Is Your Community Ready For An Active Shooter Event?
Providing Emergency Medical Services in Hostile Environments
Active Shooter/Mass Casualty Incidents (AS/MCIs) in the U.S. have increased at an alarming rate in recent years. According to date collected by researchers at Texas State University, 47 active shootings events transpired between 2000 and 2008 — an average of 5.22 per year. Why should we be concerned? These figures have more than tripled in the past five years to an average of 16.8 annually, with a total of 89 active shooting incidents taking place between 2009 and 2013. There have also been disturbing trends in the scope and lethality of AS/MCIs. In the 2012 shootings in Aurora, Colorado, 70 people were wounded-12 fatally-when a gunman stormed the Century Theatre movie complex. Later that same year, 26 people, including 20 children, were murdered inside an elementary school in Newtown, Connecticut. And in April 2013, 264 people were injured in the Boston Marathon bombings, with 3 of the victims dying.
AS/MCIs present several dilemmas for public safety officials — the first of which is expediency of police response. There is a direct correlation between police response time and AS/MCI duration: the average AS/MCI lasts 12 minutes, with 37% ending in 5 minutes or less. Once police arrive on scene, the perpetrators typically turn their attention on police or commit suicide. Regardless, additional loss of life is usually mitigated upon police arrival and deployment on scene, as police prevent the assailants from accessing further victims.
Another notable problem manifested at AS/MCIs is the timeliness of emergency medical personnel response. In most instances, firefighter/paramedics are required to stay outside the secure perimeter while police clear the scene of the threat. This is a process that can take hours, as was the case with the Columbine and Washington Navy Yard shootings. While police search and neutralize active shooting scenes, those wounded desperately lay in wait for medical attention; a human being can die of blood loss in as little as 2-3 minutes, airway obstruction in 4-5 minutes, and a collapsed lung in 10 to 15 minutes. Therefore, paramedics need to be able to access and treat victims on scene, and cannot always wait for the police to conduct an exhaustive search for the perpetrators of active shootings.
In stark comparison to the rapid interdiction model implemented by police organizations across the U.S., most fire/EMS departments do not have established protocols for treating the wounded at active shooting events. The typical response is for fire personnel and paramedics to remain on standby until the scene has been rendered safe by police. Officials at some jurisdictions, such as the Arlington County Fire Department (ACFD), have s adopted a more proactive approach. In 2007, ACFD established the nation’s first Rescue Task Force (RTF). The RTF is based on the military’s Tactical Combat Casualty Care (TCCC) protocols. RTF consists of specially equipped firefighter paramedics partnered with police officers to respond to active shooter or other atypical, high threat medical emergencies. Other fire departments, such as those in Orange County and Los Angeles, California have also recently created Rescue Task Forces after active shooting events. Although the initiation of these RTFs is a positive development, the majority of municipalities in the U.S. do not have the standard operating procedures, equipment, or trained personnel to effectively deal with medical emergencies during active shooter and mass casualty incidents. It often takes a tragic event, such as the Los Angeles International Airport Shooting in November 2013, to demonstrate why Tactical Emergency Casualty Care (TECC) programs such as Rescue Task Forces are necessary.
Several prominent public safety organizations in the U.S. have recommended the establishment of formalized tactical emergency programs. The International Association of Firefighters (IAFF), a fire service advocacy group with over 300,000 members, has issued Position Statements recommending the establishment of TECC and Rescue Task Force programs. The Hartford Consensus, an ad-hoc group medical emergency professionals which includes representatives from the American College of Surgeons, fire service officials and Federal Bureau of Investigation (FBI) also recommends the adoption of Tactical Combat Casualty Care (TCCC) programs* by state and local public safety agencies. According to the Hartford Consensus, TCCC programs are quintessential in improving survivability of victims in active shooting events because they make provisions for “a more integrated response by law enforcement fire/rescue.”
In September 2013, the U.S. Fire Administration issued formal recommendation that public safety agencies across the U.S. look to TECC programs to provide optimal response to active shooter and mass casualty events: “Training, equipment and protocols around use of TECC for medical first responders should be explored, considered and implemented when feasible.”
The Committee-Tactical Emergency Casualty Care (C-TECCC), which is comprised of emergency medical experts from over 55 agencies, is working to expedite the transition of TCCC to the civilian domain. C-TECC recommends, and works with agencies all over the U.S. to advocate and assist with implementation of TECC programs.
Despite the declared need for tactical emergency medical programs by emergency medical professionals and public safety officials across the U.S., there exists no national standard or policy for the implementation of such programs. In fact, most jurisdictions in the U.S. currently have no standardized tactical emergency programs; if TECC programs are implemented, they are frequently established only after calamities involving loss of life occur. On a multi-jurisdictional level, there appears to be disconnect between identification of the problem, and realization of the solution to this problem.
Chances are, you live in an area that does not have a Rescue Task Force, or any other type of formalized TECC program. I would recommend that you engage your elected officials and public safety officials to see what the comprehensive plans are for response to a mass casualty event in your city or town. It is not a matter of if, but when your community will have to endure a mass casualty event.
*TCCC (Tactical Combat Casualty Care) is the original tactical emergency medical program created by the U.S. military, and TECC is the civilian off-shoot version of TCCC. Rescue Task Force (RTF) is a TECC-based program.
