Are your community's law enforcement and EMS agencies prepared to work together effectively in the event of a "rapid mass murder" attempt?

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Permalink Reply by Val Bilotti on January 9, 2013 at 10:11pm

I did not take it as confrontational at all. No harm.

 

Skip, That was my intent, Thank you.

 

In my evaluations of EMS, FIRE and LE across the county, I have found that they all come together in their own way. They integrate with in their (EMS, Fire, LE) comfort zones. Some agencies have been integrated for a long time and have earn each other’s trust in these high risk situation and have integrated EMS into their SWAT training. I think each individual needs to evaluate their own comfort level in putting themselves in potential life threating situations. I do not think everyone is cut to go in when everyone else is running out. I have known young hard chargers pull back and hang up their body armor after their first child was born. Their priorities changed...

 

Regarding this question: "Are you saying that a law enforcement officer is skilled and well practiced in the art of trauma care?" The answer is yes, they can be, if we support their interest. I work with a paramedic (he was this before he went into law enforcement) that is a deputy. He maintains his practical by working at a trauma center, the infirmary at the jail and as a SWAT medic....He is a boss in my book! I know another guy who is a medic in the guard and a deputy; he too is very comfortable with trauma.

 I am seeing many military service members entering the academy. When I have them in my classes they are a wealth of combat medical experience. They have saved and lost comrades in many tours. They continue to fight the fight on the homeland. They too would be a great medical asset.

Lastly, The increase in training in the academy, CPT, SWAT, HRW’s is increasing and becoming expected. Hot zone medicine is BLS…nothing fancy. The LE I know are making efforts to help bridge the gap between EMS/FIRE and LE in MCI/Terrorist/Active Shooter/Hostage situations.

I believe that it is this work on both sides of the fence that will benefit all lives on the line.

Just my humble opinion.

 

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Permalink Reply by Skip Kirkwood on January 10, 2013 at 8:13am

Here's an issue.  My perspective - I'm a systems guy.  We protect communities.

You can't build policy, procedure, or practice based on "one guy" scenarios.  That guy is never on duty when you need him (or her).  You have to build systems, and their policies, procedures, and practices, based on stuff that EVERYBODY is trained and expected to do.  It's why you can't wait for the SWAT team to deal with an active shooter - and you can't wait for the SWAT medic to deal with the guy who's bleeding out in what used to be the hot zone (and is now maybe still a little warm).  In both cases, if you wait, people die.

We need to integrate, train, build capability at the agency and system level if we're going to be able to respond well each and every time.

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Permalink Reply by Nathan on January 11, 2013 at 8:42pm

Val,

I agree that the ex-combat lifesaver trained soldier is a huge asset to a LEO team.  If every LEO is trained and experienced to the BLS level then thats a little different than one guy here and there. I would argue however that he will not surpass the efficiency and skill that a practicing (daily) EMT level provider will.  I would agree with you that most if not all trauma care in the hot zone is BLS which is why I said EMT above.  But if you take that average EMT and raise the education to the Paramedic level how much better/faster/more experienced would you expect the operator to be?  

Im thinking of it this way, I am having a heart attack.  Do I want the cardiologist taking care of me or the family doctor from the doc in the box taking care of me?   Personally if I could choose I'd take the specialist.  Does the family doc know what having a heart attack means and how to give me some aspirin and nitro?  Sure.  But does he know the latest methods for caring for a heart attack patient? Is he proficient at reading 12leads? Can he anticipate the possible reactions to any and all of the interventions he chooses to perform?  Does he know what the local hospitals are capable of and exactly which one has the best capabilities?  Finally, Is he experienced with taking care of active MI patients?  The answer to all of those is probably not....

For me this translates easily to our arena.  Yes trauma is significantly simpler than medical.  Yes that combat life saver trained ex soldier has the basics covered and they knew the way things were done when they were in the military training and practicing often.  I would assume (maybe Im wrong) that he isnt as skilled as the Paramedic you could have on your team if you took the time to train practice and plan with your local EMS agency.  I never turn down the offer for help!  More hands are usually a good thing!   Besides wouldnt you rather be able to focus your LEO portion of the team on stopping the threat?  Let the EMS crew wearing vests and maybe accompanied by one of your guys BLS maybe ALS (depending on what ALS means at the local level and depending on the scope of the incident, thats where the Paramedic REALLY comes in) and extract victims ASAP.

