<p dir="ltr">Timely hemorrhage control is critical for preventing fatalities during active shooter incidents, particularly when interventions occur before hemorrhagic shock. Agent-Based Modeling (ABM) has been widely used to inform safety policies in such scenarios and is a well-researched domain. However, a major limitation in existing studies is the assumption that all injuries are fatal, oversimplifying the complex dynamics of injury outcomes. Real-world data paints a more nuanced picture: for example, a study of 1,226 gunshot wound patients in St. Louis emergency departments reported a 93% survival rate when victims received timely care (de Anda et al., 2018). In specific incidents, such as the 2019 Gilroy Garlic Festival shooting, rapid on-site response resulted in only 3 fatalities, while in the 2016 Orlando Pulse Nightclub shooting, studies suggest that 16 lives could have been saved with timely medical intervention (C. P. Smith et al., 2020a; E. R. Smith et al., 2018).</p><p dir="ltr">This study employed ABM to explore strategies for minimizing casualties by analyzing factors such as the spatial distribution and quantity of Hemorrhage Control Kits (HCKs), the number of trained responders, and the impact of their placement—in corridors, classrooms, or go-bags—on accessibility during lockdowns. It seeks to address the following research questions: How can survival rates in active shooter situations be improved? What impact do hemorrhage control training and the use of HCKs have on outcomes? How does the availability and distribution of medical supplies influence outcomes?</p><p dir="ltr">By incorporating models of injury progression and the stabilizing effects of timely treatment, the research revealed that increasing the number of trained responders significantly improves survival rates, with optimal results achieved when all teachers are trained in hemorrhage control. The most effective strategy combined HCKs in go-bags or on responders’ persons with well-distributed corridor stations, ensuring compatibility with lockdowns and faster response times. External responders, including tactical medics and EMTs, also benefited from these strategies due to the accessibility of medical supplies. Conversely, placing kits in individual rooms was less effective, as accessibility challenges often delayed critical interventions. This study underscores the importance of strategic planning in hemorrhage control and provides actionable insights and simulation tools to guide tailored emergency preparedness and response planning.</p>

The goal of this research was to find ways to help churches keep safe from a mass shooter. To do that, I hoped to find common ground among academics, law enforcement, peace churches, and defense churches and then leverage that common ground to find ways the groups could collaborate on church safety. I observed three churches and conducted interviews at 14 churches. I reviewed academic literature about academics and law enforcement officers. The common ground I found between all groups was fear of violence, desire to be safe, and a general belief in metaphysical forces. Other key takeaways were that outsiders cannot make accurate assumptions about religious groups based on denomination and that a religious group's response to the threat of violence might not be internally consistent or make sense to outsiders. I designed a course based on my research results and pedagogical best practices. I limited the target audience to police officers because they were the easiest to identify and contact and because their job was to counter violence. Police officers who complete the course should better understand religious worldviews, know examples of how different Christian groups view violence, know how to effectively interact with religious groups, and know how to leverage common ground between religious groups and law enforcement officers. Future efforts include producing the course, observing law enforcement officers, and creating an undergraduate course on contemporary Christianity. / Doctor of Philosophy / The goal of this research was to find ways to help churches keep safe from a mass shooter. I hoped to connect academics, police, and different Christian churches so they could collaborate on church defense. To learn about Christian churches, I attended three churches and interviewed leaders at 14 churches. I read prior research about academics and police. I found that all groups had in common the desire to stay safe from violence and a general belief in a force greater than themselves. I also learned that outsiders could not make accurate assumptions about religious groups based on denomination and that a religious group's response to the threat of violence might not be internally consistent or make sense to outsiders. To apply my results, I designed a course for police officers because they were the easiest group to identify and contact and because their job was to counter violence. Those who complete the course should learn to better understand religious worldviews, know examples of how different Christian groups view violence, know how to effectively interact with religious groups, and know how to leverage commonalities among religious groups and law enforcement officers. Future efforts include producing the course, observing law enforcement officers, and creating an undergraduate course on contemporary Christianity.

