Response protocol for active shooter type incidents?

[JJB531 652]

A lot of great points and posts have been made in this thread already, so I'm going to try not to repeat anything that's been said already. With that, just a couple of points and a few things to think about:

1) In regards to liability and EMS providers operating within the inner perimeter of an active shooter incident; There are a great number of things that need to take place first before EMS providers should even think about taking on such a responsibility. Proper training, continuous on-going training with members of local Law Enforcement, proper equipment, especially personal protective equipment (i.e. ballistic vests), and written standards/response protocols need to all be in place. It's not as easy as taking a TEMS class, throwing on a fancy uniform and saying you're now a TEMS Operator, and think you're going to save the day when the bell rings.

2) Death benefits. What death benefits are provided to EMS providers should they be killed and/or seriously injured operating in the inner perimeter of one of these incidents? Police Officers either retain their pensions if injured or their designated beneficiaries will retain their pension benefits should they be killed; Officers with resultant permanent disabilities will receive 3/4 disability pay; Police Foundations and Unions provide financial support for LEO's and their families. As an EMS provider, if you take a more aggressive role and operate within the inner perimeter and are seriously injured and/or killed, you need to ask yourself what benefits you and your family will be entitled to if you are either no longer able to work or you are killed and leave your family behind without any guaranteed financial support. You can call it a greedy way of thinking, but it's a reality. Obviously anything can happen to any of us at any time, but this is a calculated risk that we do have some control over. If you are knowingly going to take that chance should something happen to you, you and your family may not be guaranteed any financial death/disability benefits depending on where you work/volunteer.

3) As others have pointed out already, to respond to one of these incidents as an EMS provider who plans on operating within the inner perimeter with law enforcement, it takes a lot more then reading an article about it or sitting in a 4 hour class and thinking you're good to go. Taking a Tactical EMS or Active Shooter course is a great start, but unless you have the cooperation of your local law enforcement agency and undergo constant training with them on a very continual basis, your plans of being the EMS hero that day will quickly dissolve, possibly with deadly results. Joint training between agencies can make or break your response to one of these incidents because every one needs to be on the same page and everyone needs to know what each others responsibilities are at one of these incidents.

4) Pre-planning. Both through individual and joint training, as well as response plans that detail building schematics, staging areas, landing zones, etc. Although these are dynamic, rapidly changing incidents, a well designed written pre-plan will aide responding units with their responsibilities and operations, and should be adjusted as the situation unfolds.

5) Law Enforcement's priority is not treating/evacuating the injured. Their priority is to end the threat, either by apprehending the shooter or neutralizing the shooter through the use of deadly physical force. Their primary role could take 5 minutes, it could take 5 hours. How long after the onset of a traumatic injury can a casualty exsanguinate? We all know it can happy pretty damn quick if untreated. That being said, EMS does play a key role in response to these incidents, and the professional recommendations of the US Fire Administration and the National Tactical Officers Association officially recognizes Tactical EMS and Tactical EMS Operators as a necessity during tactical law enforcement operations, and during Active Shooter incidents. There are still a lot of roadblocks, especially here in the Northeast, preventing EMS from having more of a recognized role during Tactical Law Enforcement operations.

6) When coordinating with local Law Enforcement, EMS agencies need to decide if they are going to operate as "business as usual" and stage in a cold zone and wait for Law Enforcement to extract victims to their staging area; or if they are going to operate in a warm zone inside the location in a casualty collection point with Law Enforcement providing overwatch and security where they can start triaging and providing immediate life-saving treatment to casualties; or if they are going to operate in the hot zone, once again with Law Enforcement providing security, but the EMS provider is moving through the location with the team and treating the seriously wounded as they come across them. The decision on how EMS will operate at these incidents is not solely up to EMS; it has to be a joint decision between EMS administrators and Law Enforcement administrators. You can't have EMS providers going cowboy inside the school doing their own thing without consulting with and coordinating with Law Enforcement. If you plan on having EMS operating within a warm or hot zone, they need to be properly trained, continually trained, and properly equipped to effectively operate as such.

7) Treatment priorities shift from conventional A-B-C treatment protocols to the C-A-B design of Tactical Combat Casualty Care protocols, where uncontrolled hemorrhage is a treatment priority, followed closely by recognition and treatment of tension pneumothorax. Effective and proper triage is a necessity as in any Mass Casualty Incident.

8) We can stress scene safety in our EMT classes. We can stress that our safety comes first. We can say that EMS should never be intentionally put in harms way. The fact is that when the bell does ring, and the incident is rapidly evolving, sometimes we find ourselves in places we shouldn't be or doing things that we probably shouldn't be doing because human nature takes over, and we simply start doing anything and everything we can to provide aide and medical care to the injured. On April 20th, 1999, I can guarantee you that the crews of Littleton Fire Department didn't think that by noon they were going to be performing civilian rescues under effective gunfire. I can guarantee you that they weren't trained to perform such rescues. I can guarantee you that they weren't properly equipped to effect such rescues. Despite all that, the EMS crews were tasked with performing these rescues while under effective gunfire from the library windows. My point is that regardless what we say about liability, safety, and what the role of EMS should be at the incidents, the fact is that EMS is going to be in the mix in one way or another, so we should take the initiative to be properly trained, equipped, and prepared to operate at these incidents. Prior to Columbine, Littleton had 1 Tactically trained Paramedic... by the end of the year they had 30 trained and equipped tactical medical providers. Typical line of thinking in EMS (and emergency services altogether), it can't happen here and when it does, and only when it does, will we do something to be prepared for the next time.