Its good that you're seeing a trend toward working together in all the fields.  I know we are a bunch of type A personalities and sometimes there is tension but thats sad and I would like to see the tension go away from between the agencies.  There's always going to be some ribbing but as long as no one takes it personal on either side.... I would hate for the opportunity for lives to be saved to be missed over some simple personality conflicts!  

 Maybe not all Paramedics feel the way I do but I would say thats just an education/training/exposure thing that I think could be fixed.

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Permalink Reply by Val Bilotti on January 11, 2013 at 9:42pm

At Skip, I love what you said regarding EVERYBODY. I believe in the process and not on "one guy" I was asked a specific question and gave an example of validation. Although every unit, team, agency has their ringers, there has to be a consistent level of training and I keep raising the bar in my agency. It takes time but I will take every two steps forward, one step back I can get. That is still moving forward in my book.

 

At Nathan, EVERY LEO in our agency/ and Academy have a basic tactical medicine class in addition to their regular Title 22 Basic First and CPR PRO class. EVERY patrol officer is issued a TQ and instructed on its use.

A challenge regarding some Tactical Medics and SRU/SWAT teams I have encountered, is the medic in the stack? Do they go in on entry, Are they a secondary element? Are they a shooter? They have to LE to function in these roles because of the protection of color. Are they willing to take on that role.. it  is not a light one? Are they a shooter or a medic first is the question of the LE/EMT? Are the medical assets going to stage till the medic gets the all clear/secure/code 4? These are totally difference roles, risk and responsibilities.

 

Some departments do not have large agencies to provide security for EMS/FIRE...QUOTE: They train up or people have to wait. (period)(LEO, small department)  Sad, but true statement for them.

 

The issue of licensing a LE/paramedic is cost prohibited for almost all agencies that is why the increased collaboration with fire medics. They are finding the fix, working the problem. I say good for them.

If you know of a Law enforcement department that has LE/Paramedics I would love to know the agency. I would be interested in talking to them about how they do business.

You asked if the LEO should focus on the threat. Absolutely, FIRST order of business! There is no medicine with an active treat. (Except self-aid.)

What about the priority of life? Where does LE stand? Where does EMS/FIRE stand? I found there is a huge divide here. Love to hear from the group on this one. IMHO

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Permalink Reply by Skip Kirkwood on January 11, 2013 at 10:36pm

There is another issue associated with "licensing LE/paramedic."  If a medic is needed to care for a team member in a tactical situation, that officer needs a very good, very experienced medic.  Those agencies that send a LEO to school, to get a paramedic license, has -- a rookie paramedic, who has little chance to move beyond rookie skills and experience.  Unless that medic invests 4-7 full time years in mastering their medic skills, they are not the right medic for the job.

As far as "priority of life," all the LE agencies that I have served with, either as an officer or as a medic, were focused on preservation of life above all else - the same as the EMS agencies.  Their tools and techniques may be different than those of us who work out of an ambulance or EMS QRV, but preservation of life is the priority.

Agencies that have LE/paramedics?  FBI, DEA, ATF, USSS, US Park Police; there is a formal EMS unit within the DHS Border Patrol (BORSTAR - http://www.cbp.gov/linkhandler/cgov/newsroom/fact_sheets/border/bor...) that is fully staffed by LEOs.  National Park Service LE Rangers include quite a few paramedics.   Those are ones that do it formally.  There are a ton more that have one or more experienced paramedics who have become LEOs (I can think of Oregon State Police, NC Highway Patrol and NC SBI, Marion County (FL) SO), and of course the medics within NYPD Emergency Services Unit.  I had a friend (an RN, MSN, EMT-P) who was an Alaska State Trooper, later a Vancouver (WA) police officer and SWAT dude.  Another friend, paramedic and EMS chief officer, got a graduate degree in forensic psychology, joined the USSS, and is enjoying a great career.  In fact, because EMS agencies generally afford limited career opportunities, the LE world is a great place for a medic to move both laterally and vertically, while doing what they love (taking care of sick and injured) while remaining in the public safety community.

