Rapid response to mass shootings

• DOI: http://doi.org/10.1111/1745-9133.12479
• Author: Sonali Rajan,Sara Jacoby,Charles C. Branas,Paul M. Reeping
• Date: 01 February 2020
• Published date: 01 February 2020

DOI: 10.1111/1745-9133.12479

SPECIAL ISSUE ARTICLE

COUNTERING MASS VIOLENCE IN THE UNITED STATES

Rapid response to mass shootings

A review and recommendations

Paul M. Reeping1Sara Jacoby2Sonali Rajan1

Charles C. Branas1

1Columbia University

2University of Pennsylvania

Correspondence

PaulM. Reeping, Department of Epidemiology,

MailmanSchool of Public Health, Columbia

University,722 West168th Street, New York,

NY10032.

Email:Pmr2149@cumc.columbia.edu

Research Summary: We conducted a scoping review of

literature indexed in the National Library of Medicine’s

journal citation database, MEDLINE, and Scopus to iden-

tify articles in which the rapid response of hospital staff,

emergency medical services personnel, the police, and the

public to mass shootings is covered. Sixty-fivear ticles were

included, and critical themes related to reducing the harm

from a mass shooting were summarized.

Policy Implications:According to our findings, when mass

shootings occur in the United States, several evidence-

informed steps can be taken from the moment the first bul-

let is fired until the last injured individual is transported

to the hospital to promote a rapid response that can reduce

death and disability. Ten recommendations are made rang-

ing from recognition of the need for rapid response and

bystander training to triage and transport training of police

and avoidance of over-response.

KEYWORDS

firearms, mass casualty incidents, mass shootings, rapid response, review

On October 17, 2017, just after 10 PM, the highest causality mass shooting event in U.S. history

occurred at a music concert in Las Vegas, Nevada. From a 32nd floor window of the building across

from the concert venue, a single individual shot more than 1,000 bullets into the crowd on the ground

below. After performing retrospectiveevaluation, the devastating human toll of this shooting was con-

firmed; more than 800 people were injured, more than 500 required medical care, and 58 people died

(Lake, 2018). Arguably, the response to this mass shooting was alsoone of t he most profound tests of

Criminology & Public Policy. 2020;19:295–315. wileyonlinelibrary.com/journal/capp © 2019 American Society of Criminology 295

296 REEPING ET AL.

the capacity of the local hospital system, emergency medical services (EMS) system, and law enforce-

ment in and around Las Vegas in rapidly responding to a civilian act of mass violence.

In a case study published by the Nevada Hospital Association, the author reviewedt he manylessons

learned in the aftermath of the shooting. The socially and medically complex nature of these kinds of

human-made disasters was highlighted. For example, people at the scene of the Las Vegas shooting

behaved differently than they might have in the aftermath of other high causality events, such as a

multiple-vehicle road traffic crash (Lake, 2018). In Las Vegas, many victims fled the scene of the

shooting and sought medical care on their own, bypassing EMS and established protocols for choosing

appropriate medical facilities and notifying hospitals of impending arrivals (Lake, 2018). Many vic-

tims and noninjured bystanders also used smartphones and mapping applications to find health-care

facilities. Given the sheer volume of victims, both trauma centers and smaller community hospitals

received patients with major injuries and little notice (Lake, 2018). As a result, these hospitals experi-

enced unplanned strains on their resources and staff capacities (Lake, 2018).

The Las Vegas mass casualty shooting may have been unusual in its magnitude, but its need for a

rapid multisector, mass casualty, and mutual aid response is notunique. Both medical and law enforce-

ment responses are necessary and interdependent when contending with mass casualty incidents and

reducing the risks of death. The findings from research spanning two decades on the use of law enforce-

ment personnel as a coordinated part of the medical response to shootings have demonstrated benefits

in terms of rapid access to medical care and mortality reductions (Band et al., 2014; Branas, Sing,

& Davidson, 1995; Wandling, Nathens, Shapiro, & Haut, 2016). In addition, based on the results of

national research funded by the Centers for Disease Control and Prevention more than a decade ago,

rapid access to accredited trauma center hospitals in the United States has been shown to reduce the risk

of death significantly for people who are severely injured (MacKenzieet al., 2006). The findings from

further national research on the mass casualty response capabilities of 25 major U.S. cities showed

that longer wait and transport times needed to distribute high numbers of severely injured patients to

trauma centers after fast-onset mass casualty incidents resulted in predictable increases in mortality.

This research was funded by the NationalInstitutes of Health and conducted in conjunction with Office

of the Assistant Secretary for Preparedness and Response at the U.S. Department of Health and Human

Services, and its findings highlight the need for a coordinated systems-based approach to mass casualty

incidents that includes multiple public sectors—hospital, EMS, and law enforcement—and appropri-

ate execution of multijurisdictional mutual aid agreements (Carr, Walsh, Williams, Pryor, & Branas,

2016).

Mass shootings are a category of mass causality incidents for which there is no single definition or set

of criteria. The Congressional Research Service designates mass shootings as incidents in which four or

more people are killed with a firearm, in one event, and at close proximity.By comparison, t he Federal

Bureau of Investigation’s (FBI’s) operationalizing of a mass shooting differs in that its definition

requires an “active shooter” (an individual attempting to kill people in a populated area). Nongovern-

mental and media organizations also track mass shooting events over time. In these databases, mass

shootings are identified as any incident that occurs in a public place, with a firearm, where three or

more people are killed, and where the motive seems to be indiscriminate (Follman, Aronsen, & Pan,

2019).

By many of these definitions, mass shootings have been increasing in frequency and lethality in

the United States (Center for Victims of Crime in partnership with the Office for Victims of Crime,

2018). Mass shootings garner extensive public attention and often become the center of policy debates

around firearm ownership and prevention efforts (Shultz, Thoresen, & Galea, 2017). It is important to

note, however,that many U.S. cities contend with multievent and multivictim firearm injury scenarios

on a near everyday basis, most of which do not make the news. In an article published in 2019, the