American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Leadership Comments Following Orlando

Dear Colleagues,

Last week in Florida the world witnessed an unspeakable tragedy. The horrific mass shooting in Orlando focused the world’s attention on what we, as surgeons, have long known to be the devastating impact of violence and multi-casualty events. It also shed light on the role of trauma surgeons and how bystanders can save lives by stopping patients from exsanguinating hemorrhage until emergency medical professionals arrive on the scene.

We want to share with you the American College of Surgeons' approach to reducing deaths from firearm injury and mass casualty incidents. First, we believe addressing firearm injury as a public health and trauma system issue is critical, an approach we began addressing long before the events in Florida. All Americans dearly hold freedom as a core value, as do we. Our current comprehensive approach emphasizes freedom with responsibility. For the good of our patients and our communities, we believe these efforts must be at the forefront of ACS programs and projects. Several active ACS initiatives are working in concert along three broad lines: 1) a consensus approach to reducing firearm injuries, 2) a comprehensive project aimed at teaching bleeding control principles to non-medical first responders and the public at large, and 3) advocating for robust and effective trauma systems for all Americans.

This past week, a meeting between ACS and COT leadership was held in Chicago to discuss advocating for the following three tenets from our Statement on Firearm Injuries. These are:

  1. Ensuring that health care professionals can fulfill their role in preventing firearm injuries by having the professional freedom to perform health screening, patient counseling, and referral to mental health services for those with behavioral medical conditions;
  2. Developing and promoting proactive programs directed at improving safe firearm storage and the teaching of non-violent conflict resolution for a culture that often glorifies violence; and
  3. Support for evidence-based research on firearm injury to create improved data to inform health policy.

Most of you are aware of the work accomplished by the Hartford Consensus, which has flourished under the stewardship of Regent Lenworth M. Jacobs, Jr., MD, FACS, and will be housed under the Committee on Trauma. The Hartford Consensus was born out of the Sandy Hook crisis, and the desire to educate first responders with the training they needed to provide lifesaving skills before medical professionals could arrive on the scene. Soon the College and the Hartford Consensus will launch a website known as to raise public awareness of how they can help “stop the bleeding.”

You should also know that last week, on June 14, greater public access to bleeding control training and kits gained strong support within the U.S. medical community when our ACS-sponsored resolution to enlarge the pool of trained first responders who can render assistance to victims of mass casualty events was approved by AMA House of Delegates. The resolution, which is now AMA policy, also calls for placing bleeding control kits containing tourniquets, pressure bandages, hemostatic dressings, and gloves with first responders. This policy puts forth the recommendations of the ACS-led Hartford Consensus, which advocates that “no one should die from uncontrolled bleeding.”

Our work in bleeding control and preparing trauma centers for mass casualties has not gone unnoticed. Recent news coverage of these efforts has been picked up on CBS News, USA Today, and other national media. This coverage highlights our efforts and educates viewers and readers.

The Committee on Trauma has been working on both reducing and treating firearm injuries for at least 30 years. Recently the COT has moved aggressively to set the stage for effective firearm injury prevention that can be supported by all or almost all Fellows of the ACS. This approach centers on three key principles: 1) treat firearm injury as a public health and medical problem, not a political problem; 2) identify and implement evidence-based violence prevention programs; and 3) make the COT a forum for a civil, collegial and professional dialogue centered around how to effectively develop a consensus approach to reducing firearm injury in America.

In the June 2016 issue of the Journal of Trauma and Acute Care Surgery, Drs. Ronny Stewart and Deborah Kuhls published “Firearm injury prevention: A consensus approach to reducing preventable deaths.” At the 2016 Clinical Congress, the two authors will present findings from a survey of COT membership that will show areas of consensus and disagreement as it relates to building consensus on firearm injury prevention. Preliminary results were presented to the ACS Board of Regents in June. The Committee on Trauma has also worked with the ACS Board of Governors to include a section in its annual survey of its members on firearm safety. And the COT will hold a special session at the 2016 Clinical Congress on Firearm Injury Prevention.

Lastly, the American College of Surgeons COT has led the way in developing effective regional trauma systems in America. The ACS was a key sponsor of a National Academies of Medicine’s Institute of Medicine Report: A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury. We are proud that we have been able to put this report into action through our partnership with the U.S. Department of Defense Military Health System (MHSSPACS), which is translating lessons learned on the battlefield into the civilian trauma system as well as ensuring continued readiness of our military medical corps. These efforts are also critical in developing a response to mass casualty events.

We are proud of the lifesaving work done by our colleagues in Orlando, and we believe this highlights the critical importance of regional trauma systems as the foundation for effective disaster and mass casualty response. The ACS and the ACS COT will push to make the IOM’s goal of zero preventable deaths a reality. The most effective way to reach this goal is to make certain all Americans have ready access to a robust trauma system wherever they live and work.

We trust that you agree that we are working on a number of fronts to address what has long been a significant public health crisis. As your professional society, we take this responsibility very seriously.


Valerie W. Rusch, MD, FACS
Chair, ACS Board of Regents

J. David Richardson, MD, FACS
ACS President

Lenworth M. Jacobs, Jr., MD, FACS
ACS Regent

Ronald M. Stewart, MD, FACS
Chair, ACS Committee on Trauma

David B. Hoyt, MD, FACS
ACS Executive Director