Jonathan Mckelvey
August 21, 2018
Hartford Consensus
On December 14, 2012, the horrific mass shooting at Sandy Hook Elementary School sparked a movement to enhance survivability during mass-casualty incidents. Several months after the shooting, in April of 2013, Joint Committee to Create a National Policy to Enhance Survivability from Intentional Mass Casualty and Active Shooter Events was created. This committee meet multiple times and formulated what is known as the Hartford Consensus. This is a guideline of protocols and suggestions on how to react and help during a mass casualty incident such as an active shooter.
The Hartford Consensus focused on strategies for hemorrhage control. One of its main messages being “Stop the Bleeding”. It uses the acronym THREAT, to lay out the appropriate steps of care. The first piece of the acronym being threat suppression. As with any case of an EMS call, the safety of yourself and your team comes first. Before any treatment can begin, the threat must be subdued. The second letter “H”, stands for hemorrhage control. The consensus recognizes the most prevalent preventable cause of death in the pre-hospital environment is uncontrolled bleeding via an external hemorrhage. Those onscene should be using direct pressure or tourniquets to help stop bleeding threats. The “R” and “E” stand for rapid extrication to safety. The degree of safety is defined in three types of zones: hot (dangerous), warm (less dangerous but still unsecured), and cold (secured and safe). “A” stands for assessment by medical providers. This is assessment by on-site professional first responders. They must optimize rapid patient assessment and triage, while working also to complete the last step, “T”-transport to definitive care.
THREAT integrates many types of responders, whom fit into three main categories: Immediate responders, professional first responders, and trauma professionals. Immediate responders, also known as bystanders, are those who are at the scene. These people may be able to control breeding using their hands or equipment on scene to accelerate bleeding control. Although these people may be able to save a life through hemorrhage control, one must remember the first step: scene safety. No person should ever enter a dangerous or potentially harmful environment.
The next type of first responder is the professional first responders. These include: law enforcement, Fire personal, and emergency medical services (EMS). Law enforcement is typically the responder that suppresses the threat during mass casualty incidents. The responders involved should also be able to control external hemorrhage. The last step of care is definitive care. This encompasses the trauma professionals that work in hospital settings. In these hospital settings, the trauma professionals have all the necessary equipment and skills to continue care for the patients.
The Hartford Consensus is working to extend Good Samaritan Laws to encourage the public to help. They currently empower the public to become involved with immediate response of choking victims or cardiac arrest, by using the Heimlich maneuver or cardiopulmonary resuscitation (CPR) respectively. The consensus would like the legal protections of immediate responders to extend to those helping with bleeding control.
To facilitate their goals, the Hartford Consensus also promotes education. Life saving actions can be taken by any person who has been properly trained. These training for immediate responders include, personal safety, identification of life threatening bleeding, direct pressure, and how to use tourniquets. The National Association of Emergency Medical Technicians offers a course in Bleeding Control for the Injured (B-Con). This is targeted towards those with little to no medical background. The Hartford Consensus would like to approach bleeding control as something everyone should know about. Just as cardiopulmonary resuscitation is taught to all age-groups and varieties of people. This preparation, ensures that the public will have a faster and more quality response as immediate responders.
Just as education is becoming more prevalent, as is access to necessary life saving equipment. In highly populated areas, like shopping malls, schools, museums, hospitals, airports and other transportation centers, bleeding control bags can be found. Just as automated external defibrillators (AED), are found in case of cardiac arrest, bleeding control bags can be used for quick access to medical equipment for an external hemorrhage.
The Hartford Consensus, along with the growing risk of mass-casualty incidents, is transforming EMS care. NFPA, the National Fire Protection Agency, released guidelines on standards for active shooter and hostile event responses. One specialized group of emergency medical services to arise from these programs are known as Tactical EMS. These responders are armed and respond with SWAT teams. These programs are limited and often times may arrive too late to help the situation. In more widespread ways, the Hartford Consensus affects EMS through its training. Active shooter drills are being integrated to improve familiarity with the event and improve jointly developed protocols, with law enforcement, Fire, and EMS. Extensive planning, recurrent training, and pre-planned coordination during mass casualty incidents increase survivability of the situation. Joint protocols have been emphasized, and even terminology should be uniform between agencies, as they will be working together in mass casualty incidents.
The Hartford Consensus has become an extraordinarily important document. As the number of active shootings and mass casualty incidents are rising since the Columbine shooting in 1999, everyone needs to be prepared in how to react. The education of the public will help save countless lives, many of whom without immediate external hemorrhage control would bleed out before definitive help can arrive. The continuum of care, that is focused on in the Hartford Consensus II, is life saving. The police protocols have evolved from containment to a more modern, aggressive response, using the zones of safety, that allows early involvement of EMS personnel in patient care. Instead of waiting for the entire scene to be secured, work can begin in zones deemed safe enough.
The Hartford Consensus and the American College of Surgeons (ACS), promotes simple streamlined messages to encourage the public to help. Although this is a good tactic, it may also lead to harm. The simple messages such as, “See something, Do something” do not contain the vital information that responders need to know. This includes personal safety, from disease contractions and harmful situations, as well as proper techniques for treatment of external hemorrhages. To combat this problem, classes and thorough training should be normalized. In classroom settings and beyond, the public can never be over prepared for the ever growing problem of mass casualty incidents.