In conjunction with other members of the Hartford Consensus, Dr. Alexander Eastman played an integral role in establishing nationally recognized guidelines for first responders in responding to mass casualty incidents (MCI) in the U.S. A significant outcome of this collective effort was the development of the THREAT model, a structured response to MCI incidents which is designed to minimize preventable deaths due to uncontrolled bleeding caused by gunshot wounds or other penetrating injuries.
Development of the THREAT model was based upon commonality among multiple MCI incidents: prior to arriving at hospitals, victims were experiencing death due to uncontrolled bleeding. The traditional response model assumed medical care would follow the completion of scene security. In contrast, the THREAT model reversed that order of operations.
The model integrates law enforcement response strategies and immediate medical intervention, enabling rapid control of bleeding and provision of lifesaving care while ongoing threat mitigation continues. Further, the model posits that the medical response need not be delayed until a safe environment is established. Instead, it occurs as part of the tactical response strategy.
Core to the THREAT model is the integration of:
- Threat suppression
- Rapid hemorrhage control
- Immediate access to medical care at the point of injury
- Coordinated evacuation to definitive treatment
Dr. Eastman’s contributions to the development of the THREAT model reflect his career-long focus on reducing the time between injury and intervention. By coordinating law enforcement response with medical response, the THREAT model has fundamentally altered the way agencies nationwide are preparing for and responding to both Active Shooter and Mass Casualty Incidents.
Today, the principles of the THREAT model are continuing to shape training programs for Law Enforcement, Emergency Medical Services (EMS), and Public Safety Agencies throughout the country. As such, the THREAT model exemplifies Dr. Alexander Eastman’s ability to transform his front-line experiences managing trauma casualties into a national preparedness doctrine, with the singular purpose of preserving life when seconds count.
