With 100% agreement between reviewers, only 9 of the analyzed 125 fatalities (excluding the 14 without detailed autopsy data) were found to be potentially survivable, yielding a potentially survivable wound rate of 7% (Table 2). There was near-equal distribution between shotgun and handgun wounds in this group and no wounds caused by high-velocity rifles. The most common potentially survivable injury was a gunshot/shotgun to the chest (89%), with autopsy reports showing no significant vascular or cardiac injury and only small hemothorax.
Does this mean external hemorrhage control for civilians is unimportant? Emphatically no! Tourniquets and simple hemorrhage control measures most definitely have a role in improving survival but should no longer be a myopic focus of first responder and public.
Basically, tourniquets are good, chest seals are gooder.
What you should train for:
Per TECC, in addition to immediate patient access and external hemorrhage control (direct pressure, tourniquets, and hemostatic agents), immediate medical care in the wake of a CPMS must include strategies to prevent further injury to the wounded, simple airway management, recognition and management of declining respiratory function as a result of penetrating trauma to the chest, proper positioning of the casualty, efficient movement of the casualty, and prevention of hypothermia.
The old ABC (Airway, Breathing and Circulation) is still valid. I saw not too long ago some article discrediting “The Golden Hour” and basically any emergency training in civilian shootings because the easier and faster access to emergency medical care in the cities. I found that not only stupid but dangerous because your particular FD may have in average a fast response time, it does not mean that will be the response time on the incident you are involved. Murphy Lives.
And what I like a lot about this report is their acknowledgement of limited data access and needing to go deeper. And the conclusion is proof once again that what is done in the military does not necessarily translate to civilian life
We found that the overall wounding pattern and the fatal wounding pattern following civilian active shooter events differ from combat injuries. There were no deaths from exsanguinating extremity wounds. As such, we discourage the current myopic focus on hemorrhage control for civilians. Instead, we urge that the tenets of civilian-based TECC be implemented across the entire prehospital trauma spectrum, and we further recommend studying this strategy to affirm its benefit.
But still: Military First Aid training beats no training at all!