In the first 13 years of this century 1,043 people were injured or killed in 160 active shooter events across the United States, generally involving a lone shooter and mass casualties.
And the vast majority of the 486 people killed bled to death, said Roger Bonin, Lincoln's Emergency Medical Services chief.
Ninety-one percent of victims died as a result of hemorrhage, 13 percent of external hemorrhage from an arm or a leg, according to Bonin’s statistics.
That’s why tourniquets are becoming standard equipment in police cruisers and even in office buildings, hanging up there beside the defibrillators.
The number of active assailant incidents -- Bonin prefers the term rather than active shooter because the weapon is not always a gun -- has increased dramatically in recent years, creating a need for new police and fire tactics and equipment and new training for public safety staff and the public, he said during a recent presentation to the local Board of Health.
Police have learned they need to get into buildings quickly during situations that may involve guns, bombs, knives, etc., and firefighters have learned they, too, need to enter as quickly as possible, sometimes under armed escort.
Many experts recommend police have easy-to-use tourniquets to apply before medical personnel get inside.
Today, Lincoln police cruisers and Lincoln Fire and Rescue vehicles have new trauma kits, and about 300 officers have been trained to use the combat application tourniquets, which can be applied with one hand to or by an injured person, said Lincoln Police Officer Katie Flood. Police officers also carry one tourniquet on their uniforms, according to the Lincoln-Lancaster County Health Department.
The black canvas kits hold protective gloves, sterile abdominal pads, bandage rolls and three tourniquets, thanks to funding from the U.S. Department of Health and Human Services. The $22,000 project was a joint venture between the county-city Health Department, Lincoln Fire and Rescue and Bryan Health.
Before, Lincoln police cruisers had trauma packs that included one tourniquet and bandage.
"The new kits allow our officers to assist in mass injury incidents," Flood said in an email.
The Lancaster County Sheriff’s Office already has bleeding control kits, said Bonin, who said the combat application tourniquets were battle tested by the U.S. Army and Marine Corps.
Although they're expensive -- “about $30 for probably 30 cents of material” -- they work, they have science behind them and they're easy to use, he said.
“You look at the picture and can figure out how to put it on in about 20 seconds,” Bonin said.
“The cowboy move where you put the belt on the leg doesn’t work," he said. “You have to generate enough pressure to obstruct the blood flow.”
Public safety and medical staff are trying to get the public out of the mindset that homemade tourniquets are acceptable, Bonin said.
The next step is to get training to the community, said Robbie Dumond, trauma systems coordinator for Bryan Health. In Kansas City, he said, 200 to 300 members of the public are being trained in hemorrhage control.
Lancaster County emergency and medical staff are just beginning to talk about what might work here, Dumond told the Board of Health.
"We think it (educating the public) would be a great idea,” said Bonin. “It will take time and money, and we are a little short on both.”
In some businesses, the active assailant drill is now as routine as tornado and fire drills, said Health Board Chairman Craig Strong.
A training video shown at the board meeting focused on potential victims and used these easy-to-remember words of advice: Run, Hide, Fight.
* Run to safety if you can.
* Hide if you can’t run (and turn off your phone because even the vibrate mode can give away your position).
* Fight as a last resort.