If you're lucky, one of those guys will be one of the first responding LEOs to a rapid mass murder situation.  If not, my HO is that we have to get members of the EMS community ready to do what needs to be done with an appropriate and reasonable level of safety.

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Permalink Reply by dr-exmedic on January 12, 2013 at 9:52am

Skip Kirkwood said:

ready to do what needs to be done with an appropriate and reasonable level of safety.

And that's the clincher. We've got to get out of the mindset that our scene needs to be totally safe--in part, because our day-to-day scenes aren't (as already noted). I ran into a medic just the other day who was saying that "if I need to be wearing the ballistic vest, I shouldn't be in there." 

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Permalink Reply by Skip Kirkwood on January 12, 2013 at 10:06am

My latest rant - "safe" is not a binary, either/or concept.  It's all relative.  And it's not about what you know before the call (that's too easy) - it's about what develops after you are there.

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Permalink Reply by Nathan on January 12, 2013 at 10:33am

Val,

As Skip mentioned one agency is the NPS.  I just worked in Yellowstone for the summer in the Old Faithful district.  There were 5 full time Rangers stationed there 2 of them were Paramedics.  The NPS is a different animal though...  Jack of all trades....  LE/FIRE/EMS.  

 I know its expensive and even impractical to have LEOs trained as Paramedics.  Thats not what Im advocating.  Im advocating for each Ambulance to have vests, training, and an aid backpack for them to make entry with the initial arriving officers.  WE CAN'T WAIT for SWAT.  Columbine showed that.  The LE side got the message and now first arriving officers make entry immediately   How long until EMS catches up and realizes we too need to make entry ASAP to save lives.  Im advocating for each EMS crew to have the training to know how to as safely as possible make entry when reasonable and start treating and removing patients.   I want to see the report on the Aurora and the Sandy Hook incidents.  How long from EMS arrival to first patient contact?

Exactly. Its relative and subjective.  Its going to be different for everyone.  "BSI,Scene Safe.."  Needs to go away.  Yes be alert and trust your 6th sense.  Dont just stand there and wait for someone to hold your hand and tell you its all going to be ok and its safe for you to go in...  Its life.  Go watch the Forest Gump movie.  Even Hollywood gets it. "Sh** Happens."   Thats never going to change. We need to adapt and overcome.  My opinion...  It may change as I get older...

Skip Kirkwood said:

My latest rant - "safe" is not a binary, either/or concept.  It's all relative.  And it's not about what you know before the call (that's too easy) - it's about what develops after you are there.

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Permalink Reply by Skip Kirkwood on January 12, 2013 at 10:57am

Our SAS Bag (shooting and stabbing) bag is the only piece of equipment required to be "taken in" on shooting and stabbing calls.  It's a small backpack containing the following:

TOP COMPARTMENT

2 – OLEAS BANDAGE

2 – CAT TOURNIQUET

 

CENTER

1 – BVM WITH ADULT MASK

1 – CHILD MASK

1 – MEGAMOVER (folding cloth stretcher)

 

FLAP

1 – SCISSORS

1 – PENLIGHT

5 – 4X4

1 – ADAPTIC 3x9

1 – TAPE 2”

1 – EMERGENCY CHEM STICK

1 – EMERGENCY WHISTLE

1 – IV CATH 14ga. 3.25in.

1 – NASAL AIRWAY 28fr.

1 – KY Jelly pack

10 – TRIAGE TAGS

2 – 4” ACE WRAP

The purpose is to provide immediate treatment only, followed by rapid evacuation.  If more is required, a casualty collection point will be established and additional material moved to that point.

