A Hartford Hospital trauma physician met with doctors from the FBI, the Navy, the Dallas SWAT team, the New Orleans Police Department and elsewhere one day in April to begin work on a plan to help cities and towns better prepare for a mass shooting.
The goal is to coordinate teams of first-responders and increase the number of survivors.
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The idea was hatched by the American College of Surgeons in response to the shootings at a movie theater in Aurora, Colo., and at Sandy Hook Elementary School in Newtown.
The meeting place was Hartford Hospital, partly because it is close to Newtown, one member of the team said, but also because it has a level one trauma center and is the center for disaster preparedness for northern Connecticut.
The group of doctors has become known as The Hartford Consensus, a committee of eight people from medicine, the military and law enforcement.
Dr. Lenworth Jacobs, director of trauma and emergency medicine at Hartford Hospital, said the group hopes the plan it is drafting will be a blueprint for each community — something towns and cities would use as a starting point for coordinating emergency response efforts. The short paper that came out of the daylong conference will be published in the June issue of the Bulletin of the American College of Surgeons.
Jacobs chaired the committee and is lead author of the paper.
"Active shooter/mass casualty events are a reality in modern American life," the authors wrote. "As our experience with these events has accumulated, it has become clear that long-standing practices of law enforcement, fire/rescue and EMS responses are not optimally aligned to maximize victim survival."
Committee member Dr. Alex Eastman, who is the interim chief of the trauma center at Parkland Memorial Hospital in Dallas as well as a lieutenant on the Dallas police SWAT team, said The Hartford Consensus is an effort to "put on paper what we all know needs to be done."
"The public safety response to these kinds of things has traditionally been segmented," he said. "What we've learned is that we really can't afford to do business like that anymore."
Eastman said he plans to discuss the paper with the Officer Safety and Wellness Working Group, an organization of the U.S. Department of Justice.
One of the points emphasized in the paper is that all levels of responders — police, emergency medical technicians and doctors — should be speaking in common terminology.
"This all sounds very straightforward, but when it's happening in Columbine or in a movie theater, or in Sandy Hook, everybody has to know exactly what the expectation is because all of this has to happen immediately," Jacobs said.
For instance, Jacobs said, Hartford Hospital uses the term "Code Rover" to indicate a fire, but a different hospital would use another term. When you have only minutes to assess the level of care needed for a victim and decide where that person should go, Jacobs said, little things like that make a huge difference.
"You really have to do this in a very orchestrated way very quickly, and everybody has to know what they're doing," he said. "And everybody has to practice it."
Another major point of the paper is the importance of controlling the bleeding of victims at the scene. The eight-member committee met two weeks before the Boston Marathon bombing, which showed just how critical the use of tourniquets are, even the many makeshift ones that were used in Boston.
Dr. Dave Wade, chief medical officer at the FBI and a member of The Hartford Consensus, said the tourniquet had gone out of favor for a few years because of fears that improper use could cut off circulation.
"We found that that's not true," he said. "They're more likely to bleed to death than lose a limb because the tourniquet is too tight."
Another suggestion the committee puts forth is that medical personnel be trained in weapons and ammunition to better assess the kind of damage that different firearms can do.
The members stress that the paper they wrote in April is only a start. The real work comes later this year when the committee meets again to draft a more detailed version and then figure out how to get municipalities on board with it.
No date has been set, Jacobs said, but he expects that it will happen within the next few months.