Rapid Response and Treatment Model R2TM for Active Shooter Incidents Operational Detail v30 About FSF The Firefighters Support Foundation is a 501c3 nonprofit organization whose primary mission is to develop produce and distribute training programs to firefighters and first res ID: 675842
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Firefighters Support Foundation
Rapid Response and Treatment Model (R2TM) for Active Shooter Incidents--------Operational Detailv3.0Slide2
About FSFThe Firefighters Support Foundation is a 501c3 non-profit organization whose primary mission is to develop, produce and distribute training programs to firefighters and first responders. All of our programs are distributed free of charge.
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Permission
Permission is granted to reproduce or distribute this material so long as the Firefighters Support Foundation is credited as the source3R2TM - Operational DetailSlide4
Accompanying VideoThis PowerPoint presentation accompanies the video presentation of the same title.
This program is a follow-on program to our introductory program on the R2TM (Rapid Response & Treatment Model) active shooter response model, titled: Active Shooter: the Rapid Treatment Model (note the name change of the model). We encourage you to view the earlier program first because familiarity with the basic elements of the R2TM is assumed in this program.4R2TM - Operational DetailSlide5
PresentersJeff Gurske is an Engineer and Acting Lieutenant in the Portland metro area. Jeff is a training contractor/consultant, contributing author and adjunct college instructor. Craig Allen is serves as Training Sergeant in the Portland metro area. Craig holds numerous instructor certifications in firearms, defensive tactics, less lethal weapons and other tactical subjects.
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Lots of good work being done nationallyStill a long way to goHow do we integrate?What impacts does this integration have on training, protocol and sustainability?
Integration of Public Safety
Welcome
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R2TM - Operational DetailSlide7
2007 – 2013 Highest numbers of incidents2014 – On track for a record setting year Historically these events have taken > 12 min
2010 - 2014 90% under 5 minutes Rumors of a 2nd shooter usually high
Time & Intensity
What We Know
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Public safety response not integratedCondition of our SOPs or SOGsTradition and culture
Incident Friction8R2TM - Operational DetailSlide9
The PrinciplesHot Zone: Exclusion Warm Zone: ReductionCold Zone: Support
The Problem:#1 most common A.A. itemCauses a progress friction point Fire/EMS is waiting for the “all clear”Zone Response9R2TM - Operational DetailSlide10
Level I Trauma Hospital14 years: 1996-200919,167 casesBlunt and penetrating traumaResults found:
Increased mortality rate with scene times ≥ 20 minTrauma StudyOrange County, CA McCoy CE, Menchine M, Sampson S, Anderson C, Kahn C. et al. Emergency medical services out-of-hospital scene and transport times and their association with mortality in trauma patients to urban Level 1 trauma center. Ann Emerg Med. 2013 Feb;61(2):167-7410R2TM - Operational DetailSlide11
Data driven answers:Mitigate the threat / saving life on the front endThe life-saving timeline continues
Mitigate time loss / saving life on the back end Meaningful integration has the best chance to impact life-saving across the spectrum Law Enforcement Goal11R2TM - Operational DetailSlide12
Data driven answers:Access patient as quickly as possibleAddress critical-fixable injuries
Get patient to definitive medical care ASAPEMS Goal12R2TM - Operational DetailSlide13
Engineer the Response
You may be able to use your current resources to operate efficientlyDo not be distracted by tacticsTactics require a functional system to be effectiveEngineer your response to workEmbed a “Warm Zone”13R2TM - Operational DetailSlide14
Friction Psychological
Physiological EnvironmentallyUncertainty Remedy ExperienceTraining
Nature of Conflict
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A combined effort putting the caregiver at the patient’s side within minutes of wounding to maximize life saving
Agency expertiseClearly defined rolesFamiliarity Simplicity Unification of CommandSystemic Problem-Solving15R2TM - Operational DetailSlide16
“Everything in war is simple,
but the simplest thing is difficult.The difficulties accumulate and end by producing a kind of friction that is inconceivable unless one has experienced war.”Carl Von ClausewitzR2TM Response16R2TM - Operational DetailSlide17
3 Tenets:Rapid LE responseEMS securely introduced into a warm zoneRapid treatment and transport of the victims
Keep closest to normal SOPsR2TM Foundation17R2TM - Operational DetailSlide18
R2TM LE OverviewR2TM - Operational Detail18
ResponseRapid Response Tactics Threat mitigationInitiate Sergeant / Battalion Chief link-up AssessmentEstablish foothold (FOB)Identify Casualty Collection Point (CCP) SecurityInternal / External security Police bring wounded to CCP
Introduction of Fire EMSSlide19
R2TM Fire/EMS OverviewR2TM - Operational Detail19
StageOut of line of sightPrepare for response entryLink-UpEstablish Unified CommandSecurity escortEnter Warm ZoneBegin MCI protocolsSlide20
