LAFD dramatically overhauls response to shootings

[x635 4,066]

Los Angeles fire officials are dramatically changing how rescuers respond to mass shootings after a gunman with a high-powered rifle mortally wounded a federal security officer in a shooting rampage last month at LAX.

The new goal is to have Los Angeles Fire Department paramedics and firefighters, protected by armed law enforcement teams, rapidly enter potentially dangerous areas during active shooting incidents to treat victims and get them en route to hospital trauma centers.

Read more: http://www.latimes.com/local/la-me-ems-response-20131223,0,7894044.story#ixzz2oL0foi9i

[RES24CUE 168]

This seems like a terrible idea to me. I don't know what everyone else thinks but it would seem that having more people enter an unstable environment would just create more targets for the shooter/s. I guess they went the total opposite direction from the "stage away until the scene is secure" rationale. LA does everything ass-backwards anyways...maybe they can order some salad bowl helmets that are bullet-proof to enhance scene safety.

[antiquefirelt 994]

This seems like a terrible idea to me. I don't know what everyone else thinks but it would seem that having more people enter an unstable environment would just create more targets for the shooter/s. I guess they went the total opposite direction from the "stage away until the scene is secure" rationale. LA does everything a**-backwards anyways...maybe they can order some salad bowl helmets that are bullet-proof to enhance scene safety.

You're going to see many more places move toward this. Those studying these events are able to show that many victims die while awaiting care and in most case the shooter is dead upon PD's arrival. The clearing and calling the all clear takes far too long for those wounded and bleeding. If you use "risk/benefit analysis" you'd be hard pressed to find a larger "benefit" than children's lives (school shootings) and statistically the risk is likely much lower than entering a vacant building under fire conditions.

[38ff 250]

I think it can be done, but the medical people need to be in a "grab and go" mindset. A "grab team" under LEO protection could save a lot of lives while the building is still being cleared. The initial entry team of LEO goes in, and starts clearing, while the grab team under the cover from additional LEO follows behind. They don't even need to be EMS to be on a "grab team". No doing patient evaluation/vital signs/treatment/etc... Just make contact, get them on a SKED, and get them out. Those patients that the team cant get to, the team may be able to throw a prepackaged kit of bandages to the patients so perhaps they can do self aid until the situation permits the grab team to get to them.

Edited December 24, 2013 by 38ff

[Dinosaur 844]

This seems like a terrible idea to me. I don't know what everyone else thinks but it would seem that having more people enter an unstable environment would just create more targets for the shooter/s. I guess they went the total opposite direction from the "stage away until the scene is secure" rationale. LA does everything a**-backwards anyways...maybe they can order some salad bowl helmets that are bullet-proof to enhance scene safety.

We ALL enter unstable environments every day, that's our job. We just have to manage the risks and develop procedures to limit the potential to become injured as well. Tactical medics, active shooter responses, and changes to the approach to mass shootings is not a terrible idea. It's just a sign of the times. There was once a time where they prevailing sentiment was that paramedics were a terrible idea too but that seems to have caught on.

[x635 4,066]

I don't think Paramedics, especially those who work for commercial services, are paid enough nor have good compensation should be entering this type of environment.

My safety is first, then my partner, then my gear, then my patient. If it's a dangerous situation, let the police do their job. If you're dead, you're not helping anybody. And most critical patients turn out to be a traumatic arrest, and the survival rate for that is extremely low, almost impossible to reverse.

Paramedics have enough to worry about, the focus should be on better clinical care then entering these type of environments.

[38ff 250]

What about those that aren't in traumatic arrest, but wind up bleeding out because it takes so long to get to them? Im not saying the teams go in while bullets are flying, but after a SWAT team has gone in an cleared a wing of a building, send in the grab team. No reason to wait until the whole building is cleared.

[SageVigiles 1,194]

"Risk a little to save a little, risk a lot to save a lot."

Have we forgotten that?

[tbendick 27]

And most critical patients turn out to be a traumatic arres

These would be the least critical patients or the lowest priority. In these situations we should use triage and make these black tags.

The goal is to get to the red tag patients who are bleeding out.

Also as far as just grabbing people and pulling them out, may want to rethink this. No need to pull dead people out and we should consider quick combat type bleeding control and then remove. Green Tags can be directed a safe route out and only issue would be the yellow tags. Would need to consider leaving in place if safe or use resources to remove.

Look at Boston. Most patients who were in danger of bleeding out had some form of bleeding control done, many by bystanders. No spinal immobilization just quick bleeding control and go.

[38ff 250]

100% agreed. No need to move the dead, they aren't going anywhere.. Quickly control bleeding and get them outside/hand off to EMS. Go back and get more/repeat.

[INIT915 1,119]

Look at Boston. Most patients who were in danger of bleeding out had some form of bleeding control done, many by bystanders. No spinal immobilization just quick bleeding control and go.

Great point. You're going to see more cases of average bystanders taking more risk to help their fellow man than the average trained rescuer.

[SageVigiles 1,194]

Great point. You're going to see more cases of average bystanders taking more risk to help their fellow man than the average trained rescuer.

Which gives me just the tiniest bit of hope for humanity.

[NoWestFF 21]

"My safety is first, then my partner, then my gear, then my patient."

No argument from me about the order of #1 and #2, but putting gear that can be replaced above the safety/well-being of a patient who is in your care seems backwards.

[everybodygoes 331]

These would be the least critical patients or the lowest priority. In these situations we should use triage and make these black tags.

The goal is to get to the red tag patients who are bleeding out.

Also as far as just grabbing people and pulling them out, may want to rethink this. No need to pull dead people out and we should consider quick combat type bleeding control and then remove. Green Tags can be directed a safe route out and only issue would be the yellow tags. Would need to consider leaving in place if safe or use resources to remove.

Look at Boston. Most patients who were in danger of bleeding out had some form of bleeding control done, many by bystanders. No spinal immobilization just quick bleeding control and go.

We know where you will be, listening to your 'pilot program' scanner behind cover. And unless you have forty people on your grab team you won't have an opportunity to tag patients, especially when $hits on!

[FFPCogs 863]

"Risk a little to save a little, risk a lot to save a lot."

Have we forgotten that?

Hit the nail right on the head Alex.

[SageVigiles 1,194]

Fire/EMS Department Operational Considerations and Guide for Active Shooter and Mass Casualty Incidents

Dept. of Homeland Security / Federal Emergency Management Agency / US Fire Administration

I don't think anyone has posted this yet. This is the document that's bringing about this change in strategy/tactics.

Edited December 30, 2013 by SageVigiles

[velcroMedic1987 330]

I don't think Paramedics, especially those who work for commercial services, are paid enough nor have good compensation should be entering this type of environment.

My safety is first, then my partner, then my gear, then my patient. If it's a dangerous situation, let the police do their job. If you're dead, you're not helping anybody. And most critical patients turn out to be a traumatic arrest, and the survival rate for that is extremely low, almost impossible to reverse.

Paramedics have enough to worry about, the focus should be on better clinical care then entering these type of environments.

Have you looked at the pay scale for the US Army? Paramedics may not earn enough but they earn more than a Sergeant with 6 years experience.

Unfortunately mass shootings is now part of the job. Either we get onboard and start training up for it or we will continue to be unprepared and continue to be treated like the bastard step-child of emergency services.