The EMS MEd blog is the mouthpiece of the National Association of EMS Physicians and, as you’d expect, features a lot of content on complex medical topics. One post I could actually understand, however, involved an evaluation of the potential “survivability” of those who died from wounds received during public mass shootings.
The upshot: only 7% of fatalities could have been saved with prompt medical intervention. And for everyone who carries a tourniquet every day, according to the National EMS study, none of the fatalities died of blood loss from the extremities.
From the National EMS Blog site:
Article Bites #12: The Profile of Wounding in Civilian Public Mass Shooting Fatalities.
Background & Objectives:
Civilian mass shootings are unfortunately on the rise and afflict the lives of many individuals and their families. Given the rising incidence and severity of these events, there has been much in the way of public initiatives at improving morbidity and mortality in individuals who have been critically wounded.
Much of the prior emphasis on management of these patients in the prehospital environment has focused on external hemorrhage control with widespread education on use of tourniquets. The strong focus on civilian management of exsanguinating extremity hemorrhage during mass shootings is largely based on the blast injury patterns identified during the US operations in Iraq and Afghanistan which suggest that between 52% and 64% of injuries in combat are to the extremities.
Whether these lessons translate to civilian mass shootings is unclear. The overall purpose of this paper was to precisely identify the anatomic wounding pattern, fatal wounds and incidence of potentially survival wounds in civilian mass shooting incidents.
Yes, they studied the commonly-accepted model for deaths – based upon military operations overseas – and they found (spoiler alert) that civilian injuries don’t correspond with military fatalities. Perhaps that’s because the average civilian in America doesn’t wear Improved OTV armor in their daily lives.
Key Results:
In total, based on responses from medical examiners, a total of 12 mass public shooting events were analyzed in the study. A total of 139 fatalities with 371 total wounds were examined by the investigators. The key results from the study were as follows:
- There was an average of 2.7 wounds associated within the group of fatalities
The case fatality rate for civilian mass shootings was 44.6% (compared to approximately 10% during Operation Iraqi Freedom and Operation Enduring Freedom as reported in other studies).- 58% of all victims (with fatal and non-fatal wounds) had at least one wound to head or chest/upper back
- 20% (28/139) of all wounds were to the extremity, of which none were deemed to be fatal
- 77% of all fatal wounds were identified in the head or chest/upper back.
In total, only 9 of the 125 fatalities or roughly 7% (14 excluded given absence of autopsy data) were determined to be potentially survivable- The most common survivable injury was a wound to the chest (89% of all survivable injuries) without obvious evidence of vascular or cardiac injury
- There was 100% agreement between the reviewers of the study regarding potential survivability of injuries
“The most common survivable injury was a wound to the chest without obvious evidence of vascular or cardiac injury.”
That combat application tourniquet won’t save someone with a chest wound. Yet at the same time, especially for first responders, they weigh next to nothing and it’s better to have it and not need it than need it and not have it.
Takeaways:
- Only 7% of victims in civilian mass shootings had a potentially survivable wound. No fatalities likely occurred secondary to exsanguination from extremity hemorrhage
- The majority of wounds in civilian mass shootings occur primarily in the head, chest/upper back compared to combat environments where the majority of wounds occur in the extremities.
- The case fatality rate for civilian mass shootings compared to military data was much higher, and associated with lower number of potentially survivable injuries
As a layperson, I can’t help but think a two-plus-hour delay between getting shot at the Pulse Nightclub and getting medical treatment resulted in more than 7% of fatalities from delayed diagnosis and treatment of their wounds.
At the same time, even if the National EMS experts are off by a factor of five, that still means two-thirds of fatalities will die even if provided immediate, professional medical care.
The bottom line: the single tool that saves the most lives in mass shooting situations is not a tourniquet or prompt medical care…it’s a good guy’s gun.
We recently saw this demonstrated vividly in the attack on the Poway synagogue. Unlike the Tree of Life shooting, a good guy brought his gun to services in Poway. Along with another congregant, he chased the shooter out of the synagogue and opened fire on him.
So carry your gun. The life you save may be your own. One way or another.
I’m no expert on mass shootings, or anything else, but just at a cursory glance mass shootings occur at close ranges. Against un armed victims. The shooter frequently has a rifle or shotgun but even with just a pistol he has time to pick and chose his targets and the number of shots for a target. So it kinda figures the wounds will be torso/head and more than one per victim.
