Public safety agencies across the United States recognize the need and urgency to create active shooter response protocols and training programs. There are numerous recommendations from public safety professional organizations stating that regardless of size, every law enforcement, fire, and EMS agency must have an active shooter protocol. In addition, multiple court cases demonstrate clear liability against departments and department chief officers for failure to adequately plan and prepare for these events.
As departments either implement active shooter protocols, or refine existing protocols, many departments are deciding what equipment they need. Simply put, aside from tourniquets, there is no additional equipment necessary to implement an active shooter response protocol. Budget limitations should never be a reason why a department will not participate in the rescue task force (RTF) model. However, there are several equipment considerations that will increase the effectiveness of the rescue task force.
Medical equipment should follow the guidelines of care established by the Committee for Tactical Emergency Casualty Care and local medical protocols. Medical equipment should focus on hemorrhage control, basic airway management and chest seals. Response to active shooter events have demonstrated that medical bags need to be designed in individual, modular pouches, with each pouch designed to treat three or four patients — including children. The individual kits allow for responders to effectively treat multiple patients, including patients in different locations. Command vehicles may be equipped with larger bags that carry multiple tourniquets (in quantities of 25 or more), and/or multiple mini-medical bags to aid in quick restocking of depleted medical equipment on scene.
The modular pouches should include the following equipment: four to six tourniquets, four to six chest seals, pressure dressings, nasopharyngeal airways, hemostatic dressings and medical gloves. Equipment should purposefully be limited in the pouches. By limiting equipment, responders will effectively reduce the time it takes to extract victims to vehicles that can rapidly transport patients to hospitals with surgical capabilities. Numerous white paper recommendations from physicians advocate simple medical care at the point of injury, hasty extraction from the crisis site and rapid transport of patients.
Tactical Extraction Equipment
There are a variety of commercial tactical extraction equipment available. Universally, nearly every active shooter after-action report noted that responders faced difficulty moving victims. Responders encounter many challenges with victims at these events, including bloody victims, wet victims, unconscious or combative victims, victim movement up and down stairs and challenging routes of egress on the exterior of the building. Responders should consider the use of standard patient movement devices, such as backboards, rescue baskets and other litters.
There are numerous tactical, commercial patient movement devices available on the market. Many of these devices have application in normal emergency response — such as soft, canvas litters like the Mega-Mover™. If your agency is considering purchasing tactical patient movement devices, plan on incorporating the devices into everyday response. Devices should be simple to deploy and easy to operate. Agencies should also consider purchasing devices rated for vertical lowers of patients, in the event responders need to conduct hasty lowers from windows or elevated positions. Used appropriately, responders can quickly make a hasty harness with webbing to lower victims. All responders should focus on utilizing safe and simple methods to extract victims to reduce unnecessary delays in victim extraction.
Prior to bulk purchasing of patient extraction devices, frontline responders should test and evaluate the equipment. This will save time and money in purchasing devices that may or may not be used during an actual event. Responders should also receive training on making and using ad hoc extraction litters, such as carpet, chairs, heavy blankets and any other readily accessible device or material that can aid in victim extraction. At every opportunity, educate responders to look for non-standard extraction equipment. In addition, consider training law enforcement officers in the use of extraction equipment.
Ballistic Protective Equipment
Ballistic protective equipment for non-law enforcement responders is hotly debated. Ideally, every first responder should have ballistic protective equipment issued to them and available on every call. However, there are multiple considerations to address before this utopian idea is obtained.
The first question to ask is, “Has a non-law enforcement responder ever been injured by hostile action at an active shooter event?” To look at this objectively, we use the Department of Justice’s definition of an active shooter event: “An event in which three or more people are shot in public, in the absence of gang or drug activity, or secondary to the commission of another crime (such as a bank robbery).” People often point to Webster, New York as an active shooter event in which responders were injured and killed. However, this was not an active shooter event, rather an ambush event in a residential setting. Others point to random events in which responders where shot during “check the welfare” calls, structure fires, and other types of calls. Nearly every event in which fire or EMS personnel were injured by gunfire occurred during the response to a residence. All of these events do not meet the Department of Justice definition of an active shooter event.
There is one recorded event in United States history in which fire or EMS personnel were injured by hostile action at an active shooter event. This occurred on December 30, 1974 in Olean, New York when six firefighters were shot by a student perpetrator during an active shooter event at a high school. In this event, the perpetrator deployed smoke bombs and set fires during the shooting to lure fire personnel to the building. All six firefighters who were shot survived the event.
Data compiled by the Federal Bureau of Investigation and Texas State University in 2017 show that 15 minutes after the perpetrator has started shooting, there is a 92 percent chance that the perpetrator is dead, fled or in custody. The 15-minute mark coincides with an idealistic time for RTF deployment. This data demonstrates that the risk for hostile action against the RTF is minimal, albeit present.
