The emergency response in Tucson: Timeline shows ambulance delays

[mikeinet 37]

Have not seen this posted on here yet...Curious what everyone thinks of this article.

http://openchannel.msnbc.msn.com/_news/2011/01/15/5843330-the-emergency-response-in-tucson-timeline-shows-ambulance-delays

I think MSNBC does a decent job showing that there wasn't a delay in a single point, but a series of legitimate delays that often put the blame on "EMS being slow" (IE: Scene Safety, MCI not being officially declared, etc.)

Thoughts?

[Goose 188]

EMS: the preverbal whipping boy

[NJMedic 96]

I read this once and realized I would have to sit down again and really pay attention. Somewhere there has to be a happy medium between securing the scene and SECURING THE SCENE. No one from the public is going to be able to rationalize why emergency responders (EMS and Fire) are going to stage away from the scene. Hindsight being 20/20 the scene was secured before the first 9-1-1 call was placed with the civilians tackled the nut job and secured the weapon. I've never heard EMS crews held back with Law enforcement searched for a second gunman.

I don't know the point of the article. Was anyone complaining about an ambulance delay? The article seems to discount any allegations about scene mismangement. I suspect if this happened in my area our Comm Center would have heard the police radio traffic indicated multiple victims and would have begun sending additional resources. Clue in the responders it sounded like an MCI.

Seems like a lot to do about nothing. Although there seemed to be enough ambulance plus the helicopters used when the trauma center apparently was only 10-15 minutes ground time away.

[Danger 160]

I find it interesting that all these government figures were appearing in public and no police agency was on hand. Around here we have cops standing at the mall and Wal Mart.

[ladder55 26]

I thought the same thing danger.

[antiquefirelt 994]

Interesting issues of risk-benefit analysis. Often PD wants/needs to secure the scene, but at what cost? Also, EMS preaches scene safety to the point of assume nearly no risk. At what point do the victims who are still endangered by a supposed second shooter become less valuable than incoming rescuers who could mean the difference between life and death? This is by no means a slam to LE in Tuscon or anywhere, but a question that sums up a few recent years worth of mass shooting where scene safety may have compromised lives. Are we doing the best we can? Should we assume greater levels of risk? Is there a need for more EMS units to be trained an integrated into initial shooting scenes?

[helicopper 1,050]

I find it interesting that all these government figures were appearing in public and no police agency was on hand. Around here we have cops standing at the mall and Wal Mart.

The overwhelming majority of elected officials - excluding obviously the President and VP - have no regularly assigned, full-time security details. While this may seem counter-intuitive, prior to last week it had not posed a major problem.

[Danger 160]

The overwhelming majority of elected officials - excluding obviously the President and VP - have no regularly assigned, full-time security details. While this may seem counter-intuitive, prior to last week it had not posed a major problem.

I can understand not having full time details, and I can even understand the logic on not having any police presence there. But it makes sense to have a car there, especially when we have two guys posted at the movie theater every weekend.

[INIT915 1,119]

Having been involved in a number of high-profile and/or MCI incidents from both the EMS and LE perspectives, this time-line doesn't seem troublesome at all.

The one interesting quote that did stick out for me was:

Battalian Chief Spalla said he was responsible as the scene commander for calling for an upgrade, which doubled the number of crews responding, and he is always cautious about taking this step. If too many units are sent to a minor incident, that puts them out of position if genuine calls come in.

"We might show up and there's nothing. Stories often change from the first 911 caller to the second, from the time we get on the scene, from the ambulance crews to the ER doctors. We sent a higher level of response from the beginning, more than we would send for chest pains, and until I get units on the scene, until I get eyeballs on bodies, I don't upgrade again."

It is not common practice with multiple callers all indicating multiple GSW victims that maybe the information was credible enough to start out additional resources before actually getting boots on the ground? Seems like something I would be okay with if the sheer numbers were being relayed to me while I was responding.

[v85 212]

I really don't know what the solution is, to the whole scene safety issue, maybe have at least some PD members with EMS training so they can start treatment in the hot zone. Kind of like an extended Tactical EMS program?

Edited January 18, 2011 by v85

[Guest alsfirefighter]

As a tactical EMS provider I think it needs to be the opposite. You can train anyone to do anything but one of the things that expanded the tac team I'm part of is the thought that the first penetrating trauma victim someone should treat shouldn't be one of their own. Yet again the wheel doesn't need to be re invented. Look at what Littleton, CO did after the Columbine incident. They were and may still be the largest tactical EMS team in the U.S. The other thing about having tactical EMS is that it allows the guns to remain a gun and reduces role confusion. In many places outside of liberal, attorney on every corner so we're fearful of lawsuits downstate NY many tactical medics are made peace officers so they can carry a handgun for self/patient protection as a last resort. But either way it is proven to make some differences and that is why your seeing more brought in. It took some time for some on my team, but we train hard right with them and train each other and I'm comfortable and trust them as well as they do I.

[ny10570 745]

Danger, look at precedent. These events happen all over the country and were usually without incident. Some movie theaters can't go a Friday night without a police response.

I've been involved in many multiple shootings. None as large as this, but unless they are trying to cover multiple locations its usually just ALS, BLS, and a boss for multiple callers. Once PD or EMS arrives and starts giving patient totals the flood gates open up. Callers are unreliable. Whether it 3 or 13 people shot the caller will be excited and generally use vague terms.