Even having bullet resistant clothing and back packs means little if the shooter is in the same room as you and has the time and ammo to go for your head.
Guns are the problem. And at this point in our history guns are the only real solution.
If you could have programmed your way back machine and dropped back 120 years or so and melted all the non .gov guns in existence at that point you may have had an effect on our current mass shooters. But that ship has long since sailed.
Guns in the hands of decent folk is the only real answer.
Quote: ” Guns are the problem. ”
Guns are not the problem, people are the problem, criminals are the problem, an inanimate object is not the problem!
Don’t let the antis define the language, there is no such thing as gun violence.
Well said
+1. Guns are not the problem. Criminals are the problem.
You repeating an NRA mantra doesn’t make his point incorrect. It is entirely correct, which you would know if you’ve ever tried to kill a hundred people with a butcher’s knife from a hotel balcony (pretty sure an AR works better). Guns are secondary only to explosives in killing potential for terrorist attacks but are much easier to use.
If you can’t accept that guns are why mass shootings are so lethal, you are intellectually dishonest. Just like the other side is intellectually dishonest when they pretend that putting a “no guns allowed” sign up is going to do literally anything useful.
If you start erasing guns from history, I don’t think you’re going to like the new present that you create any better than the current one. Regardless, there are some seriously despondent young adults in this world and there doesn’t seem to be much interest in identifying and addressing root causes that drove them to these dark states of mind before they get to the point of acting.
Sorry dude but you are entirely wrong. There are more firearms than people in this country yet more people will die from hands and feet used in a fight that from a rifle. Furthermore if you remove suicides and black males 18-28, the use of firearms in homicides is staggeringly low.
You simply choose to ignore facts. It doesn’t make you right, but it does make life harder on you.
“Guns are secondary only to explosives in killing potential for terrorist attacks . . . ”
A question that I wonder about is the net impact if – hypothetically – guns could be (magicly) removed from the hands of terrorists and crazies. What would terrorists/crazies do?
I hypothesize that terrorists/crazies (today) have a choice between guns and explosives. Assume, artificially, that they are equally available. Which do they choose? In America, they seem to choose guns. Boston Bomber and OK City are the only exceptions that immediately comes to mind. Why is that?
Do terrorists/crazies (mistakenly) imagine that they can kill more people with guns than explosives? We could think about this long and hard to see if this might be a rational hypothesis. Suppose we refute this hypothesis.
Now, for the money shot. Do terrorists/crazies want to go out in a blaze of glory like a scene from Rambo? Is there little to no glory in planting a bomb and running away from the scene of the crime? If this hypothesis were true then (hypothetically) getting rid of guns would have some psychological impact.
Some terrorists/crazies would simply stew, frustrated that they can’t realize their Rambo glory with explosives. Others would be so committed to their ostensible mission (killing) that they would resort to explosives. If so, what would the net effect be?
Is civilized society better able to cope with and respond to shooters vs. bombers? If this were so then gun controllers ought to beware of answered prayers.
Alas, even if all the foregoing were demonstrable it would not matter. Gun controllers are fixated on guns and wouldn’t care whether a net effect of more deaths by explosives would be the answer to their prayers.
Agreed. When I was in college decades ago a study was done on population increase. With it came more crime and more mentally ill people. Today this is all exacerbated by the fact that the working man’s wages have stagnated for the last 50 years. Its tougher to make a living now than ever before. Its unfathomable to the younger generation that when we made way less money in the 50’s it went a lot farther and women could stay home an properly raise children. Today we have latch key children who seldom see their parents for more than a few hours a day and when they do the pressures of life lead to parents being constantly at each others throats and soon divorced making a bad situation now disastrous for the children. The children see that their future life is not worth living and that leads to mass shootings.
I might add we had our local gun show banned permanently by the city fathers when a criminal bought a second hand pistol at a gun show which our State law does not require a background check for and he shot and crippled a local home owner. The gun was then sold to an underage kid who could have used it to shoot up his school if he had wanted to. That was the end of our gun shows.
We were lucky the city did not try and confiscate all of our handguns or simply tax them out of existence by requiring special permits, that was before a State preemption law was passed which the city fought for over 2 years in court by simply ignoring the new law which ended up costing us tax payers several million dollars. We were paying the city through our taxes so they could try and take away our rights. All this happened because just one second hand gun was sold legally without a background check and ended up in the hands of a criminal .
