Law enforcement has learned valuable lessons from Columbine and now enters volatile situations to reduce the loss of life by engaging suspects. The fire service and EMS routinely train for multi-casualty incidents. As first responders, has any department trained or equipped their personnel to follow behind law enforcement into a volatile/unsecured scene to remove victims to triage/treatment areas? This question is not posed to the Swat Medics but to the first responders on engines and medic units who arrive on scene behind law enforcement. Is the fire service and EMS prepared to take on a changing environment? Outfitting personnel with firearms is not a consideration or an option.

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The way I see it, only a trained SWAT type of medic would be going in under such conditions, and from what I gather, a SWAT medic is there for the team, not victims.

 

IMO, and as far as our operations go, we don't move in until the scene is secured by LE.

As John says, T Medics are for the team, not the civilians. FD or EMS wouldn't (or shouldn"t) be allowed in the area until after it is secure. However, my department has an excellent relationship with the schools, and law enforcement. As such, we participate with them in the required lock down drills. Scenarios are replayed and critiqued. Changes are suggested and made. We all know what part we play in the system.  

Are we prepared? Of course we are. Is that not the reason we train? Are we naive enough to believe that we are prepared for ANY possible scenario? Never going to happen. But that's the nature of the fire service. We learn to adapt and overcome, and we make mistakes. We tweak our proceedures and continue on. Whether it is a small structure fire or a mass casuality incident, we take on an ever changing environment.

It appears another, perhaps more important, question is "Are you prepared for what you will see?"

Sandy Hook Scene Haunts Newtown First Responders

""There was nothing I could do for a hysterical parent that was looking for their child," [Newtown Hook and Ladder 1st Asst. Chief] Corbo said. "Parents were coming from every direction. They were abandoning their cars and running to the scene. You could see the panic on their faces."

If you look at a metroplitan area what would be sent to the scene. If you look at my area you would expect to see a mass casualty ambulance bus and support vehicles along extra EMS units with first in units dsipatched. It would be Box Alarm with 4 engines, 2 to 3 ladders, 1 heavy rescue, command staff and the extra EMS units of basic and advanced crews and mass cas units.                                                                                                                                                 The state trauma center may fly out a GO Team to the site. 

Police wise we would have our county police and sheriff teams, state police, city and town PDs and any law enforcement agency that operates in our county. Then we could have outside agencies from other counties.

I'm not sure any of us including a jaded old man like myself, would ever be "prepared" to see this kind of carnage. I hope that our brothers and sisters in all the public service agencies involved in this incident not only have Crisis Counseling available, but choose to utillize it, whether in a group, individually, or both. 

I'm not sure any of us including a jaded old man like myself, would ever be "prepared" to see this kind of carnage. I hope that our brothers and sisters in all the public service agencies involved in this incident not only have Crisis Counseling available, but choose to utillize it, whether in a group, individually, or both

 

I would agree, nothing is really going to prepare someone for the scene in which they witness or soften the realities of the incident. The aspect of having crisis counseling is a significant factor and should be something that should be "dispacthed" soon after a significant incident and personnel who were present should have a debrief before allowed to leave the station.

 

Everyone is going to have their own thoughts and opinions and their own way of dealing with things, but it is imperative that there is some type of response of a member assistance program or similar for significant incidents. For example, in our state, there is a MAP program in place and members on it throughout the state, for significant incidents, the program is automatically activated and members sent to depts to be ready to help. Given that members are throughout the state, they can get people to a scene rather quick and can also activate the "call tree" of other people trained with counseling etc.

 

The reason being is to give a debrief of the program, make responders aware of the signs and symptoms they may experience, ways to help deal with what they saw, things to be made aware of to avoid (alcohol, drugs, etc) and be there to talk with those responders who may want to right away.

 

 

 

 

Years ago when we had a LODD, it was the similar approach. Those crews that were on the immediate dispatch were talked to on the scene (we do have several of our own members trained to peer counsel) and made aware of MAP personnel on the scene. Crews were also told they were done for the day, that they would no longer be responding to calls. Of course we are able to do this and not every dept could. It was the option of the responder if they wanted to stay at the station or go home after the debrief.....most stayed at the first due station. Crews that were relieved on scene were sent back to their station and there were other counselers there to talk with each crew.....again giving members a chance to talk if needed and again go over the signs of grief and what to avoid, and again, one on one help was offered.

 

It was several days later that there was a mass CISD for all personnel involved, firefighters, police officers, and dispatchers. (it is important that dispatch also be included in such incident debriefs and offered assistance as well). There was also a mass CISD type of debrief done for those spouses, significant others, etc of the responders, to make them aware of what the responder may be going through.

