Colo. shooting: Police pleaded for ambulances

[SRS131EMTFF 471]

Colo. shooting: Police pleaded for ambulances

As the horror unfolded for police first on the scene of the Colorado theater massacre, the officers repeatedly sent out urgent pleas for more ambulances even as a two-man crew and their rig were idling just a few miles away.

http://news.yahoo.com/colo-shooting-police-pleaded-ambulances-082042249.html

[PEMO3 523]

Here comes the Monday morning quarterbacks. Was the scene secured and deemed safe for EMS to operate? If so when and how long after the first call? Could answer a lot about the "delays" in EMS response.

[FFEMT150 214]

Here comes the Monday morning quarterbacks. Was the scene secured and deemed safe for EMS to operate? If so when and how long after the first call? Could answer a lot about the "delays" in EMS response.

Joe, From what we can hear on the audio tapes from an earlier thread, there was cahos for quite awhile. I would say it is safe to assume the scene was NOT secure and deemed safe for EMS to enter. I agree with you that it is just a bunch of monday morning quaterbacking.

[NJMedic 96]

Move along, nothing to see here. Who knows who is driving this story. PD responds and is confronted with 72 people shot or injured. The Aurora PD is going to do the same thing every other PD in America will do.....starting calling (screaming) for ambulances. Any why not......can't every EMS in the country muster that type of response at a moments notice? At best this sounds like failure of the command element to coordinate incident command. Had the PD branch director been in the position to talk to the EMS branch director on the scene would this have happened? A week of history shows that the danger was controlled within a very short time, but who know that then. Maybe the PD knew that or perhaps they didn't.

[v85 212]

I doubt a formal command structure was even in place at the initial response. ICS is all well and good, but in the first minutes of an active shooter response I think the PD has more pressing issues on their minds than even thinking about who the "branch directors" are going to be.

I also wonder if something like this could set bad case law. Say a victim or family member sues saying that the delayed EMS response caused further harm and the jury rejects the scene safety argument and awards millions of dollars. What happens then?

[OoO 24]

I listened to the police tapes of the shooting and heard the police repetitively requesting ambulances but never declaring that the situation was under control or that the scene was safe. At one point the officers were requesting EMS respond inside the theater and was offering police officers to "guard" them.

I can understand that the police on scene encountered a horrific scene and all they wanted to do was help the injured, but they either did not realize that EMS would not respond in until the situation was under control or they were simply not thinking given the situation.

Edited July 28, 2012 by OoO

[efdcapt115 1,511]

People go under the assumption (not the original poster of this thread, he's just passing along information) that because agencies go through so much training and planning for catastrophic incidents, that when something horrific such as this MCI happens, things will/should go according to these static plans; drawn on white boards in our planning rooms, presented on Powerpoint and practiced time and again in our controlled environments on the drill field.

When something so horrendous happens, the first in officers are naturally going to be way ahead of the planning curve. Of course when they see multiple people injured, some obviously DOA, they're going to urgently ask for help.

The practiced and rehearsed response to these incidents is going to take time time to catch up to the real time action on the ground.

In this case if officers are possibly pleading for EMS and EMS is probably chomping at the bit to get in there and help; being removed from the scene gives the EMS personnel the ability to reasonably think that they should be waiting for the proper orders; a secure scene advisory to move in, etc.

As in every catastrophe, there are so many individual acts of heroism and valor that occur during and immediately after the event, they are hard to count. I think, with so much focus on sensationalism in media reporting, we should always recognize that none of these events are going to go exactly as they were presented to us on a white board in our training classrooms.

I also think that point has been made many times here on Bravo, but should be mentioned again.

My personal wish is for all emergency personnel who responded into this event to get the follow-up care that they are going to need, and certainly all of the victims and civilians who acted with courage and valor under fire, get the help and care they need as well.

Nobody, no matter how experienced, no matter how fearless and salty they may be, on any of our jobs can walk away from such an incident "untouched."

Once again, the emergency responders of this country, in this case Aurora, Co. did the best they could under extreme duress. I'm quite confident they ALL did an excellent job.

Edited July 28, 2012 by efdcapt115

[T. John 21]

This event is a reminder of how our jobs as emergency responders is changing. Hats off to all of the responders - police, fire and ems - in Aurora for the courageous acts that day, including that of the dispatchers. I am sure there will be lessons learned from our brother and sister responders that we all can take home. Until such time, I won't comment on the events there but rather some of the lessons we have learned from other events.

Post analysis of the Columbine shooting and other high profile attacks revealed that first responders need to respond and react differently to hostile events. Hence new active shooter policies for police departments (i.e. rapid entry of patrol officers and not waiting for SWAT). One area that has been historically overlooked is how to treat/evacuate a mass number of victims from the "hot" zone. How do you reach and quickly extricate dozens, if not hundreds, of injured victims?

Fire and EMS need to be included as part of a coordinated response to a hostile event. Police quickly become overwhelmed. We (non law-enforcement) have been trained to wait for an "all clear" or to know the scene is completely "safe." Post incident analysis' has showed that this approach doesn't work. In Columbine, victims were bleeding out but were unable to be reached. Realistically, it can take upwards of a few hours for an area to be deemed safe (by our traditional definition).

