Tueries par armes à feu: Causes évitables de décès

Fatal Wounding Pattern and Causes of Potentially Preventable Death Following the Pulse Night Club Shooting Event.

Smith ER et Al. Prehosp Emerg Care. 2018 Nov-Dec;22(6):662-668.

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Cet article confirme que la nécessité d'une organisation spécifique de la prise en charge des victimles de terrorisme. La répartition des causes évitables de décès après tirs d'armes à feu diffère quelque peu des problématiques militaires. La probabilité de survie est moindre. Si la stratégie de pose précoce du garrot est importante, elle n'est pas suffisante.  Ainsi il est rapporté qu'un tiers des décès pourrait être évités, que si des exsanguinations liées à des atteintes des membres sont observées, les causes thoraciques apparaissent être une cible de prise en charge précoce notamment par exsufflation de pneumothorax compressif dont l'occurence apparaît plus fréquente qu'en milieu militaire.

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BACKGROUND:

Mortality following shooting is related to time to provision of initial and definitive care. An understanding of the wounding pattern, opportunities for rescue, and incidence of possibly preventable death is needed to achieve the goal of zero preventable deaths following trauma.

METHODS:

A retrospective study of autopsy reports for all victims involved in the Pulse Nightclub Shooting was performed. The site of injury, probable site of fatal injury, and presence of potentially survivable injury (defined as survival if prehospital care is provided within 10 minutes and trauma center care within 60 minutes of injury) was determined independently by each author. Wounds were considered fatal if they involved penetration of the heart, injury to any non-extremity major blood vessel, or bihemispheric, mid-brain, or brainstem injury.

RESULTS:

There were an average of 6.9 wounds per patient. Ninety percent had a gunshot to an extremity, 78% to the chest, 47% to the abdomen/pelvis, and 39% to the head. Sixteen patients (32%) had potentially survivable wounds, 9 (56%) of whom had torso injuries. Four patients had extremity injuries, 2 involved femoral vessels and 2 involved the axilla. No patients had documented tourniquets or wound packing prior to arrival to the hospital.

 

 

One patient had an isolated C6 injury and 2 victims had unihemispheric gunshots to the head.

CONCLUSIONS:

A comprehensive strategy starting with civilian providers to provide care at the point of wounding along with a coordinated public safety approach to rapidly evacuate the wounded may increase survival in future events.