The Survival Gap

One of the strongest arguments for minimizing the time between "Stop the Killing" and "Stop the Dying" is that casualty survival is highly time-dependent. While no model can predict exact survival rates because injuries vary dramatically, we can estimate the effect of treatment delays based on trauma literature, military experience, TECC principles, and active shooter after-action reviews.

The Three Casualty Groups

Immediate Deaths (Non-Survivable)

Examples:

These victims die regardless of how quickly rescuers arrive.

Estimated: 15–30% of fatalities

Potentially Survivable Casualties

Examples:

These are the victims who benefit most from rapid intervention.

Estimated: 10–20% of fatalities are potentially preventable.

These are the lives won or lost during the transition from Stop the Killing to Stop the Dying.

Delayed Casualties

Examples:

These patients may survive for tens of minutes to hours but require evacuation and definitive care.

Estimated Survival Impact

Traditional Secure Scene Model

Historically:

Time to care:

20–60 minutes

For critically bleeding patients:

Many potentially survivable casualties die before treatment.

Rescue Task Force Model

Time to care:

8–15 minutes

Advantages:

Estimated effect:

Law Enforcement Rescue Model

Time to first intervention:

1–5 minutes

Advantages:

Estimated effect:

Limitation:

Example: 50-Victim Active Shooter

Assume:

Of the 15 critically wounded:

These are not precise predictions, but they illustrate a consistent principle:

Every minute saved in hemorrhage control and evacuation increases survival.

What Matters Most?

The largest survival benefit usually comes from:

First 3–5 Minutes

First 10 Minutes

First 30 Minutes

The Operational Reality

For most active shooter incidents, the difference between the models is not whether the shooter is stopped.

The difference is:

How many victims receive meaningful care in the first 5 minutes?

A casualty with a femoral artery injury may be dead in 3–5 minutes.

A casualty with a tension pneumothorax may be salvageable for 10–20 minutes.

A casualty with an abdominal wound may survive long enough to reach surgery.

Because of this, the greatest survival gains occur when law enforcement begins rescue operations immediately after enough force exists to prevent additional victims, while simultaneously establishing the conditions for Fire/EMS to enter and assume the "Stop the Dying" mission.

For your teaching, a useful way to frame it is:

The clock does not start when Fire/EMS enters. The clock starts when the first victim is shot. Every minute between "Stop the Killing" and "Stop the Dying" consumes survivability.

The clock does not start when Fire/EMS enters. The clock starts when the first victim is shot. Every minute between "Stop the Killing" and "Stop the Dying" consumes survivability.