In April of 2013, the American College of Surgeons convened the Joint Committee to Create a National Policy to Enhance Survivability from Intentional Mass Casualty and Active Shooter Events. The impetus for the committee was the active shooter incident that occurred a few months earlier at Sandy Hook Elementary School in Newtown, CT. The committee’s purpose was “to create a protocol for national policy to enhance survivability from active shooter and intentional mass casualty events.”

Membership on the committee included a broad array of stakeholders, including the medical community, the federal government, and governmental and nongovernmental emergency medical response organizations. To date, the committee’s recommendations consist of four reports released over a three-year period that are collectively referred to as the Hartford Consensus.

The four reports are:

• Improving Survival from Active Shooter Events: The Hartford Consensus.
• Active Shooter and Intentional Mass-Casualty Events: The Hartford Consensus II.
• The Hartford Consensus III: Implementation of Bleeding Control.
• The Hartford Consensus IV: A Call for Increased National Resilience.

The overarching principle of the Hartford Consensus is that a life should not be lost as a result of uncontrolled bleeding.

In the Consensus III report the acronym THREAT was adopted to summarize the steps that should be taken when responding to incidents:

• Threat suppression
• Hemorrhage control
• Rapid Extrication to safety
• Assessment by medical providers
• Transport to definitive care

Three different levels of responders were identified in the Consensus III report:

• Immediate responders: The individuals who are present at the scene who can immediately control bleeding with their hands and equipment that may be available.
• Professional first responders: Prehospital responders at the scene who have the appropriate equipment and training.
• Trauma professionals: Health care professionals in hospitals with all of the necessary equipment and skill to provide definitive care.

The report found properly trained immediate responders as crucial in providing lifesaving intervention by performing critical external hemorrhage control before the arrival of professional first responders.

The Consensus III report recommended specific educational content for immediate responders:

• actions to ensure personal safety;
• appropriate interactions with professional responders;
• how to identify bleeding as a threat to life;
• use of hands to apply direct pressure;
• proper use of safe and effective hemostatic dressings;
• proper use of effective tourniquets; and
• use of improvised tourniquets as a last resort

The Consensus III treatment recommendations apply to incidents other than the active shooter and mass casualty events envisioned by the report and are effective for all serious bleeds whenever and wherever they occur. All of Excelsior’s bleeding control and trauma response courses include the recommended educational content for training immediate responders from the Hartford Consensus III report and all courses have been reviewed and approved by Excelsior’s Medical Director.

At Excelsior, we believe that proper training saves lives and that a life should never be lost as the result of a lack of proper training.