Re: [Salon] Stop the bleed: When gunshots ring out, the first five minutes are pivotal

[Todd Pierce <todd.e.pierce@icloud.com>]

P.S. These so-called “Christmas cards, and the families holding the guns, are the epitome of the "Banality of Evil” Hannah Arendt described so well. And what we see wherever the U.S. military is killing people, and as I saw at Guantanamo, and in a West Bank Israeli so-called “Military Court,” not far from Jerusalem, with a gum-popping, video-game playing, young Israeli woman soldier, displaying the "casual brutality” epitomizing the “Banality of Evil,” wherever found. 

> On Jun 4, 2023, at 6:18 PM, Todd Pierce <todd.e.pierce@icloud.com> wrote:
> 
> Only in America! 
> 
> Consider this a PSA, as necessary for such a militarized/militaristic culture as our own, where all can follow their muse and be a “Warrior,” and murder children! With semi-automatic AR-15's, but "rapid-fire” of the sort an Individual Marine Corps Rifleman can lay down a barrage of fire with from their M-4 version of the M-16. And have far-right maniacs like Alex Jones deny it even happens!  As epitomized by our Republican members of Congress shilling for both the civilian side and the military side, of the “Military Industrial Complex” arms trade. And thereby, shilling for war, celebrating it through “symbolism” of our “National Gun:” https://govtrackinsider.com/ar-15-national-gun-act-would-declare-the-firearm-americas-national-gun-ccc6813c7254
> While making any venture outside our homes potentially life-threatening to us and our family members by becoming the victims of our “organic,” home-grown domestic terrorists. So celebrated and fetishized as “Warriors”  in these “Christmas” family photos. 
> 
> How much more evidence is necessary to see how a culture dedicated to Perpetual War, for over 30 years now, since GHW Bush celebrated that we “kicked the Vietnam Syndrome,” with our country then embarking upon the psychopathy of Perpetual War, wreaking carnage upon much of the world, would have that carnage inevitably returning to our own shores? As a form of the “Blowback” Chalmers Johnson warned us of, though he may have had more in mind the “foreign blowback” such military aggression inevitably results in. But Hannah Arendt nailed it with her recognition of the “Boomerang Effect,” of the “Chickens Coming Home to Roost:”  https://www.nybooks.com/articles/1975/06/26/home-to-roost-a-bicentennial-address/?printpage=true
> 
> BLUF: "Much more decisive, however, than these social and economic consequences is the fact that Madison Avenue tactics under the name of public relations have been permitted to invade our political life. The Pentagon Papers not only presented in detail “the picture of the world’s greatest superpower killing or seriously injuring a thousand noncombatants a week, while trying to pound a tiny backward nation into submission on an issue whose merits are hotly disputed”—a picture which in Robert McNamara’s carefully measured words was certainly “not a pretty one.” They also proved beyond doubt and in tedious repetition that this enterprise was exclusively guided by the needs of a superpower to create for itself an image which would convince the world that it was indeed “the mightiest power on earth.”
> 
> "The ultimate aim of this terribly destructive war, which Johnson let loose in 1965, was neither power nor profit, nor even anything so real as influence in Asia to serve particular tangible interests for the sake of which prestige, an appropriate image, was needed and purposefully used. For the ultimate aim, all “options” were but short-term interchangeable means, until finally, when all signs pointed to defeat, this whole outfit strained its remarkable intellectual resources on finding ways and means to avoid admitting defeat and to keep the images of the “mightiest power on earth” intact.
> "Image making as global policy is indeed something new in the huge arsenal of human follies recorded in history, but lying as such is neither new nor necessarily foolish in politics. Lies have always been regarded as justifiable in emergencies, lies that concerned specific secrets, especially in military matters, which had to be shielded against the enemy. But this was not lying on principle; it was the jealously guarded prerogative of a small number of men to meet extraordinary circumstances. Image making, the seemingly harmless lying of Madison Avenue, was permitted to proliferate throughout the ranks of all governmental services, military and civilian—the phony body counts of the “search-and-destroy” missions, the doctored after-damage reports of the air force, the constant progress reports to Washington, as in the case of Ambassador Martin up to the very moment when he boarded the helicopter to be evacuated. These lies concealed no secrets from friend or enemy; nor were they intended to. They were meant to manipulate Congress and to persuade the people of the United States.
