Presentations text content in Active Shooter – EMS Response
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Active Shooter – EMS Response
September 21, 2016
UNYAN
Membership Meeting
Butch Hoffmann, BA, EMT-P
Slide2Active Shooter (AS) definition
Provide AS behaviors
Describe AS situations - unusualProvide case studies - lessons learnedLessons learned from military combatToday’s EMS AS tactics
Today’s
Objectives
Slide3Where individual(s) is ‘actively engaged in killing or attempting to kill in a confined and populated area; in most cases, active shooters use firearms and there is no pattern or method to their selection of victims’.
Active Assailant/Hybrid Targeted Violence Incident: One or more suspects, ongoing, random or systematic spree, any weapon with the intent to inflict mass casualties
US
DHS – Active Shooter Definition
Slide4Domestic Attacker: Occurring more frequently!
American citizen
Born in another country, naturalized a U.S. citizenSelf-radicalized, no direct contact with terrorist organization‘Inspired’ by terrorist propaganda i.e. ISISNo combat experience or limited experience with weapons
Plan for other attacks
A Type of Active Shooter
Slide5Slide6Int’l Terrorist GroupExtremists
Criminal
GangsInsider – mental health, anger or revenge, political / religious beliefs, notorietyOther Types of AS Attackers
Slide7Commerce & Educational environments (~ 70%)City streetsMilitary & Governmental properties
Private residences
House of worshipSporting eventsHealth Care FacilitiesTargets of Opportunity
Slide8Columbine High School, Colorado – April, 1999Traditional Police Response
Perimeter Secured
45 minutes for SWAT to enter13 victims shot and killed during SWAT mobilizationShooters committed suicide upon police entryStaged EMSSWAT to clear school before EMS entryOne teacher died of hemorrhage. Preventable?
Case Study
Slide9Nationwide LE changed their AS SOPs
- First few officers form a response team - Don’t wait for command level decisions - Engage the subject(s)Following Columbine, 1999
Slide1015% of deaths in conventional combat are potentially preventable, COL Ron Bellmany, Vietnam War 1967 -1969
Most common preventable causes of deaths
ExsanguinationTension pneumothoraxAirway obstruction Tactical Combat Casualty Care (TCCC) developed
Military Data:
Slide11Virginia Tech, Norris Hall – April, 20099:40 Shooting begins
9:50 ERTs with 2 SWAT Medics enter Norris Hall
SWAT medics use TCCC Use multiple chest valves & tourniquets - saved lives 32 killed, 17 wounded, 6 inj’d from falling from windows
Rapid police entry forced action of shooter
Quick EMS presence saved lives
How many AS incidents are occurring annually in the U.S.? 6.4, 16.4, or 20.3
Case Study
Slide12http://www.policeforum.org/assets/docs/Critical_Issues_Series/the%20police%20response%20to%20active%20shooter%20incidents%202014.pdf
Slide13Cinemark Century 16, Aurora, CO – July, 2012
12:30am Shooter releases tear gas first, then shooting begins
- 12 killed, 58 wounded - No adequate access route for EMS - LE transports victims to local hospital - No triage tags, lack of staging
- No Unified CP during first hour
- AAR: LE needs medical care training
Case Study
Slide14FBI, NAEMT, IAFC, ACS & the Military produced
Hartford Consensus: a nat’l strategy to enhance the survival rates in mass casualty shootingsPast practices of LE, Fire and EMS were not optimally aligned to maximize victim survivalRapid EMS entry integrated with LE would save lives
Use military’s TCCC concept; by introducing a
civilian version
Utilize
Rescue Task Force
(RTF) concept
After Sandy Hook, Conn. – Dec. 2012
http://www.policeforum.org/assets/docs/Critical_Issues_Series/the%20police%20response%20to%20active%20shooter%20incidents%202014.pdf
http://www.policeforum.org/assets/docs/Critical_Issues_Series/the%20police%20response%20to%20active%20shooter%20incidents%202014.pdf
Slide15Critical Strategic Responses: ‘THREAT’ Principle
T = threat suppression
H = hemorrhage control RE = rapid extrication A = assessment by EMS providers T = transport to definitive care
Hartford Consensus (cont’d)
Slide16Tactical Emergency Casualty Care (TECC), civilian version of TCCC guidelinesDirect Threat Care: care under fire, LE only, hot zone
Indirect Threat Care: care with cover under relative safety, warm zone
Casualty Collection Points: casualties assembled for treatment & transportation Evacuation Care: transitional EMS care
First Line EMS Providers
Slide17Slide18Contact Entry Team - LE OnlyInitial rapid police entry
Stop the bad guy
Bypass victimsRescue Task Force (RTF)LE escorting EMS/Fire/RescueLocate, stabilize, remove victimsMaintain situational awareness
Tactical Emergency Casualty Care
Slide19Key Rapid EMS/Fire Interventions
- open airway
- tourniquet application - hemostatic gauze, pressure dressings - chest seal - chest decompression - triage tag applied
- apply portable patient carrying device, i.e. extrication
straps, man-sack, Sked, reeves, backboard, etc.
Rescue Task Force
Slide20ProRapid patient contact
Saves lives
ConEMS RiskLack of Equipment and TrainingLack of familiarity with LE tactics and movement* Agency’s value judgment to acceptable risks
Rescue Task Force
Slide21- local, regional LE - jurisdictional & county EMS agencies
- local Fire/Rescue agencies
- local/regional EM - local 911/PSAP/dispatch/communication agencies - neighboring jurisdictions providing mutual aid - local school officials - major public venue reps: shopping malls, stadiums, entertainment, private industry
Conduct multi-agency planning committee mtgs:
Slide22Education
Training – hands on skill development
Tabletop exerciseFull-scale exerciseTrain regularly
Multi-agency Planning cont’d
Slide23Gas munitionsFire alarms, sprinklersSmells, smoke
Victims screaming
Death Destruction, structural collapseDetonations/gunshotsDarkness, confusionAS Training: Warm Zone Stressors
Slide24Establish CP, delineate safe zones, cover vs concealmentStress keep access paths open for EMS
Establish multiple CCP/triage/transportation areas
Consider tactical physician at sceneConsider ‘cleanup/hydration’ stationCISM, EMS staffing at FACs All RTF EMS personnel are trained & have exercised in AS scenariosMaintain integrity of crime scene
AS Training/Planning
Slide25LE early representation in formal incident CPBuilding side nomenclature, common terminology
Consider towing or pushing civilian vehicles out of way
Familiarization with other jurisdiction’s schoolsLessons Learned From AS Exercises
Slide26TrainingDHSES State Preparedness Training Center (SPTC)
www.dhses.ny.gov/sptc Advanced Active Shooter Scenario (A2S2) www.fema.gov
www.dhs.gov
AS Booklet: How to Respond
www.usfa.fema.gov
Fire/EMS Department Operational Considerations & Guidelines for AS & MCI
FEMA IS 253
Resources:
Slide27Kennesaw, GA; Washington, DC Navy YardNewtown, Connecticut; Omaha, Nebraska
Columbine, Colorado; Tucson, Arizona
Binghamton, NY; Brookfield, WisconsinForth Worth, Texas; Salt Lake City, UtahBlacksburg, Virginia; Boston, MAAurora, Colorado; Manchester, IllinoisSan Bernardino, CA; Orlando, Florida
JUST HAPPENED AGAIN……
“IT COULD NEVER HAPPEN HERE”
Slide28Thank you
Questions???
butch.hoffmann@aol.com
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Active Shooter – EMS Response
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