 

 

In the end it does come down to the individual and how they react and if they choose to talk with someone, but the assistance or means to talk with someone should be there. I do think that responders should be debriefed and made aware of symptoms and options, etc....not just told to call a number if one wants to talk. There should also be a group/crew debrief prior to responders leaving for home, etc.

Unfortunately if this happened at our school we would be first on the scene. We would not be entering the school until police arrived and gave the ok to enter. But we are to block off all three roads to the school and let no one in or out. In our county we could have up to a 20 minute response from law enforcement. We do the same thing for every bomb threat also.

 I can not believe anyone could ever be prepared to see this type of carnage. I have seen some pretty bad stuff and i hope i never have to see what these guys and girls had to see. 

I also agree, Crisis counseling is necessary. When i first joined the department we had a bad call and i passed up the counseling. I have never passed it up after that. I went a couple of months without sleeping and letting the stuff i seen bother me.

Is the fie service and EMS prepared to take on a changing environment? Not completely, but there are many who realize that the traditional thinking needs to be challenged; I love tradition and fight the new ways many times, but we must really question our response to active shooter incidents. We stage, saying that we must for the safety of our members. I would challenge each to think this over, we do things on a regular basis that put our members at risk. I am not trying to start an argument as to what is acceptable and what is not, but I want to offer a system that we currently use and have been for several years.
We are lucky enough to have a progressive PD and OMD that have pushed this down the field hand in hand with the FD. We call our response to active shooters, the Rescue Task Force; it is made of several teams comprised of PD & FD and the move quickly and treat quickly. Here is the system in a nutshell . . .
First four cops create a hunter/killer team, and move to isolate/eliminate the threat. The next four cops form a team and they begin identifying the warm zones, and then relay that information to the Unified Command. The establishment of the wam zones is the trigger for the forward movement of the Rescue Task Force Teams. These teams are four person teams; two cops and two firefighters (one ALS at a min). The FD members are protected with ballistic vests and ballistic helmets. They have enough advanced bandaging materials to treat approximately 25-30 patients. The team moves throughout the warm zone and makes contact with patients and stop life threatening bleeding which is what kills most people. The patient contact time is typically less than 90 seconds.
This is just a snapshot, and there are many details that are obviously not listed; this does work and it takes very little time to put EMS providers at the area of need versus the old way of staging for an hour or two. People bleed out while we stage, and we need to change our approach. If you review the incidents, the threat is usually short lived since they usually take their own lives as soon as they are challenged. The FD should not wait for the entire building to be cleared before we care for the wounded.
Please consider and give some thought to changing the approach used to these events.

Be safe,
John

Couple of comments:

We have a county-wide joint police/fire active shooter response program very similar to the model that Chief258 mentioned. It has been in place for about 2 years. I have personally instructed about a dozen classes with our L/E counterparts and taken part in multiple full scale exercises. We have monthly meetings to discuss events, training, improving the program, etc. The days of patrol securing a school perimeter and waiting for SWAT are long gone. 

The main point is that Fire/EMS are part of a "rescue team", escorted by law enforcement into areas already cleared by the contact teams. Our purpose is immediate treatment (TCCC concepts) and extraction. Unified LE/Fire command is a required component, as is an agreed upon definition of "tactical warm zone". It doesn't work if Fire/EMS and L/E don't play well in the sandbox.

As mentioned, this is not a SWAT medic concept. We have a tacmed group that works with a local SWAT team. We train with them regularly and deploy on their missions. This is a separate issue. Active Shooter is not the same response model as HR, barricaded suspect, etc. Historically speaking, the immediate threat is resolved within minutes, before SWAT arrives.

B

Our region is in the planning stages of implementing a program similar to the concept you have described.  If you are able to share the Fire/EMS portion of your SOG's I would very much appreciate the input.  Thanks

Thank you Chief258 and Medicsix. I agree that the traditional approach of staging does not apply to the recent active shooting incidents we have witnessed. If our organizations continue to take that approach, we will also become labeled the bad guys for failure to act. I would like to read your policies and training docs on the subject of making entry into the warm zone with force protection in place.

 I have seen some some bad situations between fire service, work, and search team work. Its hard not to get emotional But don't be afraid to seek counseling. We are never really ready to cope with some incidents especially involving children or people that protect a community. I still carry bad images of my time in Rochester, NY. I hope it better now. There many persons like that shooter in any area of the country and  we must try to find them first whether your are fire or police or social worker or just plain Joe or Jane down the street. My prayers are with the men and their families.     

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