“Agreed. When I was in college decades ago a study was done on population increase. With it came more crime and more mentally ill people. Today this is all exacerbated by the fact that the working man’s wages have stagnated for the last 50 years. Its tougher to make a living now than ever before. Its unfathomable to the younger generation that when we made way less money in the 50’s it went a lot farther and women could stay home an properly raise children. ”
Population increase does not have to come with problems. A free market solves those problems but we have not had that for a long time. Working man’s wages have not stagnated. The government has continually devalued the currency and regulated us to death. The money people made in the 50’s was more valuable per unit than the money we make today because the federal reserve constantly puts more money into circulation. If you want to solve the problem then end the fed and eliminate as much government as we possibly can.
If you want to educate yourself on economics visit http://www.fee.org and http://www.mises.org
I’ll leave you with a quote from that may be of interest to you. It is from Stephan Molyneux’s podcast in 2014
“There was a study that came out recently that said if American regulations and controls over the economy had stayed at 1946 levels GDP would not be $15 trillion, it would be $53 trillion. This is the opportunity cost of one tiny slice of the expansion of government power. There would be no poverty. Nobody would have to worry about healthcare costs. Charity would take of everyone. And there would not be, as there is in America at the moment, children born into $1.4 trillion worth of debt that they never voted for, never chose, and will spend the rest of their lives groaning under the yoke of foreign banksters to pay off. ”
Stephan Molyneux Freedomain Radio Podcast 2678 Money, Power and Politics: The Bitcoin Revolution – Stephan Molyneux at the The Next Web conference ~27:00 minute mark April 24th 2014
https://www.fdrpodcasts.com/#/2678/money-power-and-politics-the-bitcoin-revolution-stefan-molyneux-at-the-next-web-conference
The best preventative medicine is fire superiority.
If guns are the problem, why didn’t the early settlers go extinct? They had one or more guns in every house, after all, and they were all willing to use them.
I propose that our society is the problem. Progressives have changed our society for the worse, and these mass shootings are part of the results of those changes.
We are not going extinct now, why would they have gone extinct then?
You’re wrong.
Due to leftist ideology, Europe and the US would go extinct since we dont reproduce at high enough replacement rates. The only reason our population grows is by importing people.
And of coarse given the makeup of who is coming to America in another 50 years America won’t REALLY be American.
Glad that I wont be here to see that.
It’s only a matter of time until the increasing numbers of concealed carry permit holders reach a point where spree killers and/or terrorists begin encountering and being engaged by armed private citizens. This doesn’t mean that private gun owners who defend themselves will always win—some will and some won’t. What a growing population of armed private citizens means, however, is that when The Really Bad Thing happens people will have at least a fighting chance to save themselves and others. Gun-control dogma, in contrast, insists that making sure people continue to be vulnerable is somehow a better path to follow.
The main takeaway I have is:
Marksmanship is a lot easier to accomplish when your targets are not shooting back.
Even directly ineffective return fire will have a serious negative affect on the attacker’s accuracy. I don’t recall a single case within the last 30 years where the attacker continued killing civilians after being fired on.
“Guns are the problem.”
Not in Nice, France
“…the single tool that saves the most lives in mass shooting situations is not a tourniquet or prompt medical care…it’s a good guy’s gun….”
That was the conclusion I also quickly came to. The reason military casualties tend to be arms and legs, aside from the body armor, is that they do not congregate in large rooms and stand there helpless and unarmed while people shot at them.
It really is apples and oranges. I can’t think, off the top of my head, of a single US mass shooting that also employed explosives. Soldiers have to contend with IEDs pretty regular.
” I can’t think, off the top of my head, of a single US mass shooting that also employed explosives.”
Attempted, at Columbine.
The propane bottles set up in the cafeteria failed to detonate…
Yeah, Columbine showed why most people don’t bother with bombs. Everyone thinks they can be the next unibomber by reading some internet page about being an anarchist but it takes a surprising amount of ability to make bombs go off when you want… and not go off when you don’t want (like when you’re putting them together). There’s a reason most people use guns.
Yes, there is a reason most mass murderers use guns. It isn’t that guns are the most effective rool, per se, at least not in terms of body count relative to effort. Arson takes that prize, hands down. A couple gallons of gasoline and a match can take out hundreds, if you choose the right venue.
What guns provide is an optimal tradeoff between destruction and participation.
With bombs or arson, you kill many, but you don’t get to see people’s terror with your own eyes, close up. Everything happens at a safe distance for you. With a knife, you do get that close up intimate experience, which is why deeply personal murders are often committed with a knife and many stabs. That doesn’t scale up all that well, however.
