The Stop the Bleed course aims to improve bystander hemorrhage control skills and may be improved with point-of-care aids. We sought to create and examine a variety of cognitive aids to identify an optimal method to augment bystander hemorrhage control skills in an emergency scenario.

Randomized trial of 346 college students. Effects of a visual or visual-audio aid on hemorrhage control skills were assessed through randomization into groups with and without prior training or familiarization with aids compared with controls. Tourniquet placement, wound packing skills, and participant comfortability were assessed during a simulated active shooter scenario.

A total of 325 (94%) participants were included in the final analyses. Participants who had attended training (odds ratio [OR], 12.67; P = 9.3 × 10−11), were provided a visual-audio aid (OR, 1.96; P = 0.04), and were primed on their aid (OR, 2.23; P = 0.01) were superior in tourniquet placement with less errors (P < 0.05). Using an aid did not improve wound packing scores compared with bleeding control training alone (P > 0.05). Aid use improved comfortability and likelihood to intervene emergency hemorrhage scenarios (P < 0.05).

Using cognitive aids can improve bystander hemorrhage control skills with the strongest effects if they were previously trained and used an aid which combined visual and audio feedback that they were previously introduced to during the course training.

While hospital-related shootings are not common, recent years have demonstrated an increasing trend, especially involving the emergency department (ED). Despite this increase, there remains a lack of effective training for providers for active shooter events. Existing trainings commonly lack active participation, departmental-specific plans, or feasibility.

Sixty-six emergency medicine physicians, nurses, and technicians participated in a two-phased multimodal active shooter training aimed to increase response knowledge and comfort. The initial training phase included a lecture on “Run-Hide-Fight” principles with departmental adaptations, followed by scenario-based discussion, and then safety walkthrough. Months later in the second phase, participants completed an active shooter simulation. An identical knowledge survey was collected before and after each phase along with descriptive analysis. Surveys were compared using paired t-test. Comfort levels were reported on a Likert scale and compared by paired t-test.

Paired t-tests confirmed a statistically significant difference in both active shooter knowledge and comfort levels. Participants showed retention of response knowledge and comfort with implementing response behaviors. Further descriptive analysis demonstrated effective fleeing and barricading, suggesting a real-life gain of knowledge and comfort.

A two-phased, multimodal training design for active shooter response was successful in increasing ED provider active shooter knowledge, comfort, retention, and effective response behaviors.

This study evaluated how Tactical Emergency Casualty Care (TECC) training prepared law enforcement officers (LEOs) with the tools necessary to provide immediate, on-scene medical care to successfully stabilize victims of trauma.

This was a retrospective, de-identified study using a seven-item Fairfax County (Virginia USA) TECC After-Action Questionnaire and Arlington County (Virginia USA) police reports.

Forty-six encounters were collected from 2015 through 2016. Eighty-four percent (n=39) of the encounters were from TECC After-Action Questionnaires and 15% (n=7) were from police reports. The main injuries included 13% (n=6) arterial bleeds, 46% (n=21) mild/moderate bleeds, 37% (n=17) large wounds, 20% (n=9) penetrating chest wounds, and 13% (n=6) open abdominal wounds. One-hundred percent of officers reported success in stabilizing victim injuries. Seventy-four percent of officers (n=26) did not encounter problems caring for a patient while 26% (n=9) encountered a problem. Ninety-seven percent (n=37/38) answered Yes, the training was sufficient, and three percent (n=1) indicated it was OK.

This is the most comprehensive study of TECC use among LEOs to date that supports the importance of TECC training for all LEOs in prehospital trauma care. Results of this study showed TECC training prepared LEOs with the operational tools necessary to provide immediate, on-scene medical care to successfully stabilize victims of trauma. Continuing to train increasing numbers of LEOs in TECC is key to saving the lives of victims of trauma in the future.

RothschildHR, MathiesonK.Effects of Tactical Emergency Casualty Care Training for Law Enforcement Officers. Prehosp Disaster Med.2018;33(5):495–500.

The primary objective of this exercise was to conduct a full-scale functional exercise utilizing an active-shooter-based scenario to test and evaluate hospital response and coordination with local law enforcement.

A multidisciplinary group, including community partners, formulated objectives in accordance with the Homeland Security Exercise and Evaluation Program and defined a scenario. A date to conduct the exercise was chosen on the basis of the expected completion of a large section of the new emergency department but prior to its opening for patient care.

The exercise highlighted several strengths, but more importantly, illuminated areas for improvement that might otherwise have been missed in tabletop exercises and smaller-scale drills. Educational opportunities to improve functional skills and protocol were recognized.

Conducting a full-scale functional exercise of an active shooter in a newly constructed emergency department prior to opening for patient care provided valuable insight into areas for improvement while minimizing the impact such an exercise can have on daily operations. Should a similar opportunity arise as a result of new facilities being developed or renovations and maintenance requiring temporary closure, we advise hospitals to consider planning an exercise in the area prior to reopening for patient care. (Disaster Med Public Health Preparedness. 2017;11:522–525)

Emergency Medical Services (EMS) routinely stage in a secure area in response to active shooter incidents until the scene is declared safe by law enforcement. Due to the time-sensitive nature of injuries at these incidents, some EMS systems have adopted response tactics utilizing law enforcement protection to expedite life-saving medical care.

Describe EMS provider perceptions of preparedness, adequacy of training, and general attitudes toward active shooter incident response after completing a tactical awareness training program.

An unmatched, anonymous, closed-format survey utilizing a five-point Likert scale was distributed to participating EMS providers before and after a focused training session on joint EMS/police active shooter rescue team response. Descriptive statistics were used to compare survey results. Secondary analysis of responses based on prior military or tactical medicine training was performed using a chi-squared analysis.

Two hundred fifty-six providers participated with 88% (225/256) pretraining and 88% (224/256) post-training surveys completed. Post-training, provider agreement that they felt adequately prepared to respond to an active shooter incident changed from 41% (92/225) to 89% (199/224), while agreement they felt adequately trained to provide medical care during an active shooter incident changed from 36% (82/225) to 87% (194/224). Post-training provider agreement that they should never enter a building with an active shooter changed from 73% (165/225) to 61% (137/224). Among the pretraining surveys, significantly more providers without prior military or tactical experience agreed they should never enter a building with an active shooter until the scene was declared safe (78% vs 50%, P = .002), while significantly more providers with prior experience felt both adequately trained to provide medical care in an active shooter environment (56% vs 31%, P = .007) and comfortable working jointly with law enforcement within a building if a shooter were still inside (76% vs 56%, P = .014). There was no difference in response to these questions in the post-training survey.

Attitudes and perceptions regarding EMS active shooter incident response appear to change among providers after participation in a focused active shooter response training program. Further studies are needed to determine if these changes are significant and whether early EMS response during an active shooter incident improves patient outcomes.

JonesJ , KueR , MitchellP , EblanG , DyerKS . Emergency Medical Services Response to Active Shooter Incidents: Provider Comfort Level and Attitudes Before and After Participation in a Focused Response Training Program. Prehosp Disaster Med. 2014;29(4):1-7.