> "Lying as a way of life is also no novelty in politics, at least not in our century. It was quite successful in countries under totalitarian rule, where the lying was guided not by an image but by an ideology. Its success as we all know was overwhelming but depended on terror, not on hidden persuasion, and its result is far from encouraging: quite apart from all other considerations, to a large extent this lying on principle is the reason that Soviet Russia is still a kind of underdeveloped and underpopulated country."
> 
> . . . 
> "In our case, not terror but persuasion enforced by pressure and the manipulation of public opinion is supposed to succeed where terror failed. Public opinion at first did not show itself to be very amenable to such attempts of the Executive; the first response to what happened was a rapidly increasing stream of articles and books about “Vietnam” and “Watergate,” many of which were eager not so much to tell us the facts as to find out and teach us the lessons we are supposed to learn from our recent past, quoting again and again the old adage that “those who do not learn the lessons of history are condemned to repeat it.” 
> That “Lying in Politics” is now of course endemic in domestic politics and “waging” foreign policy, and political campaigns, as Arthur Finklestein brought into political campaigning for “Right-wing” candidates, the very techniques of "lying” the CIA used as well-honed tactics for coups, regime change operations. These have been further developed so even less “violence” is necessary for the US to overthrow governments as we’ve escalated the sophistication of our “Battle’s for Consciousness,” in the way Israeli described what has been variously called PsyWar (Willmoore Kendall), PsyOps, Perception Management, and now, “Cognitive Warfare.” Against other countries, between rival right-wing campaigns, like between Clinton/Trump, and in 2020, Biden/Trump, and by our USG; against the American people, to “condition us" for ever-more war. As what was the “Lesson-Learned” of the Vietnam War for “Deadender” CIA and military officers, and Conservative politicians. We can’t “fight-back” against Perpetual War and its perpetrators, if we allow the real cultural “war perpetrators” to get amongst us and behind us, to “stab us in the back" once again, as what they do to us when “influencing us culturally” to engage in more unsustainable, suicidal wars, by “Heroizing” Warriors and their guns. But “we” can never learn either, so one thing I know is that the killing will go on, domestically, and in our Perpetual War overseas. Whether by proxy (now that the “lesson learned” from Iraq too is that even the American people can get “war weary”), or as predictable when we finally provoke China “over the edge,” as we finally did with Russia, by US military members. As this chapter from a book I can’t identify explain quite well, for those capable of reading beyond one of Trump’s tweets. But note, it was written in 2001, before the US went into “Total War Militarism.” But what it says about Wilhelmine Germany and pre-WW II Japan, fits the U.S. to a T. I disagree with the “organizational theory” he relies upon and disagree with making non-German, Western colonialism, more benign than it was. But he is right on point in discussion the US Air Force officers who were so enthusiastic for using nuclear bombs in a war. Though he omitted including General Goldwater who was right up there with, and as a friend of, the named officers, especially LeMay, as a war fanatic. Thanks to all of them for giving us today’s MIC, and “Radical U.S. Militarism.” Now “Coming Home to Roost!"
> 
> <4-Low-Intensity Warfare.pdf>  <The Cognitive Campaign- Strategic and Intelligence Perspectives.pdf> <Militarism-with highlighting.pdf>   <Lying in Politics: Reflections on The Pentagon Papers | Hannah Arendt | The New York Review of Books.pdf><Home to Roost: A Bicentennial Address | Hannah Arendt | The New York Review of Books.pdf><The Next War by Daniel Ellsberg.pdf>
> 
> https://www.forbes.com/sites/zacheverson/2021/12/24/congressman-thomas-massies-christmas-card-arsenal-is-probably-worth-tens-of-thousands/?sh=44ed1e33054b
> <0x0.jpeg>
> 
> And these “Happy Warriors!"
> 
> <C794CED0-5380-4BA6-839C-F208C48351AC.jpeg>
> <76CC11DC-B7C2-49FA-9A12-7ADE0DC270C9_1_105_c.jpeg>
>> 
>> 
>> https://www.sun-sentinel.com/2023/06/03/stop-the-bleed-when-gunshots-ring-out-the-first-five-minutes-are-pivotal-to-survival/
>> 
>> Stop the bleed: When gunshots ring out, the first five minutes are pivotal to survival
>> Cindy Krischer GoodmanJune 3, 2023 at 7:00 a.m.<A stop the bleed sign in the emergency room at Memorial Regional Hospital in Hollywood. (Joe Cavaretta/South Florida Sun Sentinel)>
>> A stop the bleed sign in the emergency room at Memorial Regional Hospital in Hollywood. (Joe Cavaretta/South Florida Sun Sentinel)
>> Parkland, Pulse nightclub — and now Hollywood Beach.
