Implementation of the Hartford Consensus initiative to increase survival from active shooter and intentional mass casualty events and to enhance the resilience of citizens.

The Joint Committee to Create a National Policy to Enhance Survivability from Active Shooter and Intentional Mass Casualty Events was founded by the American College of Surgeons (ACS) in collaboration with representatives from the federal government, the National Security Council, the U.S. military, the Federal Bureau of Investigation, and police, fire, and emergency medical organizations. The committee recognized that a strategic response to active shooter and intentional mass casualty events requires a consensus of multiple agencies and organizations, all of which have an interest in enhanced survivability but have differing philosophies and jurisdictions. The call to action declared that no one should die of uncontrolled bleeding. Preventable deaths after an active shooter or intentional mass casualty event should be eliminated through the use of a seamless integrated response system. To develop a response system that can be effective 24 hours a day, seven days a week in any locale—whether it be a city, a suburban setting, or a rural environment—it is critical to identify the organizations and governance structures responsible for ensuring that a plan can be implemented immediately. It is then essential to identify all groups that would be available to respond to an intentional mass casualty emergency. The critical actions to enhance survival, the training necessary to achieve competence, and the necessary equipment and its immediate availability also need to be identified and be ready to be implemented. It is essential to establish a partnership with government agencies that are responsible for making intentional mass casualty events of sufficient importance that a national initiative is implemented to mitigate injury and death. The Executive Branch of government, through a Presidential Directive, established the importance of a national response. The directive outlines areas of responsibility and appropriate time lines to implement a national solution. The federal government, through the Department of Homeland Security, Federal Emergency Management Agency, Federal Bureau of Investigation, Department of Defense, and National Security Council, has identified the elements of the problem and appropriate solutions. It has communicated this information to more than 50 organizations in the medical, law enforcement, public health, and emergency medical prehospital services arenas. The government also has included major private sector organizations in the dissemination of this information. At the state level, the departments and commissioners of public health and public safety have received guidance from Federal Emergency Management Agency as to an appropriate response, which can be tailored to local jurisdictional idiosyncrasies. The statewide directives have been transmitted to local law enforcement agencies, municipalities, hospitals, and private companies.