Chris Strattner

After utilizing the Run-Hide-Fight method during an active-shooter situation, there may be individuals who are injured. You should remember that initial responders like police and armed security will be extremely busy and focused on making sure that any continuing threat is neutralized. Police and armed security assume that where there is one bad guy, another may be lurking in the shadows. They will likely leave no stone, closet, cabinet, or desk drawer unturned in their search and this procedure can take a while. In the meantime, anyone hurt and in need of medical attention may be getting worse. If they are left unattended for too long, some of them could die.

However, there is good news. The US Military looked at all of the data from casualties during the Vietnam War and learned that a few simple things can make a big difference, especially before paramedics arrive with advanced medical care. Anyone can learn how to do these simple techniques without much special training.

The first technique that can be used is a tourniquet. A tourniquet is a constricting band wrapped around an arm or a leg that cuts the blood supply off, and therefore stops the bleeding. Once upon a time, it was thought that applying a tourniquet meant that the victim would lose the limb. This isn’t true. You can actually put a tourniquet on anyone, and as long as the victim is in a hospital within two hours, there won’t be any damage resulting from the use of it. This was confirmed by military studies in Iraq and Afghanistan. However, this technique isn’t really “news”. Surgeons have been using tourniquets to prevent bleeding in the operating room for years without any problems. It's important to place a tourniquet like a marine’s haircut; “high and tight”. High because when arteries are cut, the end shrivels up. Similar to cutting an earthworm on the sidewalk. The artery is trying to stop its own bleeding as a defense mechanism. For us, it means that we can’t see how far the artery has retracted. To be safe, you should put the tourniquet as high as possible every time. You should remember, nothing bad will happen as long as we get the victim to a hospital within a couple of hours. Make the tourniquet as tight as possible; pulling a belt tight is good, but a tie is better. Especially if you can find something like a “stick” to slip underneath and twist to tighten. Just one note, no tourniquets around the neck. Unless it’s the bad guy, then….

The second technique is pressure. If someone is bleeding from a part of the body where a
tourniquet won’t be useful, wadding up some cloth into a firm ball and applying pressure on the injury will usually work. Use two hands if possible and get your body weight over your arms (think CPR position). Hold firm pressure in the injured area for three full minutes. Time it if you have to and resist the urge to “check out” how it looks. Removing pressure will release any semi-formed clots and puts you back to square one with the bleeding.

The third technique that can be used on injured individuals after an active-shooter situation is sealing up holes. Any hole in “the box” (that’s your body minus your arms, legs and head) should be sealed up. The problem with holes in “the box” is that they might have penetrated all the way into the victim’s lung. The body has a pretty well designed system
 that functions on pressure changes to fill and empty the lungs. When there is a hole, those pressures get messed up, and the victim can end up with a collapsed lung. Or worse, one of the membranes in their chest can start to fill up like a balloon, obstructing the lungs and heart. Sealing up the chest doesn’t fix these problems entirely, but it slows the process down a lot. Without a seal, someone could die within 10 minutes. With a seal, an individual can have closer to an hour – and they don’t even have to get all the way to the hospital. Paramedics have some pretty fancy ways of solving the problems of holes in chests. Speaking of fancy, the seal doesn’t have to be fancy at all. A sandwich bag or a piece of a garbage bag (take the garbage out first, please! Points off for putting an old banana peel in someone's chest!) can be used to seal a hole. If you can tape it in place, great. If not, try holding it as close to an airtight seal as possible with your hand over the plastic. If you do tape it in place, make sure you take a good look at it every few minutes. If it looks like a balloon filling up with air, you’ll need to let some air out and reseal it (it’s ok to get a new seal). It is important that all holes in “the box” are sealed, so take a good look at the victim’s chest, back, and sides to make sure you didn't miss one.

If you can do these three techniques: (1. tourniquets high and tight, 2. serious pressure, and 3. a seal on anything in “the box”), while armed security and police are dealing with the threat, you’ll be giving the victims a fighting chance until the paramedics arrive. 

Chris ShrattnerChris Strattner is the Director of Product Development for Mobilize Rescue Systems. Mobilize provides interactive and mobile medical rescue kits that enable untrained bystanders with the knowledge and equipment to save lives during unexpected medical emergencies. Chris worked as an EMT in New York City in the 1990s. He transitioned into law enforcement in 1997 and was assigned to the SWAT team, while continuing as a paramedic in Newark, NJ. He has been instructing SWAT and civilian medics around the world in tactics for dealing with violent events since 2004. Chris holds a B.A. in Cognitive Psychology from Colombia University and a J.D. from Seton Hall University.

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