This dissertation investigates the value of deep reinforcement learning (DRL) within an agent-based model (ABM) of a large open-air venue. The intent is to reduce civilian casualties in an active shooting incident (ASI). There has been a steady increase of ASIs in the United States of America for over 20 years, and some of the most casualty-producing events have been in open spaces and open-air venues. More research should be conducted within the field to help discover policies that can mitigate the threat of a shooter in extremis. This study uses the concept of dynamic signage, controlled by a DRL policy, to guide civilians away from the threat and toward a safe exit in the modeled environment. It was found that a well-trained DRL policy can significantly reduce civilian casualties as compared to baseline scenarios. Further, the DRL policy can assist decision makers in determining how many signs to use in an environment and where to place them. Finally, research using DRL in the ASI space can yield systems and policies that will help reduce the impact of active shooters during an incident.

Sammanfattning    Introduktion: Sverige befinner sig under våren 2024 på nivå fyra av en femgradig skala avseende risken för terroristattentat i samhället, vilket är ett högt hot. Ambulans, polis och räddningstjänst är samhällsaktörer som inom ramen för sina ansvarsområden förväntas agera skyndsamt vid allvarliga händelser i samhället. Insatser som sker relaterat till terroristattacker eller pågående dödligt våld [PDV] händelser framkommer som särskilt komplexa och riskfyllda. Det övergripande syftet med litteraturöversikten är att undersöka vilka säkerhetsrelaterade utmaningar som prehospital personal identifierar gällande insatser under terrordåd och PDV-situationer. Vilka faktorer identifieras i forskningen av prehospital personal kunna påverka deras förmåga att agera i dessa situationer? Vilka framgångsfaktorer och utmaningar framkommer i vetenskaplig litteratur gällande prehospitala insatser vid terrordåd och PDV situationer?    Metod: En scoping review utfördes (översiktsstudie). Urvalet av artiklar vid en scoping review genomförs utifrån breda kriterier. Litteratursökningen till studien genomfördes genom att söka i databaserna Scopus, Web of science och Cinahl. Även snöbollsurval tillämpades i processen av att finna relevant material till studien. Både kvalitativa och kvantitativa studier inkluderades i analysen. För analys av data användes grundläggande kvalitativ innehållsanalys där tema och underkategorier identifierades.    Resultat: Totalt 28 artiklar inkluderades och analyserades. Resultatet organiserades i fyra övergripande teman. Temana som bildades var kommunikation, kompetens, ledarskap samt känslor och upplevelser. Inom varje tema bildades underkategorier. Faktorer som identifierats som viktiga för insatspersonal är god kommunikation inom och mellan organisationer. Brist på kommunikation försvårar koordinering och samverkan under insatser. Även god planering samt kompetenshöjande aktiviteter för personal är viktigt för säkerheten och för att effektiva insatser ska kunna genomföras. Ett välinformerat, erfaret och kunnigt ledarskap är betydande för insatsernas genomförande. Personalens känslor, upplevelser samt vilja till att delta under insatser orsakat av terrorism och/eller PDV-situationer varierar. Terrorhändelser som inkluderar vissa typer av hot kan skapa en ovilja hos insatspersonal att delta under dessa insatser. Exempelvis vid terrorhändelser som inkluderar hotet från CBRNE.   Slutsats: Förmågan att kunna bedöma risker, arbeta säkert och effektivt under situationer orsakat av PDV eller terrordåd förutsätter kunskap, träning och en väl fungerande organisationsstruktur på platsen för en händelse. Insatserna behöver bedrivas med en tydlig ledning samt en välfungerande koordinering inom och mellan närvarande organisationer. En fungerande koordinering bygger på att en god kommunikation existerar inom och mellan polisens, räddningstjänstens och ambulansens ledningsstruktur samt närvarande personal.

