Modeling hemorrhage control in the context of agent-based active shooter simulations

Computer simulation modeling provides significant value in enhancing emergency preparedness policies for schools, businesses, and outdoor events. This is especially true for complex and unpredictable events like active shooter scenarios, which are difficult to physically replicate due to their diversity in terms of circumstances, venues, and challenges. Active shooter events can occur under various circumstances and take place in a wide range of venues including schools, offices, and outdoor events and create a wide range of unique challenges. According to a 2017 study, 15 percent of human-caused mass casualty incidents with over 10 fatalities are mass shootings. Therefore, our work focused on adding injury type, blood loss related to the function of placement of gunshot wounds, and time lapse from injury. These additional parameters significantly improve active shooter event simulation and changes the paradigm established by currently available simulations where the victims are either "killed" or "unaffected." This traditional binary approach is unsuitable when the timeliness of interventions is of concern and does not help improve emergency preparedness and emergency response protocols. In a previous work, the authors demonstrated how simulating physiological decline can be quantified, improve realism, and lead to response protocol improvement. The current work proposes a model for simulated mitigation of gunshot wound injuries, which complements the previously presented exsanguination model. To simulate injury and blood loss mitigation, a number of data sources were consulted to quantify the blood outflow and how it can be limited by different measures, as well as the time required to apply them and their individual effectiveness. This work summarizes the findings and provides a practical guide for implementation. In an additional work, the authors provide a reference implementation in a software library for AnyLogic®. That research focused on the simulation of the initial injury, its mitigation, and the time for critical care transport during the proverbial golden hour of trauma. The human body is complex; the circulatory system alone has several compensatory mechanisms and a wide range of variability in every organism. In addition, the way it responds to coagulating agents and other blood loss control techniques may vary between different organisms and humans. In this work, the authors focus on the primary effectors of those variables and introduce a limited set of mitigations for a relatively short-term simulation. While the model is imperfect, it creates a common ground for further simulation work where different researchers can converge on a known unified deterministic model, allowing them to control that variable while testing hypotheses about other parts of the emergency response. Furthermore, by increasing fidelity, this model can help assess the effects of bystander volunteer hemorrhage control, medical first response, and critical care transport times.