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In many ways, the Las Vegas shooting was not a typical active shooter incident. Yet, the brave and the prepared both adjusted to this horrific circumstance and saved many lives during the attack. How can we learn from, and improve upon, their good work to be ready for the next mass shooting?
In this article will dispel commons myths, like that people’s response to attacks is panic (it’s not). We’ll talk about how Las Vegas was different, and how the active shooter protocol: run, hide, fight, worked in this situation. Next we’ll consider gunshot wounds and what to do to help victims. And if you don’t live in the area, but you want to help after this tragedy, is giving blood the best thing to do, and how else can you help?
How We Realize We’re Under Attack
How do you make the best decisions to protect yourself and others during an emergency? First, you need to understand what will happen as the realization dawns on you, and everyone around you, that you are all in danger.
Amanda Ripley, author of The Unthinkable: Who Survives When Disasters Strike And Why, has identified the three distinct stages of realizing you’re in the middle of a disaster. She calls these stages the “survival arc” as she told Forbes. While these stages happen during essentially any disaster, we can see them clearly in many of the videos captured during the Las Vegas shooting.
- Denial: During this phase people are not ready to believe they are in a disaster. Many survivors of the Las Vegas shooting report that they, and the people around them, assumed the gun shots were fireworks. In the video below one man can be heard arguing “someone’s tapped into the sound system,” thinking someone was only playing a recording of gunfire to frighten the crowd.
The video begins just before the gun fire starts. Most people do not react much to the first sounds. As the music cuts you can hear people talk. They ask if others agree with them, does it sound like gunshots? Be warned, this video has disturbing and graphic content.
While these reactions are normal, you need to break yourself out of denial as quickly as possible. The consequences for over-reacting to potential gunfire (or whatever the disaster may be) are low. The consequence of failing to act could be your life.
Just consider one man who, around the 8:31 mark of that video, tells his companions he thinks the sound is fireworks, and that they should stop. Don’t be this guy. If there’s even a small chance you’re facing gunfire, leave.
- Deliberation: Now you realize you’re in danger, but you are trying to decide what to do. In the moment, this stage can feel slow and overwhelming.
Doctor Penelope Burns, specialist in disaster medicine, discussed this feeling with SBS. “In a big stress event, when you drive into the hazard, there is a period of being almost stunned. The input from your eyes and ears leaves your brain trying to work out what it’s going to do… Do I run? Do I stay? We see this takes a period of about a minute to two minutes,” Dr Burns explains.
During this stage many people will move, but without the urgency they need. You can see this in the first clip of the video, where people are slowly walking.
Similar slow action has been reported before other tragedies, like passengers on a burning plane trying to bring their carry-on as they evacuate, or those who experienced the World Trade Centers attack, roughly 80 percent of whom gathered up their personal items before evacuating.
- Decision: You’ve made your choice, and you’re acting on your decision. Hopefully, you’ve made the best choice available.
During the Las Vegas attack, you can see most people have hit this stage and begun to move by the 34 second mark. By Dr. Burn’s count, this is early, but there’s a reason for that.
During a disaster there “is a lot of indecision… If no one is doing anything, people will often be waiting for someone to do something, waiting for someone else to initiate course of action,” Dr. Burns explained.
In such a large crowd as the one gathered in Las Vegas, there are many natural leaders and even trained first responders and military members in the crowd to push everyone’s decision forwards.
One woman within ear shot of the camera did this for the people near her. Around the 28 second mark you can hear her firmly and repeatedly say “get down.” It is exactly these kinds of people, the natural leaders, who saved so many lives during the Las Vegas attack.
You may be surprised to hear that most people will not be panicking while in these three stages. Usually, but not always, their instincts will take over and propel them forward. Hopefully, their instincts push them to do the right thing. Let’s talk about what you should do.
How to Make the Most of the Deliberation Stage
Once you’ve realized you’re in danger from an active shooter, you need to act quickly. The three step protocol sums it up: run, hide, fight. Always do these steps in order!
- Run: Your first priority is always to get away from the shooter as fast as possible. In most active shooter scenarios this step is more straightforward. You hear gunfire, or you hear people calling out warnings, and you run away. Don’t get stuck in the deliberation phase and move as quickly as it is safe to do so.
Of course, all of that advice was of little use to those in the Las Vegas shooting. The echoes of gunfire off the various buildings in Las Vegas was confusing. The shooter attacked from two different angles. He broke two windows from two separate hotel rooms, which were right on the corner of the building.
As he switched between the angles he compounded the confusion. Also, he was also so high up that it was hard to estimate his trajectory from the ground. Remember, at the time, many people in the crowd had assumed the shooter was among them, not above them.
So how do you determine which way the bullets are coming from? People who are bleeding are a good indication that gunfire is nearby, instead of just being an echo. The wounded will know first hand where they were hit, so heading in the same direction they are going is a good guess.
Your second clue is sound. Those who have been under gunfire before know that the sound of a bullet in the distance is different from the sound of it whizzing past your head. When a bullet is nearby, you hear a crack, the sound of it breaking the sound barrier.
