Ask a Firefighter: Improving survivability in a mass-casualty crisis

Ask a Firefighter: Improving survivability in a mass-casualty crisis

When tragedy strikes, the willingness and capability of everyday citizens to take action can make the difference between life and death.  Residents have asked what they can do to improve survivability in the event of a mass-casualty crisis. Your local firefighters and emergency medical technicians want you to know that with very little equipment, the individuals closest to the scene of an accident or mass-casualty situation can control bleeding until first responders arrive to take over treatment. This will save lives.

According to the National Academies of Science, trauma is the leading cause of death for Americans under age 46. Dr. David Wade, the chief medical officer for the FBI, states that active-shooter incidents are not just a “big-city” issue, because they can happen anywhere. A report issued by the Federal Emergency Management Agency (FEMA) states that more than 250 people have been killed in the United States during active-shooter and mass-casualty incidents since the Columbine High School shootings in 1999. The Las Vegas attack in October 2017 is considered to be the deadliest shooting in modern U.S. history, where 58 people were killed. The Orlando nightclub shooting claimed 49 lives in June 2016, and November's shooting in Sutherland Springs, Texas, took the lives of 26 victims.

Although active-shooter or mass-casualty incidents have become the reality of modern life, until recently the responses to these tragic incidents have focused more on law enforcement goals (stop the shooting) than trauma care goals (stop the bleeding). Experts now agree that the leading cause of preventable death in these incidents is uncontrolled bleeding or hemorrhage.  

All too often, victims of active-shooter or mass-casualty incidents bleed to death waiting for medical treatment. Quick actions to control external hemorrhage on the part of first responders, including bystanders, can provide effective, lifesaving, first-line treatment in eliminating preventable pre-hospital death. Since the window of opportunity to save a life by controlling bleeding from an exterior wound may be as short as 5 minutes, there is no time to run to the car or find the location of a wall-mounted trauma kit.  

The result is a program called “Stop the Bleed,” a national awareness campaign. The guiding belief of “Stop the Bleed” is that no one should die from uncontrolled bleeding. “Stop the Bleed” is intended to encourage bystanders to become trained, equipped, and empowered to help in a bleeding emergency before professional help arrives. Uninjured or minimally injured victims can act as rescuers. Everyone can safe a life.

You may be able to save a life by taking simple actions, but remember to be aware of your surroundings and ensure your own safety before providing care. Once the scene is safe, begin the ABCs of Bleeding.

■A– Alert – Call 911■B– Bleeding – Find the source of the bleeding■C – Compress – Apply pressure to stop the bleeding by covering or packing the wound with a clean cloth or your hands and apply, firm, steady pressure to the bleeding site.

Experts suggest that the key to improving survival in active-shooter mass-casualty incidents is expanding the pool of first responders. The reality is that bystanders are first responders. Preparing citizens and first responders to safely intervene will help control bleeding and save lives.

Remember, you may be able to save a life by taking simple actions, but always call 911 for help. For more information, visit

Jane Perkins is a fire-safety specialist for the Rhode Island Southern Firefighters League and captain of the Watch Hill Fire Department. If you would like to see a question answered in this column, please e-mail her at


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