The growing EMS response to Active Assailants.
I recently had the opportunity to participate in Rescue Task Force(RTF) training. Our regional EMS council has established a RTF "to train and equip EMS personnel for response to active shooter type incidents." This is a review of these two days spent on this topic.
First off, let's be clear. I am not going to give out any specifics. To readily implement this to all EMS is going to take a change in some of EMS culture. Let's first talk about scene safety. I feel this a large portion of where EMS struggles to accept this process.
When I went for my EMT-B(and subsequent skills or certifications) it went like this
"Is scene safe?"
That was the response.
I thought it was not practical. I would like to see us change this approach, i.e. EMT asks, "What dangers should I be mindful of/see?"
"You have traffic on the interstate, a downed power line, couple of people on the side yelling at each other", etc. Whatever it is, we need to set the mindset in our students to be aware of the scene and make that a continuous analysis. It doesn't start and end once we arrive. It continues throughout the process. This no different then our patient care. We continuously monitor our patient. We can't be looking at these areas constantly but we need to make sure it is a continuous part of our evaluation. It doesn't stop. This is especially true when we began looking at active assailant situations.
I spent a lot of time over just scene safety but what does that have to do with RTF? I think that is core to understanding this concept. It has been a challenge for the medical community to accept an active assailant situation as anything but safe. We take risk in other venues on a regular basis. MVCs and burning houses have a lot of risk that we use equipment and training to reduce some of that risk. Let's do the same in these active assailant situations. There have been several articles written on this subject. Here are a couple:
‘Scene Safe’ Mantra Provides EMS Danger - Journal of Emergency Medical Services - jems.com<https://www.jems.com/articles/print/volume-38/issue-6/administration-and-leadership/scene-safe-mantra-provides-ems-danger.html>
It’s become a mantra: “Is the scene safe? BSI in place?” Once the answer is determined, a course of action follows—either we go about our business with an assumption that we can not be ...
What does scene safety really mean? - EMS1<https://www.ems1.com/safety/articles/913625-What-does-scene-safety-really-mean/>
Scene safety, what does it mean? In essence, they want you to look for things like downed power lines, flaming vehicles, or some rabid raccoon that is high on meth.
With that realization, we have to decide what level of risk we are willing to assume. We do so on a regular basis and fortunately, we are starting to see a change in this field in regards to an active assailant.
We can be doing exercises as frequently as possible. We should have more LEs and medical to work together on these drills. We do regular drills, right? The two initial medics that responded to the Pulse nightclub shooting attribute much of their success to regular MCI training. Yearly testing or qualification on skills is not an effective method to develop or maintain skills. If you are in a department that fits this description, find time in your own schedule. If you are in a position to make decisions, see how you can implement improvement here.
About the class it self. Again, I will try to refrain from specifics.
Day 1 was strictly classroom.
Day 2 was all hands on. Scenarios that built upon each of the previous. On a side note, there was a great group of actors and moulage to help create a more authentic experience.
The first iteration had everyone in their traditional roles. Medics were medics. LE were LE. During the second run, people switched roles. Medical became LE and LE became medical. I thought this was a good part of the process that allowed everyone to see what the other part of the team was responsible for and helped develop a bigger picture of how the team worked. After that run, all of the following runs were completed back in everyone's traditional roles.
It was difficult for the LEs to not press forward. Most of these were high speed guys so it was definitely a different pace. They had to realize they are not the hunters here. It almost takes an executive protection mindset. Protect the medics. That is the focus. It also became difficult at times to not get caught in doing minutia or get sidetracked. Time is loss of life. That is the lesson to learn. We have to reduce this time as much as we can. Transitioning to a medical response that enters into warm zones seems to be one way to help meet that goal.
Do I think this process is helpful?
Do I think this should be mandatory for EMS?
Yes. These events will continue to rise in frequency and are not going away. Put it into protocols. Let's make this a standard.