EMS Corner

Scene safety has never been in the forefront as much as in the Active Shooter incidents. Current in the malaise of societal issues is that of the armed citizen, often heavily armed, taking lives of innocent, defenseless individuals in commonplace situations. Active Shooters in theaters, schools, shopping malls, and other heavily trafficked areas seem to be a common (daily?) occurrence. EMS providers placed in the situation of an active shooter, must remember scene safety and the concept of not putting crew lives in jeopardy.  In the EMS arena, not much has changed relative to the involvement of life saving crews except the addition of the Tactical Medic. 

Police involvement has drastically changed in approach and all initial efforts of Law Enforcement personnel are now directed to finding and neutralizing the Active Shooter threat versus standard command and control of isolation and negotiation. Standard police training is being changed and augmented with this new philosophy and responding officers must incorporate a new hierarchy of risk when confronted with these situations. Whereas the previous training was to contain the incident and wait for SWAT, hostage negotiators, etc. all in the interests of public and officer safety; current training places the Police Officer in the front line and officer safety far down the list:

Neutralize perpetrator

Containment

Public/hostage safety

Officer safety

Perpetrator safety

When investigating multiple “Active Shooter” incidents, it was found the most victim deaths occurred very early in the incident (ALL deaths in the Columbine HS shooting took place in the first 7 minutes) and these perpetrators seek out multiple defenseless targets. They also do not appear to stop the killing until confronted by superior force.  They readily will engage this opposing force or end the incident with a suicide. This is truly a law enforcement operation until the neutralization of the threat has taken place.  Law Enforcement personnel are directed toward neutralization, NOT negotiation. Stop the threat at all costs. EMS, as well as all other components of incident command, is placed in staging until Law Enforcement has completed the task. Once the primary goal has been achieved the standard Unified Command can take over.

EMS personnel are routinely kept out of harm’s way but sworn uniform personnel may be placed at risk under certain circumstances. Tactical Medics have been implemented by many law enforcement agencies but these are typically police officers that have received EMS training in addition to their training as police. They are often part of the initial assault teams to tend to wounded officers in the neutralization phase but also to tend to victims found along the way and facilitate removal to safe areas those that cannot move themselves. Certain situations have arisen where uniform fire department paramedics have been ordered into the line of fire by medical direction (mostly due to medical direction being unwilling to accept liability for “doing nothing” for injured citizenry). In Chicago, the Police and Fire Departments, in conjunction with Medical Direction, negotiated an agreement to keep Fire Department Medics out of the danger zone by having the Police accept all of the liability for those decisions.  Address this to your superiors and have this discussion with all the major players as part of the pre-planning phase and NOT during the incident itself.

So, how do we train for such a situation?  Broad awareness of all roles is essential for the coordinated response to be effective. Police have integrated these responses into their training regimes, but most others including community leaders, school officials, Fire Extinguishment and Rescue, EMS providers, and ancillary players such as social services may need to have special training or briefings to further delineate each other’s roles within the Unified Command of the Active Shooter. This requires further training on all levels.

Training has evolved over the years.  Video and slides have been taken over by PowerPoint and web-training although some of the video produced out there may be effective when used in conjunction with other methods.  A newer video (produced in 2009) by Emergency Film Group (EFG) ® addresses some of the issues.  This video, Active Shooter: Rapid Response is approximately 30 minutes long and offers the broad picture in the approach to these disturbing incidents.  It is also is very focused toward the Police response.  The rest of the video is about unified/incident command and the related players, but does not offer much (within the video) insight into further defining the roles of those other than law enforcement. 

The great thing about this video is that it has an accompanying information CD that includes PowerPoint and instructor training materials, including exams and current reports, for the incidents.  This alone makes the $425.00 price tag somewhat palatable.  (Video is extremely expensive to produce, hence the high dollar price tags.)  Also, often times producers seek to maximize the “viewable audience” so they try to hit as many players as possible.  This video does do that and may leave the perception that they hit many includable areas but did not do any of them justice sans Law Enforcement.  I do not recommend this video as stand-alone training for EMS/Extinguishment agencies although it may have value as an addition to a comprehensive total program, but it really offers very little as an EMS/Fire tool, except in the implementation and overall application of Unified/Incident Command.  Contact Emergency Film Group at: EFG

For community leaders interested in understanding and revamping their own participation and response in these scenarios, the EFG video may offer at least part of tools necessary for City Managers, school principals, College and University faculty and staff, as well as some training for Social Services. Information in key here and this video and training material may fit quite well into an overall training package when ancillary players are preparing and training their personnel.

There may be multiple other training offerings out there.  The Department of Homeland Security and FEMA have a plethora of offerings within their Independent Study Programs in Distance Learning. From Hazardous Materials to Incident Command introductions for all types of services, the DHS and FEMA have a very diverse offering, all Distance learning (Web-based or on-line) format. All are FREE (unless you want to apply for College credit) for the asking.  Yes, there is even one for the “Active Shooter” that I found comprehensive (for all non-emergency workers) and great for all levels of ‘awareness’ training.  All managers should consider at least consider the Active Shooter web training and should also peruse the training listings as there may be other web-based training opportunities that may be utilized at the FEMA site. Go to: FEMA Independent Study for the comprehensive list and for the Active Shooter training: Active Shooter. Remember these are FREE training modules that your personnel can utilize almost anywhere.

Emergency Film Group:  http://www.efilmgroup.com/

FEMA Independent Study:  http://www.training.fema.gov/IS/

Active Shooter:  http://www.training.fema.gov/EMIWeb/IS/IS907.asp