On May 24, 2022, an armed teenager thought to be mentally disturbed entered a Texas elementary school and began shooting.  Before the threat was neutralized, 19 children and 2 adults were dead.  After a period of quiet, perhaps due to the pandemic, it appears that public venues are again at risk for mass casualty events.

In the last few years, shooting events by the disaffected, disturbed, and disgruntled have occurred on a regular basis.  Schools, churches, places of business, and other public venues have been fair game for those with bad intentions.  Armed not only with weapons but with a blueprint from previous incidents, gunmen can identify soft targets easily and are more "successful" in achieving their goal of creating mass casualties.

You might think that the "successes" achieved by active shooters occur at random.  The increase in the sheer number of casualties, however, reveal a strategy that has been refined to deadly effect.  The selection of soft targets is becoming a science and is leading to higher numbers of deaths and injuries.

Some of these events are more deliberate than others.  In the 2018 South Florida high school shooting, for example, the gunman activated the fire alarm to make sure there would be lots of targets in the hall.  To create confusion, he tossed smoke bombs (but prudently wore a gas mask).  The Texas shooter picked an elementary school so he could have many targets that couldn't defend themselves.

If the ill-intentioned are now that much better at creating mayhem, it stands to reason that our society must become better at thwarting those intentions.  Here are ways that would, in my opinion, decrease the number of shooter incidents and the deaths caused by them:

Improve security in areas at risk: I would define an "area at risk" as just about anywhere where a crowd of people would gather.  Better protection at malls or grocery stores may just be a matter of hiring more security personnel.  It's not a bad idea to train and hire workers specifically to keep an eye out for those with bad intentions.  If the money isn't there, establishing and training a volunteer safety team in places like churches, schools, or workplaces can increase the level of vigilance and identify threats early.

Although the recent attacks occurred in cities, rural areas aren't immune.  Establish volunteer safety officers in small towns where there may not be law enforcement and emergency medical personnel just around the corner.  These persons should have training in security, firearms, and first aid.  If there are volunteer fire departments, while not volunteer safety departments?

Instill a culture of situational awareness in our society: Situational awareness is a state of calm, relaxed observation of factors that might indicate a threat to safety.  Seems like common sense, doesn't it?   But in these days of smartphone distractions, many are oblivious of their surroundings.  Learning to recognize abnormal behavior can identify dangerous situations and save lives.

Identify persons of interest through their statements and actions: Some active shooter candidates are vocal about their intentions.  Look out for signs of mental illness and violent urges in those around you and don't be afraid to report them.  Fight the impulse to avoid getting involved and hoping others will act in your stead.  From a government standpoint, each municipality must set a mechanism for the authorities to apprehend, interrogate, and even hospitalize afflicted individuals.

If this suggestion means more focused surveillance than you'd like, realize how much there is already.  Watching people who publicly threaten violence more closely makes sense; so does increasing access to mental health resources to, perhaps, prevent someone from going off the rails.

Teach the Department of Homeland Security's "Run, Hide, Fight" triad in schools:  The decision-making process may be more instinctive and rapidly implemented if taught at an early age.  Make sure it's a part of every child's education

Teach the average citizen or student how to stop bleeding in emergencies: The most likely cause of death in these scenarios is hemorrhage.  Rapid action by bystanders can decrease the numbers of fatalities due to bleeding, depending on the location and extent of the injury.  Add "Reduce" hemorrhage to "Reading, 'Riting, and 'Rithmetic" as part of school curriculum. Offer it along with CPR classes. 

Provide first aid kits for bleeding in public venues: With supplies, the good Samaritan will be more likely to save a life.  In the last few years, bleeding kits have been packed into fire extinguisher wall cabinets in many public venues.  Unfortunately, in many places, there isn't even a sign that indicates these kits are available.

Let's stop being "soft" targets.  We must forsake the notion that shootings are just part and parcel of the New Normal and begin a new process; the process by which the public changes its attitude and level of vigilance, not just in isolated cases, but as a society.

The New Normal is an angry, dangerous place.  It's a recipe for disaster that's likely to get worse if we don't reverse course, but that takes fortitude and determination on the part of all parties.

You don't have to be a Department of Homeland Security official to know that there are more active shooter events on the horizon.  Watch for anomalies in behavior and always have a plan of action.  A prepared nation wouldn't be invulnerable to attacks, but its citizens would have a better chance to survive them.

Joe Alton, M.D. is the N.Y. Times bestselling author of "The Survival Medicine Handbook: The Essential Guide for when Help is Not on the Way."

Image via Pxhere.