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Basic Skills to Know in the Event of a Shooting

“If a shooting victim or bystander had basic trauma skills, it could significantly impact morbidity and mortality.”

Gun violence in the United States routinely kills more than 30,000 people a year, according to the CDC. That's the slow-burn reality, punctuated all too often by the kind of horrific, grotesquely familiar killing seen in Las Vegas yesterday.

With tragedy dominating the headlines, it's understandable that people want information that can make them feel safer, more prepared, more in control. One Twitter thread responded to that need by recommending trauma kits: an emergency bandage and tourniquet that could help people save lives, even if they have no training. "This is the cheapest, laziest way to increase the odds of someone surviving yet another American mass shooting," the post suggests.


"It's a fucking terrible day when we are discussing or possibly recommending that civilians carry a trauma kit, but if people want to pay money for it, I can't argue against it," says Darragh O'Carroll, an emergency physician and Tonic contributor.

But more important for the average person, O'Carroll says, is a basic understanding of trauma. He points to the 2013 Boston Marathon bombing, where many people were injured in a short period of time, many of them with shrapnel in their limbs. First responders and civilian bystanders applied tourniquets to 27 people, all of whom survived. That's one reason experts suggest stockpiling tourniquets in public places, the same way we provide automated defibrillators. But people in Boston used improvised, non-commercial tourniquets—and they worked. "If a shooting victim or bystander didn't have a trauma kit but instead had basic trauma skills, it could significantly impact morbidity and mortality," O'Carroll says.

Such skills, in their most fundamental form, are not that complicated. "The first step is well-aimed direct pressure on the wound," O'Carroll says. "The smaller the area of pressure the better—so if you can stop the bleeding with one finger, use one finger." The emergency bandage, aka the Israeli dressing, is a sterile bandage that applies pressure to a wound. It makes it easier to apply pressure, but in a pinch, a T-shirt tightly wrapped with duct tape would do, O'Carroll says. Even duct tape alone would work.

If bleeding continues, or bright red, pulsing, or squirting blood appears, this indicates an arterial injury, and a tourniquet is the tool to use. "Anything that can be tied around a limb could be used as an improvised tourniquet, such as a belt," O'Carroll says, "but the wider the tourniquet is the better." Skinnier ropes or cords can risk nerve and tissue injury. That's one advantage to commercial tourniquets—they're designed with the right width and material. "Avoid placing the tourniquet directly around a joint, as nerves run very superficial, and you'll risk nerve damage in time," O'Carroll says. "Ideal placement is one or two inches above the wound."

In Las Vegas, hospitals were flooded with more than 500 casualties. Paramedics and first responders appear to have been under incredible pressure. "Unless triaging hundreds of gunshot victims is something done every day," O'Carroll says, "it will never be easy or go smoothly." Basic trauma knowledge can help an untrained bystander keep people alive until medical professionals can get to them. That's the real value of a trauma kit—or just trauma knowledge alone.

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