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Comment by M Clark on September 27, 2008 at 10:49am

One of the prevalent threats to firefighters across the nation is that of an active shooter. Our mindset as members of the fire department and EMS is to allow for the law enforcement to secure the scene while we stage in the cold zone. This has been a long standing template and an acceptable practice by all agencies. However, today's new challenges as well as threats, focus on deviants in our society to select softer targets such as schools, malls and hospitals. The law enforcement community coins this term as an "active shooter" and have learned valuable lessons from school, malls and hospital shootings. Law enforcement is being taught to coordinate and engage the active shooters to draw the fire away from innocent bystanders. This is a violent encounter and is meant to put the shooter down. In this, fire/rescue/EMS stage in a perceived cold zone and wait. The need for our collective thought process now enters a new dimension and should focus on a more manageble template that will yield a higher survival ratio for all first responders to such incidents and related calls to include, domestics. A shooter in the United States of America has on their side the ability to move freely from where the incident starts. This makes it leathal for all responders who do not carry a badge and gun. Simply put, the shooter or domestic, can walk away from the scene, comandere a vehicle (be it motor vehicle, waterborne, bicycles) and evade the public safety effort to contain the scene.

I have been involved in research and protocol development to increase responder safety as well as surviving these incidents. Our first step as first responders is to realize that if you are the first responding unit YOU ARE ALREADY IN THE HOT ZONE. Second, there is NO COLD ZONE. Third, preplan for a high threat extraction. Fourth, medical intervention is limited to addressing blood loss first. When you are in a more secured area, behind cover of a vehicle or building, the airway concerns can be addressed. C-spine is a lower priority in shooting incidents and data collected from Prehospital Trauma Life Support 6th edition supports this as well as data collected from the Iraq and Afghanistan theatres.

The case studies as well as the mindset of law enforcement reflects this new paradigm of having their own personal medic to treat one of their own should he/she go down. When and where the tactical medic chooses to use their skill set is very critical. That is where having the correct information as well as proper training becomes an essential element in the tactical medic's tool chest. The tactical medic is an unconventional approach by agencies trying to solve the problem of traditional staging of fire/EMS. Across the United States, SWAT teams are adopting different medical approaches to fit within law enforcement risk benefit analysis. One agency may opt to have medics stack up with the entry team and function accordingly. Another agency may opt to place specially trained medics closer to the hot zone in a casualty collection point or strong hold and yet another agency may opt for traditional fire/EMS staging. Whatever the option, SWAT mission commanders recognize the need for medical assets, intervention, team health, resource caching and proper medical placement. The commanders base their decisions on how to best utilize these assets to best support their mission profiles on input from fire/EMS. All medical professionals play a key role in advising law enforcement, but the data must be correct, complete and not based upon theories.

Approximately a year or so ago, Brian Nichols was awaiting trial in Atlanta Georgia. When the female guard entered the room, Brian Nichols attacked her and severely beat her. He then took her gun, went into the court room, shot the judge and court clerk, killing them. The officers set up a perimeter to contain the incident but Brian Nichols evaded the police and made a get away. Later on, Brian Nichols shot and killed another off duty officer while evading capture. One week later, he was cornered and captured one county away at a woman's apartment whom he took as a hostage.

Several years ago in the metro Atlanta area, Cobb County SWAT responded to a barricaded subject with hostage. The SWAT team request that firefighters stage with a K-9 officer in the cold zone. The firefighters were given the instruction to do whatever the K-9 officer told them to do. The SWAT team breached the residence and was immediately met by gun fire that struck the first two entry team members. Shots were exchanged and the Cobb County SWAT team were force to evacuate their casualties. The K-9 officer ran into the hot zone with firefighters in tow. The shooting in the house had not stopped and the extraction of the two downed officers was conducted under fire. An ambulance staged in the cold zone was requested to enter the hot zone for evacuation. The ambulance responded to the scene and pulled into the driveway of the house directly across the street from the shooting. The back doors to the ambulance were wide open and exposed to the shooting as the officers were loaded in. It took a few more additional minutes before the ambulance left the scene.