[helicopper 1,050]

Your opinion is likely spot on in those areas where ESU or tactical personnel are not more than 30 minutes away. But in large portions of this country tactical ops are generally barricaded subjects as the time to assemble is far too long. In an active shooter situation where there's a large population exposed (such as a school or office building)by the time can be too great. This reportedly was a factor int he deaths of one or more victims at Columbine. It has nothing to do with "being benched" or feeling insulted, it has to do with taking calculated risks where the reward is great. Again, none of this should take place without an actual pre-plan worked out between all those involved to understad the responsibilities, roles and liabilities.

Your statement about liability, for lack of a better term as I mean no disrespect, is typical of much of the law enforcement community who when faced with a task, scenario or situation puts their liability questions in the priority one slot. It's not the fault of the individuals, yet a our culture who has put so much fear or legal reprisal that many key decision are based on liability. As those commanders in Iraq and Afghanistan who suffered under conditions that lawyers had to be consulted before making some key decisions.

ALL law enforcement personnel should be trained in active shooter countermeasures. It shouldn't be a SWAT or ESU response unless they're immediately available but this thread isn't about law enforcement tactics and operations.

Liability issues can and should be discussed during the planning stages so they can be engineered out of the responses with training, equipment, and procedures. Liability is a reality in the emergency services but the risks are managed on a daily basis so liability is reduced.

[JJB531 652]

Take a look at this, regarding SWAT teams and Tac Medics

Columbine Timeline:

1110: Suspects arrive on campus

1119-1124: First 911 call for "sound of explosion" Shooting begins shortly after

1124: First School Resource Officer arrives on scene and engages suspects unsuccessfully (Does NOT pursue suspects into the building)

1133: Jefferson County SWAT Commander orders paging out of SWAT and Command Post

1149: Denver Metro SWAT Arrives on Scene

1206: SWAT makes entry behind cover of firetruck, begins evacuating patients while conducting search

1208: Suspects commit suicide

The suspects had already done the most damage before SWAT was even on scene. Hell, they killed themselves 2 minutes after the team entered. Some victims didn't get evacuated by SWAT until after 3PM. Unless you have a full time ESU/SWAT like some of the larger municipalities, your SWAT team isn't going to have time to get set up before the shooting ends. Neither is your Tactical Medic Team. Virginia Tech and so many other incidents have learned the same thing: Wait for SWAT doesn't work in an active shooter, unless you have a full time SWAT/ESU driving around waiting for a job.

The sooner PD can stop the threat, the sooner EMS can begin triage and treatment. IMO, there isn't time to stop and treat people. Stop the shooting and you will be able to SAFELY and effectively operate as EMS/Fire responders. This is not to take away from Tactical EMS at all, its definitely necessary in many instances and its an EXCELLENT program to have in place if you can have it. But as I understand it, the priority in an active shooter is not providing treatment, its ending the threat. JCESU or Helicopper or someone can correct me if I'm wrong, but that seems the most logical conclusion.

Maybe this is a good reason for a "Tactical/Active Shooter Incident Awareness" type course, so that the front line Firefighters and EMTs on every rig know what's expected of them at an active shooter incident and can begin setting up triage, treatment and transport areas. Knowing how and where to set up staging areas, knowledge of cover and concealment so you can avoid becoming a target. These are the things the everyday non-tactical responder can do to prepare for this type of incident.

And one more thing about staging. At Columbine the 2 shooters called false fire alarms for months before the incident to see where the FD and PD staged their units. They placed them the same spots almost every time. Guess where the two scumbags planted their bombs outside???

If you get the chance, read the book "Columbine" by Dave Cullen. You get a good picture of the lessons all the emergency responders learned at that incident. It would be folly not to use their knowledge.

Because these are rapidly evolving, dynamic incidents, the scene is not technically 100% safe until a thorough and methodical search by law enforcement has been conducted and they can say with 100% certainty the scene is secure. Look at the average size of any school, and think about how long one of these searches can take. Issues arise related to multiple shooters, sleepers or shooters who disguise themselves as a "friendly", Improvised Explosive Devices, conflicting information, etc. to say that just because the shooting has stopped, the scene is 100% safe and secure.

Awareness courses are an excellent start, but as I mentioned in my previous post, in addition to just taking a class, EMS needs to be involved in thorough and on-going training with other local response agencies (Police and Fire) and needs to take an active role in designing written response guidelines and pre-plans for the schools and/or larger business/corporate buildings within their jurisdictions.

For the sake of Operational Security, the discussion of Law Enforcement tactics is not appropriate for a public forum other then the information that has already been made public knowledge that Law Enforcement is not waiting and is relying on the first arriving officers on scene (patrol and school resource officers) to rapidly deploy to the sound of gunfire and stop the immediate threat.

[efdcapt115 1,511]

A lot of great points and posts have been made in this thread already, so I'm going to try not to repeat anything that's been said already. With that, just a couple of points and a few things to think about:

1) In regards to liability and EMS providers operating within the inner perimeter of an active shooter incident; There are a great number of things that need to take place first before EMS providers should even think about taking on such a responsibility. Proper training, continuous on-going training with members of local Law Enforcement, proper equipment, especially personal protective equipment (i.e. ballistic vests), and written standards/response protocols need to all be in place. It's not as easy as taking a TEMS class, throwing on a fancy uniform and saying you're now a TEMS Operator, and think you're going to save the day when the bell rings.

