Part of being prepared to deal with a mass shooting — and hopefully surviving it and helping others to survive it — is knowing what you will face once the shooting stops. When the gunfire finally ceases and the haze of adrenaline and terror begins to subside, the work has really just begun. If you are uninjured, or injured and still able to render aid to others, you must kick into first-responder mode and make it your mission to save lives. After all, you might have a while before medical professionals get to the injured, and your actions can save lives that might otherwise be lost.


Mass Shooting Wounds

The injuries resulting from these assaults are likely to be penetrating gunshot wounds to virtually any part of the body. These wounds can result in hemorrhage (bleeding) from the extremities (arms and legs), the junction where extremities and head meet the torso (neck, groin, armpit, etc), or the torso itself. This hemorrhaging can be controlled or uncontrolled. Uncontrolled hemorrhage can obviously kill you if not brought under control quickly

There may also be wounds to the central nervous system (brain and spinal cord), which may or may not be immediately fatal, as well as catastrophic wounds to vital organs such as the heart, which can also be immediately fatal. Finally, one may encounter wounds to the face or neck that could compromise the airway, making a person unable to adequately breathe. 

If you are on scene and no longer in imminent danger of being killed yourself, your first course of action is to triage the victims around you. Triage is a sorting out of who is potentially savable and who is not. If a victim has no pulse, is not breathing, and is not conscious, you must leave them and focus on a victim you can save. Look for those with uncontrolled, pulsing, or spurting bleeds in the extremities. Such bleeding can be stopped with a tourniquet. If a commercial one is not available, an improvised tourniquet will do.

A bleeding artery in an extremity, such as the femoral artery high in the leg, can kill a person in as quickly as three minutes if not brought under control. Do your best to tighten a tourniquet around such an extremity between the wound and the heart, and make that bleeding stop with whatever force it takes.

If the victim is bleeding in the junctional areas or in the torso, you can try to apply direct pressure to the wound if you do not have a hemostatic dressing immediately available to pack inside the wound. If you can see and clamp off a bleeding vessel, this pressure might be applied with your fingers, or you might have to put your knee or both hands on the wound and place as much pressure as possible on it. Again, use whatever force is necessary to stop the bleeding.


Compromised Breathing

Another grave injury you might encounter is someone with a bullet hole in their chest experiencing a rapidly increased difficulty in breathing. This likely indicates the development of what is called a tension pneumothorax, or a build-up of air inside the chest cavity. Such an injury is going to put pressure on the lungs and heart and will eventually kill the victim. While you might not be capable of inserting a needle into the proper part of the chest to relieve this pressure, you can at least identify such a victim and have them ready to be handed over to arriving medical care as soon as possible. This might very well save their lives.

For patients with compromised airways, your best course of action is to help them get into a position where they can breathe more easily, if at all possible. Place them on their side, or if they seem more comfortable sitting up and leaning forward, because they are bleeding in their mouth or nose, then help them do so. If they are unconscious and need their airway opened, use the head-tilt chin-lift or jaw-thrust maneuver to open their airway.

The head-tilt chin-lift maneuver. (Wikimedia Commons)


The jaw thrust maneuver. (Wikimedia Commons)

At this point in the incident, you can expect that help will be arriving soon. Do your best to point the arriving fire or EMS personnel to the most seriously injured — and savable — victims.  If you can, help them move those victims out of the “hot zone” and to an area where they can be more extensively treated and transported to a medical facility.

Do not be a passive victim if you find yourself in a mass shooting situation. Once the shooting stops, join the effort to save lives and mitigate the catastrophe that is unfolding before you. You can make a difference and be someone’s savior. 


This piece was originally published in November 2017. It has been edited for republication.