Firefighters Support Foundation

1. Firefighters Support Foundation Rapid Response and Treatment Model (R2TM) for Active Shooter Incidents -------- Operational Detail v3.0

2. About FSF The 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. R2TM - Operational Detail

3. Permission Permission is granted to reproduce or distribute this material so long as the Firefighters Support Foundation is credited as the source R2TM - Operational Detail

4. Accompanying Video This 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. R2TM - Operational Detail

5. Presenters • Jeff 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. R2TM - Operational Detail

6. Welcome Integration of Public Safety • Lots of good work being done nationally • Still a long way to go • How do we integrate? • What impacts does this integration have on training, protocol and sustainability? R2TM - Operational Detail

7. What We Know Time & Intensity • 2007 – 2013 Highest numbers of incidents • 2014 – 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 R2TM - Operational Detail

8. Incident Friction • Public safety response not integrated • Condition of our SOPs or SOGs • Tradition and culture R2TM - Operational Detail

9. Zone Response The Principles • Hot Zone: Exclusion • Warm Zone: Reduction • Cold Zone: Support The Problem: • #1 most common A.A. item • Causes a progress friction point • Fire/EMS is waiting for the “all clear” R2TM - Operational Detail

10. Trauma StudyOrange County, CA • Level I Trauma Hospital • 14 years: 1996-2009 • 19,167 cases • Blunt and penetrating trauma • Results found: • Increased mortality rate with scene times ≥ 20 min • 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):167-74 R2TM - Operational Detail

11. Law Enforcement Goal Data driven answers: • Mitigate the threat / saving life on the front end • The 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 R2TM - Operational Detail

12. EMS Goal Data driven answers: • Access patient as quickly as possible • Address critical-fixable injuries • Get patient to definitive medical care ASAP R2TM - Operational Detail

13. Engineer the Response • You may be able to use your current resources to operate efficiently • Do not be distracted by tactics • Tactics require a functional system to be effective • Engineer your response to work • Embed a “Warm Zone” R2TM - Operational Detail

14. Nature of Conflict • Friction • Psychological • Physiological • Environmentally • Uncertainty • Remedy • Experience • Training R2TM - Operational Detail

15. Systemic Problem-Solving • A combined effort putting the caregiver at the patient’s side within minutes of wounding to maximize life saving • Agency expertise • Clearly defined roles • Familiarity • Simplicity • Unification of Command R2TM - Operational Detail

16. R2TM Response “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 Clausewitz R2TM - Operational Detail

17. R2TM Foundation • 3 Tenets: • Rapid LE response • EMS securely introduced into a warm zone • Rapid treatment and transport of the victims • Keep closest to normal SOPs R2TM - Operational Detail

18. R2TM LE Overview Response • Rapid Response Tactics • Threat mitigation • Initiate Sergeant / Battalion Chief link-up Assessment • Establish foothold (FOB) • Identify Casualty Collection Point (CCP) Security • Internal / External security • Police bring wounded to CCP • Introduction of Fire EMS R2TM - Operational Detail

19. R2TM Fire/EMS Overview Stage • Out of line of sight • Prepare for response entry Link-Up • Establish Unified Command • Security escort Enter Warm Zone • Begin MCI protocols R2TM - Operational Detail

20. LE Response • Immediate introduction of LE assets • Move quickly to last known area of suspect / verification? • Understand “sweeps” vs. “clears” • What are immediate threat indicators? • FOB’s can be useful R2TM - Operational Detail

21. Threat Mitigation • Does not require 100% confirmation of suspect location • Fled, Dead, Captured • Once Immediate threat indicators have lapsed, transition to victim assessment / retrieval • Can continue sweep operations and CCP identification R2TM - Operational Detail

22. FOB Purpose • Brings stabilization to operations • Provides for dual operations • Aids UC and 9-1-1 point of contact on interior • Increases efficiency of interior sweeps • Aids with decentralized tactics R2TM - Operational Detail