>> Floridians know firsthand that any public place can instantly turn into a shooting range, where multiple victims are wounded or killed. Such incidents have been escalating in the United States, which has more mass shootings than any other country.
>> Surviving a gunshot often depends on what happens in the first five minutes after a bullet enters the body and where the metal lodges.
>> The Memorial Day incident on Hollywood Beach in which nine people were shot illustrates just how much those initial minutes count.Sean Bennett had been eating at Hollywood Beach on Memorial Day when he heard multiple gunshots and saw a teenage boy drop to the ground. He approached the boy, 15-year-old Kyan Reddix, and asked if he was okay. “I’ve been shot,” Reddix replied.
>> Bennett quickly jumped into action, rolling the teenager onto his back and putting his hand over the chest wound from which blood gushed out. Reddix also had a small hole on the side of his stomach. “I shouted out to people around me for a clean towel, and when that filled up with blood, I asked for another,” Bennett said. “Even though there was a whole lot of blood, I kept the pressure on.”
>> Within minutes, a Hollywood police officer, equipped with a tourniquet, chest seal, and quick clot, arrived and worked with Bennett to control the blood loss. Hollywood Fire & Rescue eventually brought the teenager, shot four times, to Memorial Regional Hospital and after surgery, he survived.
>> The others who were shot also benefited from good Samaritans and police officers working quickly to control bleeding. They, too, survived. On Friday, all but two had been released from the hospital, including a 1-year-old boy.
>> “Everyone thinks the ER docs save the lives of gunshot victims, but that’s false,” said Dr. Peter Antevy, EMS medical director in Broward and Palm Beach counties and an emergency physician.  “It’s everything that happens before someone gets to the ER. If you have an arterial bleed and pressure is not applied before you get to the ER you are not going to make it.”
>> Gunshots more common, but survivable
>> In an average year, 2,849 people die and 5,267 are wounded by guns in Florida, according to EveryStat.org’s analysis of CDC data.
>> Nationally, more than 320 people a day are killed or wounded by a gun, the CDC’s WONDER online database shows.
>> More Americans died of gun-related injuries in 2021 than in any other year on record. That included record numbers of both gun murders and gun suicides, the CDC data shows.
>> Experts believe 2022 and 2023 will surpass those records. On May 31, the 150th day of 2023,  there have been 263 mass shootings (incidents with four or more people shot) reported in the U.S., with 327 victims killed —  the highest ever recorded this early in a year.
>> While firearm deaths and injuries already were rising in the United States, the pandemic fueled more gun ownership and more casualties.
>> Studies show that victims can survive gunshots, even those to the head, heart or torso. Most victims of fatal firearm injuries, however, die at the scene of the shooting, which is why new efforts have focused on the immediate response.
>> Memorial Regional Hospital Trauma Administrative Director Candace Pineda demonstrates a tourniquet in a stop-the-bleed kit in the emergency room at the Hollywood hospital. (Joe Cavaretta/South Florida Sun Sentinel)
>> If someone has life-threatening bleeding, all of their blood can come out of their body in three to five minutes, said Candace Pineda, trauma administrative director for Memorial Regional Hospital. “So that’s why the moment anyone recognizes that there’s bleeding, they have to take the initiative right then to get it to stop,”
>> “The only place that is a little tricky is your abdomen,” she said. “If you have an injury in your chest or your abdomen the only way we can get bleeding to stop is for somebody to go inside … If you are at the scene, just cover it and get them to the hospital as soon as possible.”
>> Over the last few years, bleeding control kits have been placed next to AED defibrillators in airports, schools, malls and other public places where there are more than 100 people.  “There’s a big push to put the kits where they need to be,” Antevy said.
>> Minutes — actually seconds — count.
>> If there isn’t a kit around, which happened at Hollywood beach, the first step is to apply direct pressure and then, with shots to the legs or arms, look for something to use to make a tourniquet high up on an extremity to cut off circulation, like a belt or rope, said James Roach, Broward Health chief of emergency medicine and Broward Sheriff Office’s EMS medical director for Fort Lauderdale and Sunrise.