Once you know where the bullets are coming from, or having a working guess, you need to move. Preferably, towards an exit. Many people in Las Vegas didn’t know where the seven exits of the venue were. One survivor told Fox News that he kept coming across massive fences where he thought there would be an exit. That’s why you should always know where the exits and entrances are in any building or venue you’re in.
According to a CNN report, the shooter had stationed himself closest to the entrances, while the exits were all on the opposite side of the venue. It’s human nature to return to the entryway you came through instead of seeking a new exit, but in this case the instinct worked against the victims.
But, for those who were attack in Las Vegas, running wasn’t always possible. Running in a massive crowd as it tries to empty out of a stadium is a recipe for stampedes and crowd crush.
Crowd crush happens when a group of people are trying to move through a small entrance, at such speed that the pressure in the crowd becomes more like fluid dynamics than like a normal crowd. When this happens, waves of pressure will thrust through the crowd, crushing people to death.
One of the amazing facts of Las Vegas is that crowd crush didn’t occur. You can hear two men on that first video telling others, in the same firm and clear tone the woman used, not to push. These men must have known of the dangers of crowd crush. Overall, it worked.
- Hide: When you can’t run, you have to hide. In most active shooter scenarios this will mean hiding in a closet, or under furniture. For the people who lived through the Las Vegas attack, hiding meant taking cover under anything they could find. Many took cover under the stands, but they didn’t provide ideal protection.
- Fight: During the Las Vegas attack, this stage was irrelevant. It’s important to point out that this is ALWAYS the last resort. I won’t say more about this stage here, but you can read about it, and other more general advice for active shooter situations, here.
How to Direct and Support People During Emergencies
In that top most video, beginning around the 8:01 mark, you can hear a woman clearly panicking. She keeps repeating that she doesn’t know what to do and is alone. People are more likely to panic when they are alone or feel abandoned, or when they believe their window for escape is closing.
A kind soul keeps telling this woman to come with them. He uses a calm but firm voice, and repeats his simple message many times. That’s the exact right approach. He could have
To sum it up, when talking to someone who is panicking you should:
- pick a simple message
- speak calmly, but firmly
- repeat your message
Most of the behavior we think of as panic is actually rational fear-based response, according to the CDC. As long as there is something to do, and the person has others with them, they probably won’t panic. Instead, breaking people out of their denial or deliberation stage is actually a more common problem.
When you try to motivate someone you’ll quickly find that general warnings are ineffective. Instead, you should be as specific as you can about the danger. One man does this very well in the above video. He says, “we are going to be trampled if we don’t move.” And this convinces his companions to stand up and start moving out of the way. If he had simply said “we need to move” or “we are in danger here,” he would have been less effective.
One last thing to look out for is people responding with wildly inappropriate emotions. During the Las Vegas attack one woman is caught on camera saying the concert was “exciting.” Warning: this video is also disturbing.
Don’t shame this woman or people who react like her– they are simply having trouble coping with the situation. Instead, recommend they get a psychological assessment after the disaster. People who react like this are more likely to develop PTSD down the line. Other warning signs that someone is at risk of mental health effects from the tragedy include:
- being quiet during the disaster
- being eerily calm or emotionally numb during the disaster
- laughter, cheer, or optimism (without a reason for optimism) during the disaster
- having trouble acknowledging or realizing they are in danger
- nightmares and sleeping trouble months after the incident
- fearful vigilance months after the incident
How to Assess Gun Wounds and Give First Aid
Assessing a gun wound is not normally something a non-medical professional would do. Yet, many during the Las Vegas attack found themselves confronted with that situation. Many people truly stepped up to help the wounded. Stretchers were made out of bleachers and other objects. People guarded the wounded who couldn’t be moved, or stayed to try to stop their bleeding. One woman even stayed behind to hold the hand of a dying man.
When confronted with many wounded you need to know who needs your help the most. Ideally, you’d let a first responder make that decision. But, sometimes its just you. The survival doctor, James Hubbard M.D. M.P.H., outlines some great information.
Heart, brain, lung, and chest wounds are the most lethal wounds. For these people, there is little you can do other than get expert help right away. Direct pressure should always be applied.
- Head wound: Don’t let the person choke to death, have them lean forward or roll them onto their side. Then apply direct pressure, unless the carotid artery has been hit (then use soft pressure and an occlusive dressing).
- Chest wounds: Be careful moving these victims, especially if their spine may have been effected. If a chest wound is “sucking” or has impacted the lungs, you need to cover it as soon as possible with an occlusive dressing.
These were among the most common serious wound from Las Vegas, at least that one hospital saw. The University Medical Center of Southern Nevada’s chief of trauma surgery, Douglas Fraser, said, “Many did not require surgery but required chest tubes to the chest so they could breathe better. The other patients had surgery to remove holes to their bowels and intestines.”
