平民大规模枪击事件死亡者的创伤情况
The profile of wounding in civilian public mass shooting fatalities.
作者信息
Smith Edward Reed, Shapiro Geoff, Sarani Babak
机构信息
From the Department of Emergency Medicine (E.R.S.), Operational Medical Director, Arlington County Fire Department, Arlington, VA; The George Washington University, Washington, DC; Emergency Medical Services Program (G.S.), The George Washington University, Washington, DC; Center for Trauma and Critical Care, Department of Surgery (B.S.), The George Washington University, Washington, DC.
出版信息
J Trauma Acute Care Surg. 2016 Jul;81(1):86-92. doi: 10.1097/TA.0000000000001031.
BACKGROUND
The incidence and severity of civilian public mass shootings (CPMS) continue to rise. Initiatives predicated on lessons learned from military woundings have placed strong emphasis on hemorrhage control, especially via use of tourniquets, as means to improve survival. We hypothesize that both the overall wounding pattern and the specific fatal wounds in CPMS events are different from those in military combat fatalities and thus may require a new management strategy.
METHODS
A retrospective study of autopsy reports for all victims involved in 12 CPMS events was performed. Civilian public mass shootings was defined using the FBI and the Congressional Research Service definition. The site of injury, probable site of fatal injury, and presence of potentially survivable injury (defined as survival if prehospital care is provided within 10 minutes and trauma center care within 60 minutes of injury) was determined independently by each author.
RESULTS
A total 139 fatalities consisting of 371 wounds from 12 CPMS events were reviewed. All wounds were due to gunshots. Victims had an average of 2.7 gunshots. Relative to military reports, the case fatality rate was significantly higher, and incidence of potentially survivable injuries was significantly lower. Overall, 58% of victims had gunshots to the head and chest, and only 20% had extremity wounds. The probable site of fatal wounding was the head or chest in 77% of cases. Only 7% of victims had potentially survivable wounds. The most common site of potentially survivable injury was the chest (89%). No head injury was potentially survivable. There were no deaths due to exsanguination from an extremity.
CONCLUSION
The overall and fatal wounding patterns following CPMS are different from those resulting from combat operations. Given that no deaths were due to extremity hemorrhage, a treatment strategy that goes beyond use of tourniquets is needed to rescue the few victims with potentially survivable injuries.
LEVEL OF EVIDENCE
Prognostic/epidemiologic study, level IV; therapeutic/care management study, level V.
背景
平民公共大规模枪击事件（CPMS）的发生率和严重程度持续上升。基于从军事创伤中吸取的经验教训所开展的举措高度重视出血控制，尤其是通过使用止血带，以此作为提高生存率的手段。我们推测，CPMS事件中的总体创伤模式和特定致命伤与军事战斗死亡中的情况不同，因此可能需要一种新的管理策略。
方法
对12起CPMS事件中所有受害者的尸检报告进行回顾性研究。平民公共大规模枪击事件采用联邦调查局和国会研究服务处的定义。每位作者独立确定损伤部位、可能的致命伤部位以及存在潜在可救治损伤的情况（定义为如果在受伤后10分钟内提供院前护理并在60分钟内提供创伤中心护理则可存活）。
结果
对12起CPMS事件中的139例死亡病例（共371处伤口）进行了审查。所有伤口均由枪击造成。受害者平均有2.7处枪伤。与军事报告相比，病死率显著更高，潜在可救治损伤的发生率显著更低。总体而言，58%的受害者头部和胸部有枪伤，只有20%有四肢伤口。77%的病例中可能的致命伤部位是头部或胸部。只有7%的受害者有潜在可救治的伤口。潜在可救治损伤最常见的部位是胸部（89%）。没有头部损伤是潜在可救治的。没有因四肢失血而死亡的情况。
结论
CPMS后的总体和致命创伤模式与战斗行动导致的不同。鉴于没有因四肢出血而死亡的情况，需要一种超越使用止血带的治疗策略来救治少数有潜在可救治损伤的受害者。
证据级别
预后/流行病学研究，IV级；治疗/护理管理研究，V级。
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