Effecting Your Survival in a Mass Killing

Madmen exist. There is literally nothing that can be done to change this. 
After events like the mass murder in Las Vegas, many of us feel powerless, without control, and want to “do something” about such events in the future. These feelings can spin out of control, an emotional spiral that leads us away from actions that could really help us. Change that, look to yourself, your family, your tribe of friends: Here you can affect things. 
The nature of the beast that is violence is that no one is coming for you, in the moments you need them the most. You are on your own, and must be responsible for yourself. Take this to heart, and think about what you would do, caught in a situation like the Las Vegas shooting.
There is little room in such situations for paralysis or doubt, or for romantic notions of heroics. Getting to cover, finding an escape route out of the area, and rendering first aid once safe from gunfire are the absolute best anyone could do to survive that kind of violence. So, ask yourself questions about how you could accomplish those things. 
Can you: Identify escape routes before anything happens; Tell the difference between cover and concealment (one stops bullets, the other merely hides you); Manage traumatic wounds?
Do you: Have an established plan with your family/friends for emergencies; Regularly practice exercises such as “If we had to get out of here right now, where are the exits” with those friends/family; Plan rendevous points, that aren’t the main entrance, in case you’re separated at a large event; Carry any kind of first aid kit?
At a fundamental level, for those on the scene of a violent event, the most life saving measures are to get behind cover and then away, and to be able to provide aid for anyone injured once you’re safe to do so.

Let’s zoom in on two particulars from the above, medical concerns:
There are other tools (flashlight, tools for opening or securing doors, etc.) that can be taken most places and are useful in these events, but they pale in importance to having medical skills and the right tools to manage life-threatening trauma.

One form of “Blow-Out Kit”, containing tools for controlling massive bleeding and dressing wounds. Such kits can be much smaller, for the pocket or purse.

Pictured above is a trauma specific first aid kit, called by some a “blow-out kit”. These can be larger, but they can also be small enough to fit in a pocket, purse, or jacket. The minimum contents are a tourniquet, vacuum packed gauze (with or without blood clotting agent impregnated), a pressure bandage or wrap, and gloves. Very sticky tape, think duct or gorilla not medical tape, should also be included. Occlusive dressings called “chest seals”, for sealing torso injuries, are also valuable but can be made from plastic packaging and tape if necessary.
In brief: Massive hemorrhage (bleeding) must be stopped. The chest must be sealed to maintain proper flow of air into and out of the lungs. To do this, the tourniquet constricts limbs, while the gauze is for packing into wounds in the limbs or junctions between limbs and body (armpit, groin, hip) to control bleeding. The bandage is to hold the gauze in place, chest seals close chest wounds to prevent outside air entering between the chest wall and lungs, the tape secures such interventions in place, and the gloves protect you from potential infection.
These are the tools necessary to manage most gunshot injury (or stabbing or shrapnel injury) that’s not immediately fatal. You can have them with you anywhere. None of these things are hard to use, just the opposite. Learning the basics of their use can take as little as 4 hours of your time. The value of having them and the knowledge to use them, when needed, is truly priceless. Your life, a loved ones life, a child’s life, could be saved with these items.
These skills and tools are useful beyond situations of violence, too. Not two months ago, on the side of the highway, I saved a life with the same type of tourniquet pictured here.

If you want to know more, want to learn these skills, there are currently a wealth of learning opportunities for the private citizen.
The best training is hands on, but you can begin right now by reading, and familiarizing yourself with the tools and methods of managing this kind of trauma. A great introductory article from Active Response Training called Field Medicine for Terrorist Attacks can get you started (Active Response Training also provides excellent hands on classes in medical skills, and self defense). Additionally, Stop The Bleed, an initiative from the American College of Surgeons and Hartford Consensus, maintains a resource filled website specifically on controlling life-threatening bleeding. 
There are companies which provide first aid classes specifically for violent trauma. Lone Star Medics out of Texas, and Dark Angel Medical out of Colorado, both provide excellent courses in trauma first aid, and are hosted across the US. 
In New Mexico and the SouthWestern US, you are welcome to contact my own company specializing in this type of training, BFE Labs.
In Canada, CTOMS provides civilian courses of this nature, as well as an online class aimed at law enforcement but with open enrollment that is available in the US, Canada, and Australia.
The Stop the Bleed initiative teaches bleeding control classes across the US, and has a class locator on their website. 
There are many other classes across the US and internationally, that can be located via a Google search. Suggested terms would be “civilian trauma class”, “trauma first aid class”, and the like. Look for instructors with current or recent background in EMS, emergency room care, military medicine, expedition medicine, and/or conflict medicine.

General first aid training, which now includes tourniquet training, is available from the American Red Cross widely across the United States.
Classes in Wilderness and Remote first aid can also provide good skills for managing trauma, relevant to events of violence where it may take a long time for first responders to reach victims. This type of class is fairly common, found at community colleges and small teaching institutions across the US. Sterling examples are available from Remote Medical International, National Outdoor Leadership Schools, and Wilderness Medical Associates.

Notes on Specific Tools:
The best commercial tourniquets, the only two approved for use by the US military, are the CAT Tourniquet available from North American Rescue, and the SOFT-Tourniquet from Tactical Medical Solutions. The official Red Cross tourniquet is the SOFT-Tourniquet. These tourniquets are available from many retailers, but use caution when purchasing: Counterfeit tourniquets, intended for reenactors and cosplay, have infiltrated the market. You will be paying around $30USD for a real CAT or SOFT-Tourniquet. When in doubt, purchase from either North American Rescue or Tactical Medical Solutions directly. These companies also make pressure bandages, compact packages of gauze, and other trauma first aid essentials.

A bandage to take particular note of is the Mini-Compression Bandage, from H&H Medical, who also make compact packages of gauze (3+ yards, vacuum packed smaller than a deck of cards). For those looking at having medical gear in a pocket, purse, daypack, or diaper bag, these items are invaluable for their size.

Gauze with blood clotting agent impregnated into it, called “hemostatic gauze”, is made by QuikClot (Combat Gauze), and Celox. These hemostatic gauzes are available from many retailers, easily found online.

Nitrile (latex free) gloves are available almost anywhere, from CVS to your doctors office (just ask for a couple pairs next time you’re there).

The tools are important, but the training is vital. Get into, at least, a Red Cross first aid class, if not something more specific, and update that training every couple of years.

Morgan Atwood is a medical and wilderness educator in New Mexico. He has been an EMT episodically since 2004, and taught gunshot trauma and survival medicine classes since 2009.