I'm spoiled in NYC when it comes to scene safety. Every time I was on scene during the shooting either the fight came to us or we just had bad info and didn't know what we were getting into. Otherwise if its a shooting I know an army of cops are on the way and will likely be on scene well before me. Staging away isn't practiced unless its a standoff type situation. I don't believe we should be waiting for a completely secured scene. Once the officers on scene are comfortable with my presence I'm in there. That has meant scoop and runs from an angry crowd and immobilizing while officers were charging past with guns drawn. Neither of these were the state definition of scene safety but were the best compromise for the patient at that time.

[mikeinet 37]

I don't believe we should be waiting for a completely secured scene. Once the officers on scene are comfortable with my presence I'm in there.

Why do you feel that way? What if the officers are still working to secure the scene, recover weapons, etc.?

[helicopper 1,050]

Why do you feel that way? What if the officers are still working to secure the scene, recover weapons, etc.?

Herein lies one of the problems - define "still working to secure the scene"? Does that mean the cops are searching a building and your victim is outside or vice versa? What if the victim is in front of 123 Main Street and the cops are searching 139 Main Street? Is that scene secure? What if there is a crowd gathered - do you respond or not? Odds are the crowd won't go away until the victim is removed so it's a catch-22.

As for recovering weapons, if a weapon is on the ground it isn't a threat to anyone and if PD is there, I'd say that scene is pretty safe.

We will probably never come to a consensus on this and it is a thorny issue for sure. Every agency needs to develop training and standard procedures for this and interact regularly with law enforcement so we are on common terms with what we all expect, how we communicate, how we'll protect our EMS asse(t)s while operating at a critical incident etc.

The mantra "scene safety" is great but it really doesn't do it or the process justice.

[Goose 188]

As a tactical EMS provider I think it needs to be the opposite. You can train anyone to do anything but one of the things that expanded the tac team I'm part of is the thought that the first penetrating trauma victim someone should treat shouldn't be one of their own. Yet again the wheel doesn't need to be re invented. Look at what Littleton, CO did after the Columbine incident. They were and may still be the largest tactical EMS team in the U.S. The other thing about having tactical EMS is that it allows the guns to remain a gun and reduces role confusion. In many places outside of liberal, attorney on every corner so we're fearful of lawsuits downstate NY many tactical medics are made peace officers so they can carry a handgun for self/patient protection as a last resort. But either way it is proven to make some differences and that is why your seeing more brought in. It took some time for some on my team, but we train hard right with them and train each other and I'm comfortable and trust them as well as they do I.

I think this offers some good insight. But, like you mentioned, some of the more progressive thinking will never find traction in new york.

On a law enforcement perspective, maybe there could have been a way to preliminarily secure the area where the victims were in an effort to give EMS access and a means of egress. Not sure if this was possible.

As far as antiquefirelt's comments, i will offer this:

My biggest concern is that i am neither trained or equipped to enter an ongoing, hostile scene - in terms of multiple or unaccounted for shooters. I don't own or have been issued a bullet proof vest and i don't carry any offensive weapons to protect myself or my patients. If we end up becoming casualties, it does no one any good. There is enough liability and danger in being a paramedic, i don't need to assume more by putting myself and others into situations i'm not properly equipped or trained for.

That said, maybe DPS should offer a class to FD and EMS on just this sort of thing. I know i would definitely attend.

Edited January 18, 2011 by Goose

[antiquefirelt 994]

As far as antiquefirelt's comments, i will offer this:

My biggest concern is that i am neither trained or equipped to enter an ongoing, hostile scene - in terms of multiple or unaccounted for shooters. I don't own or have been issued a bullet proof vest and i don't carry any offensive weapons to protect myself or my patients. If we end up becoming casualties, it does no one any good. There is enough liability and danger in being a paramedic, i don't need to assume more by putting myself and others into situations i'm not properly equipped or trained for.

While I agree that we should have more integrated training, I find the prevailing sentiments in EMS to be much like yours, which typically differs from many firefighters who assume higher risk as part of saving life. While firefighters are specifically trained in the job (lots aren't well trained), no PPE or training eliminates all risk. Therefore I wonder how much risk can we take to ensure rapid care to GSW victims in such situations.

[Goose 188]

While I agree that we should have more integrated training, I find the prevailing sentiments in EMS to be much like yours, which typically differs from many firefighters who assume higher risk as part of saving life. While firefighters are specifically trained in the job (lots aren't well trained), no PPE or training eliminates all risk. Therefore I wonder how much risk can we take to ensure rapid care to GSW victims in such situations.

While i understand what you're saying and agree more frank training/discussion is warranted, i have to say that i very respectfully feel that you're evaluation is unfair. I don't want to derail the discussion, so i will leave it at that. If i get some time, i'll send you a PM an elaborate further.

[ny10570 745]

Helicopter, there's an easy consensus. I'm right.

Seriously though, you nailed it. Every time this comes up the conversation goes right into tactical training for EMS. In a system the size of NYC with the number of shootings you'd have to train everyone to be tac medics or have units standing buy just in case. Neither is practical. Awareness training in how PD operates and what they would expect with similar training for PD on EMS operations would go a long way towards clarifying what is a safe scene. As of now we get a short lecture on evidence preservation and that's it. Everything else is learned as you go.