Immediate introduction of LE assetsMove quickly to last known area of suspect / verification?Understand “sweeps”
vs. “clears”What are immediate threat indicators?FOB’s can be useful LE Response20R2TM - Operational DetailSlide21
Does not require 100% confirmation of suspect locationFled, Dead, CapturedOnce Immediate threat indicators have lapsed, transition to victim assessment / retrievalCan continue sweep operations and CCP identification
Threat Mitigation21R2TM - Operational DetailSlide22
Brings stabilization to operationsProvides for dual operationsAids UC and 9-1-1 point of contact on interiorIncreases efficiency of interior sweepsAids with decentralized tactics
FOB Purpose22R2TM - Operational DetailSlide23
When immediate threat indicators have subsidedLE lockdown hallways, architectural features, large geographical areasSets the stage for victim transfer Minimal resource allocation can have significant impact
Corridor lockdown builds on itself Aids in scene stabilization Corridor Lockdown23R2TM - Operational DetailSlide24
Paramount!Needs to be physical is design Sgt / BC idealFire Understands / Police need to embrace and execute Only one location for UCDon
’t view UC as a monolithic entityUnification of Commands24R2TM - Operational DetailSlide25
Efficient prioritization
Centralized locationSimple Concept ManageabilityLow costEnhanced Security“Quick Connect”BenefitsCasualty Collection Point 25R2TM - Operational DetailSlide26
Provides a bridge between police and fireAllows for simultaneous operationsProven military tactic for categorizationMinimal UC Command & ControlCan have multiple CCPs if necessary and aids in incident controlUse caution on adding unnecessary layers of ops
Casualty Collection Point26R2TM - Operational DetailSlide27
Law Enforcement Identifies Fire Establishes Not necessarily victim dependent Ease of vehicle access / transport priority
Ability to Secure Adequate SpaceShould be located on the interior Can establish CCP with barricade / hostageCCP LocationKey Elements 27R2TM - Operational DetailSlide28
Make a clean workspaceIdentifiable treatment zonesReduce the desire to over complicate the MCIi.e. Internal triage zone to external treatment zoneOnly essential personnel“
Greens” and other non-injured: elsewhere“Scoop and Run” vs. “Stay and Play”Casualty Collection Point 28R2TM - Operational DetailSlide29
Limited to rapid and easy interventioni.e. TourniquetsFollow TECC recommendationsVictims transferred to CCP via LEHasty field triageGet critical patients to EMS first
Having LE transfer victims to the CCP is resource driven and supported by the 9 principles of warfareHot Zone Medical Care29R2TM - Operational DetailSlide30
Extremely effective to combat extremity bleedingEasy to train and inexpensiveStudies indicate upwards of 90% associated survival rateTourniquet Use
Kragh JF, Walters TJ, Baer DG, et al. Survival with emergency tourniquet use to stop bleeding in major limb trauma. Annals of Surgery. 2009;249: 1-7.30R2TM - Operational DetailSlide31
Stage resources out of line of sightLimit first responding fire/EMS resourcesReconnaissance; Pave the pathTake only needed equipment to get the job done
Prepare for Entry31R2TM - Operational DetailSlide32
Request link-up over interoperable channelLocation to be out of hazard zoneCapable membersFire: officer, BC, Chief; LE: Sgt, Lt., CommanderShould be physicalCautious of non-physical link up
Simplify the ICS structureCommand Link-Up32R2TM - Operational DetailSlide33
Must have radio interoperability Ability to talk and listenCritical for intelligence, integration and safety LE and Fire/EMS should conduct entity specific operations on separate channels/frequenciesDo not impede critical operations
Use short succinct communicationsCommunications Plan33
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Apparatus Security EscortOn EngineNFPA Guidelines OverwatchCCP Security
Components of Fire Security34R2TM - Operational DetailSlide35
Will your triage method hamper time?Triaged patients may shift categories on youFix major problemsTECC guidelinesPHTLSWork trauma codes?
Monitor available medical resourcesMCI Operations35R2TM - Operational DetailSlide36
Increase victim scene timesIncreases total out-of-hospital timeRequires more resourcesCreates damage
Interference with Transport
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Do not shift the MCI to another locationRefrain from blind transport (last resort only)Assign someone to communicate with receiving facilitiesExample: Medical Resource HospitalDocument as much patient info as practicalUse technology
Destination Etiquette37R2TM - Operational DetailSlide38
Stop further harm from occurringWhat is the weather?Keep in doors if appropriateNo return: 32*C / 89.6*FNeed for decontamination?
Environmental Concerns38R2TM - Operational DetailSlide39
Create a response that your jurisdictions can use on a daily basisi.e. Assault Make sure your neighbors can plug inKeep it simple and highly functionalTrain on a reoccurring basisAll hands on deck
This is a “three legged race” Commit to the Response39R2TM - Operational DetailSlide40
More infoCraig Allen craigallenasrt@gmail.comJeff Gurskejbgurske@gmail.com
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