Safety and Security in American Communities — The Pittsburgh Massacre
By Steve Birnbaum and Col (res.) Professor Isaac Ashkenazi, MD
The attack on Jews last weekend in a Pittsburgh, PA synagogue is shocking and horrific. In a particular twist of irony, the tragedy occurred during the celebration of a brit ceremony, the welcoming of a new life into the world. Such attacks, terrible as they are, are not limited to Jewish targets of anti-Semitism. Around the world, names including Mumbai, Paris, San Bernardino, Utoya, and Las Vegas remain associated with the evil that visited them. Whether perpetrated with explosives, firearms, vehicles, or knives, and regardless of the terrorist, political, or criminal motivation of the attacker, the preparedness for such events remains similar.
We aim here to provide concrete ideas that can be quickly implemented to increase the safety of our communities, provide psychological reassurance, and begin the broader dialog about community safety and security.
The prime imperative in an active shooter situation or other violent attack is to act quickly to save lives. To do this, we must stop the killing and stop the dying by directly empowering communities to stop the attacker’s ability to advance and to stop massive bleeding while still awaiting the arrival of police and EMS, and by ensuring that responders act quickly and decisively to end the threat and provide medical care under threat, if necessary.
In making these recommendations, we are certainly not attributing any blame to the innocent victims or the heroic police, fire, and EMS personnel who rushed towards the sound of gunfire to save lives.
The following is an excerpt of the timeline of the Pittsburgh attack published by the Pittsburgh Post Gazette, with input from the recording of the police radio traffic. We can begin to infer some information from this timeline, while acknowledging that it is preliminary; the Pittsburgh investigation will take time and will both reveal new information as well as correct any mistakes made on the record.
09:50 The attacker enters the Tree of Life Synagogue
09:54 The first 911 call is received by the Allegheny County 911 call center
09:55 The 911 call center dispatches the call
10:00 Officers arrive on scene and immediately come under fire
10:01–10:20 Officers heard repeatedly calling for medics
10:29 Initial casualty evacuation of two victims by SWAT, both of whom survived
10:56 Officer reports that the suspect is “holed up in a room”
11:03 Radio traffic “Spontaneous negotiations ongoing, effort to get him out, we’re not going in.”
11:08 Officers report that the attacker is in the process of surrendering
11:13 Officers report that the attacker has surrendered
Engagement Time: Internal Response vs. External Response
The term “external response” refers to a response from police or some other resource that is not already at the location of an event. An “internal response” refers to the use of response resources already present at the location of an event.
According to the timeline, the attacker was undisturbed in his murderous rampage for 10 minutes. The police response time of 4.5 minutes was extremely fast, almost beating the typical urban response times of 4–6 minutes. Even with the fastest possible external response, the attacker had a full 10 minutes without interruption, opposition, or resistance. It was possible to cause an unbelievable amount of carnage in the eternity of those 10 minutes while members of the Tree of Life Synagogue were waiting for the arrival of an external response.
Such fast response times as were seen in Pittsburgh are not always guaranteed. In a multi-site attack such as those in Mumbai and Paris, police resources will be spread over a wide area, and response times may be delayed. The nature of an attack may also delay entry of responders to a scene, such as an attack where explosives are used or suspected.
It will never be possible for an external response to be as fast as an internal response. Facilities that consider themselves to be at potential risk must give serious consideration to some kind of internal response capability. This can include contracted security, armed volunteer security teams comprised of members of the community itself, or both to create a multi-layered system. Volunteer security teams from within the community can provide a significant benefit at minimal cost. Many communities already include well-trained people, including current and former military and public safety service members, who would not hesitate to step forward if given the opportunity.
The ability of internal response and armed bystander response to stop an active attacker has been demonstrated repeatedly in Israel over many years. Such response can take many forms. First, volunteers from the community can quickly recognize something that is out of place. Secondly, an attacker may not even try to enter upon seeing a visible security presence guarding the entrance; likewise, many active shooters commit suicide as soon as they encounter armed resistance.
If the attacker does proceed, an internal response may be able to stop the threat immediately or simply delay forward progress until police can arrive, potentially saving many lives. Even if unable to neutralize the attacker, armed resistance of any kind requires the attention of the attacker and stops the forward progress of the massacre, providing valuable time to allow innocent people to escape.
Where such volunteer teams are created, it is important that the members train together, and it should be part of a much broader response plan. A single individual with the willingness and ability to act can make a big difference. It is possible that members of an internal response team may not survive, but it is a risk they knowingly take, and the measure of their success is in the lives that they saved.
Trauma First Aid & Stop the Bleed
The timeline above shows that at least 40 minutes elapsed from the time that the attack began until the first casualties were evacuated. Death can occur due to blood loss in minutes. We may find that someone killed by this horrible anti-Semitic murderer had an otherwise survivable wound but succumbed while waiting for medical intervention to arrive.
Modern military medical protocols were refined after conducting research on potentially survivable traumatic injuries. From this, the Tactical Emergency Casualty Care (TECC) protocols were created for the civilian environment. The US Government’s Stop the Bleed Campaign is intended to “cultivate grassroots efforts that encourage bystanders to become trained, equipped, and empowered to help in a bleeding emergency before professional help arrives.”
