POLICE, FIRE, AND EMS

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POLICE, FIRE, AND EMS

• Rapid Treatment for a Hostile Action/Active
  Shooter Response
• --------
• Introduction and Overview
• v1.0

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Major L/E Paradigm Shift

• Since Columbine L/E made a major shift in tactics
  in an active shooter response
• Law enforcement has focused on neutralizing the
  shooter with first responding PD
• Both approach's fails to get medical attention to
  victims soon enough for major bleeding

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Concept Addresses

• Unified Command
• Concept of L/E FOB
• Designating and securing a Warm Zone
• Treatment in the Warm Zone w/ TCCC PPE
• Establishment Casualty Collection Point
• Communications

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Mass Casualty Incident (MCI)

• Mass Casualty Incident Defined - A Mass Casualty
  Incident (MCI) can be defined as an incident that
  has produced more casualties than a customary
  response assignment can handle. Types of
  incidents that can produce mass casualties
  include
• Multiple vehicle accidents
• Building collapse

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Criminal Mass Casualty Incidents (CMCI)
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Criminal Mass Casualty Incidents (CMCI) active
shooter

• 98 male
• 98 carried out by a single attacker
• Predominately commit suicide on site
• 80 use rifle, shotgun
• 75 bring multiple weapons
• 98 occur during daytime
• Offenders are preoccupied with obtaining a high
  body count before police arrive
• They almost never take hostages and do not
  negotiate
• 85 incident over in under 6 minutes
• 2007 2012 majority of incidents occurred under
  3 minutes
• Average police response time from the first shot
  9 to 12 minutes
• More than 700 incidents in the past thirty years

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Location of CMCIs

• Schools
• 24
• Office Building
• 11
• Open Commercial
• 24
• Factory/Warehouse
• 12
• Other
• 29

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Stats on LE Engagement

• 93 of incidents were over prior to the first
  responding asset, police or fire/EMS, arriving on
  scene.
• 7 of incidents police actually arrived in time
  to interrupt the shooting.

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Percentage of Survivors

• 90 of deaths occurred prior to definitive care
• 42 immediately
• 26 within 5 minutes
• 16 within 5 and 30 minutes
• 8-10 within 30 minutes and 2 hours
• Remainder survived between 2 and 6 hours during
  prolonged extrication to care
• Only 10 of combat deaths occur after care
  initiated

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Time counts
Era
Survivability
WWI WWII Korea Vietnam Gulf War War on Terror

• 30
• 60
• 70
• 80
• 90
• 95-98

Majority of fatal combat injuries die within 30
minutes
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Cooperative effort

• The greatest benefit will be achieved through a
  combined effort that puts the caregiver at the
  patients side within minutes of being wounded to
  maximize life saving
• Agency expertise
• Clearly defined roles
• Familiarity
• Simplicity
• Unification

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IAFF Supports Concept

• On April 2, 2013 the Department of Homeland
  Security and the Federal Bureau of Investigation,
  in cooperation with the International Association
  of Fire Chiefs (IAFC) and the International
  Chiefs of Police, convened a meeting to address,
  Responding to Mass Casualty Shootings
  Strengthening Fire/Law Enforcement/EMS
  Partnerships.
• Based on the proceedings of this meeting, there
  is a real and present threat and an obvious need
  for all organizations involved to work together
  when confronted with an armed individual who has
  either already killed and injured people or is
  threatening to do so. 
• The position statements are relevant to IAFF
  locals in fire departments that are changing
  response protocols or SOPs in an effort to
  embrace a more assertive approach to rendering
  life-saving care and rescuing viable victims in
  areas considered to be "warm zones" (not fully
  secured) during such an event.

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IACP position

• First responders must prepare for, protect
  against, and respond to these threats
  collectively because not planning for the event
  will find responders fighting them together
  unprepared. 
• The Police Chief, July 2013
• A Paradigm Shift for First Responders Preparing
  the Emergency Response Community for Hybrid
  Targeted Violence, Frazzano and Snyder,

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Current fire/EMS response

• Traditional Methods
• Stage away from incident
• Waiting for all clear
• Forms of Tactical Medicine
• TEMS, TCCC, SWAT Medic
• Not fast enough, complicated
• The fate of the injured often lies in the hands
  of the one who provides the first care to the
  casualty Arlington VA Fire

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Unified Command

• Commanders from various jurisdictions or
  organizations operating together to form a single
  command structure.
• The Incident Commanders within the Unified
  Command make joint decisions and speak as one
  voice. Any differences are worked out within the
  Unified Command.
• Physical link up (face to face)(does not require
  formal command post)

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Best utilization of resources

• Large response by Law Enforcement
• Trained to work in the tactical environment
• Use proven principles
• Economy of force
• Resource driven
• Establish Forward Observation Base (FOB)
• ICS Operations Officer
• LE requires little training for victim rescue
• Drags and Carries easy to learn
• Tourniquets being taught already

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Rescue Task Force Concept
RTF FDs answer to the issue of rapidly providing
stabilizing medical care in areas that are clear
but not secure . Task Force NIMS compliant name,
any combination of single resources, but
typically two to five, assembled to meet a
specific tactical need .
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PPE
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Blow Out Kits
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TCCC
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RTF TRIAGE
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RTF TRIAGE
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Hazard zones

• Cold is relatively secure out of line of sight
• Warm, area cleared, not secured, dedicated L/E
  posted for security
• Hot, Active zone, L/E Contact Teams engaging
  assailant

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The Casualty Collection PointCCP

• A defensible location inside a warm zone with
  access to the outside for victim transport
• Provides a bridge between LE and EMS
• Allows for simultaneous LE and EMS operations

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Casualty Collection Point benefits

• Simultaneous operations
• Efficient prioritization
• Centralized location
• Forward Observation Base (FOB)
• Simplicity

• Manageability
• Security
• Resource allocation
• Quick decision making

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Police response
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Rescue Task Force
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Life-saving timeline
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Lessons learned by training together

• Benchmark timer (trigger points to move to the
  next goal)
• Willingness to compromise and work with other
  agencies

• Daily operations improvement
• 911/ radio communication improvement
• Cross agency appreciation

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Treatment and Transferred

• Victim 1, Adult, No Bleeding Apneic Pulseless
• Victim 2, Child w/ minor GSW to arm from ricochet
• Victim 3, Heavy Bleeding L Leg
• Victim 4, Heavy Bleeding LR Leg
• Victim 5, No Bleeding, Unconscious, Abdominal GSW

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RE-SUPPLY
CCP
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• Once RTF operational, Fire/EMS Command will
  establish
• RTF re-supply near point of entry
• External/Internal casualty collection point
• Dedicate non-RTF assets to assist in transfer of
  patients from RTF assets for external evacuation

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COMMS

• Dual communications
• Police communicate with Tactical Police Command
• Locations of injured and team
• Threat and other tactical information
• Medics communicate with Fire Command
• Location of injured and team
• Casualty information

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RTF Goal

• Stabilize as many victims as possible using TCCC
  principles in the WARM Zone
• Will penetrate into building as far as possible
  until they run out of accessible victims or out
  of supplies
• Stabilize, position, and move on
• Once out of supplies or victims, move victims to
  CCP

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Practical skills

• Unified command establishment
• FOB/CCP location, setup, security
• Rescue Task Force (triage, treat, transfer)
• Over watch protection
• L/E Tourniquets
• RTF Triage with MARCH not START

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