Active Shooter Incidents

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Permalink Reply by Wayne M. Zygowicz on July 20, 2012 at 4:48pm

People of Colorado are again shocked devastated by yet another mass shooting in our beautiful state. Our hearts go out to the victims and their families. Our thoughts and prayers are with them and the first responders who experienced this senseless act of violence in our Colorado community. Below are some lesson Littleton Fire Rescue learned from the 1999 Columbine High School shootings.

Tactical decisions made by first-arriving responders in the early minutes of any large-scale incident must be flexible, and multiple incident action plans (IAPs) should quickly be developed and revised as more information becomes available. Early information is usually unclear and often conflicting.
Unified incident command should be set up immediately on arrival of any multi-agency response to control freelancing and coordinate rescue and mitigation efforts. Incident commanders should establish primary and secondary staging areas early into the incident to control the flow of resources into the scene.

Communications is the key to success or failure in most large-scale incidents. Communications and channel assignments can pose problems in a multiple-agency incident unless a regional communication plan has been developed and tested to ensure interagency compatibility.
MCIs can easily overwhelm responders who are untrained and unprepared, potentially costing lives. Preplanning, MCI tabletop exercises, use of color-coded command vests and practical drills can reduce confusion during a real incident. MCI training builds a foundation for how responders will perform at a real incident, and drills will reveal flaws in your agency’s Incident Action Plan (IAP) or standard operating procedures.

Acts of random violence will continue to occur in schools, malls, churches and other public venues across the United States. Emergency responders may find themselves in the crosshairs of perpetrators or terrorists, as they did at Columbine. Shortly after Columbine, Littleton Fire Rescue (LFR) developed a Tactical Emergency Medical Support team. Fifteen tactically trained and outfitted LFR paramedics, trained by the Department of Defense, now deploy with local SWAT teams to provide medical support to each SWAT mission and humanitarian aid to victims of violent crime.

After the dust settles in the aftermath of these incidents are communities in shock and grief stricken. First responders can experience post-traumatic stress for years to come. Some may leave the service. This is where true leadership steps in. Take care of your responders and their families. Reach out to others who have gone through this type of incident and trauma for advice and direction. There are no roadmaps but people care. We are here for you!
Wayne Zygowicz, EMS Chief – Littleton Fire Rescue – Littleton, Colorado

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Permalink Reply by Jennifer Berry on July 20, 2012 at 5:15pm

JEMS Medical Editor Edward T. Dickinson, MD, NREMT-P, FACEP, provided us with his top 5 tips for coordinating your preplanning efforts with area hospitals:

1. Do early notification to hospitals, including non trauma centers, to be able to mobilize internal resources.

2. Roll-call hospitals to see how many critical and non-critical patients each can take.

3. Activate hospital MCI/external disaster protocol early.

4. Remember that hospital security and pastoral care involvement is critical.

5. Prepare for press onslaught with an identified hospital public information officer (PIO).

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Permalink Reply by Fred W Wurster III on July 20, 2012 at 10:24pm

Active shooter incidents are extremely unique in many ways. First, they really don't happen every day and training for them is like training for an earthquake, you may spend a lifetime training and never have to respond to an event. Secondly, the question comes into play of have you and your crews been trained in an active shooter incident. Many EMS agencies are more engaged with police/SWAT/ERT units than ever before. If you are part of one of these teams you most likely have the protective gear and have trainined for these types of incidents, but what do you do when it come to the real deal?

Police responses to active shooter inicident are designed to do one thing only, eliminate the threat as quickly as possible so that lives can be saved. It is down and dirty, in that, normally 3-4 officers will move in to the area immediately upon arrival and work as a cohesive unit to begin to search for the active shooter. Sometimes there are models that ask for an EMS Provoder that is willing to go with them and either stay at the last point or area that is secure or some may actually place the EMS provided in the center of the 3-4 officers. Some may say what about scene safety and the me first concept, as is impregnated into our minds from the first EMS class we attended. Yes, scene safety is and must always be number 1.

So with all that said, what do you do if you are presented with an drive shooter incident? You do what you have been trainined to do, that's what....thinking about scene safety, triage, additional resources, evacuations/shelter in place, rehab , staging, and the list goes on. If you are trained and are ready to respond as part of a tactical police element, than do that. Most of all know that when responding to these incidents, it will most likely be a life changing event for not only you but so many others!

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Permalink Reply by Travis Kusman on July 21, 2012 at 6:32am

The importance and value of utilizing the Incident Command System (ICS) as the framework to ensure efficient and effective EMS response to a Multi-Casualty Incident (MCI) can not be overstated.  Ensuring scene safety,  conducting and reporting a scene size-up as well as determining the need for and requesting appropriate types and quantities of additional resources are key priorities for first responding units. Controlling the response of the requested supplemental resources including staging and assigning these resources as appropriate is essential. 

The implementation of Triage (utilizing the Simple Triage and Rapid Treatment "START" method), Treatment and Transport Units within the ICS structure early in the MCI response evolution is essential.  Establishing communication with receiving hospitals for notification and capacity determination relative to receiving patients from the MCI should occur at the earliest opportunity.  Rember and give due consideration to the fact that some patients from the incident are likely to bypass the EMS response in seeking medical care, arriving at receiving hospitals via various other transportation means.  

Ensuring that EMS, fire, law enforcement and other essential responder types and agencies work as a team to save lives within the context of a complex MCI is imperative and facilitated through the implementation of Unified Command.  Effective communication amongst all responding parties is tremendously beneficial in assuring clarity of expectations and accountabiltiy relative to actions associated with the overall management of the MCI.  Remember that in many cases there is simply no substitute for the value of face-to-face communication, particularly when dealing with complex situations of human need. 

Because MCI's are fluid in nature, evaluating incident needs as well as adjusting priorities and actions accordingly must occur continuously. This includes reassessment of overall scene and responder safety to ensure that as EMS responders we do not ourselves become patients.  

Unfortunately acts of violence threatening and taking innocent lives such as the recent active shooter events  in Aurora, Oakland and Tucson will continue to occur. As first responders, it is incumbent upon us to be prepared to safely and effectively respond to these types of incidents and preserve life to the best of our ability.  To do so requires preplanning, exercising, continual learning and collaboration across the first responder community.

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