2) Death benefits. What death benefits are provided to EMS providers should they be killed and/or seriously injured operating in the inner perimeter of one of these incidents? Police Officers either retain their pensions if injured or their designated beneficiaries will retain their pension benefits should they be killed; Officers with resultant permanent disabilities will receive 3/4 disability pay; Police Foundations and Unions provide financial support for LEO's and their families. As an EMS provider, if you take a more aggressive role and operate within the inner perimeter and are seriously injured and/or killed, you need to ask yourself what benefits you and your family will be entitled to if you are either no longer able to work or you are killed and leave your family behind without any guaranteed financial support. You can call it a greedy way of thinking, but it's a reality. Obviously anything can happen to any of us at any time, but this is a calculated risk that we do have some control over. If you are knowingly going to take that chance should something happen to you, you and your family may not be guaranteed any financial death/disability benefits depending on where you work/volunteer.

3) As others have pointed out already, to respond to one of these incidents as an EMS provider who plans on operating within the inner perimeter with law enforcement, it takes a lot more then reading an article about it or sitting in a 4 hour class and thinking you're good to go. Taking a Tactical EMS or Active Shooter course is a great start, but unless you have the cooperation of your local law enforcement agency and undergo constant training with them on a very continual basis, your plans of being the EMS hero that day will quickly dissolve, possibly with deadly results. Joint training between agencies can make or break your response to one of these incidents because every one needs to be on the same page and everyone needs to know what each others responsibilities are at one of these incidents.

4) Pre-planning. Both through individual and joint training, as well as response plans that detail building schematics, staging areas, landing zones, etc. Although these are dynamic, rapidly changing incidents, a well designed written pre-plan will aide responding units with their responsibilities and operations, and should be adjusted as the situation unfolds.

5) Law Enforcement's priority is not treating/evacuating the injured. Their priority is to end the threat, either by apprehending the shooter or neutralizing the shooter through the use of deadly physical force. Their primary role could take 5 minutes, it could take 5 hours. How long after the onset of a traumatic injury can a casualty exsanguinate? We all know it can happy pretty damn quick if untreated. That being said, EMS does play a key role in response to these incidents, and the professional recommendations of the US Fire Administration and the National Tactical Officers Association officially recognizes Tactical EMS and Tactical EMS Operators as a necessity during tactical law enforcement operations, and during Active Shooter incidents. There are still a lot of roadblocks, especially here in the Northeast, preventing EMS from having more of a recognized role during Tactical Law Enforcement operations.

6) When coordinating with local Law Enforcement, EMS agencies need to decide if they are going to operate as "business as usual" and stage in a cold zone and wait for Law Enforcement to extract victims to their staging area; or if they are going to operate in a warm zone inside the location in a casualty collection point with Law Enforcement providing overwatch and security where they can start triaging and providing immediate life-saving treatment to casualties; or if they are going to operate in the hot zone, once again with Law Enforcement providing security, but the EMS provider is moving through the location with the team and treating the seriously wounded as they come across them. The decision on how EMS will operate at these incidents is not solely up to EMS; it has to be a joint decision between EMS administrators and Law Enforcement administrators. You can't have EMS providers going cowboy inside the school doing their own thing without consulting with and coordinating with Law Enforcement. If you plan on having EMS operating within a warm or hot zone, they need to be properly trained, continually trained, and properly equipped to effectively operate as such.

7) Treatment priorities shift from conventional A-B-C treatment protocols to the C-A-B design of Tactical Combat Casualty Care protocols, where uncontrolled hemorrhage is a treatment priority, followed closely by recognition and treatment of tension pneumothorax. Effective and proper triage is a necessity as in any Mass Casualty Incident.

8) We can stress scene safety in our EMT classes. We can stress that our safety comes first. We can say that EMS should never be intentionally put in harms way. The fact is that when the bell does ring, and the incident is rapidly evolving, sometimes we find ourselves in places we shouldn't be or doing things that we probably shouldn't be doing because human nature takes over, and we simply start doing anything and everything we can to provide aide and medical care to the injured. On April 20th, 1999, I can guarantee you that the crews of Littleton Fire Department didn't think that by noon they were going to be performing civilian rescues under effective gunfire. I can guarantee you that they weren't trained to perform such rescues. I can guarantee you that they weren't properly equipped to effect such rescues. Despite all that, the EMS crews were tasked with performing these rescues while under effective gunfire from the library windows. My point is that regardless what we say about liability, safety, and what the role of EMS should be at the incidents, the fact is that EMS is going to be in the mix in one way or another, so we should take the initiative to be properly trained, equipped, and prepared to operate at these incidents. Prior to Columbine, Littleton had 1 Tactically trained Paramedic... by the end of the year they had 30 trained and equipped tactical medical providers. Typical line of thinking in EMS (and emergency services altogether), it can't happen here and when it does, and only when it does, will be do something to be prepared for the next time.

Hello Joe,

You know how much we've communicated in the past, and I'm sure you know how much I respect not only your skills as a cross-trained responder, but also your participation here at Bravo. But I'm going to take issue with just a couple of your comments, before I bring up another idea, and probably finish with compliments about your ideas listed further down in your post.

I don't think anybody participating in this discussion up to this point had exhibited any desire to "throw(sic) on a fancy uniform and saying you're now a TEMS Operator, and think you're going to save the day when the bell rings."