A simple action that facilities can take is to equip themselves with public access multi-patient bleeding control kits and provide appropriate training to their members based upon the Stop the Bleed curriculum, or equivalent.
A public access bleeding control kit should not be confused with a first-aid kit. While the latter is generally intended to treat minor injuries or illnesses, a public access bleeding control kit is comparable to a public access AED (automated external defibrillator) and contains items such as tourniquets and trauma dressings. It is intended to treat a profusely bleeding wound that would be fatal if medical intervention is not provided immediately. A tourniquet applied by another officer, is credited with saving the life of one of the officers who responded to the Tree of Life synagogue after he suffered an arterial wound.
Like CPR training, this training will empower members of the community to become citizen responders as they go about their everyday lives in the community. Whether a community is faced with the horror of another attack or even a traffic collision in front of its building, members will have the equipment and knowledge to save lives while waiting for responders.
EMS Response Under Fire
It is heartbreaking as a medical provider to hear officers repeatedly calling for EMS to treat their own wounded officers in the initial 15 minutes of the attack in Pittsburgh. It has been reported that only half of the public safety personnel in the city have undergone Rescue Task Force training, which suggests that current protocols may have required EMS units and personnel to stage at a distance. We acknowledge that this is early speculation but believe that if that is the case, it highlights the urgency of the adoption of the Rescue Task Force model to ensure that medical response for officers is promptly available. There is no doubt that each and every EMS provider listening to the radio wanted to provide care to the officers. Their ability to do so, safely and with appropriate tools, should be ensured.
Hostage Situation vs. Active Shooter
In the aftermath of the 2016 terrorist attack at the Pulse Nightclub in Orlando, FL, Professor Isaac Ashkenazi wrote an article that discusses the difference between a hostage situation and an active shooter situation. We note that once the attacker was isolated to a room, negotiations began. It is too early to comment on the tactics and procedures used in Pittsburgh based upon what little information is known, such as whether there were victims in the room with the attacker, whether the attacker had the potential to harm any additional victims from that position, or whether the negotiations delayed casualty evacuation. As the many after-action reports are written, we hope that they will shed additional light from which we can learn.
Community Active Shooter Training
It is known that DHS had recently visited the Tree of Life synagogue to provide guidance and training on active shooter response. The training and exposure to active shooter protocols appears to have saved lives. Members of the congregation moved quickly to evacuate away from the threat or sought refuge in designated “safe rooms.” One of the horrific tragedies of this attack on the Jewish community is that the victims appear to be those who could not move quickly enough to seek refuge, but one can only imagine that the outcome may have been worse without this valuable training. This training, which we understand to be based upon the “Run, Hide, Fight” curriculum, should be provided to communities that have not yet received it.
We intend this article to be the beginning of a conversation, not the end of one. Too little is yet known, and too much still relies on speculation to draw definitive conclusions, but there is enough information available to start thinking and speaking.
If we can compress the time between the start of the attack and armed resistance, we can reduce casualties by more than 50%. If we can compress the time between the time of wounding and the first medical intervention, we can reduce mortality by more than 50%.
Bystanders can be passive, or they can be actively empowered as immediate responders, capable of acting long before the arrival of any external first responders. Those present when an attack begins are the only individuals in a position to provide immediate assistance, and they share a common goal of survival. Internal response capabilities, the presence of bleeding control kits in the hands of trained members of the community, ensuring that responders act quickly and decisively to end the threat, and providing EMS care under threat where necessary will achieve the objective of reducing casualties and reducing mortalities in the event of a violent attack.
We cannot emphasize enough the value of each individual. Even a single person within a community who has the willingness and the ability to act can make a big difference.
By empowering community members, and building an internal response capability with the proper training and equipment, we can compress the time of response to stop the killing, stop the bleeding, and ultimately, save lives.
About the Authors
Colonel (Res.) Professor Isaac Ashkenazi, MD is an international expert on disaster management and leadership, community resilience and mass casualty events with both extensive professional and academic experience. He is considered one of the world’s foremost experts in medical preparedness for complex emergencies and disasters. Ashkenazi is a Professor of Disaster Medicine at Ben-Gurion University in Israel, and the former Director of the Urban Terrorism Preparedness Project at the NPLI Harvard University. He was a consultant to Harvard University, Centers for Disease Control and Prevention, the U.S. Department of Health and Human Services, the U.S. Department of Homeland Security, FEMA, the White House, the World Bank, Rio Olympic Games, the Brazilian Ministry of Defense, India NDMA, SAMUR — Protección Civil, China Ministry of Health and other national and international agencies. Ashkenazi served as the Surgeon General for the IDF Home Front Command.
Steve Birnbaum is an independent consultant and expert on disaster and emergency response technology and innovation, with experiences responding to several major domestic and international disasters. He is a volunteer firefighter/EMT and USAR tech in Montgomery County, MD, and is trained as a tactical medic. Birnbaum serves on DHS and Dept of State advisory groups related to public safety and disaster response technology. He is a former wilderness SAR tech in Israel, and previously served in the Climbing, Rappelling, and Rescuing Section of the IDF Counter-Terror School.