What most of these killers want is infinite power, if only for a few minutes, and to immerse themselves as much as possible in the deaths they cause. Guns give them that as they can kill at whites-of-their-eyes distance, but still control, extend and experience the evolving bloody scene.
These killings ultimately are about the psychopathology of extremely broken people, not guns themselves, which only serve as mediating variables.
I had the opportunity to speak with early responders soon after the atrocity, and they were in 100% agreement that if the propane bomb in the kitchen had detonated in combination with the natural gas lines present, there would be a crater there now instead of a high school. Given the poor mental health care in the state of Colorado (this state ranks 48th in the nation in providing mental health care to children and adolescents who need it, and this is 20 years after the massacre at Columbine. Inexcusable!), had the killers been unable to acquire firearms, without any treatment or intervention, they would have simply regrouped and tried again until they were successful. The problem is that gun control is cheap and easy. Mental health reform is anything but. Guess what we keep trying.
After the shooting in San Bernadino, where the guy and his wife killed the people at an office party, who were his co-workers; it showed on tv at least 3 pipe bombs with the fuses inserted, and all set to go. O-blame-a-gun, who harped about the guns, never said one word about the bombs.
Carry an IFAK with tourniquet, compression bandages, gauze, Hyphen Vent (or other) vented chest seals, Nasal-Pharyngeal airway, Tension pneumothorax pen, gloves and lots of waterproof tape (Frog Tape, etc.). A 6″ and 8″ Israeli Bandage is good to have too.
Oh, and learn how to use it.
That’s what i’m thinkin’. At roughly $100 for a gun shot wound trauma kit in it’s own pack located next to the FAK and supplemental training to 1st aid (every 2 years?), lives can be saved.
That was my thought. There is more to immediate action trauma treatment than just a TQ.
Why would they only analyze 12?
Oh, and why, even though I click the effing “save my name and email for the future” choice do I have to type my effing name and email every time I choose to comment?
I guess I’m lucky. Out here you are more likely to die from a single car accident or being run over by a cow. Also old age.
I carry a med kit in the truck and haven’t needed it in 20+ years, knock on wood.
Never been to Wyoming. But I’ve got extended family in Montana. Any medical emergency there becomes an issue of time and distance. Stuff that I have a good chance of surviving here in the bay area would likely prove fatal there.
True. That’s usually the case with single car accidents at night. That or winter. If you can get to the clinic you have a chance, or a 40 min. flight on the Air Idaho chopper.
That is 40 min both ways, no bad weather or night flights and only if the high altitude chopper is available. Other wise a ambulance ride for over 11/2 hours in good weather AFTER they get to you.
I’d like to see their studies aimed at medical malpractice. A family member nearly died last month thanks to experimentation of doctors with anti biotics.
An IFAK usually has Quik Clot gauze, chest seals, a decompression needle, and an Israeli bandage in addition to an externally mounted turniquet.
If many people had quick access to the supplies in an IFAK and training on how to use them, many lives could be saved.
I work in a gun free zone and I keep an IFAK and additional supplies handy in my work space and in my car (and range bag).
I used to wonder why there were so few wounded in the sandy hook shooting. However that mass shooting was like shooting fish in a barrel. The best chance of surviving a mass shooting if escaping isn’t possible is simply shooting back.
Seeing the video of the massacre in New Zealand showed it as well (something not available from Sandy Hook). The shooter not only was firing into groups of people huddled together afraid to move but he had time to walk out and walk back in with more ammo to do a couple more mag-dumps because there was no police response.
It was just dozens of people hiding on top of each other in corners. No chance and no resistance offered.
Agree wholeheartedly!
There is a reason why emergency medical responders and trauma physicians use the term “golden hour”.
For those of you who have never heard of that term, here is the definition that Google reports:
Yeah, if I recall correctly the idea that people bled out was NOT assessed in the report for The Pulse shooting.
Wonder how many die from shock from lying there in pain ?
I see this as apples to oranges regardless of the lack of body armor.
Battlefield medicine is battlefield medicine. The whole system is designed from the ground up to deal with war zone type injuries. That’s not the same as EMS responding to a mass shooting. Today it’s a mass shooting but yesterday they dealt with two strokes, a morbidly obese guy with a heart attack, a mental health crisis, a guy who fell of a ladder, a lady who slipped with a kitchen knife, three ODs and a girl who broke her ankle at soccer practice. Tomorrow it’s all that plus car accidents and someone who got electrocuted.
