First aid from a gunshot injury can save a life. Here is what to do.

Twelve people died this week after an armed gunman opened fire in a bar in Thousand Oaks, California. More than 20 others were injured. Two weeks ago, an armed man killed 11 people at the Tree of Life synagogue in Pittsburg. Mass shootings in public places have become increasingly common in recent decades. There have been 307 shootings in the United States by 2018.

At the scene of mass shooting, the main purpose of law enforcement is to identify and capture the shooter. When the area is sufficiently secure, the focus is on the victims and providing them with the medical care they need. Emergency medical services, nurses and hospital doctors, nearby civilians and even those affected by the event play a role in the survival of people.

How passers-by can help save the victims of gunfire

After the mass shootings at Sandy Hook Elementary School in 2012, the American College of Surgeons formed the joint committee to develop a national policy to improve survivability in case of injuries serious and intentional intentional shootings, with the goal of developing policies and programs to keep people alive during mass shooting incidents. They created the Stop the Bleed campaign to help civilians control bleeding. Victims of trauma or a shot often die as a result of a blood loss, rather than the injury itself.

"Someone may die from bleeding in five to eight minutes," says Jeffrey Kerby, a surgeon at the University of Alabama in Birmingham, involved in the Stop the Bleed campaign. "Someone on the scene will have to step in to save the injured victims. EMS can not arrive on time. "

People nearby must first ensure their own safety and then ensure that law enforcement and first responders have been alerted. Then they can help the victims of the shooting by searching for the source of the blood – by opening or removing clothes if necessary.

Life-threatening bleeds requiring care include blood that accumulates on the floor or gushes out of a wound, partial loss or loss of a limb, or bleeding from the body. an unconscious person. There are some techniques to stop bleeding, and all involve applying pressure to the wound.

If there are no supplies available, cover the wound with a cloth (a shirt, a scarf, anything around), press firmly with both hands and continue to press. If the injury is particularly deep, squeeze the tissue in to wrap the wound.

If a trauma kit is available and the injury is on a limb, squeeze a tourniquet around the person's arm or leg above the wound. According to Kerby, contrary to popular belief, a tourniquet does not mean that a person will need an amputation. If a tourniquet lasts less than two hours, the limb will probably be in good condition. "We have to break these myths," he says. "You do not hurt the patient, you save his life. Life on the member. "

For Kerby, pressing a wound or tightening a tourniquet will be painful for the injured person. "It's not because the person you're trying to help feels uncomfortable that you're hurting him," he says. "You are doing the right thing."

Kerby says one of the main goals of the Stop the Bleed campaign is to empower people to help in all serious injury situations. "People do not feel that they can help, so they do not, which is certainly understandable," he says.

First responders and police officers who had followed the Stop the Bleed training and had tourniquets saved at least three lives after the shootings in the Tree of Life synagogue, Pittsburgh trauma surgeon Matthew D. Neal wrote in an editorial .

In addition to managing bleeding, people can identify first responders and ask experts what they can do, says Lesley Osborn, emergency medicine specialist at UTHealth's McGovern Medical School in Houston. Witnesses may be asked to monitor those with minor injuries to make sure they do not get worse and help them stay calm. "During these kinds of things, people are ready to help," she says. "When you look at these events, passersby are among the biggest assets."

How Emergency Medical Response Teams and Hospitals Manage the Crisis

Emergency medical services, when they arrive, start by sorting: sort the victims by bullet according to the urgency of their injury and have them treated as quickly as possible.

There are some detailed systems for classifying people after an incident involving many victims – START (simple triage and rapid treatment) is most commonly taught in the United States, and SALT (sorting, assessment, rescue interventions, treatment / transportation ) is often used, as well as. "They are all alike and each doctor would have an opinion they would like," says Osborn.

They all follow the same basic structure: determine which people are not going to survive, which are the most serious injuries that require immediate attention and must go to the hospital first, and which people have less serious injuries.

"If you listen, your initial procedure is to say," If you can hear my voice, go to me, "says Osborn. This tells the medical services if you have a medical condition normal enough to understand what is said and vital signs sufficient to walk. "These people are probably the least critical, at least for the moment."

Depending on the system, patients are then sorted according to the type of wound they present, their heart rate, and their respiratory status. Sorting systems use tags to identify patients based on the severity of their injuries and to track their vital signs or other information.

Despite the training and planning, the specificities of the different sorting systems – the thoroughness of which one serious bullet victim is slightly more at risk than another – are often not followed to the letter.

"We all plan with one of these sorting methods in mind, but then you come to an event that goes out the window," says Osborn. "It's just moving the sickest patients away from the most dangerous area and to the hospital."

Hospitals use similar sorting systems to sort patients as soon as they arrive and identify those that require immediate attention from physicians and surgeons. According to Osborn, the additional challenge in hospitals is that they often do not know which patients will arrive and when. Ambulances give news to hospitals, but after a large-scale shootings, people often arrive at the emergency room at the back of police cars and other vehicles.

We have better control over mass shots because we have more experience with them.

Emergency medical services, first responders and hospitals are increasingly dealing with victims of large-scale shootings. Organizations have plans in place for what they will do when there is a big shot in their area, and Stop the Bleed courses are offered for free or at a low price across the country.

"We want to make it as mundane as CPR," Kerby said. "It's too bad we had to do that. We do not have to accept what is happening, but we must prepare for it. "

Hospitals and first responder teams can also learn from the experience of doctors in places where shooting has already occurred: UPMC staff Presbyterian, the hospital that has treated The victims of the Pittsburgh Synagogue attack, said he refined his plans and procedures after hearing surgeons who worked on the shootings in Orlando and Las Vegas.

"Unfortunately, we are all better trained," says Osborn. "I hope that someday we will not need these skills."