- Abdomen wounds: For these patients you need to cover the wound and/or organs with a soft, sterile dressing. Do not use a shirt or other dirty cloth, because the risk of deadly infection is very high. If the intestines have ruptured, this person is an even higher priority for medical help. Do not let this person eat or drink anything.
- Limb wounds: Apply direct pressure, elevate the wound, and then add a pressure bandage aka a tourniquet, directly onto the wound.
It’s my personal opinion that you should have a tourniquet with you at events so you can deal with these wounds. If you don’t want to have one on your person, at least keep one in your car so you can apply it on your way to the hospital. My paramedic friend put it simply “Tourniquets save lives.”
The goal is to get a gunshot victim to a hospital, and the first thing they will die of on the way is blood loss. Keeping a whole trauma kit in your car is ideal.
My paramedic friend suggests that a tourniquet needs to twist. When a commerical tourniquet is not available he suggests using belts and shirts, in combination with a stick or other item that can twist the dressing. He told me that most shirt material is good for tourniquets, because it’s usually rough and that keeps it from loosening over time.
Apply it on the wound but make it wide enough to effect a large area. Add a windlass, a twisting device to get enough pressure to stop the bleeding. Applying a tourniquet hurts, a lot, but it saves lives. Do not apply a tourniquet around a neck.
If someone has internal bleeding or has signs of going into shock they are also a top priority and need to get to a hospital ASAP.
Signs of internal bleeding include:
- decreased alertness
- weak pulse
- lowering blood pressure, or a fast and faster pulse
Signs of shock include:
- confusion or agitation
- sweating and cool skin
- capillaries refill slowly
- fast heart beat, especially if rising
- breathing quickly
How to Help After Mass Tragedies
- When you leave, take people with you. Many people volunteered to drive victims out to the hospital. In the video, one woman can be heard immediately agreeing to drive people out. This heroism is truly heartwarming, but there is a way we can do it even better.
The CDC reports that in most disasters the closest hospital is overwhelmed, whereas the other nearby hospitals get prepared for patients who never arrive. Authorities think that patients will arrive by ambulances, which can co-ordinate their efforts to avoid overloading any single hospital, but most patients will actually be driven by a family member or good Samaritan (because ambulances are all being used).
If you find yourself carrying people who will certainly survive the longer drive to the second closest hospital (if their bleeding is controlled, perhaps their injury was superficial or not life threatening– like a broken bone) they may get faster treatment if you take them to that second hospital. When in doubt, ask officials.
- Try to talk to missing people through normal communication methods first. It is normal to want to reach out to find out if your loved ones were effected by the tragedy. We all want reassurances that our people are safe. But, emergency lines and even missing person hotlines get overwhelmed after mass tragedy.
We saw this after the Las Vegas attack, where the Las Vegas Police Department first asked people to only call the missing persons line if they were making a report. Then, the line went down. They had to change the number to bring it back up. So, do not call emergency lines looking for information. Do not call the missing persons line unless you exhausted other possibilities.
To find a loved one first look at their profile on Facebook and see if they’ve marked themselves safe or put out an update. Then call and text them. When you’re looking for a young person, I like to include a line that says: “I’m going to report you missing if you don’t respond to this.” Even really infrequent texters will be more likely to respond when you say that.
- Sharing appropriate information is another great thing you can do, especially if you’re not in the effected area. Get your information from official sources or from first-hand knowledge. If you’re looking to share a post another average citizen has made, take a moment to confirm the information, if you can. Updates about the description and location of shooters is especially important while the attack is occurring. Afterwards, stories about the heroes can comfort people and provide catharsis.
Information you should share:
- description of and location of shooter(s), even if not confirmed
- closures of buildings and roads
- police requests for help in locating people of interest
- numbers of emergency hot-lines
- locations to donate blood
- locations of crisis services, family re-unification sites, etc.
- stories of heroes, which provide hope and catharsis
There is some information you shouldn’t share though. For example, it is generally looked down upon to publicly share your personal theories, speculations, or solutions while a tragedy is on-going or just ended (but hey, I’m not your boss). One thing officials usually ask though, is: Do not live stream police officers or share their location– you are endangering them.
- Donating blood is an amazing response to a tragedy such as this one, and often health departments will request people come down to donate so they can fill the sudden need. People leapt to do so after Las Vegas.
If you’re moved to help people injured during the Las Vegas shooting, make an appointment to donate blood for a week, or four, down the road. The blood banks currently appear to be booked up, and the need for blood will continue after this blood has been used, or expired.
In fact, if you are moved to donate blood in the wake of tragedies, it may be better to become a regular donor. That way, more blood is available during the immediate aftermath of the event. The donations that occur at that time, though essential, still need to be processed before they can be used, which takes time.
There’s no way to fully prepare for any kind of tragedy. All we can do is keep spreading the lifesaving information and skills that so many heroes in the Las Vegas attack relied upon.
In horrible moments like this, the ability to empower oneself to onfront evil should be our top priority. And to all those who used that power to save other innocents, you have our eternal respect.
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