In Texas, another barricaded subject with hostage incident. It was a hot day and negotiations were not going well. The SWAT team prepared to make entry by stacking at the front of the house. Just prior to entry, a shot was fired and the point man went down. The SWAT team immediately made entry and exchanged fire. Several minutes passed and two officers went to make an extraction of the downed officer. They eached grabbed a foot of the down officer and drug him by his feet across the lawn, onto the sidewalk and put him into the awaiting armored personnel carrier (APC). After review of the incident, the point man was shot in the back of the head by the SWAT sniper who was overseeing the operation. The report states that the sniper had requested water and was becoming dehydrated. The downed officer was dragged across the lawn and the side walk, face down.

Each case had fatalities. The first case was a failure to control the hot zone which was very dynamic, fluid and porous. It also involved multiple agencies and several counties to conduct the manhunt. The second case placed responders in the hot zone because there was not an extraction plan in the event an officer was to go down. The third case involved team health issues.

The are numerous case studies from law enforcement. Each case, medical intervention and rescue were crucial skill sets that the law enforcement agencies lacked. The tactical medic course bridges that gap. It provides those that wish to operate in non-permissve medical enviroments a clear and definitive understanding of the challenges that you may encounter as a tactical medic. The fire and EMS community greatly benefits from any tactical medical course because of real time information on new medical technology and methodology that will have a significant impact on us in the near future. Our tactical medic course is being conducted in the City of Austell Georgia on November 10-14, 2008. I really do invite you to attend.

Comment by Ben Waller on September 24, 2008 at 11:10pm

Siren,

Not clowns, but related to the rodeo...
http://www.despair.com/tradition.html

Ben

Comment by Ben Waller on September 24, 2008 at 10:51pm

Siren,

I wondered about the big red noses and the floppy pants and shoes...now I know for sure.
I just wanted to find out if it took a clown with rodeo bullfighter training to do the job, or if the cowboys could just shoot the bull and have regular clowns do the treatment.

Ben

Comment by Ben Waller on September 24, 2008 at 9:39pm

Siren,

In Tennessee and the Carolinas, tactical medics are generally EMS personnel who do tactical entries with the SWAT teams. I'm very familiar with several, and I've worked with EMS or FIRE/EMS-based tactical medics for many years. I understand the concept the way you explain it, but from what I've seen, the concept hasn't been proven to be effective. I'm familiar with one EMS-based tactical medic unit that has their medics do unarmed tactical entries. Their theory is that if a LEO is shot, the medic can then pick up the officer's weapon and return fire. Let's see - the LEO is exposed, get's wounded, and the medic leaves cover to recover the weapon, and the medic is now the second GSW victim.

I don't have an issue with providing high-quality medical care to LEOs - but the fact is that LEO body armor and tactics (surprise, flash-bangs, gas, overwhelming force, multi-directional entries, body armor and kevlar helmets, etc, etc) makes it very unlikely that a SWAT LEO will suffer a wound that will be fatal before either a) the perp is killed or immobilezed and the scene is safe enough for EMS to enter or b) the officer has a wound that is survivable given a two or three-minute difference in extraction time. If I'm wrong, please cite the case studies in civilian law enforcement as evidence.

As for dirty bomb scenarios, the difference here is spending a lot of time, money, and effort for an unlikely scenario that will at worst, affect a single LEO versus spending a lot of time, money, and effort for an unlikely scenario that will, at best, affect hundreds of unprotected civilians, disrupt city infrastructure, and maybe incapacitate an entire municipality's ability to provide basic services. It all goes back to risk-reward. The dirty bomb training clearly passes the risk-reward test. I have an open mind about the tactical medic training, but I still don't see any direct evidence that tactical medicine passes the risk-reward test outside the military world.

I'm not blasting anyone or anything, either...just asking questions to which I don't yet have answers. Can you help me with the "treat the officer while exposed to a close-quarters battle gunfight" concept as not being perceptibly different from the "treat the firefighter while exposed to an interior fire attack" concept?