>> “The bystanders and police need to do something immediately to stop bleeding,” Roach said. The next step is a quick transport. “You want the victim to be off-scene in 10 minutes and on their way to the hospital.”
>> In most cities, 911 operators have been trained to instruct callers how and where to apply pressure to a gunshot wound and how to use a bleeding control kit.  Police officers, who typically arrive before fire rescue, now come with kits that include tourniquets, chest seals, and packing gauze.
>> On Memorial Day, when 911 calls came in about the beach shooting, officers “immediately responded,”  said Deanna Bettineschi, a spokeswoman for the Hollywood police department. “They found the nine victims with gunshot wounds. They immediately rendered aid.” Bettineschi said all officers arrived with a tourniquet, chest seal, and quick clot. Videos and photos show police officers using their bleeding kits on the injured people before the arrival of EMS.
>> What happens in the golden hour
>> With a gunshot, emergency responders will take victims to a level one trauma center. Broward has three:  Memorial Regional in Hollywood, Broward General in Fort Lauderdale and North Broward Hospital in Deerfield Beach; Palm Beach County has two: Delray Medical Center and St. Mary’s Medical Center in West Palm Beach.
>> While the first five minutes are key, the first hour is important, too. The “golden hour” is the period of time immediately after a traumatic injury during which there is the highest likelihood that prompt medical and surgical treatment will prevent death. Trauma teams are well aware of the ticking clock.
>> At Memorial Regional, where the nine gunshot victims arrived on Memorial Day, a team of 20 trauma-trained medical professionals awaited in designated bays where multiple people can be treated at the same time. “As soon as we get that call, a notification goes out to the entire trauma team,” Pineda said.
>> A variety of factors influence the level of bodily damage: the caliber of the bullet, the location of the impact, the distance from which the gun was shot.  “All of that makes a difference in how much damage there is,” Roach said.
>> Hollywood Fire and Rescue now has stop-the-bleed kits in all its EMS vehicles. (Cindy Krischer Goodman/South Florida Sun Sentinel)Inside the trauma bay
>> On Memorial Day, the nine injured people included five adults, ranging in age from 25 to 65. The four wounded youth ranged in age from 1 to 17 years old. All were transported to Memorial where the trauma team — with about five minutes’ notice — awaited.
>> “The rooms were warmed, the equipment was set up for blood, for fluids, and we had equipment ready to see if they had had severe bleeding or something life-threatening,” Pineda said.
>> “Typically if someone is bleeding internally inside their body, the only way to get it to stop is to go inside their body and do surgery, so patients with gunshot wounds specifically in their chest or abdomen usually they’re only in the trauma bay three minutes and then they are taken to the OR,” Pineda said.
>> Some of Monday’s gunshot victims fell into that category: “Some patients had injuries more central to their body and therefore needed surgery,” she said. One patient was critical. The youngest patients were then transferred to Joe DiMaggio Children’s Hospital for recovery.
>> Memorial Regional Hospital surgeon Matthew Chatoor talks about gunshot treatment in the emergency room at the hospital, saying “We … make quick decisions that honestly are life-and-death decisions.” (Joe Cavaretta/South Florida Sun Sentinel)
>> Dr. Matthew Chatoor, a general surgeon and trauma specialist at Memorial Regional, said not everyone with a gunshot wound arrives by ambulance. Some arrive to the ER on their own or are dropped off by a family member or friend. Upon arrival, an assessment happens quickly. “We get to work doing our respective roles to make quick decisions that honestly are life-and-death decisions.”
>> Chathoor says the scenes on television of doctors removing a bullet and tossing it into a bowl aren’t real.
>> Often, Chathoor said, the doctors leave the bullet in.  “Unless it’s in your line of sight, you don’t go chasing for it.”
>> Shots to crucial organs typically are deadly, but anyone who arrives at the hospital with their bleeding controlled has a good chance of survival, he said, noting how important the “stop the bleed” campaign has become.
>> The doctor, who is treating some of the recovering patients, said he saw the videos on social media of bystanders and police officers applying pressure to the wounds at Hollywood Beach within minutes of the shooting,
>> “That’s exactly what they should be doing, I am sure lot of injuries were mitigated.”
>> Sun Sentinel reporter Cindy Goodman can be reached at cgoodman@sunsentinel.com or Twitter @cindykgoodman.
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