Active Shooter – EMS Response

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September 21, 2016. UNYAN . Membership Meeting. Butch Hoffmann, BA, EMT-P. Active Shooter (AS) definition. Provide AS behaviors. Describe AS situations - unusual. Provide case studies - lessons learned. ID: 653028 Download Presentation

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Active Shooter – EMS Response

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Active Shooter – EMS Response

September 21, 2016


Membership Meeting

Butch Hoffmann, BA, EMT-P


Active Shooter (AS) definition

Provide AS behaviors

Describe AS situations - unusualProvide case studies - lessons learnedLessons learned from military combatToday’s EMS AS tactics




Where 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


DHS – Active Shooter Definition


Domestic 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



Int’l Terrorist GroupExtremists


GangsInsider – mental health, anger or revenge, political / religious beliefs, notorietyOther Types of AS Attackers


Commerce & Educational environments (~ 70%)City streetsMilitary & Governmental properties

Private residences

House of worshipSporting eventsHealth Care FacilitiesTargets of Opportunity


Columbine 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


Nationwide 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


15% 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:


Virginia 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



Cinemark 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


FBI, 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


Rescue Task Force

(RTF) concept

After Sandy Hook, Conn. – Dec. 2012


Critical 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)


Tactical 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



Contact 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


Key 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


ProRapid 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


- 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:



Training – hands on skill development

Tabletop exerciseFull-scale exerciseTrain regularly

Multi-agency Planning cont’d


Gas munitionsFire alarms, sprinklersSmells, smoke

Victims screaming

Death Destruction, structural collapseDetonations/gunshotsDarkness, confusionAS Training: Warm Zone Stressors


Establish 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


LE 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


TrainingDHSES State Preparedness Training Center (SPTC) Advanced Active Shooter Scenario (A2S2)

AS Booklet: How to Respond

Fire/EMS Department Operational Considerations & Guidelines for AS & MCI




Kennesaw, 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




Thank you





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