Page 149 - Journal of Special Operations Medicine - Winter 2015

Recent events have shown that, despite the lessons learned from more than 6,800 U.S.
combat fatalities over the last 13 years, opportunities exist to improve the control of
external hemorrhage in the civilian sector.

Editor’s note: The Joint Committee to Create a National events, no one should die from uncontrolled bleeding.
Policy to Enhance Survivability from Intentional Mass- An acronym to summarize the necessary response is
Casualty and Active Shooter Events developed the fol- THREAT:
lowing call to action at its April 14 meeting in Hartford,
CT. This committee meeting, chaired by American Col- • Threat suppression
lege of Surgeons (ACS) Regent Lenworth M. Jacobs, • Hemorrhage control
Jr., MD, MPH, FACS, focused on implementation of • Rapid Extrication to safety
strategies for effective hemorrhage control. The delib- • Assessment by medical providers
erations of the group yielded the Hartford Consensus III • Transport to definitive care
document. This report was presented at a White House
roundtable forum on April 29, which included repre- The Hartford Consensus calls for a seamless, integrated
sentatives from 35 medical and surgical, nursing, law response system that includes the public, law enforce-
enforcement, fire, emergency medical services (EMS), ment, EMS/fire/rescue, and definitive care to employ the
and other stakeholder organizations (see pages 22 and THREAT response in a comprehensive and expeditious
24 [in The Bulletin Sep 15 issue] for lists of participat- manner.
ing organizations and agencies). The participants unani-
mously endorsed the principles set forth in the Hartford Three Levels of Responders
Consensus III. The following is the Hartford Consensus There are different levels of responders in an intentional
III, edited to conform with Bulletin style. mass-casualty or active shooter event:

ur nation’s threat from intentional mass-casualty • Immediate responders: The individuals who are pres-
events remains elevated. Enhancing public resil- ent at the scene who can immediately control bleeding
Oience to all such potential hazards has been iden- with their hands and equipment that may be available
tified as a priority for domestic preparedness. Recent • Professional first responders: Prehospital responders
events have shown that, despite the lessons learned from at the scene who have the appropriate equipment and
more than 6,800 U.S. combat fatalities over the last 13 training
years, opportunities exist to improve the control of ex- • Trauma professionals: Health care professionals in
ternal hemorrhage in the civilian sector.* These oppor- hospitals with all of the necessary equipment and skill
tunities exist in the form of interventions that should to provide definitive care
be performed by bystanders known as immediate re-
sponders and professional first responders, such as law Immediate responders
enforcement officers, emergency medical technicians One goal of the Hartford Consensus III is to empower
(EMTs), paramedics, and firefighters (EMS/fire/rescue), the public to provide emergency care. During inten-
at the scene of the incident. tional mass-casualty events, those present at the point of
wounding have often proven invaluable in responding
The Joint Committee to Create a National Policy to to the initial hemorrhage control needs of the wounded.
Enhance Survivability from Intentional Mass-Casualty Traditionally thought of as “bystanders,” these im-
and Active Shooter Events was founded by the ACS. mediate responders should not be considered passive
The committee met twice in 2013, making specific rec- observers and can provide effective lifesaving first-line
ommendations and issuing a call to action. The delib- treatment.
erations of the committee have become known as the
Hartford Consensus. A third meeting was convened on Immediate responders contribute to a victim’s survival
April 14. This Hartford Consensus III meeting focused by performing critical external hemorrhage control
on implementation strategies for effective hemorrhage at the point of wounding and prior to the arrival of
control. traditional first responders. Immediate responders
contribute to what is the critical step in eliminating
The overarching principle of the Hartford Consensus preventable prehospital death: the control of external
is that in intentional mass-casualty and active shooter hemorrhage.

The Hartford Consensus 137