The second comment I have to point out is " your plans of being the EMS hero that day will quickly dissolve."

I don't think you intended it to read the way it does. Most of the participants I've read in this discussion are highly respected, and highly professional members of the board. They don't read like free-lancers to me.

That said, I can't help but think of the analogy of this shooter situation, with the early actions police officers regularly undertake when they enter an occupied structure fire, many times with no actual firefighting training or experience, no firefighting gear, and begin or attempt to begin evacuations or rescues from the structure. What protections are these valiant officers afforded when they undertake action based on the "risk/benefit" analysis they themselves perform? They are putting themselves at greater risk, for the greater good of the population they serve.

Now for the compliments on describing actually how to get the response organized, so as the chief from Maine who regularly takes his time to come down to this NY forum and offer some great information describes, the risk/benefit analysis is properly defined, people are properly trained, and hopefully never utilized. Without ALL of the preparation, rehearsal, coordination, and definition of responsibility you have aptly described in the latter portion of your post, I agree nobody should do more than they are tasked with doing at any scene.

Stay well.

[SageVigiles 1,194]

Because these are rapidly evolving, dynamic incidents, the scene is not technically 100% safe until a thorough and methodical search by law enforcement has been conducted and they can say with 100% certainty the scene is secure. Look at the average size of any school, and think about how long one of these searches can take. Issues arise related to multiple shooters, sleepers or shooters who disguise themselves as a "friendly", Improvised Explosive Devices, conflicting information, etc. to say that just because the shooting has stopped, the scene is 100% safe and secure.

Awareness courses are an excellent start, but as I mentioned in my previous post, in addition to just taking a class, EMS needs to be involved in thorough and on-going training with other local response agencies (Police and Fire) and needs to take an active role in designing written response guidelines and pre-plans for the schools and/or larger business/corporate buildings within their jurisdictions.

For the sake of Operational Security, the discussion of Law Enforcement tactics is not appropriate for a public forum other then the information that has already been made public knowledge that Law Enforcement is not waiting and is relying on the first arriving officers on scene (patrol and school resource officers) to rapidly deploy to the sound of gunfire and stop the immediate threat.

Good point, I wasn't going to go too deeply into the IED/VBIED component other than the brief snippet I mentioned, but, as with Columbine, that is an issue we need to be concerned with. But that's going to be a risk v. benefit the Incident Commander is going to have to make the call on. Wait for EOD to arrive and totally clear the building or start treating patients? I'm not saying either way is right or wrong, just demonstrating that someone is going to have to make that difficult decision.

Agreed, as with anything, taking a class is not going to make you proficient. My point is that typically first responders are not aware of these kinds of things, and a program needs to be put in place to prepare for them. Planting the seed for discussions and planning is more along the lines of what I had in mind. Naturally that means at some point we're all going to have to check our egos and have a (GASP) interdisciplinary discussion on how we're going to respond to these calls.

Everything I said was open-source gathered from the book "Columbine," I left out some of the other things I've learned that might not be for public consumption. However, if you or anyone else believes anything I said is an OPSEC concern I will gladly remove it out of common courtesy.

I must say, this is becoming one of the more productive discussions I've seen on this site in a LONG time.

[JJB531 652]

Hello Joe,

You know how much we've communicated in the past, and I'm sure you know how much I respect not only your skills as a cross-trained responder, but also your participation here at Bravo. But I'm going to take issue with just a couple of your comments, before I bring up another idea, and probably finish with compliments about your ideas listed further down in your post.

I don't think anybody participating in this discussion up to this point had exhibited any desire to "throw(sic) on a fancy uniform and saying you're now a TEMS Operator, and think you're going to save the day when the bell rings."

The second comment I have to point out is " your plans of being the EMS hero that day will quickly dissolve."

I don't think you intended it to read the way it does. Most of the participants I've read in this discussion are highly respected, and highly professional members of the board. They don't read like free-lancers to me.

That said, I can't help but think of the analogy of this shooter situation, with the early actions police officers regularly undertake when they enter an occupied structure fire, many times with no actual firefighting training or experience, no firefighting gear, and begin or attempt to begin evacuations or rescues from the structure. What protections are these valiant officers afforded when they undertake action based on the "risk/benefit" analysis they themselves perform? They are putting themselves at greater risk, for the greater good of the population they serve.

Now for the compliments on describing actually how to get the response organized, so as the chief from Maine who regularly takes his time to come down to this NY forum and offer some great information describes, the risk/benefit analysis is properly defined, people are properly trained, and hopefully never utilized. Without ALL of the preparation, rehearsal, coordination, and definition of responsibility you have aptly described in the latter portion of your post, I agree nobody should do more than they are tasked with doing at any scene.

Stay well.

Greetings George!

My comments about "EMS Heroes" and "fancy uniforms" was not intended to be disrespectful or degrading in any way, nor was it directed at any particular individual, agency, or provider. If it came across that way to you or anyone else for that matter I apologize and will take this opportunity to clarify my point.

