police, fire, and ems rapid treatment for a hostile action/active shooter response --------...

POLICE, FIRE, AND POLICE, FIRE, AND EMSEMS

Rapid Treatment for a Hostile Action/Active

Shooter Response--------

Introduction and Overviewv1.0

1The Rapid Treatment Model of Active Shooter Response

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


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

The Rapid Treatment Model of Active Shooter Response3

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


Criminal Mass Casualty Incidents (CMCI)


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


Schools– 24%

Office Building– 11%

Open Commercial– 24%

Factory/Warehouse– 12%

Other– 29%

Location of CMCIs


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.

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


Time counts


WWIWWIIKoreaVietnamGulf WarWar on Terror

30%60%70%80%90%95-98%

Era Survivability

Majority of fatal combat injuries die within 30 minutes

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

Cooperative effort


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.

IAFF Supports Concept


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 2013A Paradigm Shift for First Responders: Preparing the Emergency Response Community for Hybrid Targeted Violence, Frazzano and Snyder,


• 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

Current fire/EMS response


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”)


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


Rescue Task Force Concept

The Rapid Treatment Model of Active Shooter Response 17

RTFFD’s answer to the issue of rapidly providing stabilizing medical care in areas that are clear but not secure .

Task ForceNIMS compliant name, any combination of single resources, but typically two to five, assembled to meet a specific tactical need .

PPE


Blow Out Kits


TCCC


RTF TRIAGE


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

The Rapid Treatment Model of Active Shooter Response 23

• 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

The Casualty Collection Point“CCP”


Casualty Collection Point benefits


• Simultaneous operations• Efficient prioritization• Centralized location• Forward Observation

Base (FOB)• Simplicity

• Manageability• Security• Resource allocation• “Quick decision

making”

Police response


Rescue Task Force


Life-saving timeline


Definitive Medical Care

Mechanism ofInjury

LEResponse

FOB IdentifyCCP

RTF treat & move to CCP

MedicalTransportMCI

Wounded to Treatment

EstablishSecurity

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

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 L&R Leg• Victim 5, No Bleeding, Unconscious,

Abdominal GSW



CCP

RE-SUPPLY

• 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


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


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–


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


police, fire, and ems rapid treatment for a hostile action/active shooter response --------...

Documents

minutes slide

ems rapid treatment

incidents police

warm zone treatment

customary response assignment

majority of incidents

mass casualties

types of incidents