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ByLauranNeergaard The Associated Press WASHINGTON Up to 1 in 5 deaths from car crashes, gunshots or other injuries mightbepreventedwithbet- ter, quicker trauma care that doesn't depend so much on where you live, according to government advisers — ad- vice that takes on new ur- gency amid the increasing threatofmasscasualtieslike the massacre in Orlando. The Orlando shooting happened just blocks from a major trauma care hospi- tal, an accident of geography thatundoubtedlysavedlives. But Friday's call to action found swaths of the country don't have fast access to top care, and urges a national trauma system that puts the military's battlefield exper- tise to work at home. The ultimate goal: Zero preventable deaths after in- jury,andminimizingdisabil- ityamongsurvivors,saidthe National Academies of Sci- ences,EngineeringandMed- icine. It called on the White House to lead that effort. Today, there's no way to be sure "the current best trauma care is going to reach you no matter where you are," warned Dr. Donald Berwick of the Institute for HealthCare Improvement, who chaired the NAS com- mittee. "The meter is run- ning on these preventable deaths." The report found a patch- workofcare,fromdisjointed systemsoffirstrespondersto deathratesthatvarytwofold between the nation's best and worst trauma centers. Yet the biggest opportu- nity to save lives comes be- foreanyonereachesatrauma center: About half of deaths occur at the scene of the in- jury or enroute to the hospi- tal — and the military has proven that both bystanders and well-trained emergency medical services can make a big difference. "Theanswer'salwaysbeen to drive faster or fly faster. We're almost at the limit of that.Minutesreallydocount inthesecriticallyillpatients. But we can do things to stop bleeding, resuscitate better, while we're flying or driving faster,"saidpanelistDr.John Holcomb,aformerArmycol- onel now at the University of Texas Health Science Center in Houston. Trauma is the leading cause of death for Ameri- cans 45 and younger, killing nearly148,000peoplein2014 alone and costing a stagger- ing $670 billion in medical expenses and lost produc- tivity. AVAILABILITY OF CARE By Mitch Weiss and Russ Bynum The Associated Press FORT PIERCE, FLA. As early as third grade, the Florida nightclub shooter talked frequently about sex and violence and be- fore finishing high school was suspended for a to- tal of 48 days, including for fighting and hurting classmates, school records showed. In the years since, other people reported having disturbing run-ins with Omar Mateen, including a bartender who said he stalked her nearly a de- cade ago and sent so many uncomfortable Facebook messages that she blocked him on the social network. Mateen, whose attack on the Pulse nightclub left 49 people dead and 53 wounded, enrolled in Florida public schools af- ter his parents moved in 1991 from New York City to Port Saint Lucie, on Florida's Atlantic coast. Teachers "couldn't seem to help him," said Dan Al- ley, retired dean of Martin County High School. "We tried to counsel him and show him the error of his ways, but it never had the effect that we were hop- ing for." The 29-year-old son of Afghan immigrants was killed Sunday in a shoot- out with police as they moved into the club. At least some of his sus- pensions were for fight- ing that involved injuries. Others were for unspeci- fied rules violations, ac- cording to the records. For elementary and early middle school, Ma- teen attended class in neighboring St. Lucie County, where teachers said he was disruptive and struggled academically. A third-grade teacher wrote that he was "very ac- tive ... constantly moving, verbally abusive, rude, ag- gressive." The teacher de- scribed "much talk about violence & sex," with Ma- teen's "hands all over the place — on other children, in his mouth." The same teacher wrote that Mateen and another student sang the words "marijuana, marijuana" rather than the school's song, "mariposa, mari- posa." In seventh grade, school administrators moved Ma- teen to another class to "avoid conflicts with other students." That same re- port said Mateen was do- ing poorly in several sub- jects because of "many instances of behavioral problems." In a 1999 letter to Ma- teen's father, one of his middle school teachers wrote that the boy's "atti- tude and inability to show self-control in the class- room create distractions and become a main source of difficulty for him." "Unfortunately, Omar has great difficulty fo- cusing on his classwork since he often seeks the attention of his class- mates through some sort of noise, disruption or dis- traction," the letter said. Mateen attended high school and part of middle school in Martin County, spending time on three campuses in all, includ- ing one alternative facility. He withdrew from Mar- tin County High School in 2003 and eventually grad- uated from Stuart Adult Community High School with a standard diploma, records show. In 10th grade, he re- ceived a five-day suspen- sion on Sept. 13, 2001 — two days after the terror- ist attacks on the World Trade Center and Penta- gon. The records offer no details except to call it a "rule violation." But in re- cent media reports, class- mates have said it was be- cause he celebrated the at- tacks. Alley said Mateen's fa- ther, Seddique Mateen, "would not back up the school, and he would al- ways take his son's side." Mateen's father has sug- gested his son had anti- gay feelings after recently seeing two men kiss. But others have said he was a regular at the Orlando club and that he tried to pick up men there. Dina McHugh recalled Mateen taunting her about being a lesbian when they were in middle school, be- fore she was even aware of her own sexual orien- tation. Now openly gay, McHugh said Mateen's teasing more than 16 years ago stung deeply enough that she paid him back by kicking him in the crotch. In an interview Fri- day near the Port St. Lu- cie supermarket where she works, the 29-year- old McHugh said a teacher who saw the fracas took both students to the dean's office. McHugh said they were both scolded and told to leave each other alone. "He was the jerk of the class," said McHugh, who attended Southport Middle School with Mateen from 1997 until 1999. "He just got on everybody's nerves. He found a way to get un- derneath everybody's skin." After high school, Ma- teen attended Indian River Community College, graduating in 2006 with a degree in criminal justice technology. It was around that time that he met a bartender from Fort Pierce. "He was one of those guys who wouldn't leave me alone," Heather La- Salla told an Associated Press reporter Friday in an interview in the door- way of her home. She worked at a bar in Port St. Lucie at the time, and Ma- teen started coming there, mostly by himself. "He was always like a loner," LaSalla said. The tone of Mateen's Facebook messages made LaSalla uncomfortable, she said, but she never filed a criminal complaint. She ran into him again at a park in November while she was with her young son and Mateen was with his, she said. "He still had that weird vibe to him," LaSalla said, but she did not feel threat- ened as Mateen told her had a wife and talked about his son's soccer league. Asked whether she be- lieved Mateen was gay, La- Salla said she "never no- ticed." She said he never exactly propositioned her in his messages. NIGHTCLUB SHOOTING Records: Gunman talked about violence in 3rd grade PHELANM.EBENHACK—THEASSOCIATEDPRESSFILE Emergency personnel wait with stretchers at the emergency entrance to Orlando Regional Medical Center hospital for the arrival of patients from the scene of a fatal shooting at Pulse Orlando nightclub in Orlando, Fla. Study: Up to 1 in 5 trauma victims may die unnecessarily ORLANDO POLICE DEPARTMENT Omar Mateen SATURDAY, JUNE 18, 2016 REDBLUFFDAILYNEWS.COM | NEWS | 3 B