My point is that in order to successfully operate as a medical provider in the warm or hot zone of a tactical environment is a great responsibility, one that goes well beyond taking a TEMS class and wearing a SWAT Medic patch, because hey it looks cool and chicks dig it. Most EMS providers reading this thread who are not as "in-tune" with the TEMS world may not realize the commitment, training, and responsibility that goes along with pursuing this type of medicine. I know from personal experience, because at one time I was self-admittedly one of those individuals who took a class, wore the snazzy uniform, and thought I was "good to go" as a TEMS provider. With more time, more training/education, and more real world experience, I realized over time what it takes to be able to effectively and efficiently operate as a medical provider in a tactical environment, and that it takes a whole lot more then just taking a class. I guess if I was "knocking" anyone with my comments, I was knocking the person I was 11 years ago when I took my first TEMS class at Camp Blanding and thought I was now a high speed tactical medical operator. Call it enthusiasm; call it immaturity; call it over eagerness; call it whatever you want; but in that environment being misinformed or having a false sense of ability can be a very, very bad thing.

The analogy of police officers entering a fire scene to rescue individuals and comparing it to EMS providers entering an active shooter hot zone is a valid analogy. The only thing that I can say is that most humans look at fire as a inanimate, non-living object. Although we realize the dangers associated with fire, as humans we may have an inherent belief that we are "smarter" then fire because we are living, thinking, complex creatures and therefore we may believe that we are able to effect rescues by using our ability to reason and to think to keep ourselves safe. This leads us to potentially have a false sense of security that we can control the outcome of exiting the structure safely with minimal injuries because we're smart and can control the outcome based on our actions, and not the actions of the fire itself. It's almost written in our code, as a part of human nature, to get in that building without drawing up an intense amount emotion or thought to what we are about to do. A lot of times, when that adrenaline rush has worn off and we are back to a place of safety, does the raw emotion overcome us. If we all had the knowledge that firefighters have about fire and fire behavior, many of us may have a deeper respect for fire and it's deadly capabilities.

An active shooter situation scenario is slightly different. It's can quickly develop into the purest form of human combat, where as a LEO, you are essentially a hunter, hunting another human being and doing what you have to do when you finally confront this individual. It has a very "tactile" emotional component to it, and is full of so many scenarios that we just can't control because we are going up against another complex creature. When you're talking about entering a situation where another human being is determined to injure, maim, and kill as many other human beings as he/she can, it's an unnatural feeling that overcomes us; a feeling that can draw very raw emotions from deep within ourselves. I don't think that anyone would go into one of these situations with that same false sense of security as if we were entering a burning structure. With fire, the average person may have the feeling that he/she can turn back, outrun the fire if need be, and escape to safety. People just may not realize the true dangers of breathing in toxic gases, being in an IDLH or oxygen deficient environment, and may only see the flames as the true enemy, and if they can avoid the flames they'll be okay. Difference is that everyone knows the dangers of bullets, and the ramifications if you're hit by one.

I once read a study that asked people about running into a burning building versus running into a building where they knew a person was shooting unarmed individuals. The majority had no problem running into the burning building, while the majority said "NO WAY" to running into the building wih a shooter. It comes down to the emotion knowing that you're going up against another human being who may be smarter, faster, better trained, better equipped, etc., all which puts you at a serious disadvantage and all factors which you really can't control.

Now in no way am I trying to say that running into a fire is an easy task; I understand it's not and the dangers are just as real as running into a building where someone is firing a gun. I'm just trying to rationalize why some people may be quick to run into that burning building, and yet not to fast to run into the building with an armed gunman.

[Buff93 8]

EMS 101= SCENE SAFTEY (1.Your saftey,your crew's safety, then your patient's safety. )Your dispatch should advise you to stage away from the scene if the scene is unsafe. Once the scene is safe then you may enter and treat patients.

[JJB531 652]

EMS 101= SCENE SAFTEY (1.Your saftey,your crew's safety, then your patient's safety. )Your dispatch should advise you to stage away from the scene if the scene is unsafe. Once the scene is safe then you may enter and treat patients.

With conventional pre-hospital medicine scene safety is the utmost priority. The idea is to take EMS providers and give them the proper training, knowledge, and equipment to operate safely in an active shooter/tactical environment.

It's no different then having an EMS provider participate in a high angle rescue. Without the proper training, knowledge, and equipment it would be extremely unsafe. With the proper training, knowledge, and equipment you mitigate the hazards (to the greatest extent that you can) to allow the EMS provider to safely operate in that environment.

The simple concept of providing the right training and equipment has worked for EMS agencies all across the country to safely (with regard to the inherent dangers) place EMT's and Medics in high angle environments, confined space environments, collapse environments, waterborne environments, and yes, even tactical environments.

[Buff93 8]

With conventional pre-hospital medicine scene safety is the utmost priority. The idea is to take EMS providers and give them the proper training, knowledge, and equipment to operate safely in an active shooter/tactical environment.

It's no different then having an EMS provider participate in a high angle rescue. Without the proper training, knowledge, and equipment it would be extremely unsafe. With the proper training, knowledge, and equipment you mitigate the hazards (to the greatest extent that you can) to allow the EMS provider to safely operate in that environment.

Agreed, I have read that some tactical teams run "mock" shooter situations and work with EMS. Which is great but is very difficult to put together, especially with Budgets and attendance, not to mention the numerous variables that come with every scene from weather conditions, personal, mutal aid, what units are operating, what type of setting is it (school, supermarket, hospital, etc). This type of training should really be mainstreamed and mandated.

[JJB531 652]

Agreed, I have read that some tactical teams run "mock" shooter situations and work with EMS. Which is great but is very difficult to put together, especially with Budgets and attendance, not to mention the numerous variables that come with every scene from weather conditions, personal, mutal aid, what units are operating, what type of setting is it (school, supermarket, hospital, etc). This type of training should really be mainstreamed and mandated.