That’s a bit different from what a Corpsman does day to day in a combat zone.
I’m not knocking anyone here, just saying that civilian/peace time EMS isn’t specialized and streamlined for a mass casualty event involving battlefield type injuries.
Of course there’s also the delay mentioned above in regards to the Pulse nightclub. Not only does a soldier on a battlefield get introduced to a streamlined system meant to deal with his/her type of injuries but also gets that kind of help immediately by comparison. Buddy aid isn’t something you’re going to get at a nightclub or a school shooting in most cases and it could make a huge difference.
That doesn’t mean we can fix every problem involved here. I had a guy die in my arms who was fucked pure and simple. Same injuries in an OR with his chest already cracked open and the surgeon chomping at the bit to get to work and this dude still would have died. Sometimes it’s just not a winning hand.
If I had to be treated for gunshot wounds there are a few places I would pick. Shock trauma in Baltimore or a major hospital in Chicago would be top of the list. Docs there probably have more experience with GSW than most army medics.
Supposedly battlefield medics train at Chicago hospitals.
Primary military emergency medical instruction is taught in San Antonio, Texas. Special Forces medics (18D)and the W1 (short course) are taught at Fort Bragg, NC. Trauma rotations for 18D are taught in a few places, and the Special Operations Medical Sergeant Sustainment Course is taught there in San Antonio and some at Bragg as well.
I would tend to agree.
I’m thinking more along the lines of getting people to the treatment facility than the facility itself though. With the right care on hand people survive some really crazy shit, the trick is often getting them to that care.
Kinda hard to bring em back to life with their head split like a watermelon.
How about showing us some of the evidence. Even the New Zealand shooting where we had live video – I saw it. Makes me question the official story. That’s a common theme with all these shootings. Too many questions. You say they happened. PROVE IT.
Prove they didn’t happen.
The shooter live-streamed the video from NZ. You’ll have to ask the next school shooter very nicely to do the same.
So , now we should expect to see mass shooters with a go-pro mounted on their guns ???
I’m actually really surprised that hasn’t been the norm…when part of the motive for mass murder is infamy and celebrity, and with people conditioned to post pics and videos of basically everything, the lack of go pro footage of mass shootings is a bit odd. Perhaps now that it’s been done we will begin to see mass shooters doing just that; videoing their own crime. It’s not as if the plan usually includes getting away with it, it’s hard to imagine a downside to videoing it.
A police officer in Santa Fe was indeed saved by a tourniquet. Without it there is NO WAY he would have survived from a shotgun blast to the arm. Also, on that Friday, May 18, 2018, the odds of a shooting happening at the school were very slim. Until the gunman opened fire. I don’t take much stock in odds unless I’m playing poker.
As a longtime member of the naemt, I appreciate the focus of this study. However, that focus may be a little too tight and may lead the reader to some false conclusions.
Specifically, and glaringly, the study does not point out the number of victims who lived because of immediate, appropriate emergency medical care.
The lesson learned is that police or armed citizens who react aggressively against the shooter save lives. Disarmed citizens who manage to disarm the shooter (waffle house massacre) can sometimes save lives. Police who cower in the parking lot or the hallway of the Mandalay Bay Hotel while they wait for the shooting to stop are just as guilty of killing the victims as the shooter.
For one, their sample size for this study is excruciatingly small. It is an absurd claim that only 7% of wounded in a mass shooting will survive. Just yesterday, in Colorado. 1 dead, 8 wounded. You have to assume they picked the most “successful” spree shooters in the last 20 year for this study, not a true cross section of all spree shooters.
Second, as mentioned above, comparing combat wounds in the GWOT to spree shootings is completely irrelevant. There are 3 huge reasons that most trauma in combat right now is to the extremities
1) If i soldier catches a bullet to his vest or helmet, he is not going to get logged as an injury unless he is treated at a Role 3 facility (major surgical unit). In most cases, he will be seen by a physicians assistant after the mission to be evaluated and returned to duty . The fact he was wearing body armor suddenly eliminates him from the data set. When you consider the gear present on the outside of body armor, and the fact that military body armor has soft armor AND ceramic plates, it is not surprising that most reported wounds are too extremities.
