse and there are still other people wounded and breathing, leave them and move on to someone that is breathing. Technically you should adjust the airway and look listen and feel for breathing, but someone shot lying in a pool of blood, that doesn’t appear to be breathing and has no discernible pulse is more than likely dead. The chances of successful resuscitation after traumatic cardiac arrest are very, very slim. It’s not a pleasant thing to consider, but your efforts are better utilized helping someone that has a chance. Obviously if the amount of rescuers matches or exceeds the number of patients then give it your best shot.
So if you take anything away from this post and find yourself in one of these situations, remember if possible to, stop the threat, get to cover, stop the bleeding, get to a trauma center. The more these attacks happen the more likely anyone reading this will find themselves in a similar situation and the principles can apply to any situation that you find injured people.
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