There are efforts popping up across the county to address this issue. In Minnesota, for example, a program called 3E (3 Echo) is being rolled out that incorporates fire/ems into a coordinated response to a hostile event. The program is based on extensive research of past events both within the United States and across the world, taking best practices deploying in many countries (i.e. Israel) that see active terrorist activity, as well as research coming from the Iraq war. The program integrates police, fire and EMS into a coordinated, initial response with a goal to rapidly treat/evacuate massive numbers of patents within minutes (15-20 minutes or less) of a hostile event. From a fire/EMS perspective, it is a fairly significant shift in the paradigm of waiting blocks away for an "all clear" or for the scene to be 100% "safe." A collaborative approach will allow first responders to evaluate the risk/benefit, realizing that some risk will need to be taken. The key in this program is training, exercise and collaboration between first response agencies prior to an incident happening. Due to the sensitive and mission critical nature of the program, its training and policies, I can't go into much further detail online.

Our jobs are changing. The fire service isn't what it used to be 30-40 years ago. While we can only hope that events such as Columbine, Virginia Tech and now Aurora will not happen in our own community, we cannot ignore the reality that, in 2012, we need to take a better look at how we (police, fire and ems) will respond to a hostile event. Its our job.

Edited July 28, 2012 by T. John

[efdcapt115 1,511]

Great post T John. Thank you.

[v85 212]

I agree that we should look at how we respond to hostile events, but before we can start thinking about a coordinated response to a hostile event, we need to be able to have coordinated responses at all.

At least in Orange County it is the rule, rather than the exception that all three emergency services are on different radio bands (ie. Police on 800, Fire on UHF/Low Band, and EMS on VHF), not to mention they are often dispatched by different people (PD by their own dispatchers and FD/EMS by the County 911 center).

Something as simple as requesting EMS to an accident thought to be PDAA only takes four steps

[helicopper 1,050]

Move along, nothing to see here. Who knows who is driving this story. PD responds and is confronted with 72 people shot or injured. The Aurora PD is going to do the same thing every other PD in America will do.....starting calling (screaming) for ambulances. Any why not......can't every EMS in the country muster that type of response at a moments notice? At best this sounds like failure of the command element to coordinate incident command. Had the PD branch director been in the position to talk to the EMS branch director on the scene would this have happened? A week of history shows that the danger was controlled within a very short time, but who know that then. Maybe the PD knew that or perhaps they didn't.

First off, having listened to the tapes, there was very little screaming. Agitation and frustration perhaps, but the officers of the Aurora PD were incredibly professional given what they were confronted with. Their dispatcher deserves an award, a raise, and a vacation, too. I don't know what they do in dispatch training out west as this is not the first time I've heard a remarkable dispatcher during a catastrophic incident. This is not a slight on our dispatchers here in the east, but there seems to be a consistency out west that is lacking here.

On to the subject of ICS.... were there even established branch directors as you describe or are you speculating on the possible organization? In your model who was the IC?

I doubt a formal command structure was even in place at the initial response. ICS is all well and good, but in the first minutes of an active shooter response I think the PD has more pressing issues on their minds than even thinking about who the "branch directors" are going to be.

A formal structure seemed to evolve fairly quickly in each traditional discipline but how well integrated it was remains to be seen. FD/EMS talked about all kinds of division and group positions but how many frontline resources were pulled out of service to fill those roles further exacerbating the resource shortage?

Did the PD, FD, and EMS management form a single command post or were they all working in different locations playing the game of telephone to get messages out?

The first minutes of any critical incident are where ICS can be most valuable and is most often overlooked because you can claim the chaos defense when asked why things weren't done. If we don't properly implement ICS on the routine day to day stuff and drill/exercise on the bigger, less frequent stuff we're planning to fail. We don't need to assign "branch directors" but we do need to identify and communicate the location of the command post, who is in charge, where the staging area is and what resources are needed. We then need to establish objectives and start assigning resources to do that. All management 101 and all part of the ICS process. Big charts and fancy titles can be added as the brass gets there and needs to feel important or empowered.

I listened to the police tapes of the shooting and heard the police repetitively requesting ambulances but never declaring that the situation was under control or that the scene was safe. At one point the officers were requesting EMS respond inside the theater and was offering police officers to "guard" them.

I can understand that the police on scene encountered a horrific scene and all they wanted to do was help the injured, but they either did not realize that EMS would not respond in until the situation was under control or they were simply not thinking given the situation.

Define "under control" or "safe" in a situation like that? One of the big problems that faced responders was the geographical size of the scene. This wasn't a single room or house with a person shot or otherwise assaulted inside. This was a movie theater complex at a suburban shopping mall.

I'm a cop at one entrance on one side of the building with multiple people shot, no direct threat to me or anyone else, and I'm calling for an ambulance. Is that under control? Should EMS respond? I'm going to bet that just the way active shooter protocols evolved from Columbine, so will improvements in the EMS integration into a tactical response at a large-scale incident.

