The Fort Hood Massacre

Abstract

Prognostic study, level V.

Pre-hospital management of mass casualty civilian shootings: a systematic literature review

“…Study design in the included manuscripts comprised case reports ( n  = 14), review articles ( n  = 4), commentaries ( n  = 14), government reports ( n  = 5), information technology report ( n  = 1), consensus statements ( n  = 2) and original research papers on matters relevant to pre-hospital management of mass casualty civilian shootings ( n  = 7) [1, 2, 10–54]. The search revealed heterogeneous primary source information on seventeen mass shooting events, the majority from the USA and others from Norway, the UK, Kenya and France (Table 2).…”

“…Currently the methods of triage for mass shootings are not validated by reliable evidence [66]. In many of the papers included in this review, triage was identified as an area of potential improvement or concern [13, 30, 48, 49, 53, 54]. …”

“…It attempts to provide the maximum benefit for the most casualties with the available resources [67, 68]. The mass shootings reported in the results section used a mixture of the START triage system [30], local physiological-based triage systems [54], unspecified methods of triage by experienced medical staff [48], an anatomic site of bullet entry triage methods [53] and, in some cases, moving patients rapidly to nearby hospitals where triage occurred after arrival [46]. …”

“…This occupied the triage resources and prevented the identification of the severely injured. The Fort Hood report concludes that a lack of scene safety, chaotic triage organisation and communication failures led to fear amongst the emergency staff, which compromised triage and led to the inappropriate or under-triage of several patients [54]. A second attack on this base in 2014 reported similar triage issues, noting that ongoing clinical reassessment was critical [49].…”

“…Two other incidents reported the benefits of having senior surgeons play a pivotal role in pre-hospital triage; the terrorist attacks in Jerusalem and the Dark Knight cinema shooting in Aurora Colorado [32, 45]. Furthermore both also supported the concept of keeping initial triage simple [31, 54]. …”