Personally, I think the only thing (especially around here) that makes the integration of EMS into these scenarios difficult is the overall lack of interest/enthusiasm from the EMS community to take the time to attend training sessions and expand on their responsibilities as EMS providers. BNechis has already pointed out this issue in this thread; and what he says is 100% true.

Whether it's a school or a supermarket, your EMS tactics really are not going to change much.

It goes back to the line of thinking, "oh that can't happen here"; "we'll never use that training"; "that's not my job"; and so on.

[SageVigiles 1,194]

Personally, I think the only thing (especially around here) that makes the integration of EMS into these scenarios difficult is the overall lack of interest/enthusiasm from the EMS community to take the time to attend training sessions and expand on their responsibilities as EMS providers. BNechis has already pointed out this issue in this thread; and what he says is 100% true.

Whether it's a school or a supermarket, your EMS tactics really are not going to change much.

It goes back to the line of thinking, "oh that can't happen here"; "we'll never use that training"; "that's not my job"; and so on.

Similar to HAZMAT, Tech Rescue or any other special ops discipline. But when that incident happens you'll get everyone out on scene so they can say "I was there man, you don't know what I saw"

[JJB531 652]

Similar to HAZMAT, Tech Rescue or any other special ops discipline. But when that incident happens you'll get everyone out on scene so they can say "I was there man, you don't know what I saw"

Lol, you're 100% right. HazMat is another one of those disciplines where EMS can and should be intimately involved in the warm zone performing triage, decon, and patient care... But you could offer a free HazMat Ops course for EMS that meets NFPA requirements and the turnout would most likely be poor. Kudos to Empress for their aggressive and forward thinking staff who sought out increased capabilities and have entered the HazMat world as emergency medical providers under the guidance of Yonkers FD.

[Goose 188]

Maybe its, me, but all this great discussion seems to be for naught. We have to remember that we are talking about Westchester County here...the majority of transporting agencies are overwhelmed by 1 request for an ambulance which (patient care aside) ties up some of us fly-car medics for inordinate swaths of time. That alone, in my mind, prevents any real ability to establish or properly interface with PD to plan for or effectively respond to these sorts of events.

God forbid this were to happen anywhere here...its going to be a cluster.

Edited March 1, 2012 by Goose

[SageVigiles 1,194]

Maybe its, me, but all this great discussion seems to be for naught. We have to remember that we are talking about Westchester County here...the majority of transporting agencies are overwhelmed by 1 request for an ambulance which (patient care aside) ties up some of us fly-car medics for inordinate swaths of time. That alone, in my mind, prevents any real ability to establish or properly interface with PD to plan for or effectively respond to these sorts of events.

God forbid this were to happen anywhere here...its going to be a cluster.

Believe me, Westchester is not the only place with these problems.

[Goose 188]

Believe me, Westchester is not the only place with these problems.

Oh, i know...i thought we were focusing on Westchester

[Guest alsfirefighter]

Personally, I think the only thing (especially around here) that makes the integration of EMS into these scenarios difficult is the overall lack of interest/enthusiasm from the EMS community to take the time to attend training sessions and expand on their responsibilities as EMS providers. BNechis has already pointed out this issue in this thread; and what he says is 100% true.

Whether it's a school or a supermarket, your EMS tactics really are not going to change much.

It goes back to the line of thinking, "oh that can't happen here"; "we'll never use that training"; "that's not my job"; and so on.

Bingo!!!

I learned more upon my first interactions with my tac team then I did in my tactical medical provider courses. With that came trust in both directions and understanding of limitations and needs of both of our responsibilities.

[Guest alsfirefighter]

I think the point is here that just throwing supplies to untrained bystanders is not likely to solve any issues that wouldn't have been taken care of anyway. What I mean by that is, as mentioned previously, anyone with the training to determine that a tourniquet is needed would likely have made a makeshift one, or would identify themselves as being "trained". And this relates to the idea of applying pressure, anyone who has the training for a tourniquet would (hopefully) already have attempted applying pressure and other attempts.

And in terms of the use in the OR, again it comes down to training, we can (hopefully) assume that they are being applied as a last resort and that they are not going to be removed without necessary precautions. Who's to say that a bystander wouldn't take it off once they think the bleeding has stopped or be stupid enough to try to use in on their neck?

And in terms of the CPR example, I would agree that while they are dead, and dead is dead, as you mentioned, it can reduce the low statistical chance, generally considered more harm than good.

I have to disagree...there may be times outside of active shooter situations where you may have to provide supplies to untrained people (stand offs) and explain how to use it or what needs to be done. Medicine through the Door is a common term/training course given in this aspect. Your assuming that someone assumed a tourniquet would be needed...if you have contact..you may be the one who deems it useful or needed.

Who would say a bystander would take it off? The same as to who would say a doctor wouldn't. Risk v. Benefit...without they may be doomed. On their neck...really? Little sensational don't you think. And even if I would even think of that as a reason not too...I'm fairly sure they would stop when they can't breath. No offense....but is that really your rationalization as to why not to consider it.

For all you quoting scene safety...yes you're right for your level of training. You're also missing the mark as to why that is detrimental to many that your staging waiting to "help."

JJB...just like the many convo's we've had over the past few years huh brother...

[HubEng21 14]

Forgive me if I repeat what was mentioned in earlier Posts.