If you're waiting for an "all-clear" you may be waiting for a while while some areas of the scene are safe and readily accessible. There is also going to be some risk to everyone because we probably won't know with any certainty if all the suspects are dealt with or hazards neutralized.

Post analysis of the Columbine shooting and other high profile attacks revealed that first responders need to respond and react differently to hostile events. Hence new active shooter policies for police departments (i.e. rapid entry of patrol officers and not waiting for SWAT). One area that has been historically overlooked is how to treat/evacuate a mass number of victims from the "hot" zone. How do you reach and quickly extricate dozens, if not hundreds, of injured victims?

Fire and EMS need to be included as part of a coordinated response to a hostile event. Police quickly become overwhelmed. We (non law-enforcement) have been trained to wait for an "all clear" or to know the scene is completely "safe." Post incident analysis' has showed that this approach doesn't work. In Columbine, victims were bleeding out but were unable to be reached. Realistically, it can take upwards of a few hours for an area to be deemed safe (by our traditional definition).

There are efforts popping up across the county to address this issue. In Minnesota, for example, a program called 3E (3 Echo) is being rolled out that incorporates fire/ems into a coordinated response to a hostile event. The program is based on extensive research of past events both within the United States and across the world, taking best practices deploying in many countries (i.e. Israel) that see active terrorist activity, as well as research coming from the Iraq war. The program integrates police, fire and EMS into a coordinated, initial response with a goal to rapidly treat/evacuate massive numbers of patents within minutes (15-20 minutes or less) of a hostile event. From a fire/EMS perspective, it is a fairly significant shift in the paradigm of waiting blocks away for an "all clear" or for the scene to be 100% "safe." A collaborative approach will allow first responders to evaluate the risk/benefit, realizing that some risk will need to be taken. The key in this program is training, exercise and collaboration between first response agencies prior to an incident happening. Due to the sensitive and mission critical nature of the program, its training and policies, I can't go into much further detail online.

Our jobs are changing. The fire service isn't what it used to be 30-40 years ago. While we can only hope that events such as Columbine, Virginia Tech and now Aurora will not happen in our own community, we cannot ignore the reality that, in 2012, we need to take a better look at how we (police, fire and ems) will respond to a hostile event. Its our job.

Lots of good points here. Training and exercise absolutely should be integrated (wouldn't that be nice?) and frequently test the credible worst case scenario. Unfortunately, we don't like to do that because we're not well prepared for the day to day stuff let alone the big one.

Just as Fire and EMS need to be included in the coordinated response, Fire and EMS need to recognize and embrace that there is risk inherent to the job and that risk must be accepted and managed. This doesn't mean take chances or become a dead hero but how can anyone possibly know when a scene like this one is really "safe"? Hours probably went by before anyone would say with any degree of accuracy and certainty that the scene in Aurora was safe because it probably took hours to search every theater and every room and all the vehicles, etc.etc.etc.

Scenarios like this one (not necessarily this big) need to be played out on white boards and tabletops and discussions had until we all improve our responses to them. This is not Monday morning quarterbacking but rather how we will improve in our fields.

[JJB531 652]

T John, are there more resources out there to get more information about the 3 Echo program being rolled out in Minnesota?

I don't think that anyone can argue that a coordinated PD/FD/EMS response to these incidents is necessary, and I agree with you wholeheartedly T John that we do need to take a better look at how we respond to a hostile event. But there are a few factors, like them or not, that are going to hinder the type of aggressive coordinated response to these incidents we would all like to see.

No matter how necessary it is, no matter how much it will benefit the victims of a hostile incident, there is still one rather significant issue at hand that would need to be addressed before we can even consider placing non-sworn EMS providers in a hostile environment and task them with the extraction of wounded victims... LODI/LODD benefits for EMS responders. I understand this can vary from state to state, even agency to agency. I'm going based off my "local knowledge" of EMS systems in the Metro NY area.

There is a plethora of training programs to prepare EMS providers to work in a hostile/tactical environment. There is a plethora of high speed tactical medical equipment designed for EMS responders to operate in a tactical environment. We can supply EMS providers with ballistic protection and other specialized PPE to operate in the midst of a tactical assignment. The training and the equipment is readily available, and incorporating EMS into these types of responses is not an unrealistic or impossible venture.

Now try convincing a volunteer or even commercially paid EMS provider to don such equipment and go charging forward with PD into a potentially hostile environment. It is easy to have our judgment clouded by the thought of throwing on this high-speed equipment and go forth to render aid to our victims in the tactical theatre of operations. It sounds exciting, looks cool, has the CDI (chicks dig it) factor associated with it, and so on. But what if things go south, and now the EMS provider ends up a victim him/herself?

