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Stopping the bleeding: police, EMS coordination at Power Ultra 

Twenty-eight were injured in the mass shooting; none killed.

click to enlarge CRIME SCENE: Police block off the 600 block of West Sixth; the Ultra Lounge was in the red-brick building in the background.
  • CRIME SCENE: Police block off the 600 block of West Sixth; the Ultra Lounge was in the red-brick building in the background.

Malcolm Steward, 23, of Brookhaven, Miss., was in town Friday visiting friends when they decided to go a concert at Power Ultra Lounge. Sometime after 2 a.m., as rapper Finese2Tymes performed, shots began to ring out and chaos ensued.

Steward hit the floor, then bolted downstairs to the restaurant kitchen, where he stayed with employees of the club and a crowd of concertgoers. When he heard police sirens, Steward made his way to the street.

He didn't know he'd been shot through the left thigh, Steward said, until he was outside on the street.

"I just started feeling a funny feeling in my leg," Steward said. "I lifted up my pants and saw that I was bleeding. I realized I was shot. There was an officer right there and he put a tourniquet on my leg. After that I was pretty much fine. I could still walk and everything, and I'm walking right now."

Steward said he is expected to make a full recovery and hopes to be cleared to go back to work next week.

Steward was one of 28 people injured, 25 by gunshot wounds, in the shooting at the club at 220 W. Sixth St. Thirty-six police officers responded to the incident, which Little Rock Police Chief Kenton Buckner attributed to "gang" activities. There were no fatalities, and partial credit has been given to Little Rock police officers' use of their Emergency Casualty Care training to apply five tourniquets and one chest seal bandage.

It's not yet known if Little Rock police saved lives using the army-based training they received from Metropolitan Emergency Medical Services (MEMS) paramedics. MEMS personnel are following up on the medical outcomes of the injured this week. But what is known is that MEMS and the state Trauma System's decision to develop training for law enforcement officers across Arkansas and work with police and fire agencies to create a new paradigm for reaching victims of mass attacks has produced results.

"On Friday night, we had a very positive demonstration of that working [together] on a large scale," Jon Swanson, MEMS executive director, said Monday. The major change: The police no longer wait until a scene is completely secured and no danger exists before calling help for the injured. The scenario now allows EMS responders to assume some risk so they can get to victims before they bleed out. In the case of a gunshot wound to the femoral artery, that would be three minutes. In the case of the brachial artery, 10 to 15 minutes.

Five MEMS units and a supervisor responded to the early Saturday morning shooting, and only 31 minutes elapsed from the first call for help to the last victims transported to hospitals.

"Traditionally, law enforcement would have gone in, secured the area and continued to put yellow tape up, and then call" for ambulances, said Clayton Goddard, special operations supervisor for MEMS. That could take a lot of time, a point driven home by the shootings at Sandy Hook Elementary School and the Boston Marathon, Goddard said. "There were lives being lost because of blood loss."

Those incidents spurred training for civilian law enforcement and responders, training the U.S. military could provide using methods adapted from the battlefield. Goddard said MEMS sent him and other paramedics to Georgia to take a course in civilian tactical care "with the intention of coming back and developing more instructions to put in the hands of every law enforcement officer."

Goddard and Swanson are themselves both ex-military — Goddard a Navy seal for six years, Swanson an Air Force pilot for 28 years — and Goddard heads the Special Tactics Advanced Response (STAR) team that provides medical backup to local police departments, the State Police and the FBI. The military's reintroduction of tourniquets reduced the death rate from bleedouts in the Afghanistan and Iraq wars from 24.1 percent to 3 percent. Tourniquets had long been considered taboo because if applied inappropriately they could cause nerve and muscle damage.

click to enlarge CHIEF BUCKNER: In a press conference after the shooting, he attributed the shootings to gang activity.
  • CHIEF BUCKNER: In a press conference after the shooting, he attributed the shootings to gang activity.

In 2014, MEMS met with Little Rock's police and firefighters at the Central Fire Station to draw up a coordinated response to active shooter and terror incidents. Previously, the LRPD had a policy on how to respond to school shootings, but that policy had not been shared with other first responders.

Thanks initially to state Trauma System funds and since then to federal grants, MEMS has been able to outfit thousands of individual first-aid kits to provide to police. The IFACs include tourniquets, blood clotting agents and other medical aids.

The scene in the wee hours of Saturday morning was chaotic. There was no time to put together a SWAT team; instead, patrol officers responded. "I'm so proud of the police department's role in this," Swanson said. In the past, when emergency medical services personnel arrived on the scene, "the police would have their heads down, focused on the threat, and not have the mindset to engage MEMS or the fire department until the situation was under control. [On Saturday] the supervisor was able to go to the police commander immediately and build on the scene a relationship. The commander engaged us and we formed a much more cohesive team than we would have seen in the past."

MEMS personnel will keep working with police departments. Starting in late summer, 900 public school nurses will begin training under the Stop the Bleed initiative.


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