Active Shooter Preparedness: What You Need in Your First Aid Kit

Active shooter is a term that conjures images of gunmen walking through schools or offices, shooting unsuspecting innocent bystanders. It can also mean any assailants or even groups of terrorists working together to attack gatherings of people in public places. Whether we're talking about a single bad actor or a group, the term is the same.

Active shooter preparedness usually focuses on what to do in the event that you find yourself in that situation. The Department of Homeland Security advises us to do one of three things if we are faced with a shooter:

  1. Run. The single best way to remain safe during an active shooter incident is to not remain at the active shooter incident at all. Get out and away as fast as you can.
  2. Hide. If you can't run, hide. Be quiet and stay out of sight, preferably behind a locked door. Silence your cell phone.
  3. Fight. Lastly, if you don't have any other choice, fight back. Improvise weapons and commit to your actions because your life depends on it.

Call 911 and expect to be a suspect once the police arrive. They don't know who's who, so when they get there, they're going to be careful of everyone. Follow their instructions and be patient.

In many cases, the how-to's don't include what to do for injuries. Injuries from active shooter incidents—as well as blast injuries from explosive devices—follow typical patterns, especially common are projectiles and puncture wounds.

First Aid for Active Shooter Injuries

Once the shooting has stopped, there could be a long time to wait before rescue arrives. It's during this time that you have to decide if you're going to be a bystander or an immediate responder. Are you going to just stand by or do something? That choice becomes much easier if you have planned in advance of what to do.

First, learn first aid. There's nothing like the proper training to prepare you for the unexpected.

Second, get a decent first aid kit. The right kit is usually available already built, but you can also build it from scratch. Either way, there are supplies you need in your kit to prepare for an active shooter situation that probably wouldn't be needed in any other type of first aid kit.

Below is a list of supplies specific to active shooter incidents and discussions on each type. These items are essential for any first aid kit in an office, school, or personal kit. The benefit that all of these supplies have in common is that they can be applied and then allow the rescuer to be hands-free. That way, the rescuer can help move the patient or even fight the shooter if necessary.

Tourniquets

tourniquet applied to soldier
US Army soldiers training in Ghana practice applying tourniquets. US Army Africa

Tourniquets were once very maligned by the first aid community. For a very long time, we (myself included) believed that tourniquets were more trouble than they were worth. It was thought that tourniquets could indeed save lives, but they would cause the loss of a limb if used.

Here's the idea: tourniquets work by occluding blood flow to the affected arm or leg. Bleeding stops, but so does the flow of nutrients and oxygen to the rest of the limb. If the patient wasn't treated fast enough, it was believed, the loss of blood flow to the uninjured part of the extremity would lead to tissue death.

The thing is, there really wasn't much of a basis for that sort of thinking. As it turns out (no pun intended) tourniquets have been used for centuries without ill effects. The theory of damage led to a significant decrease in the use of tourniquets outside of the military.

Better research during the conflicts in Iraq and Afghanistan helped rehab the reputation of tourniquets and now they are essential for any first aid kit.

Use tourniquets when the bleeding is severe or there massive damage to the arm or leg that a pressure dressing can't cover. Massive damage would include amputations. The trick to correct application of a tourniquet is to make it very tight. A properly applied tourniquet is uncomfortable to the patient, some would say even painful.

Pressure Dressings

applying an Israeli bandage
Chris Thiel, Fairfax County CERT Class 74, acts as victim while Randy Weidman, (Class 80) applies an Israeli-style trauma bandage, under the guidance of Instructor Brian Talbot. Joe Loong

The best way to learn how to apply a pressure dressing is to do it. Buy two and open one up to practice with it. One of the most useful is the Israeli bandage, which has a lever that pushes on the wound to hold pressure. An Israeli bandage can be applied quickly with practice, but it's easy to mess up if you haven't done it a couple of times.

It's important to remember that you'll be in the throes of adrenalin when it's time to use the stuff in your first aid kit. Practice is the only way to ensure success when your hands are shaking and you're having trouble concentrating.

Unlike tourniquets, pressure dressings have never had the same type of bad reputation. That said, pressure dressings are more difficult to use well. There are several types of external and internal pressure dressings as well as hemostatic agents that help blood coagulate.

It's not a bad idea to have a few options for pressure bandages in your first aid kit. Bandages that come with hemostatic agents are great for packing wounds. Bandages that adhere to themselves without sticking to skin are great for elderly patients.

Chest Seals

Bullets and flying debris from explosive blasts can put holes in nearly anything. Any hole in the body that isn't supposed to be there will bleed. The skin and tissues of the body are the containers of blood and body fluids. Tear a hole in the container and the fluid is going to leak out.

Holes in the chest, including the upper back, not only leak blood but also allow air to leak in and out. It's such a common problem that holes in the chest are considered sucking chest wounds. It's not necessary to actually hear or see air movement. It's often very subtle.

If left untreated, sucking chest wounds can lead to collapsed lungs, a condition known as pneumothorax. Air gets trapped in between the chest wall and the lung, pushing on the lung and causing it to appear "collapsed" on an x-ray.

The way to combat a sucking chest wound is to seal it. Stopping the air movement will keep a pneumothorax from developing. In rare cases, sealing a chest wound could lead to air getting trapped in the chest from a leak in the lung. It makes sense that a bullet traveling fast enough to put a hole in the thick muscles of the chest would also put a hole in the structures of the lung.

Since air could be leaking out of the lung as well as getting sucked in through the hole in the chest, some chest seals come with a vent. The vent allows air to escape but keeps air from entering through the wound. A vent is a great addition, but it's not necessary—especially if the patient is going to get help in a relatively short time. Most civilian injuries are going to be treated much more quickly than their military counterparts.

With a little training and understanding of how chest seals work, this is one piece of equipment that can be easily improvised using the packaging of the sterile dressings already in your first aid kit. Whether you improvise it or use a commercial seal, learn how to do it before you need to.

Sources:

Active Shooter Preparedness | Homeland Security. Active Shooter Preparedness | Homeland Security. (2016). Dhs.gov.

Butler FK, Dubose JJ, et al. Management of Open Pneumothorax in Tactical Combat Casualty Care: TCCC Guidelines Change 13-02. J Spec Oper Med. 2013 Fall;13(3):81-6.

Edwards S, Smith J. Advances in military resuscitation. Emerg Nurse. 2016 Oct 6;24(6):25-29.

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