I know as an LEO, if I am seriously injured in the line of duty, I will have the financial security through a generous line of duty salary to pay my mortgage, my bills, etc. If I am killed during the scope of my employment as an LEO, my beneficiary will be well taken care of financially by my employer, union, and numerous police foundations. Now if I switch patches on my shirt and act in Paramedic mode, serious injury leads to basic workers compensation, and if I'm a volunteer who now can not work and provide for my family and pay my mortagage and bills, I have to hope the generous public will donate money to alleviate any financial strain I have endured as a result of a serious injury. Killed in the line of duty... maybe some donations for my family, but nothing guaranteed. Like it or not, these are issues that need to be raised first before we can expect any EMS provider to take on such a task. Anyone who says it's a selfish way to look at things or just doesn't care and is going to go charging in there anyway cause "it's the right thing to do", then go for it. When I was younger I had that mindset that I didn't care. As I've become more informed and a little more experienced, my mindset has changed a bit. It's not about being a coward, it's realizing that if we're going to take on this great responsibility, then take it on with addressing ALL of the variables and issues, not just the obvious issues of training and equipment. We are all adults who hopefully understand the dangers and magnitude of certain incidents and are therefore capable of making our own decisions about our fate, whether it's running into a burning house without PPE to effect a rescue, or entering an unsecured location that may contain a potential armed threat to render aid to the injured. Most times these are split second decisions made within a moments notice as an incident is rapidly unfolding in front of us; but if we're talking about a coordinated, pre-planned response, we need to look beyond the obvious operational and logistical issues.

And for those of you who are going to say, "well I can get injured or killed at the scene of an MVA as an EMT", you're right, you can get killed at an MVA, responding to a "fall down go boom", dealing with an intox in the back of the ambulance, and so on. That's why we take certain safeguards to make these scenes safe; road flares, blocking lanes of traffic, PD escorts, safe driving practices, etc. While we can't can't control every single variable at these "routine" incidents, we can control and mitigate the majority of them. Hostile scenes have so many variables that as Helicopper pointed out, it can take hours for a scene to be deemed safe. Is the shooter identified? Contained? In custody? Threat neutralized? Are there multiple shooters? Explosive/secondary devices? There are a lot of variables to process that typically require specialized PD resources (SWAT, bomb squads, aviation, etc.), and it may take time to mobilize such resources and then time for each resource to carry out its function. So I fully understand that anything can happen at any time, and that's why these issues of LODI/LODD benefits for EMS providers shouldn't just be limited to active shooter or hostile situations.

[v85 212]

The benefits issue is a very interesting angle that is not often mentioned. I wonder if one way around that would be to train certain members of FD/EMS to peace officer standards and swear them in as either Fire Police (if a member of FD) or Special Police (if a member of EMS).

With the economy the way it is there may be other benefits to this as well.

[Dinosaur 844]

The benefits issue is a very interesting angle that is not often mentioned. I wonder if one way around that would be to train certain members of FD/EMS to peace officer standards and swear them in as either Fire Police (if a member of FD) or Special Police (if a member of EMS).

With the economy the way it is there may be other benefits to this as well.

Ha. That's funny. EMS and FD already b**** that their training programs are too long and too difficult. Wah wah.

Do you really think they're going to sit for weeks of peace officer training on the off chance that something might happen to them? Doubt it!

Instead of looking for ways around it we should lobby our legislative bodies and fraternal groups like FASNY to change the benefits laws and protect us!

[peterose313 345]

A very interesting article from a dispatcher's pov.

Emergency dispatchers are often the first point of contact when tragedy strikes. Dealing with people in difficult situations such as shootings, home break-ins and fatal accidents are all part of the job.

But for Aurora, Colo., 911 dispatcher Kathie Stauffer, it took all she had to show strength on the outside -- all the while nervous on the inside -- during her five-hour ordeal directing police and other resources to the movie theater where a gunman was shooting at patrons during the midnight premiere of the latest Batman film "The Dark Knight Rises."

http://usnews.nbcnews.com/_news/2012/07/23/12907719-they-needed-help-and-they-couldnt-get-it-911-dispatcher-recalls-night-of-horror-during-colorado-movie-theater-shootings?lite

[T. John 21]

T John, are there more resources out there to get more information about the 3 Echo program being rolled out in Minnesota?

I don't think that anyone can argue that a coordinated PD/FD/EMS response to these incidents is necessary, and I agree with you wholeheartedly T John that we do need to take a better look at how we respond to a hostile event. But there are a few factors, like them or not, that are going to hinder the type of aggressive coordinated response to these incidents we would all like to see.

No matter how necessary it is, no matter how much it will benefit the victims of a hostile incident, there is still one rather significant issue at hand that would need to be addressed before we can even consider placing non-sworn EMS providers in a hostile environment and task them with the extraction of wounded victims... LODI/LODD benefits for EMS responders. I understand this can vary from state to state, even agency to agency. I'm going based off my "local knowledge" of EMS systems in the Metro NY area.

There is a plethora of training programs to prepare EMS providers to work in a hostile/tactical environment. There is a plethora of high speed tactical medical equipment designed for EMS responders to operate in a tactical environment. We can supply EMS providers with ballistic protection and other specialized PPE to operate in the midst of a tactical assignment. The training and the equipment is readily available, and incorporating EMS into these types of responses is not an unrealistic or impossible venture.

Now try convincing a volunteer or even commercially paid EMS provider to don such equipment and go charging forward with PD into a potentially hostile environment. It is easy to have our judgment clouded by the thought of throwing on this high-speed equipment and go forth to render aid to our victims in the tactical theatre of operations. It sounds exciting, looks cool, has the CDI (chicks dig it) factor associated with it, and so on. But what if things go south, and now the EMS provider ends up a victim him/herself?

