AUDIE CORNISH, HOST:
In any situation like Orlando, there are a lot of what-ifs - questions about whether lives might have been saved if only something different had happened. The National Academy of Medicine has been trying to find some answers by studying recent mass shootings, including those at Virginia Tech, Boston and Aurora, Colo.
One of the authors of the Academy's latest discussion paper is John Hick. He's the medical director for emergency preparedness at Hennepin County Medical Center. That's in Minneapolis. We reached him at the hospital, and I asked him about problems emergency response teams face when they arrive at the scene of a shooting.
JOHN HICK: I think too many times the active shooter incidents have been scenes where EMS has not been allowed to enter until law enforcement is content that the threat has been completely neutralized and that the entire building has been swept. And during that time, people die. And so we need to make sure that we get EMS into areas that are relatively secure - what we call a warm zone - as soon as it seemed reasonable by law enforcement to do that. But that involves a couple things.
Law enforcement's priority usually is to get in and get after an active shooter as quickly as possible and engage them and neutralize them or at least contain them so that they can't keep moving around a building. In the process, though, they have to be secondarily thinking about, where did I see victims, and can we get the responding officers behind me to secure entries so that EMS can get those victims out of there relatively safely and without having to worry about additional, you know, immediate threat?
CORNISH: Right, so traditionally the move has been to create a kind of staging area, right?
HICK: Yep, exactly and bring everybody there and then kind of figure what we're dealing with. And so the new paradigm is to gain access as quickly as possible and get those transports done as quickly as possible, not taking time to do much on the scene.
CORNISH: Given what you've said, that means that in the past, hospitals were sort of waiting, I guess, for a semi-orderly entrance of victims - right? - even if there were a lot of them. What does it mean now?
HICK: So I think historically we have, you know, expected or at least hoped that EMS would bring the most injured victims to us first, and then we could devote the most resources to the people that needed it the most. But the reality of most incidents is that you will wind up getting people kind of by private car. And especially if our priority is on transporting patients as we find them from these type of scenes, you may not get the most critical first.
CORNISH: So quite literally knowing that you're not seeing the worst of the worst injuries as there coming in.
HICK: Exactly. So you don't know what you don't know at that point, and there may be worse yet to come, that there's not going to be a prioritization exactly by EMS about - these are the worst cases that we found. It's just, these are the first cases we found, and here they are.
CORNISH: This has probably been a very dark bit of research for you. I know you are director of emergency services there. For you, what lesson are you learning about these last few years?
HICK: I think the main thing for me is that you really have to examine your surgical response. So just looking, you know, at the resources kind of top to bottom and figuring out from a space, from a staff, from a stuff standpoint, do I have the things that I need in place that if something like this goes down, you know, are we going to be prepared?
And the answer is, you know, we're much better prepared. Fortunately or unfortunately, we've had to become better prepared for these type of events in the last five to ten years. But I think, you know, every trauma center in the U.S. is taking a very hard look at these type of incidents and really trying to improve their preparedness for them.
CORNISH: Dr. John Hick, thank you so much for speaking with us.
HICK: Thank you.
CORNISH: John Hick is one of the authors of a recent paper on responses to mass shootings from the National Academy of Medicine. Transcript provided by NPR, Copyright NPR.