Wound patterns in survivors of modern firearm related civilian Mass Casualty Incidents


  • Chase Knickerbocker, MS
  • Mario F. Gomez, DO
  • Jose Lozada, MD
  • Jonathan Zadeh, MD
  • Eugene Costantini, MD
  • Ivan Puente, MD




mass casualty, shooting, trauma, civilian, Tourniquet


Background: Civilian mass shooting events (CMSE) are occurring with increased frequency. Unfortunately, our knowledge of how to respond to these events is largely based on military experience and medical examiner data. While this translational knowledge has improved our basic response to such events, it is critical that we have a better understanding of the wound patterns observed and the resources utilized in civilian mass shootings. This will allow us to better prepare our systems for future events.

Methods: Patients from two consecutive CMSEs presented to the same level 1 trauma center in Fort Lauderdale, Florida. The patients received by this center were studied for their wound patterns as well as the care they received while in the hospital. This included wound patterns and severity, subspecialty interventions, and hospitalization requirements.

Results: Both events produced a total of 19 victims who were brought to the center as trauma activations. The events had a combined fatality rate of 55 percent. Fifty-five percent of patients also had at least one wound to an extremity, two with major vascular injuries who had field tourniquets applied. Sixty-three percent required an orthopedic intervention and 32 percent required intensive care unit (ICU) admission, half of these with prolonged ventilator support.

Conclusions: Given the number of extremity wounds in these events, we should continue the efforts championed by the stop the bleed campaign. The variety and quantity of specialties involved in the care of these patients also highlights the importance of a multidisciplinary approach to preparation and implementation of care in mass shooting events.

Author Biographies

Chase Knickerbocker, MS

Resident, General Surgery, Mount Sinai Medical Center, Miami, Florida

Mario F. Gomez, DO

Associate Professor of Surgery, Herbert Wertheim School of Medicine, Florida International University; Broward Health Medical Center, Fort Lauderdale, Florida

Jose Lozada, MD

Associate Professor of Surgery, Herbert Wertheim School of Medicine, Florida International University; Broward Health Medical Center, Fort Lauderdale, Florida

Jonathan Zadeh, MD

Mount Sinai Medical Center, Resident of General Surgery, Miami, Florida

Eugene Costantini, MD

Broward Health Medical Center, Fort Lauderdale, Florida

Ivan Puente, MD

Director of Trauma Services, Broward Health Medical Center, Fort Lauderdale, Florida


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How to Cite

Knickerbocker, MS, C., M. F. Gomez, DO, J. Lozada, MD, J. Zadeh, MD, E. Costantini, MD, and I. Puente, MD. “Wound Patterns in Survivors of Modern Firearm Related Civilian Mass Casualty Incidents”. American Journal of Disaster Medicine, vol. 14, no. 3, Aug. 2019, pp. 175-80, doi:10.5055/ajdm.2019.0329.