23. Corridor Lockdown • When immediate threat indicators have subsided • LE lockdown hallways, architectural features, large geographical areas • Sets the stage for victim transfer • Minimal resource allocation can have significant impact • Corridor lockdown builds on itself • Aids in scene stabilization R2TM - Operational Detail

24. Unification of Commands • Paramount! • Needs to be physical is design • Sgt / BC ideal • Fire Understands / Police need to embrace and execute • Only one location for UC • Don’t view UC as a monolithic entity R2TM - Operational Detail

25. Casualty Collection Point Benefits • Efficient prioritization • Centralized location • Simple Concept • Manageability • Low cost • Enhanced Security • “Quick Connect” R2TM - Operational Detail

26. Casualty Collection Point • Provides a bridge between police and fire • Allows for simultaneous operations • Proven military tactic for categorization • Minimal UC Command & Control • Can have multiple CCPs if necessary and aids in incident control • Use caution on adding unnecessary layers of ops R2TM - Operational Detail

27. CCP LocationKey Elements • Law Enforcement Identifies • Fire Establishes • Not necessarily victim dependent • Ease of vehicle access / transport priority • Ability to Secure • Adequate Space • Should be located on the interior • Can establish CCP with barricade / hostage R2TM - Operational Detail

28. Casualty Collection Point • Make a clean workspace • Identifiable treatment zones • Reduce the desire to over complicate the MCI • i.e. Internal triage zone to external treatment zone • Only essential personnel • “Greens” and other non-injured: elsewhere • “Scoop and Run” vs. “Stay and Play” R2TM - Operational Detail

29. Hot Zone Medical Care • Limited to rapid and easy intervention • i.e. Tourniquets • Follow TECC recommendations • Victims transferred to CCP via LE • Hasty field triage • Get critical patients to EMS first • Having LE transfer victims to the CCP is resource driven and supported by the 9 principles of warfare R2TM - Operational Detail

30. Tourniquet Use • Extremely effective to combat extremity bleeding • Easy to train and inexpensive • Studies indicate upwards of 90% associated survival rate • 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. R2TM - Operational Detail

31. Prepare for Entry • Stage resources out of line of sight • Limit first responding fire/EMS resources • Reconnaissance; Pave the path • Take only needed equipment to get the job done R2TM - Operational Detail

32. Command Link-Up • Request link-up over interoperable channel • Location to be out of hazard zone • Capable members • Fire: officer, BC, Chief; LE: Sgt, Lt., Commander • Should be physical • Cautious of non-physical link up • Simplify the ICS structure R2TM - Operational Detail

33. Communications Plan • Must have radio interoperability • Ability to talk and listen • Critical for intelligence, integration and safety • LE and Fire/EMS should conduct entity specific operations on separate channels/frequencies • Do not impede critical operations • Use short succinct communications R2TM - Operational Detail

34. Components of Fire Security • Apparatus Security • Escort • On Engine • NFPA Guidelines • Overwatch • CCP Security R2TM - Operational Detail

35. MCI Operations • Will your triage method hamper time? • Triaged patients may shift categories on you • Fix major problems • TECC guidelines • PHTLS • Work trauma codes? • Monitor available medical resources R2TM - Operational Detail

36. Interference with Transport • Increase victim scene times • Increases total out-of-hospital time • Requires more resources • Creates damage R2TM - Operational Detail

37. Destination Etiquette • Do not shift the MCI to another location • Refrain from blind transport (last resort only) • Assign someone to communicate with receiving facilities • Example: Medical Resource Hospital • Document as much patient info as practical • Use technology R2TM - Operational Detail

38. Environmental Concerns • Stop further harm from occurring • What is the weather? • Keep in doors if appropriate • No return: 32*C / 89.6*F • Need for decontamination? R2TM - Operational Detail

39. Commit to the Response • Create a response that your jurisdictions can use on a daily basis • i.e. Assault • Make sure your neighbors can plug in • Keep it simple and highly functional • Train on a reoccurring basis • All hands on deck • This is a “three legged race” R2TM - Operational Detail

40. More info • Craig Allen • craigallenasrt@gmail.com • Jeff Gurske • jbgurske@gmail.com R2TM - Operational Detail