Commentary: Tragedy requires us all to become first responders

Another killing at Ft. Hood, Texas, reminds us that these horrific acts of violence can occur anywhere, at any time, even on a secured Army post.

Sadly, the shootings also highlight that our responsibilities as citizens have changed forever. These events again demonstrate that there will be situations when everyday citizens will have to help themselves. People waiting in line at the bank, watching a movie or just eating their lunch will have to act before the traditional first responders can arrive to help them. Aurora, Colo., Tucson, Ariz., Boston and last week's events have reminded us that we may all become "first responders."

The traditional definition of a first responder is: fire, police and emergency medical personnel. From Columbine forward, hard-learned experience shows this definition is too narrow. The 2014 FBI active shooter report concludes that the majority of the time, the shooter has done his damage before traditional first responders have arrived. It is much more likely that the actual first responders will be bystanders already on scene. This was true in Aurora, Tucson, Ft. Hood, and nearly every deadly event in recent memory.

This is an important realization because military data (the closest analogy to active shooter wounding patterns) shows 15% of combat wounded die from "preventable causes of death," the majority succumbing within 30 minutes of injury. But that same data also show 90% will survive once care is initiated. Critically injured people might not last until traditional first responders overcome the confusion of the first few minutes and arrive on scene. What happens during that gap can literally be the difference between life and death.

There is no question that the sooner victims get care, the greater their chances of survival. Getting this care to the point of wounding can only be accomplished by acknowledging the gap in our approach and recognizing the need for a new class of provider: the "first-care provider." Preparing for this point-of-injury care has empowered our military personnel and dramatically reduced combat mortality. There is no reason why this approach cannot be implemented publicly. Educating civilian Community Emergency Responder Teams (CERT), city and school employees and volunteer groups is vital to improving our overall response. We must accept that "first-care provider" is a set of tools that can be taught and will save lives.

In 2012, the U.S. Department of Health and Human Services developed a program titled, "Run, Hide, Fight." This is admirably simple but doesn't go far enough. At Columbine, few will recall that students Aaron Hancy and Kevin Starkey, were among the "first-care providers" at the scene. Two teenagers who probably started the day thinking about homework, girls and whether they could borrow the car ended up keeping their coach, Dave Sanders, alive for nearly three hours while awaiting police and emergency services.

The need to improve community safety through civilian medical response is glaring. But to meet the challenge of these dynamic new threats we have to understand the limitations of our "traditional" response and recognize the profound gap in our current model. This need is best summarized by Brian Ludmer, a victim in the Los Angeles International Airport shooting last fall.

Shot in the leg, but having the presence of mind to crawl into a nearby duty-free shop, Ludmer improvised a tourniquet from a child's sweatshirt. He told reporters, "I knew I had to stem the blood flow if I was going to survive." He couldn't wait for first responders; his leg needed immediate action and he took it. He was his own first-care provider.

Dr. JOSHUA BOBKO lives in Corona del Mar.

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