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The profile of wounding in civilian public mass shooting fatalities

Smith, Edward Reed MD; Shapiro, Geoff EMT-P; Sarani, Babak MD

Journal of Trauma and Acute Care Surgery: July 2016 - Volume 81 - Issue 1 - p 86–92
doi: 10.1097/TA.0000000000001031
EAST 2016 Plenary Papers

BACKGROUND The incidence and severity of civilian public mass shootings (CPMS) continue to rise. Initiatives predicated on lessons learned from military woundings have placed strong emphasis on hemorrhage control, especially via use of tourniquets, as means to improve survival. We hypothesize that both the overall wounding pattern and the specific fatal wounds in CPMS events are different from those in military combat fatalities and thus may require a new management strategy.

METHODS A retrospective study of autopsy reports for all victims involved in 12 CPMS events was performed. Civilian public mass shootings was defined using the FBI and the Congressional Research Service definition. The site of injury, probable site of fatal injury, and presence of potentially survivable injury (defined as survival if prehospital care is provided within 10 minutes and trauma center care within 60 minutes of injury) was determined independently by each author.

RESULTS A total 139 fatalities consisting of 371 wounds from 12 CPMS events were reviewed. All wounds were due to gunshots. Victims had an average of 2.7 gunshots. Relative to military reports, the case fatality rate was significantly higher, and incidence of potentially survivable injuries was significantly lower. Overall, 58% of victims had gunshots to the head and chest, and only 20% had extremity wounds. The probable site of fatal wounding was the head or chest in 77% of cases. Only 7% of victims had potentially survivable wounds. The most common site of potentially survivable injury was the chest (89%). No head injury was potentially survivable. There were no deaths due to exsanguination from an extremity.

CONCLUSION The overall and fatal wounding patterns following CPMS are different from those resulting from combat operations. Given that no deaths were due to extremity hemorrhage, a treatment strategy that goes beyond use of tourniquets is needed to rescue the few victims with potentially survivable injuries.

LEVEL OF EVIDENCE Prognostic/epidemiologic study, level IV; therapeutic/care management study, level V.

From the Department of Emergency Medicine (E.R.S.), Operational Medical Director, Arlington County Fire Department, Arlington, VA; The George Washington University, Washington, DC; Emergency Medical Services Program (G.S.), The George Washington University, Washington, DC; Center for Trauma and Critical Care, Department of Surgery (B.S.), The George Washington University, Washington, DC.

Submitted: December 1, 2015, Revised: February 15, 2016, Accepted: February 16, 2016, Published online: March 8, 2016.

This study was presented at the 29th annual meeting of the Eastern Association for the Surgery of Trauma, January 9–12, 2016, in San Antonio, Texas.

Funding source: none.

Address for reprints: Babak Sarani, MD, FACS, FCCM, 2150 Pennsylvania Ave, NW, Suite 6B, Washington, DC 20037; email:

© 2016 Lippincott Williams & Wilkins, Inc.