I know as an LEO, if I am seriously injured in the line of duty, I will have the financial security through a generous line of duty salary to pay my mortgage, my bills, etc. If I am killed during the scope of my employment as an LEO, my beneficiary will be well taken care of financially by my employer, union, and numerous police foundations. Now if I switch patches on my shirt and act in Paramedic mode, serious injury leads to basic workers compensation, and if I'm a volunteer who now can not work and provide for my family and pay my mortagage and bills, I have to hope the generous public will donate money to alleviate any financial strain I have endured as a result of a serious injury. Killed in the line of duty... maybe some donations for my family, but nothing guaranteed. Like it or not, these are issues that need to be raised first before we can expect any EMS provider to take on such a task. Anyone who says it's a selfish way to look at things or just doesn't care and is going to go charging in there anyway cause "it's the right thing to do", then go for it. When I was younger I had that mindset that I didn't care. As I've become more informed and a little more experienced, my mindset has changed a bit. It's not about being a coward, it's realizing that if we're going to take on this great responsibility, then take it on with addressing ALL of the variables and issues, not just the obvious issues of training and equipment. We are all adults who hopefully understand the dangers and magnitude of certain incidents and are therefore capable of making our own decisions about our fate, whether it's running into a burning house without PPE to effect a rescue, or entering an unsecured location that may contain a potential armed threat to render aid to the injured. Most times these are split second decisions made within a moments notice as an incident is rapidly unfolding in front of us; but if we're talking about a coordinated, pre-planned response, we need to look beyond the obvious operational and logistical issues.

And for those of you who are going to say, "well I can get injured or killed at the scene of an MVA as an EMT", you're right, you can get killed at an MVA, responding to a "fall down go boom", dealing with an intox in the back of the ambulance, and so on. That's why we take certain safeguards to make these scenes safe; road flares, blocking lanes of traffic, PD escorts, safe driving practices, etc. While we can't can't control every single variable at these "routine" incidents, we can control and mitigate the majority of them. Hostile scenes have so many variables that as Helicopper pointed out, it can take hours for a scene to be deemed safe. Is the shooter identified? Contained? In custody? Threat neutralized? Are there multiple shooters? Explosive/secondary devices? There are a lot of variables to process that typically require specialized PD resources (SWAT, bomb squads, aviation, etc.), and it may take time to mobilize such resources and then time for each resource to carry out its function. So I fully understand that anything can happen at any time, and that's why these issues of LODI/LODD benefits for EMS providers shouldn't just be limited to active shooter or hostile situations.

Feel free to shoot me a private message here and I will try to get you some more details, or at least get you in touch with the program coordinator. They are in the final staging of receiving final DHS/FEMA approval for the program which will make it more readily available. It has been rolled out in the metro region (Minneapolis/St. Paul area) and we are starting to move it into the more suburban communities.

I realize that benefit laws vary from state to state and even department to department. I agree with Dinosaur that this is something that should be lobbied for. I am sure that we all recognize that much of what we do today is governed by the way it was 100 years ago - we need to be brought into 2012 and look toward the future. The risks we face today have changed and the services we provide have increased.

Agency Cooperation

One thing I have noticed is that 3E (and similar multi-agency training programs) brings people together. While it may be training and a policy that, hopefully, we never have to put to use, it gets people in the same room working together. I was raised on the east coast and grew up in emergency services there, so I understand the silos and even, unfortunately, the turf wars that exist. To be frank, its time to get over it. These "hostile events" require cooperation and coordination. There isn't such a thing as "that's not my job" anymore. The public doesn't care and won't tolerate that excuse. The person that is bleeding inside an empty classroom and going into shock doesn't care; they want help. We are all trained to recognize and manage risk. It is part of our job and what we do. I have a very close working relationship with our local law enforcement here. The only reason that exists is because we work to make it be that way. In closing, agencies that begin to plan for these hostile events may find themselves developing a better day-to-day working relationships between each other. We, as emergency first responders, know that we are there to help support one another, regardless of what our badge or patch says.

[JJB531 652]

I wholeheartedly agree with you and your assessment of this topic and the importance of working together and being better prepared to respond to these types of unique and overwhelming incidents. I get it, I agree with it, and I support the notion.

That being said, it's not a question of if we need it, it's how do we implement it? This is why I'm curious about the 3E program. The benefits issue aside, are we going to be able to "force" volunteers to take on this responsibility? For a career crew we can make this a part of the job responsibility, but what about Susie Homemaker who volunteers 6 hours a week to get out of the house? How do we prepare an EMS agency who has a crew with the average age of 65 to respond to this type of incident? How do we prepare certain EMS providers who may have a hard enough time managing a BLS patient in a nice controlled environment, and now expect them to operate in a more austere environment?

