In the aftermath of one of our nation’s most horrific acts of intentional harm – the shooting at Sandy Hook Elementary School, the Joint Committee to Create a National Policy to Enhance Survivability from Intentional Mass Casualty and Active Shooter Events was created. Compromised of a world-class team of healthcare and government leaders, this group has met three times to evaluate issues and recommend change.
The work product of this group, which bears the name of the city in which the meetings occurred, has come to be known as the Hartford Consensus. The committee’s first report introduced an algorithm for initial response to such events, known as THREAT (Threat suppression, Hemorrhage control, Rapid extraction to safety, Assessment by medical providers and Transport to definitive care). In the most recent report, Hartford Consensus III focuses on the role of those present at the time of the event, referred to as Immediate Responders, and their essential role in rendering care to stop the bleeding. Central to this theme, this group of trauma care experts concluded that there needs to be public access to hemorrhage control tools. These recommendations call for a better integrated response between immediate responders (including civilian bystanders), professional first responders, and trauma professionals to ensure that hemorrhage control is enacted at the scene of an injury – prior to the arrival of emergency medical services.
The Hartford Consensus III states: (1) states uncontrolled bleeding is the most significant preventable cause of death in the pre-hospital environment, (2) directs all responders – civilian and professional – to have the education and necessary equipment for hemorrhage control, and (3) strongly endorses civilian bystanders to act as “immediate responders.” Hartford III recommends public access to bleeding control bags that include pressure bandages, safe and effective hemostatic dressings, effective tourniquets, and personal protective gloves. And that these resources be placed in locations that are widely accessible, similar to AEDs and should be readily visible and available for use within three minutes of need. The effort to make these resources available requires public education, private sector engagement, philanthropic and government support, and community involvement. Civilian and professional responders must be empowered to act, intervene, and assist at the scene the save lives.