Ben

Comment by M Clark on September 24, 2008 at 6:35am

I wonder why I couldn't say that in the first place? Thanks Siren. Once again, I apologize for the confusion. This wasn't a blog about blasting anyone or any agency.

Comment by M Clark on September 23, 2008 at 10:03pm

I can only surmise that you are not interested in the course. You may have mistook what I stated and I apologize for the ambiguity. I am not insulting the fire/rescue/EMS community nor am I comparing the environments to that of a tactical medic. Clearly, with your years of experience and saves, you are a subject matter expert in all aspects of your job. The Tactical Medic program is for those of us in the fire/rescue/EMS community who wish to augment, supplement and enhance the SWAT officers mission profile. It is another skill set for those who volunteer to be in this specific high threat environment. I was not citing numbers of wounded officers, but the number of officers it took to extract the student from the school to the cold zone. My statement was also alluding to the fact as trained rescuers it probably would have taken two firefighters and not four personnel that law enforcement used. Once again, I am not bashing anyone or any organization and I apologize if my comments are misconstrued. There is more information here than my ability to post online. Thank you for your comment and obvious concern.

Comment by Ben Waller on September 23, 2008 at 9:04pm

I've been in EMS for over 30 years. I've been in the cold zone for so many barricaded subjects, hostage takers, and high-risk warrants served that I've lost count. The total number of perps shot by the cops on those incidents - 3. The total number of cops shot by the perps - zero. The total number of perps that escaped - zero. I guess the cops are just better at containing the scene where I've worked.

As for the mass shooting you describe, in my area, there would have been no victim extraction by non-law enforcement personnel, because we'd have been staged well back. It is unlikely that there would have been any police officers shot while carrying a victim, because our very good local SWAT team doesn't extract victims into the line of fire with armed perps unaccounted for.

Risk taking against forces of nature such as fire, gravity, or moving water isn't the same as dealing with a person with hostile intent. And...if we can't control the fire, don't have enough rope for the vertical distance involved, or if the flood is too swift, we stay out of the hot zone. I've spent my career saving people from fire, holes in the ground, gravity, and moving water...lots of people. In that time, there have been a very small number of civilian hostages or cops saved by tactical medics. It's a simple risk-benefit equation, and the numbers for tactical medics don't seem to justify the risk.

We don't put EMS personnel inside burning buildings to treat the patients. We rescue flood victims from swiftwater before we treat them. Those analagies tend to say that we should treat victims in high-risk law enforcement operations the same way - defensively, from the cold zone.

And...in the Va. Tech incident, how many of the wounded officers you cited were saved by a tactical medic? I'm guessing that number is zero. Just curious, who actually rescued the wounded officers? I'm just guessing again here, but was it other police officers?

Comment by M Clark on September 23, 2008 at 8:21pm

Actually Ben there are several different pespectives. One is that the bad guys do have more targets. With that being said, our traditional approach of staging in the cold zone yields an even larger target should the bad guy evade the law enforcement attempt to contain the scene and the bad guy slips around to the undefended cold zone, where you would be waiting. The second perspective is not all that clear and hard to explain in a short blurb but I will try so bear with me. Law enforcement are now concerned with one of their operators going down in the line of duty. Should that happen, they need to extract their operator from the hot zone and travel the distance to you in the cold zone. If it is an arterial bleed, the officer can die within minutes. And remember, law enforcement do not train as much as we do in rescue techniques nor have the medical training. You can take a look at the Virgina Tech shooting of officers (4 of them) carrying one student to the waiting ambulances in the cold zone. If it was fire/rescue/EMS making the extraction, how many personnel would we use on that same student. In closing, it is not about presenting more targets, but saving lives in a critical and deadly place. Law enforcement place themselves in harms way with bullets, we put ourselves in fires, high angle rescues, confined spaces, swift water, ice rescue, and blood borne pathogens. Although many may comment that we are paid to do this, we all ultimately volunteer. The Tactical Medical Application Course is about usable information in many of the challenges that we face in today's society. Thank you for your comment. God Speed.

Comment by Ben Waller on September 23, 2008 at 7:19pm

Just curious...doesn't putting tactical medics into a high-risk situation just give the bad guys additional targets?