Oct. 6, 2017 -- The massacre this week in Las Vegas didn’t just start debates about gun control and get sympathy for the victims and their loved ones. It highlighted a terrible truth for Americans: We should know what to do if we have to deal with mass violence.

Predicting such random and horrific events is impossible. But public safety experts and medical officials say we can boost our odds of survival by what we do before, during, and after an attack.

Before the Event

Within seconds, festivalgoers who saw others being shot in Las Vegas became first responders, experts say. Being ready for such emergencies could help.

"Get trained in CPR and first aid," suggests Sheldon Marks, MD, a doctor in Tucson, AZ, who volunteers with the city's Police Department SWAT team and has trained others how to handle active shooter situations.

The first-aid class should teach how to apply tourniquets and to dress wounds, he says.

Before going to events, have a plan in place with family and friends in case of emergency, Marks says. That should include where you will meet if something happens.

Always take basic safety equipment along, such as a flashlight, Marks says. Be sure your phone is fully charged, even though an emergency may take out reception or make the lines too jammed to get through.

"Memorize loved ones' phone numbers," suggests Natalia Derevyanny, a spokeswoman for the Cook County, IL, Department of Homeland Security & Emergency Management. You might have to use someone else’s phone, yours may get lost in the chaos, or the cell signals may be jammed.

"Wear appropriate shoes, or have them available," Marks says. You may have to escape quickly. "Flip-flops and high heels are not a good way to escape."

At the Event

When you arrive at a venue, check out the exits, Derevyanny says. "There is always more than one way to exit," she says. Figure out your Plan B when you arrive. It might be a window, not a door.

Once in a public place, pay close attention to gut feelings and that ''hair standing up on your neck'' phenomenon that suggests something is off, says Derevyanny. "If something seems off, or strange, report it to authorities."

For instance, she says, if you are at a public venue and notice everyone taking photos, that's typical. However, she says, if you suddenly notice someone taking pictures of the heating and cooling system, or something else unusual, that bears reporting.

If you're at an outdoor summer concert and someone there has a bulky jacket on, that, too, is suspicious, she says. "Just be very aware of anything in your workplace or social life that is out of place or very odd," she says. "If it makes the hair on the back of your neck stand up, it's time to call it in."

During the Violence

Public safety experts have a mantra: Run, hide, fight. Escaping is the first choice, if possible; if not, hiding might be next best. The last resort, of course, is to fight.

"Every situation is different," Derevyanny says. "In the case of Las Vegas, everyone needed to run. There was no place to hide."

When you run, Marks says, be aware that law enforcement, when on the scene, may be looking for other suspects. ''Run in a way you are not perceived as a threat," he says.

If you have any object that might look like a weapon, for instance, don't carry it that way.

Speed is crucial. "Don't go back for your backpack or purse," Marks says. "People die trying to get their stuff."

As you run, try to look ahead and plan ahead -- you don’t want to end up in a dead end or in a room with only one entrance and exit.

Hide behind something that not only conceals you but protects you, if possible. A steel door is better than a curtain, but you may have no choice. If you find a safe place, stay there and be quiet. Turn off the ringer on your phone.

Trying to fight the attacker should be a last resort, the Department of Homeland Security says. But if you do, try to incapacitate him. “Act with physical aggression,” the agency says, and use any item you can as a weapon.

Call 911 when you’re sure it’s safe.

After the Violence

If you become a first responder to someone with a gunshot wound, the goal is hemorrhage control, says Corey Slovis, MD, a professor and chairman of emergency medicine at Vanderbilt University Medical Center.

Make a tourniquet out of anything around, he says, such as a belt or ripped clothing. ''Tie it as high on the extremity [above the wound] as possible," he says. "It's only tight enough if it hurts."

Put it over a single bone, not two, he says, because that better compresses the blood vessel to stop the bleeding.

Many doctors want more public access to tourniquets, with a goal of saving more gunshot victims, says Slovis, who's also medical director for the Metro Nashville Fire Department and Nashville International Airport.

In October, 2015, the White House launched "Stop the Bleed," a national awareness campaign and call to action. It encourages bystanders to become trained and equipped to help in a bleeding emergency before professional help arrives.

The campaign advises these steps:

  • Move the person to safety if needed.
  • Apply firm and steady pressure to the bleeding site with both hands.
  • Apply a dressing and press.
  • If bleeding continues, apply a tourniquet.

When it is safe to do so, ask if there is a place for survivors to reunite with family, Derevyanny says. If so, check in there.

Often, law enforcement officials will want to get information from anyone at the scene of the shootings so they can investigate, she says.

Show Sources

Sheldon Marks, MD, physician, Tucson, AZ, and volunteer, Tucson Police Department SWAT team.

Natalia Derevyanny, spokeswoman, Cook County, IL, Department of Homeland Security & Emergency Management.

Corey Slovis, MD, professor and chairman of emergency medicine, Vanderbilt University Medical Center; medical director, Metro Nashville Fire Department and Nashville International Airport.

U.S. Department of Homeland Security: Stop the Bleed campaign.

Mother Jones.

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