I work in the Security field in the City of Stamford, CT. For those topics related to tactical teams passing patients so that the team can proceed to eliminate the threat, I agree and believe that is the case for Stamford. Stamford's procedures (correct me if Im wrong) has a set group of possibly 5 or 6 tactical patrol vehicles that will all respond to the location and storm the building together during the event of an Active Shooter to quickly eliminate the threat.

Creating safe zones (clearing areas) for EMS personnel can only be done with confirmation of the suspect(s) exact location and to a point where Law Enforcement have trapped the suspect(s) in one zone.

That "one zone" can also be described as "barricaded", such as a Hostage situation. SWAT or SRT's now come in handy. As mentioned in the Columbine shooting timeline, SWAT are ALMOST useless when it comes to an Active Shooter where most of the damage has already been done and suspects eliminate themselves prior to SWAT arrival.

Getting back to the main point of this thread (i think), it would be nice to see an advanced EMS individual on a tactical team but that advanced EMS individual might have to be part of law enforcement patrol, not EMS, so that this individual can be readily available if such incidents arise, no? My thoughts for EMS preparation on a incident such as an active shooter are that EMS should focus more on what mutual aid will be available and what type of EMS mutual aid. Also, the tools they have available on their rigs and mutual aid rigs that can create a large staging area; not necessarily worrying about entering a hot zone building to retrieve patients. When it is "all clear" retrieving patients will be no different than entering a building to retrieve a patient who is having a heart attack. And I agree 100% that there should be more EMS commanders available in Westchester county; there was a very good point stated that the duration of EMS incidents are a lot shorter than FD incidents and someone to soley command EMS in a timely manner is essential.

Edited March 1, 2012 by HubEng21

[JJB531 652]

Hub, the issue is that a casualty with an uncontrolled, life threatening extremity hemorrhage can exsanguinate within minutes if the bleeding is not controlled. These individuals can be saved if reached in time and immediate lifesaving medical care through the application of tourniquets and hemostatic agents are initiated. Law enforcement has a priority job to do at these incidents, and treatment of the injured is not an immediate priority. This is where EMS providers who have an expanded role will have the biggest impact in saving lives. Without someone to immediately tend to the injured, victims will die from injuries that could have been effectively managed in the field.

[38ff 250]

My two cents on this is as follows, and my experience in this area is limited to being a participant in an Active Shooter training scenario that was put on by some NYSP MRT guys to train other state MRT teams and local PD.. It was an eye opening in experience. Withoput getting into Tactics, Techniques, and Proceedures and violating OPSEC, the best thing you can do to educate yourself in how an non tactical EMS plays into the whole plan is to talk to your local PD and NYSP tactical teams. Offer to run a scenario in your local school/mall/whatever. different LE agencies have different policies as to how they deal with the situation. Find out what the policies are... The LE agencies can always use the training and will be happy to do it, and you can see first hand what happens, and what your role will be. The training I participated in used paramedic students as victims, so they got experience in what happens in those situations.

Until LE offically enters and clears the rooms/building, there will need to be (hopefully) alot of public who is in the building doing self and buddy aid. It will need to be alot of victim helping victim "I was in the Boy Socuts and I know field first aid" type of stuff to help each other out, IF the situation (bad guy or absense of bad guy) allows.. Self extrication will be going on, if the situation presents itself. Unfortunately, some treatble casualties may die because EMS cant get to them due to the hallways being unsecure. Question #1 of EMS.. Is the scene secure? If not, you cant help. If you get shot, your now a victim and adding to the amount of work that needs to be done. It sucks, but it's the truth.

[antiquefirelt 994]

Question #1 of EMS.. Is the scene secure? If not, you cant help. If you get shot, your now a victim and adding to the amount of work that needs to be done. It sucks, but it's the truth.

I guess this is where a Fire based EMS system seems to show it's strength. The actual "active shooter scenario" aside, firefighters are typically used to working to make the scene safe, so standing around until someone else renders the scene safe goes against our grain. The EMS world's repeating the "Do nothing until the scene is safe" is part of the problem. The image in my minds is a bunch of EMT's in EMS pants and job shirts dancing around with their gloved hands int he air screaming: "Is the scene safe, BSI, Is the scene safe, BSI" over and over while someone actually comes in and makes the scene safe (PD or FD). Today some of us are smarter at calculating risk and understanding the actual benefits and risk vs blind assumption.The same people dancing with their gloved hands int he air awaiting a safe scene seem to have no trouble driving code three, blowing red lights and making their siren spew unnatural sounds...

Sorry for the offensive rant, but there was a time where being part emergency services meant assuming some risk for the greater good.

[JJB531 652]

I guess this is where a Fire based EMS system seems to show it's strength. The actual "active shooter scenario" aside, firefighters are typically used to working to make the scene safe, so standing around until someone else renders the scene safe goes against our grain. The EMS world's repeating the "Do nothing until the scene is safe" is part of the problem. The image in my minds is a bunch of EMT's in EMS pants and job shirts dancing around with their gloved hands int he air screaming: "Is the scene safe, BSI, Is the scene safe, BSI" over and over while someone actually comes in and makes the scene safe (PD or FD). Today some of us are smarter at calculating risk and understanding the actual benefits and risk vs blind assumption.The same people dancing with their gloved hands int he air awaiting a safe scene seem to have no trouble driving code three, blowing red lights and making their siren spew unnatural sounds...

Sorry for the offensive rant, but there was a time where being part emergency services meant assuming some risk for the greater good.