Inledning Skolattacker är ett ovanligt och komplext fenomen som ökar i det svenska samhället. Skolattacker kan ha omfattande implikationer för lokalsamhället, men även för uppfattningen om skolan som en trygg och säker plats. Flera instanser i samhället behöver vara förberedda och samverka för att förebygga och minimera risken för att en skolattack ska ske, och för att minimera skadebilden vid en skolattack. Kommuner har en särställning i det samordnande och förebyggande arbetet mot allvarliga olyckor och skador, samt för skola och utbildning i kommunal regi. Styrningen i Sverige är komplex, och omfattar flera olika lagar, förordningar, direktiv, riktlinjer och råd, varför organiseringen för att förebygga skolattacker kan variera mellan olika kommuner mot bakgrund av det kommunala självstyret. Syfte Syftet med studien är att undersöka skillnader och likheter i de policys, handlings- och åtgärdsplaner som finns för att förebygga och hantera skolattacker i ett urval av kommuner. Metod Datainsamling har skett genom att begära ut offentliga handlingar som rör pågående dödligt våld i skolor/skolattacker från ett urval av kommuner. Studien genomförs genom policyanalys genom kvalitativ innehållsanalys av kommuners handlings- och åtgärdsplaner avseende pågående dödligt våld i skolor/skolattacker. Även den information som framkommit i samband med datainsamlingen har tillförts studien. Resultat I studien framkom det att begäran om utlämnande av handling tolkades mycket olika mellan kommunerna. Det fanns organisatoriska skillnader mellan flera av kommunerna om vem som besvarade frågeställningen, samt vilken roll som ansvarade för upprättandet och uppdaterandet av handlings- och åtgärdsplaner. Både utformning och innehåll i handlings- och åtgärdsplanerna varierade mellan kommunerna. Trots detta fanns det indikationer på att det föreligger ett intresse att arbeta förebyggande mot skolattacker, med särskild tonvikt på en pågående skolattack och det efterföljande arbetet. Samtliga kommuner har åtminstone delvis anpassning till Skolverkets riktlinjer, medan enskilda kommuner även inkorporerade information kopplad till tidigare (huvudsakligen amerikansk) forskning.  Slutsatser Det finns stora skillnader i såväl organisation, ansvarsfördelning och upprättande av handlingsplaner, men samtliga kommuner har inkorporerat viss styrning. Samtliga kommuner hade någon typ av arbete avseende våld i skolan, men inte alla hade enskilda dokument eller delar av dokument tillägnat specifikt fenomenet skolattacker. / Introduction School attacks are a rare and complex phenomena, the occurrence of which is increasing in Sweden. School attacks may have extensive implications for the local community, but also for the perception of school as a safe and secure place. Cooperation between many organisations is necessary to prevent and prepare for a school attack, as well as minimise the effects during and after one occurs. Municipalities have a special role in the coordination and preventative work regarding serious accidents and injuries, along with the responisbility for school and education in the municipality. The governance of Sweden is complex, and encompasses many laws, regulations, directives, guidelines and advice. Due to the municipal self-governance, the organisation surrounding the prevention of school attacks may vary between differing municipalities. Purpose The purpose of the study is to examine the similarities and differences in the policies and action plans that exist to prevent and handle school attacks in a sample of municipalities.  Method Data has been collected through requesting public documents regarding ongoing deadly violence in schools (school attacks) from a sample of municipalities. Policy analysis was performed through use of qualitative content analysis of said documents. The information revealed during the data gathering has also been added to the study.  Result This study shows that the request of documentation was treated very differently by the municipalities. There were organisational differences between the municipalities regarding who answered the request, as well as the title and role of the person responsible for the creation and upkeep of the action plans. Both the design and the contents of the action plans varied between the municipalities. Despite this, there were indications of an interest to work preventative against school attacks, with special attention on the ongoing act and the events following an attack. All municipalities have at least partially conformed to the guidelines of Skolverket, though some municipalities also used previous research, most of which was American.  Conclusions All municipalities had some type of governance and action plan regarding violence in schools, though not all had specified school attacks as a phenomena. At the same time, there were large differences in how the action plans were created, who was responsible for the creation and maintenance thereof, as well as the organisations behind them.

<p>This dissertation examines the impact of active shooters upon patrons attending large outdoor events. There has been a spike in shooters targeting densely populated spaces in recent years, to include open-air venues. The 2019 Gilroy Garlic Festival was selected for modeling replication using AnyLogic software to test various experiments designed to reduce casualties in the event of an active shooter situation. Through achievement of validation to produce identical outcomes of the real-world Gilroy Garlic Festival shooting, the researcher established a reliable foundational model for experimental purposes. This active shooter research project identifies the need for rapid response efforts to neutralize the shooter(s) as quickly as possible to minimize casualties. Key findings include the importance of armed officers patrolling event grounds to reduce response time, the need for adequate exits during emergency evacuations, incorporation of modern technology to identify the shooter’s location, and applicability of a 1:548 police to patron ratio.</p>