We need to be brought into 2012 with the mere BASICS of EMS, such as disability benefits, comparable wages and financial benefits, professional standards, competent/well trained providers, better training and educational programs/opportunities, more advancement opportunities, changing the mindset of your typical EMS provider to go from being a stagnant, lazy, uninterested employee whose priorities are sleeping and what they're eating for lunch and instead fostering employees who are motivated; motivated to train, motivated to expand their scope of practice, expand their responsibilites and professional capabilities and so forth. With a lot of EMS providers, I just don't see it. In the Fire Service and Law Enforcement there is some level of motivation to excel or put in the extra effort because doing so leads to professional/career advancement, either through promotion or through reassignment to a desired specialized detail (SWAT, Rescue Company, etc.), which then leads to other perks (i.e. increased pay, future advancements, etc.)

Before we can charge ahead and add this huge responsibility onto an already fractured and disorganized service, we first need to address the basic issues/problems that plague the EMS service.

[T. John 21]

I wholeheartedly agree with you and your assessment of this topic and the importance of working together and being better prepared to respond to these types of unique and overwhelming incidents. I get it, I agree with it, and I support the notion.

That being said, it's not a question of if we need it, it's how do we implement it? This is why I'm curious about the 3E program. The benefits issue aside, are we going to be able to "force" volunteers to take on this responsibility? For a career crew we can make this a part of the job responsibility, but what about Susie Homemaker who volunteers 6 hours a week to get out of the house? How do we prepare an EMS agency who has a crew with the average age of 65 to respond to this type of incident? How do we prepare certain EMS providers who may have a hard enough time managing a BLS patient in a nice controlled environment, and now expect them to operate in a more austere environment?

We need to be brought into 2012 with the mere BASICS of EMS, such as disability benefits, comparable wages and financial benefits, professional standards, competent/well trained providers, better training and educational programs/opportunities, more advancement opportunities, changing the mindset of your typical EMS provider to go from being a stagnant, lazy, uninterested employee whose priorities are sleeping and what they're eating for lunch and instead fostering employees who are motivated; motivated to train, motivated to expand their scope of practice, expand their responsibilites and professional capabilities and so forth. With a lot of EMS providers, I just don't see it. In the Fire Service and Law Enforcement there is some level of motivation to excel or put in the extra effort because doing so leads to professional/career advancement, either through promotion or through reassignment to a desired specialized detail (SWAT, Rescue Company, etc.), which then leads to other perks (i.e. increased pay, future advancements, etc.)

Before we can charge ahead and add this huge responsibility onto an already fractured and disorganized service, we first need to address the basic issues/problems that plague the EMS service.

I agree with your assessment and you hit on a number of key points. The program, whether 3E or a version of it, is a significant shift in what we have been told and the way we have historically done business. Honestly, not everyone is up for it, especially in volunteer or on-call organizations. This requires effort and a shift in the way we engage our minds.

Without going into great detail, most of the entry involves police and fire, primarily due to the resources that typically arrive quickly (fire, by its nature, often responds with the greatest numbers). The goal is to get patients out and onto an ambulance. Time is of the greatest importance, including getting patients to a hospital. Studies coming out of the war are showing a significant increase in survival with the application of a tourniquet, when needed (remember the day when we basically got rid of them?). There is not a lot, if any, triage. Get them out and to a hospital. EMS needs to be in a position to get in quick, load and go. Interestingly, the officers in CO realized this and, without any hesitation, loaded patients into police cars and drove them to the hospital.

[Goose 188]

I wholeheartedly agree with you and your assessment of this topic and the importance of working together and being better prepared to respond to these types of unique and overwhelming incidents. I get it, I agree with it, and I support the notion.

That being said, it's not a question of if we need it, it's how do we implement it? This is why I'm curious about the 3E program. The benefits issue aside, are we going to be able to "force" volunteers to take on this responsibility? For a career crew we can make this a part of the job responsibility, but what about Susie Homemaker who volunteers 6 hours a week to get out of the house? How do we prepare an EMS agency who has a crew with the average age of 65 to respond to this type of incident? How do we prepare certain EMS providers who may have a hard enough time managing a BLS patient in a nice controlled environment, and now expect them to operate in a more austere environment?

We need to be brought into 2012 with the mere BASICS of EMS, such as disability benefits, comparable wages and financial benefits, professional standards, competent/well trained providers, better training and educational programs/opportunities, more advancement opportunities, changing the mindset of your typical EMS provider to go from being a stagnant, lazy, uninterested employee whose priorities are sleeping and what they're eating for lunch and instead fostering employees who are motivated; motivated to train, motivated to expand their scope of practice, expand their responsibilites and professional capabilities and so forth. With a lot of EMS providers, I just don't see it. In the Fire Service and Law Enforcement there is some level of motivation to excel or put in the extra effort because doing so leads to professional/career advancement, either through promotion or through reassignment to a desired specialized detail (SWAT, Rescue Company, etc.), which then leads to other perks (i.e. increased pay, future advancements, etc.)

Before we can charge ahead and add this huge responsibility onto an already fractured and disorganized service, we first need to address the basic issues/problems that plague the EMS service.

I appreciate you bringing up these issues because they are a very large part of the issue.

The bottom line is there is no advancement in EMS - once you're a paramedic (at least in this area) you've more or less reached the ceiling. I'm not talking about being an FTO or senior medic for an extra 50 cents or buck an hour, either.