I'm going to slightly disagree with you about the Fire Based EMS systems, and only for one reason (unless you are talking about dual role providers in a fire based system). As firefighters, a part of the training is to recognize and mitigate hazards. As Police Officers, a part of the training is to recognize and mitigate hazards. Mitigating hazards is a routine part of the job functions of these two groups. EMS providers, not dual role providers, whether volunteer, career, fire based, hospital based, commercial, etc are trained to recognize hazards and then call someone else to mitigate them. Scene safety is drilled into their heads from day one of EMT training, and there is a reliance on someone else to mitigate problems they encounter. If the initial training provided them with the knowledge and their agencies provided them with the tools to mitigate hazards, you may seen a new-found sense of confidence among EMS personnel to more effectively calculate risk and mitigate hazards. Now other parts of the country, EMS providers are far more proactive and have the necessary training and tools to mitigate certain hazards on their own. Around here, very very few systems that are modeled that way exist.

[Guest alsfirefighter]

I guess this is where a Fire based EMS system seems to show it's strength. The actual "active shooter scenario" aside, firefighters are typically used to working to make the scene safe, so standing around until someone else renders the scene safe goes against our grain. The EMS world's repeating the "Do nothing until the scene is safe" is part of the problem. The image in my minds is a bunch of EMT's in EMS pants and job shirts dancing around with their gloved hands int he air screaming: "Is the scene safe, BSI, Is the scene safe, BSI" over and over while someone actually comes in and makes the scene safe (PD or FD). Today some of us are smarter at calculating risk and understanding the actual benefits and risk vs blind assumption.The same people dancing with their gloved hands int he air awaiting a safe scene seem to have no trouble driving code three, blowing red lights and making their siren spew unnatural sounds...

Sorry for the offensive rant, but there was a time where being part emergency services meant assuming some risk for the greater good.

Excellent points...the bottom line is if you can actually achieve it and get past predisposed mentalities on all sides...a coordinated response and secure zones can be set up as time goes by and more PD resources arrive to do so.

I really can't understand how anyone can be comfortable with comments like "unfortunately some treatable casualties may die because EMS can't reach them." Call me crazy..but proactive is finding a solution where the maximum amount of casualties are treated in a timely manner. Littleton Sheriffs Office and Fire/Rescue didn't come out looking all that great and Dave Sanders was receiving first/buddy aid from a student who was a boy scout....he survived for 3 HOURS! I don't think anyone is advocating EMS just entering a building...but over a decade later we're having a discussion about tactics that didn't work...don't work and won't work for the best of our customers.

[38ff 250]

Im not "comfortable" with that statement, but it is a fact. As a FF, there are some fires you just cant go into because they are too hot to go save those who are trapped. It happens. Do we feel OK, about it, no.

Part of the problem here is LE agencies have different tactics on how they respond and react, and discussing them in open forum is not going to happen due to OPSEC. All agencies that con repsond to an event need to meet, talk about the plan and work together.

[JJB531 652]

Im not "comfortable" with that statement, but it is a fact. As a FF, there are some fires you just cant go into because they are too hot to go save those who are trapped. It happens. Do we feel OK, about it, no.

Part of the problem here is LE agencies have different tactics on how they respond and react, and discussing them in open forum is not going to happen due to OPSEC. All agencies that con repsond to an event need to meet, talk about the plan and work together.

Actually, overall the Law Enforcement tactics for a patrol response to an active shooter incident are quite similiar, with some minor tweaks here and there (without getting into specifics), so that's not really part of the problem. After Columbine, the Law Enforcement community established a standard for response to these incidents that most (if not all) local departments follow.

The problem is the lack of integration with other emergency service sectors (EMS and Fire), lack of a uniform, across the board training standard for EMS, lack of a uniform EMS response standard to these incidents, and a general lack of general interest from the EMS community as a whole to "step up to the plate" to advance their capabilities at such incidents.

[antiquefirelt 994]

Im not "comfortable" with that statement, but it is a fact. As a FF, there are some fires you just cant go into because they are too hot to go save those who are trapped. It happens. Do we feel OK, about it, no.

Part of the problem here is LE agencies have different tactics on how they respond and react, and discussing them in open forum is not going to happen due to OPSEC. All agencies that con repsond to an event need to meet, talk about the plan and work together.

Again, I don't think you'll find anyone advocating a "just do it" attitude or discussing the "how to" part. Instead this thread brings to light a topic that should be discussed amongst those whom will be called out and talk about who can and will do what, under what circumstances.

In many, I dare say most communities, the police, fire and EMS have very little knowledge of the way the other operates, short of just seeing it in the field. Truly understanding why we don't take a LEO's word on "no injury" or just anyone saying there's no fire, is different than knowing it happens and developing your own story as to the "why". I spent a wek in Anniston AL a few years back in a multi-role ICS class and was incredulous to learn how little some very senior members of other PD's, FD's, SWAT personnel, etc. knew about each others roles. I had a patrol divission commander of a very large county in CA ask what exactly it is that a Haz-mat team does?

@JJB531: Sorry I should have clarified I was envisioning dual role providers when I said Fire based EMS. It's the type of system my department operates and we tend to find our personnel are far more aggressive on nearly every front than those providers that operate under other systems, locally at least. Though the times are a changin'. Not necessarily for the better either. We used to respond to nearly every call and assess the scene ourselves (short of those involving firearms), now dispatch attempts to stage us for elderly overdose calls! Somewhere we lost common sense to liability.

Edited March 2, 2012 by antiquefirelt