J Am Coll Surg. 2019 Sep;229(3):244-251

# Incidence and Cause of Potentially Preventable Death after Civilian Public Mass Shooting in the US.

Smith E, Sarani B, Shapiro G, Gondek S, Rivas L, Ju T, Robinson B, Estroff J, Fudenberg J, Amdur R, Mitchell R

BACKGROUND: The incidence and severity of civilian public mass shooting (CPMS) events continue to rise. Understanding the wounding pattern and incidence of potentially preventable death (PPD) after CPMS is key to updating prehospital response strategy.

METHODS: A retrospective study of autopsy reports after CPMS events identified via the Federal Bureau of Investigation CPMS database from December 1999 to December 31, 2017 was performed. Sites of injury, fatal injury, and incidence of PPD were determined independently by a multidisciplinary panel composed of trauma surgery, emergency medicine, critical care paramedicine, and forensic pathology.

RESULTS: Nineteen events including 213 victims were reviewed. Mean number of gunshot wounds per victim was 4.1. Sixty-four percent of gunshots were to the head and torso. The most common cause of death was brain injury (52%). Only 12% (26 victims) were transported to the hospital and the PPD rate was 16% (34 victims). The most commonly injured organs in those with PPD were the lung (59%) and spinal cord (24%). Only 1% of PPD victims had a gunshot to a vascular structure in an extremity.

CONCLUSIONS: The PPD rate after CPMS is high and is due mostly to non-hemorrhaging chest wounds. Prehospital care strategy should focus on immediate point of wounding care by both laypersons and medical personnel, as well as rapid extrication of victims to definitive medical care.