DAYTON, Ohio (AP) - When the blasting guns fell silent, the cries and groans of the wounded rose.

As soon as six police officers hailed as heroes killed the gunman to end an attack that claimed nine lives in Dayton, police began working to save lives.

Dayton officers, who in 2017 began carrying tourniquets on their belts, first tried to stop the bleeding and quickly assessed which of the wounded they needed to get immediately to hospitals.

Their action was the latest example of how police have taken on a bigger medical role in mass shootings, among the many adjustments in tactics, weapons, equipment and training U.S. law enforcement agencies have made by studying the response of fellow law enforcement agencies after mass shootings.

“Stop the killing - and after the killing has been stopped, that’s when the stop the dying starts,” said Pete Blair, executive director of Advanced Law Enforcement Rapid Response Training , based at Texas State University.

Within minutes in Dayton, the first victims arrived at the Miami Valley Hospital emergency room in police patrol cars. Four shooting victims were hospitalized there, one in critical condition.

All survived, as have all the more than 20 other wounded people taken to Dayton hospitals after the shooting early Aug. 4 in the city’s Oregon entertainment district.

Emergency room staffers at Miami Valley commented on how effectively police used tourniquets to stop bleeding, said Dr. Randy Marriott, an E.R. physician there and the medical director for the Dayton Fire Department.

“To what extent that helped the outcome, we don’t know, but it’s another testament to how hard we’ve trained in this area and that our law enforcement officers know how to stop bleeding,” Marriott said.

There was a large-scale training exercise late last year involving hospitals, police and fire departments that helped police practice first aid in a mass casualty scenario, Marriott said.

Just as many police across the country now carry the lifesaving opioid overdose-reversal drug naloxone, many now carry first-aid kits for gunshot victims.

The few minutes before ambulances arrive are crucial for someone bleeding from gunshots, said Dr. Dustin Calhoun, a University of Cincinnati Medical Center emergency room physician and medical director for the Cincinnati Fire Department.

“It can be life and death,” Calhoun said. “Bleeding can kill a patient in as fast as 3 minutes.”

Whitney Austin, shot 12 times in the Fifth Third Bank building attack in 2018 in downtown Cincinnati, has no doubt that officers’ first aid saved her.

Right after police fatally shot the gunman who killed three people, officers pulled her out of the revolving door where she fell, and Sgt. Kara Graves applied a tourniquet on her left arm.

By then, Austin’s cream-colored shirt was drenched in crimson. She would need blood transfusions at UC Medical.

“Quickly applying a tourniquet and stopping the blood flow from my left arm was critical to my survival,” Austin said.

Cincinnati police last year got department-wide training through the UC Health system’s Stop the Bleed program, which also offers free training to schools, businesses and other groups.

A Cincinnati officer this month used his training to help save an armed man he had just shot in the chest.

Blair expects some 1,000 police, fire and medical professionals to take part in active-shooter training seminars at a conference beginning Sunday in Aurora, Colorado, site of a 2012 movie theater shooting that killed 12 people and wounded 70 more.

Study of the response made it apparent that police, who usually get to the wounded first, need to get started as soon as possible transporting the most badly hurt.

Orange County, Florida, Sheriff John Mina, who was Orlando police chief during the 2016 Pulse nightclub shooting massacre, which killed 49 people and wounded dozens, said his officers knew they couldn’t wait for enough ambulances to move all the wounded.

Police packed injured people into the back of an unmarked police pickup and made roundtrips to a nearby hospital. All of the injured survived.

“We put so many people in it, it damaged the tailgate,” Mina said. “It ended up saving their lives.”

Dayton Police Maj. Chris Malson, a veteran SWAT commander and police academy training leader, said Dayton officers had visited other departments and attended national conferences for debriefs on responses to mass shooting that they then used to train for “if it were to happen here in Dayton. … Unfortunately, it did happen.”

Now he and officials are preparing an analysis of their Aug. 4 response “to see what changes and improvements can be made.”

And to share with other departments.

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Follow Dan Sewell at https://www.twitter.com/dansewell

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