Fire personnel must train and develop strategic plans for active shooter events to save victims’ lives and protect themselves from harm. But even the best-laid plans can go wrong, requiring them to improvise in these volatile situations.
During the chaos, they’ll play a lead role in evacuating the scene, coordinating medical care, creating patient collection points, setting up triage areas, handling patient transportation and reuniting victims with their families.
“Years of practice has shown the effectiveness of using systematic triage,” said A.J. Heightman (2016), a former EMS director who has specialized in mass casualty incident management training for 30 years. This type of triage assigns patients to color-coded collection points, then to transport units and hospitals by highest criticality first.
Heightman also recommends these mass casualty procedures for firefighters and EMS responders:
- Work with law enforcement to develop safe triage and transport out of harm’s way.
- Carry dozens of Individual First Aid Kits containing essential supplies, such as trauma and wound clot dressings, chest seals, scissors, and tourniquets, that can be “tossed” to responders treating gunshot victims spread over a large area.
- Tag patients according to their severity and assign treatment coordinators to color-coded tarps prioritized by red, yellow and green.
- Alert hospitals of the incident location and scope as early as possible.
- Appoint a transportation supervisor who can poll hospitals and make sure patients are distributed to the proper facilities.
- Establish a staff transportation group, stage ambulances and begin the systematic flow of patients from the scene in an even distribution to hospitals.
- Provide appropriate protective gear, such as ballistic vests and helmets, to personnel exposed to risks.
- Because water dramatically slows and stops bullets of all sizes, use fire engine water tanks as protective barriers during active shooter events.
Since time is of the essence, patient transportation can be tricky in mass casualty incidents, especially when the community gets involved.
“History has shown that people will self-transport to hospitals, bystanders will not wait for an EMS unit arrival to transport and will attempt to move the mass number of victims to hospitals if a triage funnel system is not in place early.” (Heightman, 2017).
And sometimes rescue procedures have to be modified in less-than-safe environments, like when the shooter might still be on the scene.
Too often, EMS crews work active scenes with little to no protection.
Improvisation Can Also Save Lives
One effective example of improvisation involves the June 12, 2016 shooting at the Pulse nightclub in Orlando, where 49 people were killed, and 53 others were wounded.
Because the gunman was still inside firing his weapon, police blocked emergency responders for their own safety and used police vehicles to start taking patients to Orlando Regional Medical Center, the area’s only trauma center located about a mile away.
“Orlando police rapidly moved critically injured patients in the back of police pickup trucks that proved to be valuable at that incident,” Heightman said (2016). “While it would be preferred to transport all critical patients in ambulances, improvisation in this instance probably saved multiple lives by getting them to surgical intervention rapidly.”
Policies and initiatives adopted in the last three or four years have encouraged local residents and school personnel to take active shooter and safety training for these events.
As it turns out, that preparation is paying off. A review done after the Las Vegas shooting showed the value of partnerships with bystanders.
“Concert goers were very instrumental in initial patient care, hemorrhage control and moving victims to ambulances and other transport,” according to a “Review of Active Shooter Resources and Training.” (2017). Their actions show compassion and how public education efforts can help wounded victims of violence.
One organization, the “I Love U Guys” Foundation offers free school safety training programs for school personnel, first responder and emergency management agencies.
Ellen and John-Michael Keyes started the foundation after their 16-year-old daughter, Emily Keyes, was shot and killed on Sept. 27, 2006 during an attack at Platte County High School in Bailey, Co. While being held hostage, Emily sent a text message to her parents, saying, “I love you guys.”
The foundation offers training on the Standard Response Protocol (SRP), a safety planning program adopted by thousands of schools in the U.S. and Canada, and the Incident Command System (ICS), a standardized approach for the command, control, and coordination of multiple agency emergency response.
The foundation also provides Reunification Operation Kits. Designed from an experienced emergency management perspective, these kits include a checklist ranging from designating a staging area, to maintaining radio channels, passing out job action sheets and setting up liaisons with other agencies. In addition, it hosts an annual national symposium to share what experts have learned from traumatic events and new safety measures.
Once firefighters and EMS finish the reunification phase, and can take a deep breath, they’ll begin to file post incident reports and restore their own physical and mental wellbeing.
Homeland Security has created an Active Shooter Recovery Guide to help organizations develop policies and procedures for short-term and long-term recovery from an active shooter incident. This report covers topics ranging from evacuation and the coordination of medical assistance to memorial services and the judicial process.
The U.S. Fire Administration has issued a similar guide for mass casualty incidents, a 17-page resource that provides support planning and preparation for such incidents.
What changes has your department made to help address the active shooter crisis?
Heightman, A.J. (2016). How EMS and Fire Processes Must Change During Dynamic and Active Threat Situations. Retrieved from https://www.jems.com/articles/print/volume-41/issue-8/departments-columns/from-the-editor/how-ems-and-fire-processes-must-change-during-dynamic-and-active-threat-situations.html
Heightman, A.J. (2017). Mass Shootings in Las Vegas. Retrieved from https://www.jems.com/articles/2017/10/mass-shooting-in-las-vegas.html
“Review of Active Shooter Resources and Training” (2017) Retrieved from https://www.usfa.fema.gov/operations/infograms/100517.html
Homeland Security (2017). Active Shooter Recovery Guide. Retrieved from https://www.dhs.gov/sites/default/files/publications/active-shooter-recovery-guide-08-08-2017-508.pdf
U.S. Fire Administration (2013). Fire/Emergency Medical Services Department Operational Considerations and Guide for Active Shooter and Mass Casualty Incident. Retrieved from https://www.usfa.fema.gov/downloads/pdf/publications/active_shooter_guide.pdf