On July 13, a lone assassin shot and wounded former President Donald Trump, killed firefighter Corey Comperatore and critically wounded two others at a Trump campaign rally in Butler, Pennsylvania. In video and images seen around the world, Trump reaches to his neck before collapsing onto the stage and behind the lectern. He is swarmed by Secret Service agents who assist him from the stage.
The video of this tragic incident of violence prompts many reminders about firearms trauma and patient assessment. Here are seven:
1. The scene is NOT safe
Former President Trump is one of the most protected people in the world. Federal, state and local law enforcement spend weeks planning for a campaign visit, have hundreds of officers at the scene and use all available technology to identify and mitigate threats. Despite those efforts, a gunman was able to get within 175 yards of Trump and fire multiple shots from an elevated position.
A scene might be more safe. A scene might be less safe. But never presume or announce that the scene is safe. A heavy law enforcement presence might make a scene safer for first responders, bystanders and patients, but don鈥檛 be lulled into an assumption of safety just because law enforcement is present.
2. Move towards cover and concealment
Law enforcement officials were actively searching for the shooter after attendees reported his suspicious behavior. A law enforcement officer is even reported to have seen him on the roof before he shot at Trump. But in the immediate moments after Trump was shot, it鈥檚 unlikely responders knew if the shooter was acting alone or if other co-conspirators might be present.
When responding to a firearms incident and the location or number of shooters is unknown, moving towards cover and concealment is critical to making the scene more safe for you and the patient. If the best available cover and concealment is the ambulance or an armored vehicle, use it. If the best available cover and concealment requires an emergency patient carry or drag, do it.
3. Find and stop the bleeding
Multiple shots were fired at former President Trump. He had a visible wound to his right ear. When examining a gunshot or other type of trauma patient, avoid tunnel vision on an obvious, superficial wound and rapidly examine the patient for other wounds and bleeding. Treat the wounds you find with the tools and training available to you, including direct pressure, tourniquets, wound packing, chest seal and pressure dressing.
Even if the patient who has just been shot is awake and oriented, don鈥檛 rely on their self-report of injuries. The patient might not be fully aware of the number and severity of their own injuries. Follow up the rapid sweep for severe bleeding with a more thorough physical examination in the ambulance or once you reach a safer position.
4. Find all the patients
Former President Trump was the shooter鈥檚 target in a densely packed stage and audience. In the moments after the gunfire, the focus of the world was on Trump, the care he was receiving, his motioning to the crowd and his movement off the stage and into a Secret Service vehicle. A few feet away though, an emergency doctor was tending to Comperatore, two other people were wounded and hundreds of others were at risk of injury as they fled the chaotic scene.
Unless you are assigned to care for the VIP and the VIP only, it is the ongoing responsibility of on-scene personnel to find all the patients, find and fix life-threatening injuries as they are found and then prioritize the most severely injured patients for on-scene treatment and transport to definitive care.
5. Move with pace and purpose
The definitive care for most gunshot wounds is surgery. We have ample evidence that scene delays, especially for interventions that are either unnecessary or that could be initiated enroute to the hospital, lessen patient survival.
Move with pace and purpose, not frenzy and panic, to transport the patient to definitive care. Follow trauma patient destination protocols to transport patients to the most appropriate level of trauma care in your community or region.
6. It鈥檚 a crime scene
Responding to a shooting victim is responding to a crime scene. Even though every second of Trump鈥檚 shooting was captured on video from dozens of angles and the shooter was neutralized in moments, every inch of the Bulter, Pennsylvania, fairgrounds will be searched for clues.
As you enter and leave a shooting scene, care for single or multiple patients and document your care, don鈥檛 make presumptions about what is potential evidence or not evidence. Avoid unnecessary movement of nearby objects.
Also, if your assignment is patient care, focus on that. Leave the interrogation and investigation to others.
7. You鈥檙e on camera
Bystanders, media, security cameras, doorbell cameras and dash cams exist at every gunshot incident. Your actions will be recorded and likely by multiple cameras. Those same cameras might also be recording audio of the conversation between you and the patient or you and your partners. While still on the stage and hidden by the lectern, former President Trump asks for his shoes. Audio also records numerous verbal attempts by the Secret Service agents to move Trump.
At best, the video and audio recording of your care of a gunshot victim is a teaching tool for your colleagues. At worst, it is career-ending documentation of failing to follow protocols and delivering negligent care to someone in need. Always assume the eyes of the world are on you and provide care with professionalism, dignity and compassion.
Bonus: Zero Fail: The Rise and Fall of the Secret Service
If you want to better understand the immense challenges the Secret Service faces, as well as its historical failures, 鈥�鈥� is an outstanding book.
