Active Shooters & Public Access Bleeding Control Kits

Harvard’s National Preparedness Leadership Initiative (NPLI) plays a key role in bringing together thought leaders and professionals to address complex challenges and enhance the nation’s preparedness efforts. One NPLI meta-leadership project contributed to a new nationwide campaign that empowers bystanders to act and potentially save lives when someone is critically injured by an active shooter.

In January 2016, Birch Barron, senior policy analyst with the University of Maryland Center for Health and Homeland Security, introduced DomPrep readers to a vital new tool in active shooter survival: the U.S. Department of Homeland Security’s Stop the Bleed Initiative. Team You Can Act is a group of alums from Cohort XIII of the National Preparedness Leadership Initiative that played (and continues to play) a roll in Stop the Bleed, including conducting a September 2015 pilot test of a public access bleeding control program that was featured in the White House’s announcement of the new initiative. That pilot study allowed for the groundtruthing of different aspects of such a program, and the final report serves as a good kickoff point for any organization considering improving survivability in public spaces through the adoption of public access bleeding control principles.

Many unknowns exist when it comes to the active shooter problem. For instance, there is no standard profile for an active shooter. However, among the knowns are the facts that some of these incidents can be prevented and can be survived. Prevention is complex, and involves the use of: threat assessment; intelligence management; coordination with local law enforcement and fusion centers; use of workplace violence assessment teams and behavioral intervention teams; physical security; employee screening; and good human resources policies. Survivability requires adoption of proactive policies, such as Run. Hide. Fight® or ALICE (Alert-Lockdown-Inform-Counter-Evacuate), and making hemorrhage control a real option for people “in the scene.”

As part of Harvard’s National Preparedness Leadership Initiative (NPLI), the team coalesced in April 2015 around the belief that a practical hemorrhage control strategy would involve the development and deployment of public access bleeding control kits in public areas. Richard Serino, former deputy administrator of the Federal Emergency Management Agency and current NPLI distinguished fellow, overheard the group’s initial discussions regarding how the team would implement its ideas as an NPLI initiative. He approached the group and said, “When they ask you who your faculty advisor is, it’s me!” Serino was already involved in early discussions regarding what would eventually become the Stop the Bleed Initiative. He stated that the team’s idea of a simple, but well-researched, implementation strategy would serve to advance the nationwide plan, and he immediately put the team members in contact with the leadership of the healthcare and government coalitions behind Stop the Bleed.

The subsequent research was conducted in close consultation with representatives of the Hartford Consensus and the White House’s Stop the Bleed working group, but the team was hesitant to conduct its pilot study before the White House’s October 2015 national announcement of the Stop the Bleed program. However, in July 2015, the working group asked the NPLI team to proceed with its pilot before the initial rollout of the national program. That allowed for discussion of the test in the October forum, and an initiative rollout that already included some successful implementation.

The pilot test was implemented three weeks before the White House’s rollout of the Stop the Bleed program, and involved the deployment of a bleeding control station during a full-scale active shooter exercise at Charlotte Douglas International Airport. Some of the lessons learned are as follows:

  • Bleeding control kits may be placed in existing automated external defibrillator (AED) cabinets. The biggest cost would be new signage.

  • The contents of the kits should be determined through consultation with appropriate medical directors. 

  • Web-based guidance, reached via a smart phone, may be an effective just-in-time training technique.

Active shooter preparedness research continues to be very active. Based on recent research, the team is already leaning toward recommending additional items, such as occlusive dressings being included as part of the standard contents in any public access bleeding control kit. For additional information, please refer to the paper or contact one of the team members.

Team You Can Act

Team You Can Act is the NPLI Cohort XIII group whose goal is to develop tools for the public that can bring some of them out of the metaphorical “basement” during an active shooter incident. The team focuses primarily on research and development involving empowering the public to control severe bleeding, concepts inspired by existing public access Automated External Defibrillator (AED) programs. The following team members contributed to this article: Stephen Ahern, deputy superintendent at the Cambridge Police Department; Eric DiNoto, director of the National Guard’s Homeland Security Institute; Steve Maloney, preparedness and response specialist at the Federal Reserve Board; James Mynatt, airport operations manager at Charlotte-Douglas International Airport; Dr. Stacy Peerbolte, assistant director for preparedness and response at the U.S. Department of the Interior; and John Snider, deputy chief of the Arlington County Fire Department.



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