Pre-hospital management of mass casualty civilian shootings: a systematic literature review

Abstract

BackgroundMass casualty civilian shootings present an uncommon but recurring challenge to emergency services around the world and produce unique management demands. On the background of a rising threat of transnational terrorism worldwide, emergency response strategies are of critical importance. This study aims to systematically identify, describe and appraise the quality of indexed and non-indexed literature on the pre-hospital management of modern civilian mass shootings to guide future practice.MethodsSystematic literature searches of PubMed, Cochrane Database of Systematic Reviews and Scopus were conducted in conjunction with simple searches of non-indexed databases; Web of Science, OpenDOAR and Evidence Search. The searches were last carried out on 20 April 2016 and only identified those papers published after the 1 January 1980. Included documents had to contain descriptions, discussions or experiences of the pre-hospital management of civilian mass shootings.ResultsFrom the 494 identified manuscripts, 73 were selected on abstract and title and after full text reading 47 were selected for inclusion in analysis. The search yielded reports of 17 mass shooting events, the majority from the USA with additions from France, Norway, the UK and Kenya. Between 1994 and 2015 the shooting of 1649 people with 578 deaths at 17 separate events are described. Quality appraisal demonstrated considerable heterogeneity in reporting and revealed limited data on mass shootings globally.ConclusionKey themes were identified to improve future practice: tactical emergency medical support may harmonise inner cordon interventions, a need for inter-service education on effective haemorrhage control, the value of senior triage operators and the need for regular mass casualty incident simulation.

On the human consequences of terrorism

“…Sheffy et al's (2006) data, which covers 2000-2004 and 553 victims, are given in the fourth column of Table 1. Interestingly, the overall death rate of 33.3% in Sheffy et al (2006) is exactly that given for mass-casualty shootings in Turner et al (2016).…”

“…Comprehensive accounts of injuries sustained in terrorist mass shootings are given in Peleg et al (2004), Sheffy et al (2006) and Turner et al (2016). Turner et al (2016) is a meta-study of 17 mass casualty shootings worldwide during 1980-2016.…”

“…Turner et al (2016) is a meta-study of 17 mass casualty shootings worldwide during 1980-2016. Their study is not restricted to terrorist incidents, whereas Peleg et al (2004) and Sheffy et al (2006) are studies of terrorism-related mass shootings in Israel.…”

Marauding terrorist attack (MTA): prehospital considerations

“…In a literature review of mass casualty civilian shootings by Turner and colleagues, the authors unambiguously link disaster preparedness to a successful response 7. A lack of familiarity and unpreparedness predisposes to confusion and delay.…”

Performance of Norwegian civilian EMTs and army medics in penetrating trauma: a controlled simulation‐based assessment

“…A study of civilian public mass shootings in the US found that chest injuries were the most common death in potentially salvable victims, but these were events without explosives 3. An attack using bombs and/or firearms can be expected to cause both head/torso and exsanguinating extremity injuries 4. One may expect many victims in a shooting spree, and especially in school shootings swift recognition and proper treatment can save many quality‐adjusted years of life.…”