Are your community's paramedics trained to integrate with law enforcement rescue teams and to save lives before the scene can be "totally secured?" If not, you should be.
This is not a "SWAT medic" question. The lesson from Columbine is "if you wait for SWAT, people will die." Law enforcement has evolved a new doctrine for active shooters.....go to the sound of the guns, and neutralize the killers. And it's not for senior officers and special units - the success of the response to an rapid mass murder event is dependent on the skills, training, and physical condition of every police officer and EMS medic on the street.
EMS medics can be integrated in to LE rescue teams with a relatively high degree of safety, allowing live-saving measures (like tourniquets) to be utilized before it is too late. But it takes policy, training, communications, and cooperation to make it work.
Here, during a training exercise, City of Raleigh police officers provide security for Wake County EMS system medics conducting rapid assessment, treatment, and casualty collection evolutions. http://legeros.com/ralwake/photos/2011-07-13-ems-active-shooter/sli...
It CAN be done. It SHOULD be done. EMS has to be trained, equipped, and expected to move-communicate-assess-treat while protected by responding LEOs. It won't happen by accident - it requires planning and communication.
It's time to get started!
Nicely put, Randy!
I have across the US training EMS LE and Fire in "Tactical Medicine" I think the the biggest challenge is the cities that contract 911 to Private EMS Companies. Private companies have specific policies in place that keep providers staged. It is understandable due to the risk of loss. In these instances we have trained LE to perform life saving interventions such at TQs, Chest seals, burping Chest seals, NPAs, Combat Gauze and Hypothermia prevention.
So what do we have to do to get those policies changed? "Keeping providers staged" while shot people bleed to death doesn't sound like a good policy. What do we have to do to get those organizations engaged in the "new way" of thinking about response to active shooter events?
So far the only way to get rid of active shooters is to shoot them, or encourage them to shoot themselves. That seems to be the 100% result.
I'm looking for ways to move agencies toward policies, including training and equipment, that prepares them for a risk. Letting people bleed out may be "their prerogative," but I don't think it's a good, moral, ethical choice to make.
"Bleeding out" is a bit melodramatic.
The same thing wouldn't happen on the two way rifle range. It might for the embedded reporter from CNN but I bed those who think this is a no questions asked response system are misleading themselves. You are correct however that a system needs to exist
Responding with Police may work in those situations that the safety of the EMS personnel can be guaranteed. I don't think that is an unreasonable thing to expect. As soon as doubt exists then EMS can wait.
I don't think that just because a program would be in place that an unarmed Ambo should feel pressured into entering a scene unarmed, based on a guilt.
There are plenty of moralistic choices where we don't enter scenes due to safety. It's what we do and I'm sure it tears many of us up on enough occasions. However, my safety comes first and unless it can be guaranteed, I need to go home to my family first. No apologies for that.
"Bleeding out" is not at all melodramatic. It is precisely what happens in active shooter scenes when rescue is delayed. That was "the lesson" of Columbine. And of all the recent combat casualty care research that we've unfortunately had the opportunity to read.
"Safety....guaranteed" is an interesting choice of words. Safety is never guaranteed, unless you don't come to work and live in a bubble. The question is one of calculated risk. Right now, in the minds of many, there is no calculation whatsoever. ANY risk is deemed unacceptable, not matter the cost. I'm more of an advocate for a calculated balancing of risks. Some of my fire service colleagues have a mantra that I kind of like. We will risk a lot to save a life. We will risk a little to save a little. And we will risk nothing to save nothing. Practically, for them, that means they will go to great lengths (and accept risk) to save entrapped people. They will assume a little risk to save property (because that is their job). And they will risk nothing to put out a fire in a building that is already beyond salvage. To me, that is an intelligent corporate risk management philosophy, articulated in a way that everybody can understand - and can either accept and embrace, or get a different job.
I advocate the same for EMS, but perhaps phrased a little differently. But these are decisions that should be considered, and made, at the organizational level - and as individuals we can either embrace them or seek alternative employment. These are not decisions that should be made ad hoc, individually, at the time of an event. An employer who allows that is behaving negligently - because some will over-react and some will under-react, instead of relying on training and doctrine.
Guilt - no. Professional obligation to save a save-able life? Yes - whether it involves a highway crash and extrication, an active shooter, or contagion.
Wow. That got heavy, for a New Year's Eve discussion.
Happy New Year!
Very interesting thread. I work on the LE side of the house. I work on the LE training side. I have inserted LECC/TCCC training in the Academy, the CPT Training, Basic SWAT and HRW classes. I work on a large scale training exercise where we test ways of handling MCI, Active Shooter, Hostage, Schools, and Hospitals issues...the list is very long..with service integration. There is a lot of good work across the country on this topic. There is NO one way of doing business with EMS integration into high risk events. Each department has to cross that bridge in their own way. I work with many agencies across the country and discuss this very subject. I know of agencies that collaborate with Fire Medics, vet them, training with them, arm them. So they can provide their own security, but they are not in the stack. They may stage in the bear. I know of an agency that if EMS is not 60 seconds away, they transport in their patrol vehicles. They outfit the rear head rest with a blowout kit and are trained to manage bleeding and airway issues.
I think the fact that this topic is being discussed is a step in the right direction. The threat our first line of defense faces is changing and that goes for Fire and EMS. A united front is necessary if we are going to prevail. Everyone needs to go home. If the risks are too great for any one person, there is no shame in not wanting to be sheepdog. Not everyone can. Thank you for bringing the topic up.
Good one Val. Thanks for your insight.
Your welcome Cannulator. Just a humble observation. If anyone is interested in a look at the role of medic in an active shooter situation check out the book "Shooter Down: by John Giduck. I have mine highlighted, that is how on point its description of the medical care provided was and I use the timeline in my classes. It is a tribute to the changes made after Columbine and to the LE contribution as a force multiplier to Medical assets. It is this collaboration that should be considered. Anyone found viable at VT...lived!
My following comments are not to come across as confrontational that's not my intention. I have a few questions.
Are you saying that EMS has no place in a situation that is in any way dangerous? "There is NO one way of doing business with EMS integration into high risk events." If so, please elaborate and explain your reasoning.
Are you saying that a law enforcement officer is skilled and well practiced in the art of trauma care?
Ill leave it at that for now.
Are you saying that you don't want to go to work unless your safety is guaranteed? Because unless you live in an alternate dimension that's never going to happen. If you're saying you don't want to go to work in a situation in which there is danger from a person with a gun, that too is a universe I'm unfamiliar with. I think its just a danger one may not knowingly encounter on a regular basis so it carries with it a unique danger and one that is more frightening to some. Personally I dont see it as statistically any more dangerous than fire ground operations, or even more dangerous: operations on a high speed roadway! Each of those scenes carries specific dangers that require unique training and equipment. Why should we see the active shooter scene as any different than the other scenes? Is it statistically more dangerous than the others I've named?
I didn't read it that way, Nathan. What I read is that there is no single correct way of integrating EMS in to high risk events. I agree - there is no magic formation, yada yada.
What is required is knowledge of concepts, equipment, fitness, communication, and practice using a variety of techniques.
I'm with you, Nathan, about 'scene safety.' Safety is not a binary concept that is either present or absent. Safety is both relative and ever-changing. That 'scene safe, do what you need to do' exercise is a fool's mission.
Last - I'm more comfortable in a room filled with armed people, as opposed to unknown or (allegedly) unarmed people. Just sayin....