American College of Surgeons Releases Compendium of Strategies to Enhance Victims’ Survivability from Mass Casualty Events

CHICAGO (September 22, 2015): A new compendium of expert recommendations on strengthening the security and resilience of U.S. citizens after mass casualty events was released this month as a supplement to the Bulletin of the American College of Surgeons. The compendium, titled Strategies to Enhance Survival in Active Shooter and Intentional Mass Casualty Events: A Compendium, contains reports that represent the deliberations of the Joint Committee to Create a National Policy to Enhance Survivability from Intentional Mass Casualty and Active Shooter Events. The recommendations of this collaborative committee are called the “Hartford Consensus.”

The compendium comes in response to a Presidential Policy Directive from President Barack H. Obama, “aimed at strengthening the security and resilience of the U.S. through systematic preparation for the threats that pose the greatest risk to the security of the Nation, including acts of terrorism, cyber-attacks, pandemics, and catastrophic natural disasters.”

“The purpose of this compendium is to assist the Presidential Policy Directives in strengthening the security and resilience of U.S. citizens,” said Lenworth M. Jacobs, Jr., MD, MPH, FACS, Chairman of the Hartford Consensus, Vice President of Academic Affairs and Chief Academic Officer at Hartford Hospital, and Professor of Surgery, University of Connecticut School of Medicine. “The complexity and diversity of a country as large as the U.S. represents a significant implementation challenge. But we think it’s imperative to get this Compendium widely distributed throughout the emergency care community, and to the general public as well. It is through these coordinated responses involving the public and organized service personnel that we can enhance survivability from active shooter and intentional mass casualty events.”

Following the active shooter disaster at Sandy Hook Elementary School in Newtown, Conn., the committee, founded by the American College of Surgeons (ACS) in collaboration with the medical community and representatives from the federal government, the National Security Council, the U.S. military, the Federal Bureau of Investigation, and governmental and nongovernmental emergency medical response organizations, among others, was formed under the guidance and leadership of Dr. Jacobs.

The committee convened in Hartford, Conn., on three occasions to create a protocol for national policy to enhance survivability from active shooter and intentional mass casualty events. The result was the Hartford Consensus, which consists of three reports. The first report developed the algorithm THREAT, for initial response to deadly injury: Threat suppression, Hemorrhage control, Rapid Extrication to safety, Assessment by medical providers, and Transport to definitive care.

The compendium includes reprints of the three Hartford Consensus reports, the Presidential Policy Directive from President Obama, a letter from Vice-President Joseph R. Biden, and statements from government leaders and individuals who have contributed to the committee’s efforts.

“The common sense recommendations within this report have the potential to equip citizens with the skills to respond, and the confidence to know they can—and must—make a difference,” said Vice-President Biden in his letter.

The compendiumhas been distributed to all members of the American College of Surgeonsand will also be distributed to employees of federal agencies and stakeholders interested in improving the public’s ability to respond at the scene of active shooter and mass casualty events.

The Compendium is available for download on the ACS Website.

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About the American College of Surgeons

The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 80,000 members and is the largest organization of surgeons in the world. For more information, visit