BACKGROUND: The incidence and severity of civilian public mass shootings (CPMS) continue to rise. Understanding the wounding pattern and incidence of potentially preventable death (PPD) following CPMS is key to updating prehospital response strategy.
METHODS: A retrospective study of autopsy reports following CPMS events identified via the FBI 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 comprised by trauma surgery, emergency medicine, critical care paramedicine, and forensic pathology.
RESULTS: 19 events including 213 victims were reviewed. The average 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.
CONCLUSION: The PPD rate following CPMS is high and is mostly due 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.