2) The weapon of choice in the GWOT is IED’s , which cause separation trauma to extremities, particularly lower extremities. In order for any comparison to be valid, all explosive trauma would need to be removed from the data set
3) People who are being shot at are not very accurate. As another reader mentioned above, it is easy to walk into a room of unarmed people and shoot 10-15 of them in the head or chest at point blank range. In a gun fight where you also have to worry about being shot, you can’t usually take such deliberate shots.
Which brings it back to JW Taylor’s point, that the study also ignores the people who lived because of immediate care.
The Combat Application Tourniquet is not suitable for all, or most, injuries that one might randomly come across. But it is by no means an irrelevant piece of kit. It weighs nothing and can be tossed in a gear back or glove box and not be in anyone’s way. I don’t know many people that EDC a tourniquet (hint: anyone at all), but having a good IFAK for certain situations is smart, and should be tailored to your situation. There is great advice above about what to put in your own IFAK. But I don’t think ruling out a CAT is a smart move. If you have one (or in my case, like 9 sitting around thanks to the army), make it part of your kit. Just know, in a mass shooting situation, it probably won’t get used, and as others have pointed out, you’re better off worrying about defending yourself until the shooter is down/gone.
There is a reason that the first step taught in Combat Lifesaver training in the military is to return fire.
Folks, I would highly recommend you get a more complete data set before drawing any conclusions.
Start here and keep reading different articles that are linked to the right.
https://www.ncbi.nlm.nih.gov/pubmed/31029762
Pay special attention to this one:
https://www.ncbi.nlm.nih.gov/pubmed/29693490
It very raises some of my previous concerns of the NAEMT posted study.
To quote the Pulse study:
RESULTS:
There were an average of 6.9 wounds per patient. Ninety percent had a gunshot to an extremity, 78% to the chest, 47% to the abdomen/pelvis, and 39% to the head. Sixteen patients (32%) had potentially survivable wounds, 9 (56%) of whom had torso injuries. Four patients had extremity injuries, 2 involved femoral vessels and 2 involved the axilla. No patients had documented tourniquets or wound packing prior to arrival to the hospital. One patient had an isolated C6 injury and 2 victims had unihemispheric gunshots to the head.
CONCLUSIONS:
A comprehensive strategy starting with civilian providers to provide care at the point of wounding along with a coordinated public safety approach to rapidly evacuate the wounded may increase survival in future events.
If we want fewer people to die of their injuries in these types of mass shooting events, all we really need to do is eliminate law enforcement agencies.
They do nothing to prevent these events, little to end them once they’re in progress, and they just delay EMS response afterwards. It is difficult to establish any benefit to having law enforcement agencies at a mass shooting event that I can see. Arm the citizenry, fire law enforcement, train some more EMS responders and get on with life. “Professional” law enforcement has failed the taxpayers so many times since and especially including 9/11/01 that it has finally come time to admit that law enforcement agencies, especially federal ones, are complete failures at their jobs and they’re just in the way now. Their pensions are hugely expensive to the taxpayer.
Just arm the law-abiding populace and turn them loose. The results could not be worse than how “professional” law enforcement has been performing in the last 20 years, but they can be cheaper for the taxpayers. For those who would scream and cry that this is unthinkable, I would have you remember that “professional” law enforcement wasn’t seen in this country until the latter 19th century, and then only in large cities.
Dude, that was freaking awesome. I am going to quote that in other places.
Right on!
An added bonus to eliminating law enforcement agencies would be that it would eliminate the shooting of black people by cops, which would eliminate one of the things the left likes to hypocritically complain about.
Not to get all on-topic or anything, but as jwtaylor points out, the linked report is worth looking at and thinking about.
Why only 12 incidents? The researchers examined coroner reports. They actually identified 78 events, but only 56 events had an identified coroner or medical examiner to contact, and only 12 of them responded with the data required for the study. So twelve was their study universe.
It is important to realize that the report *only* looks at fatal injuries which might have been prevented — that is the nature and limit of the information available to examine. They did *not* look at the surviving wounded who would have died without some form of hospital or prehospital intervention — that would have been a completely other kind of study. Probably one much more complicated to undertake.
I find the point the report makes about the significance of tourniquets in light of the difference between the nature of military and civilian wound patterns likely true — but the report on fatal outcomes only does not prove that possible truth. If the researchers had obtained treatment histories for all the *survivors* of even just those 12 incidents, *and* if none of the survivors had ever had a tourniquet applied, then they really would have been onto something. But they didn’t do *that* study. So maybe we’re still with anecdotes and trying to extend military experience into civilian EMS.