Additional considerations include the cost of the ballistic protective equipment. Costs range from $300 to more than a $1,000. All soft ballistic protection has a manufacture’s five-year expiration on the armor. Other factors include sizing (one size does not fit all), vest maintenance and practicality during operations requiring maximal physical exertion.
Agencies also need to understand that policies and procedures may change significantly with the purchase of ballistic body armor for responders. In one city, the fire department purchased body armor for their firefighters to use during RTF operations. The city’s Risk Management Department found out about the purchase and reviewed the response protocols for the fire department. After review, the firefighters were required to wear their body armor on approximately 25 percent of all calls, including shootings, stabbings, assaults, drug overdose, alcohol intoxication, psychiatric calls, attempted suicide calls, medical nature unknown, check the welfare and more. Regardless if the police department was on scene and declared the scene “safe,” the fire department personnel still had to wear their ballistic protection because of the possibility of hostile actions. After six months of wearing the ballistic protection, the firefighters wanted to remove all ballistic protection from their apparatus.
If fire and EMS agencies are going to purchase ballistic protective equipment, the vests should be a minimum National Institute of Justice (NIJ) Threat Level III-A. This recommendation is consistent with several other national recommendations on ballistic protective equipment for non-law enforcement responders at active shooter events. Level III-A armor protects the responders from most handgun and shotgun rounds. In addition, agencies should consider plate carriers that have Level IV plates. These plates can either be ceramic, steel, or a composite material. These plates protect the responders from rifle rounds, including .223 and AK-47 rounds. These plates would have been necessary for protection at the Pulse Nightclub shooting, the Las Vegas Route 91 shooting, and approximately 30 percent of active shooter events in the last decade. Additional information on ballistic protection recommendations can be found in the 2016 Active Shooter/Hostile Event Guide published by the Interagency Board and available at www.interagencyboard.org.
At no point should the lack of ballistic protection equipment preclude a fire or EMS agency from utilizing the RTF concept. However, the decision to deploy RTFs without ballistic protective equipment should be the exception and not the norm. The authority having jurisdiction and the incident commander will ultimately make the decision based on risk versus reward. No victim lives should be needlessly lost because of the lack of ballistic protection by first responders. The decision to purchase ballistic protective equipment should be made after a risk/reward assessment and must be tailored to the given resources within a community. With the continued frequency of active assailant attacks, fire and EMS agencies must begin now to budget ballistic protective equipment as part of a standard personal protective equipment ensemble for first responders.
Fire personnel in the RTF need to bring multiple items with them when deploying into the crisis site. First, if the event includes a smoke alarm activation or reports of smoke or fire, all fire personnel need to report to the crisis site prepared to fight fire. Once at the crisis site, if officers or intelligence indicates that there is no threat of fire, fire personnel can remove their gear and create a forward staging cache of equipment. The intentional or unintentional threat of fire must always be considered by incident commanders.
All RTF personnel should have the ability to either wear an air purifying respirator with a CBRN-rated cannister, the ability to adapt a CBRN-rated cannister to their SCBA mask, or have an SCBA readily available. Attacks such as the 2012 Century 16 Theater shooting and the 2014 Forsyth County, Georgia, courthouse shooting demonstrates that perpetrators are deploying CS gas and other less-lethal and lethal chemical munitions. In addition, law enforcement may deploy CS gas to reduce perpetrator movement, or to distract the perpetrator. RTF personnel should also have a four-gas combustible gas indicator, flashlight (preferably body-mounted, hands-free lights), base rope rescue equipment to affect hasty interior/exterior victim lowers, and any other equipment that could aid in rapid victim access and extraction. Fire personnel also need to bring breaching equipment, including heavy breaching equipment, such as hydraulic spreaders and cutters.
Numerous companies sell tactical medical equipment. Much of the equipment has benefit during active shooter response operations. However, there are items that have limited benefit in civilian response. Some of these items are difficult to deploy and complex to use. The focus of all equipment must be to add to responders’ current skillsets, and provide easy to use equipment during times of extreme chaos and duress. The equipment should be simple enough that additional, outside responders can quickly deploy and utilize the equipment with little to no training.
Equipment should be purchased for everyday response. Responders who utilize the equipment routinely will have much better success utilizing the equipment during an active shooter event. In addition, the equipment will provide a much better return on investment for the agency. Agency administrators should allow the line personnel to test the equipment either in training exercises or on emergency calls to determine the efficacy of the equipment prior to bulk purchase.
Regardless of size, every public agency must plan and prepare for active assailant mass casualty events. This planning and preparation must include the creation of standard operating policies and procedures, training personnel and appropriately equipping providers to rapidly treat and extract victims. By doing so, we will give the victims of these events the ultimate chance for survival.