That said, i can't help but feel that you're not giving some of us on the EMS side the benefit of the doubt and chalking things up to laziness ( if i recall you are/were a medic, and I'm not arguing that there isn't laziness - there is an awful lot but there are an awful lot of lazy cops and firefighters too). I think the biggest problems with EMS in this area are structural. The entire system is plagued, its a decentralized patchwork of agencies who have little to no oversight and do what they please. If aurora happened here, we would still be waiting on ambulances. The fact it is, its never going to change here. No one wants to take the bull by the horns and tackle the issues. No politician wants to deal with the issue because the only real answer is to wipe the slate clean and established a more regional career system which will cost millions and tick off the volunteers. Maybe i'm jaded, but i just don't see it any other way.

In all honesty, this is why i'm looking to get out of this area and move down south. Down there being a paramedic is a career on par with being a firefighters and police officer - there are attractive benefits packages, line of duty protections, awesome advancement and educational opportunities and i don't need to work 100 hours a week to make ends meet.

[JJB531 652]

I give the benefit of the doubt to those providers who deserve it, and unfortunately the majority don't. Of course there's lazy cops and firemen... The same way there's lazy doctors, nurses, and workers at Walmart. I still work as a medic and I will come off a midnight tour with the PD, straight to my EMS gig and get my coworkers up off the couch to go out and train after working all night. How many other medics/EMT's do that where I work? Bottom line is that if I don't get the guys up to train, then they won't take the initiative themselves. It's nothing against any of them, it's just the way it is.

[Goose 188]

I give the benefit of the doubt to those providers who deserve it, and unfortunately the majority don't. Of course there's lazy cops and firemen... The same way there's lazy doctors, nurses, and workers at Walmart. I still work as a medic and I will come off a midnight tour with the PD, straight to my EMS gig and get my coworkers up off the couch to go out and train after working all night. How many other medics/EMT's do that where I work? Bottom line is that if I don't get the guys up to train, then they won't take the initiative themselves. It's nothing against any of them, it's just the way it is.

I think training is a good thing and i admire that you strive to keep yourself and your coworkers sharp. Personally, i keep a few books (have a great 12 lead book) in my work bag to read in the fly car, bus or station when things are slow. I also try to take out the sim man from time to time and a few of us practice crics and some advanced airway maneuvers (love working on the ice pick intubation technique). I like to think that these are good habits, but I'm not sure these are what we are talking about.

Im far from any sort of expert , but it seems to me that dealing with these sorts of issues is going to take a two pronged approach: 1) fix the structural decency, 2) correct the educational/skill decencies of providing care under these unique circumstances. These sorts of things are going to have to be multi-day or week long classes - not an hour long CME lecture - taught by law enforcement professionals who have direct experience in this sort of thing at facilities capable of putting providers through the paces.

Personally, i would love to take a course like this. Unfortunately, none of my jobs will pay for me to go, i would imagine the courses are expensive to pay out of pocket for, and taking a week off of work to go to these things will put a dent in my checking account i can't afford right now. This before we even start to talking about 1) how i would utilize my skills and who that would be with (many of these small village depts don't have any tactical elements to them) 2) how would i be covered in the event my services would be called on and if i get hurt who picks up the tab - and would my family be taken care of in the event that i was hurt and died (i already know the answer to that - its no).

[JJB531 652]

Most Tactical Medic courses are generally 5 days long, some are up to 10 days, which is not an easy venture for most providers who are working 2 or 3 jobs and can't get the training on job time. I've had the opportunity to take a few Tac Medic programs, and in terms of the medical aspect, if you're a competent Paramedic, you're not going to really learn anything new. Needle decompression is needle decompression, surgical airways are surgical airways, IV's are IV's, and intubation is intubation. There are some distinct differences in the priorities of care (C-A-B instead of A-B-C, importance of tourniquets which we're now seeing in conventional EMS, use of hemostatic agents, zones of care, less importance on spinal immobilization, Medicine Across the Barricade, remote patient assessments, among other things) and the environment you're expected to operate in is obviously quite different. A lot of it is tailoring your conventional EMS skills to the tactical theatre of operations.

The other important aspect, and this depends on how you are integrated into the tactical operation, is the actual law enforcement tactics part of it. Weapons familiarization and safety, basic team movement, defensive tactics, understanding cover and concealment and how to properly utilize each, and so on are all aspects of training some medics may have to go through if they are going to be a fully integrated member of the "stack". If the role of the medic is a less aggressive one, as in they are staged in a warm zone and will only be called up to the target location once the scene is relatively secure, then they may be able to get away with a little less tactics training, but having a knowledge of the latter is still beneficial. The other important aspect is preserving the crime scene; what you should do and shouldn't do to help preserve evidence while still providing necessary patient care.