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Permalink Reply by The Cannulator on January 12, 2013 at 7:22pm

It is actually the combat lifesavers and the equivalent in each countries defence force that are saving lives Nathan. The TCCC level of training for ALL deployed personnel is what works. 

Basic wound and haemorrhage management, airway care and evacuation. That's it.

To extrapolate that, Police (or whomever somehow believes they are police in your community) can provide basic triage and if needed BASIC first aid; train your police for that.

I think it's pretty insulting to assume that I am some sort of mental retard because I want a scene with a reduced threat before I send my colleagues in..That choice that individuals or agencies make is not ill-informed but is their own risk management system making what they think is the best solution. Many in our case is a more than likely a  Police decision; they own the scene. Not us. You can't make blanket assumption that following police into a scene is the way for every scenario. Knowing that some are just not worth the risk to providers.

With the concept that for every inured, it takes two to get them out. What happens when you do stop? Does the who team stop while you play instead of going for the shooter? Why hold up eliminating the threat so your conscience can be clear?

To think that somehow your Spidey Senses are going to protect you is ill-concieved.

It's quite simple. If paramedics don't want to go in then they don't. Quite a few went into the two towers too. Not to sully their memories, but to some extent many look at the fact externally, the desire to save lives over their own cost lives.

I'm CBRN trained. An instructor. If I move in with the FD and PD it's because I'm trained. Most threats are mitigated, because I carry my own protection. I wouldn't just throw some BA on an untrained colleague and say "She'll be right mate, follow me". I expect each of my team members to know what they are doing. Not to hold their hand, to coin a phrase, not to carry a lesser trained individual through.

I don't undertake the role because I don't want to see people die, I undertake the role because I can do it with the right equipment and training safely.

I am beginning to think that some who want to follow police through a scene clearing are the same one's who thought "If only I was there in that theatre with my six shooter......"

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Permalink Reply by The Cannulator on January 12, 2013 at 7:51pm

I do like the kit Skip. 

Do you use the OLEAS instead of the Israeli Trauma Dressing for a particular reason?

Is the plastic sheet one of them? I notice the absence of something like an Asherman seal.

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Permalink Reply by Skip Kirkwood on January 12, 2013 at 8:45pm

Actually the case of the OLEAS seems to work quite well as a seal - I think that's why our guys picked it.  There's also plastic casing on some of the trauma dressings that can be used for a valve.  Because of our location, we have some good access to the guys at the Special Forces Medical Sergeant's Schoolhouse at Fort Bragg - our advice comes from there.

I think it's pretty insulting to assume that I am some sort of mental retard because I want a scene with a reduced threat before I send my colleagues in.  I don't think anyone suggested anything about your mentality - I didn't even know that you were in the discussion.  EVERYBODY agrees to exactly what you said - "reduced threat" - which is different than no threat whatsoever.  Once the first LE suppression team has gone toward the shooter (and an expected interval has passed, and communications has established that there are wounded to the rear of the suppression team), then the threat is pretty well reduced.

With the concept that for every inured, it takes two to get them out. What happens when you do stop? Does the who team stop while you play instead of going for the shooter? Why hold up eliminating the threat so your conscience can be clear?  Actually, our doctrine (to which EVERY paramedic is trained) is that the first LE team in is the "contact" or "suppression" team - their job is to go get the shooter.  [If there were multiple shooters, that would change, as would it for a multiple-wing building.] The second LE team is the "backup" and "rescue" team, whose job it is to take the medics with them, protect them, and provide security while the medics do their business.  The team is 4 LEOs, 2 medics, 2 kits.  They can either evacuate two that can walk or limp, or one that needs carrying, or they can set up a CCP in a place that LE has cleared and for which LE will provide security in case somebody pops out of the ceiling.

If I move in with the FD and PD it's because I'm trained.  Perfect.  As it should be.  And in our system we have decided that accompanying the LE rescue team is a function to which every medic should be trained.  So we have trained them.  Just like LE discovered that they can't wait for a specialist team without loosing lives, so we have agreed that we can't wait for specialist medics to arrive to begin stopping the bleeding.

Following....at a respectful distance.....

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