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Active Shooter – EMS Response

Active Shooter – EMS Response. September 21, 2016 UNYAN Membership Meeting Butch Hoffmann, BA, EMT-P. Today’s Objectives. Active Shooter (AS) definition Provide AS behaviors Describe AS situations - unusual Provide case studies - lessons learned Lessons learned from military combat

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Active Shooter – EMS Response

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  1. Active Shooter – EMS Response September 21, 2016 UNYAN Membership Meeting Butch Hoffmann, BA, EMT-P

  2. Today’sObjectives • Active Shooter (AS) definition • Provide AS behaviors • Describe AS situations - unusual • Provide case studies - lessons learned • Lessons learned from military combat • Today’s EMS AS tactics

  3. USDHS – Active Shooter Definition 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

  4. A Type of Active Shooter Domestic Attacker:Occurring more frequently! • American citizen • Born in another country, naturalized a U.S. citizen • Self-radicalized, no direct contact with terrorist organization • ‘Inspired’ by terrorist propaganda i.e. ISIS • No combat experience or limited experience with weapons • Plan for other attacks

  5. Other Types of AS Attackers • Int’l Terrorist Group • Extremists • Criminal • Gangs • Insider – mental health, anger or revenge, political / religious beliefs, notoriety

  6. Targets of Opportunity • Commerce & Educational environments (~ 70%) • City streets • Military & Governmental properties • Private residences • House of worship • Sporting events • Health Care Facilities

  7. Case Study • Columbine High School, Colorado – April, 1999 • Traditional Police Response • Perimeter Secured • 45 minutes for SWAT to enter • 13 victims shot and killed during SWAT mobilization • Shooters committed suicide upon police entry • Staged EMS • SWAT to clear school before EMS entry • One teacher died of hemorrhage. Preventable?

  8. Following Columbine, 1999 • Nationwide LE changed their AS SOPs - First few officers form a response team - Don’t wait for command level decisions - Engage the subject(s)

  9. Military Data: • 15% of deaths in conventional combat are potentially preventable, COL Ron Bellmany, Vietnam War 1967 -1969 • Most common preventable causes of deaths • Exsanguination • Tension pneumothorax • Airway obstruction • Tactical Combat Casualty Care (TCCC) developed

  10. Case Study • Virginia Tech, Norris Hall – April, 2009 • 9:40 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

  11. http://www.policeforum.org/assets/docs/Critical_Issues_Series/the%20police%20response%20to%20active%20shooter%20incidents%202014.pdfhttp://www.policeforum.org/assets/docs/Critical_Issues_Series/the%20police%20response%20to%20active%20shooter%20incidents%202014.pdf

  12. 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

  13. After Sandy Hook, Conn. – Dec. 2012 • FBI, NAEMT, IAFC, ACS & the Military produced Hartford Consensus: a nat’l strategy to enhance the survival rates in mass casualty shootings • Past practices of LE, Fire and EMS were not optimally aligned to maximize victim survival • Rapid EMS entry integrated with LE would save lives • Use military’s TCCC concept; by introducing a civilian version • Utilize Rescue Task Force (RTF) concept http://www.policeforum.org/assets/docs/Critical_Issues_Series/the%20police%20response%20to%20active%20shooter%20incidents%202014.pdf http://www.policeforum.org/assets/docs/Critical_Issues_Series/the%20police%20response%20to%20active%20shooter%20incidents%202014.pdf

  14. Hartford Consensus (cont’d) • Critical Strategic Responses: ‘THREAT’ Principle T = threat suppression H = hemorrhage control RE = rapid extrication A = assessment by EMS providers T = transport to definitive care

  15. First Line EMS Providers • Tactical Emergency Casualty Care (TECC), civilian version of TCCC guidelines • Direct 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

  16. Tactical Emergency Casualty Care • Contact Entry Team - LE Only • Initial rapid police entry • Stop the bad guy • Bypass victims • Rescue Task Force (RTF) • LE escorting EMS/Fire/Rescue • Locate, stabilize, remove victims • Maintain situational awareness

  17. Rescue Task Force • 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.

  18. Rescue Task Force • Pro • Rapid patient contact • Saves lives • Con • EMS Risk • Lack of Equipment and Training • Lack of familiarity with LE tactics and movement * Agency’s value judgment to acceptable risks

  19. Conduct multi-agency planning committee mtgs: - 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

  20. Multi-agency Planning cont’d • Education • Training – hands on skill development • Tabletop exercise • Full-scale exercise • Train regularly

  21. AS Training: Warm Zone Stressors • Gas munitions • Fire alarms, sprinklers • Smells, smoke • Victims screaming • Death • Destruction, structural collapse • Detonations/gunshots • Darkness, confusion

  22. AS Training/Planning • Establish CP, delineate safe zones, cover vs concealment • Stress keep access paths open for EMS • Establish multiple CCP/triage/transportation areas • Consider tactical physician at scene • Consider ‘cleanup/hydration’ station • CISM, EMS staffing at FACs • All RTF EMS personnel are trained & have exercised in AS scenarios • Maintain integrity of crime scene

  23. Lessons Learned From AS Exercises • LE early representation in formal incident CP • Building side nomenclature, common terminology • Consider towing or pushing civilian vehicles out of way • Familiarization with other jurisdiction’s schools

  24. Resources: • Training • DHSES State Preparedness Training Center (SPTC) www.dhses.ny.gov/sptc Advanced Active Shooter Scenario (A2S2) • www.fema.gov • www.dhs.gov AS Booklet: How to Respond • www.usfa.fema.gov Fire/EMS Department Operational Considerations & Guidelines for AS & MCI • FEMA IS 253

  25. “IT COULD NEVER HAPPEN HERE” • Kennesaw, GA; Washington, DC Navy Yard • Newtown, Connecticut; Omaha, Nebraska • Columbine, Colorado; Tucson, Arizona • Binghamton, NY; Brookfield, Wisconsin • Forth Worth, Texas; Salt Lake City, Utah • Blacksburg, Virginia; Boston, MA • Aurora, Colorado; Manchester, Illinois • San Bernardino, CA; Orlando, Florida • JUST HAPPENED AGAIN……

  26. Thank youQuestions??? butch.hoffmann@aol.com

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