Having the training is great, but as you pointed out, unless your local PD allows you to train with them, integrate your medical skills, and develop SOP's regarding the medic's role and operational guidelines in a tactical situation, all the training in the world won't lead to a "seamless" joint operation because the left hand won't know what the right hand is doing. Your local PD doesn't necessarily need a tactical team, because in the event of an active shooter incident it's going to be the first responding patrol officers who are going to deal with the situation. If your local PD does have a tactical team, then you have to come up with SOP's to integrate a civilian TEMS component to the team, including monthly training and operational standards/guidelines. I already discussed the LODI/LODD benefits before.

[Remember585 815]

An incident like this would be an absolute clusterf*** in Westchester. I don't care where it happens, what day and what time. Here's why;

1. There isn't a day that goes by where a unit is going Mutual Aid to someone and can't figure out the trunk radios we've had for several years now. It's a shame and it is going to have an incredibly bad result one day, I guarantee it. Communications have to be fully dependable - by everyone on every end of the system.

2. There's too much chest-pounding, our way or the highway mentality in Westchester. There's how many threads on here about redundancy of services, right? And in how many of these cases are there similar services available in the same community by more than one agency because everyone wants to one-up each other? Heck, in our stupid village we now have a "Police Rope Rescue Team" that suddenly appeared and is responding to incidents without calling the FD (you know, a service we have provided forever...) But I will digress on that. My point is that in every community with very few exceptions you can't get PD, FD and EMS to play nice at a simple minor MVA.

3. Is any kind of training to prepare for this kind of thing offered to all three of the emergency service branches? I haven't seen a course for fire officers locally... perhaps I missed it.

I give the utmost respect to all the responders and dispatchers that handled this incident in Aurora. It's something nobody can even imagine, and nobody can truly prepare for. I hope that everyone that responded or worked the radio room for this gets the counseling they are going to need. We don't need guys or gals becoming casualties themselves.

And lastly, God bless the victims. It was a bunch of people, just like all of us, that just wanted to go out and see a film. Very sad.

[JJB531 652]

Of course it would be a disaster, for all the reasons you mentioned a whole lot more. A large scale incident like this with 50+ victims would more then likely it would come down to depending on the commercial providers, especially TransCare and Empress, to send any available resources they had from both their 911 and transport divisions.

As mentioned before, there is training available, none really locally but it's out there. The problem comes back to your second point. Fire and EMS can go for all the training in the world to prepare themselves for one of these incidents, but unless they have a good working relationship with their PD, and can train together to respond to one of these incidents, you'll end up with a disaster on your hands if the bell ever rings because it won't be a seamless, joint operation. Instead it will be the PD doing their thing, while FD and EMS will be trying to do their thing without really knowing where they fit into the equation. If FD and EMS start to go operational on the inner perimeter without the PD's knowledge because they were afforded some training by a third party training organization, especially if they are volunteers showing up in "plain-clothes", it could be a nightmare, and can hinder with the PD tactical operation.

To really prepare for this type of scenario takes a lot of training, equipment, and most importantly pre-planning with all 3 agencies sitting down together and coming up with written SOP's so there are no questions about each agency's roles and responsibilities when it's time to go operational.

[helicopper 1,050]

Three steps! All it would take is three steps and we'd be on the way to improved preparedness.

1. It takes the development of a plan.

2. It requires training on the plan - not just the "planning committee", not just the "Chief" but all the folks that will be at the "big one".

3. Then it absolutely requires exercising the plan and the responders.

Not just one "big Saturday" with lots of fanfare and theatrics but frequently so that you're raising the capability of the lowest common denominator or the weakest link in the chain (whichever cliche suits you). This probably means frequent exercises for lots of different people.

Years ago the PSCIM (Public Safety Critical Incident Management Course) did exercise responders from different disciplines in a meaningful way. That go pushed to the back burner and now classroom ICS training has replaced it. The ICS classroom training is essential but not at the expense of functional training! Some say they're retooling the PSCIM course but if it includes a NIMS module and an NRF module we lost the war (now I digress).

In recent threads we've identified at least four or five different MCI scenarios - not just a mass shooting - for which we, as a whole, are inadequately prepared. What are we doing about that?

Now shall we all hold our breath for this to happen?

[LTFIREPRG 154]

First and foremost, all of the emergency responders, police, fire and ems to this horrific act of home grown terror should be commended for their ability and composure to operate under these extreme and taxing conditions, as well as the civilians who assisted.

As emergency responders we must continually train and prepare for all types of incidents that we are going to be called upon to mitigate. While this training, Standard Operating Procedures, Standard Operating Guidelines, policies and procedures will help prepare us to deal with these incidents and situations, they are never going to cover every aspect of every type incident we are going to respond to.

We must never become comfortable when responding to a call and think that we have been to this type of incident 100 times before, no sweat. Compliancy is what gets us into trouble and results in a bad outcome. No call should ever be considered routine. I can recall one of our crews getting a call that came through the PD for a report of a fire, upon arrival it was determined the call was for “shots fired”. Here you think you are responded to a fire call and you pull up right in the middle of a crime scene.

Bottom line is we need to treat each and every call as if the first time we are responded to this type of incident, keep and open mind, rely on our training, experience and policy and procedure to guide us, and most of all do not be come lazy and complacent.

My the victims, their families, all of the emergency responders and the entire City of Aurora, find peace and comfort as the deal with and move forward after this tragic event.