Page 138 - Journal of Special Operations Medicine - Fall 2016

Don’t Let the Word “Myopic” Blind You

David W. Callaway, MD, FACEP

he Journal of Trauma and Acute Care Surgery article 2. CPMS case-fatality rates are higher and potentially
Tout of George Washington University titled, “The survivable wounds less frequent than in combat.
5
Profile of Wounding in Civilian Public Mass Shooting Eastridge et al. reported that 24.3% of battlefield
(CPMS) Fatalities” is currently one of the most hotly deaths were potentially survivable compared with
debated academic articles in the tactical community. 1 7% in this study. As in combat, the explanation for
The article uses some provocative language that re- this estimate is likely multifactorial, but is consistent
flects the authors’ passion and frustration at the lack with point 1—in the civilian setting, this study found
of data to inform public policy decisions. Thankfully, a higher rate of ballistic injuries to the torso and
it has sparked motivation to solve some of the data col- head/face.
lection challenges plaguing the civilian healthcare and 3. Hemorrhage control is important, just not enough.
prehospital systems. However, the unfortunate use of From the article’s conclusion, “Does this mean exter-
the word “myopic” in the article to describe some of the nal hemorrhage control for civilians is unimportant?
current initiatives may have blinded some readers to the Emphatically no! tourniquets and simple hemor-
authors’ actual conclusions. rhage control measures most definitely [emphasis
added] have a role in improving survival, but should
As the current past chairman of C-TECC and the co- no longer be the myopic focus of first responder and
chair of the American College of Emergency Physician public education.” This view is consistent with the
(ACEP) High Threat Emergency Casualty Care Task TECC and TCCC guidelines. It is consistent with the
Force, I have had the opportunity to discuss this im- Ranger First Responder Program and the National
portant, though significantly limited, article with a wide TEMS Initiative Core Competencies. If it were not,
range of professionals. The authors’ actual conclusion neither TECC nor TCCC guidelines would discuss
seems to be that hemorrhage control is a critical first chest seals, needle chest decompression, damage con-
step in high-threat response but, in isolation, may not trol resuscitation, hypothermia prevention, and rapid
be sufficient to significantly reduce mortality in these movement of casualty to definitive care as important
events. Based on the data available to the authors, here considerations/interventions.
is what they concluded about civilian wounding pat- 4. An ongoing comprehensive preventable death analy-
terns and hemorrhage control: sis that includes survivors needs to be performed
and laws must change in order to get accurate data.
1. Wounding patterns are different between combat Currently, the complex and restrictive state and local
and public mass shootings. Civilian practitioners laws restrict researchers’ access to autopsy data and
have always suspected this from informal conversa- to deidentified, national trauma databank data. In
tions and after action reports: Committed killers in order to create evidence-based recommendations
close quarters shooting people without body armor and adequately prepare our communities, this must
globally results in different injury patterns than a change.
gunfight between warriors in body armor on the bat-
tlefield. This article provides some data to support Based on the data available and understanding the limi-
this understanding but, more importantly, highlights tations of this study, these conclusions should not be
the unacceptable difficulty in obtaining accurate data controversial. Most informed readers understand that
to produce evidence-based guidance for our respond- the conclusions of this article are also limited by the fact
ers. The idea that civilian wounding and mortality that this is a retrospective autopsy study with significant
patterns differ from combat is not new and has been data gaps. Further, many readers agree and will argue
reported previously in the law enforcement line of that despite these flaws, this article is a critical first step
duty deaths. 2–4 toward understanding the evidence gap in civilian public

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