It is common knowledge that when multiple departments work together everyone has their idea of how it is supposed to work, or how their role should be the primary mission. So how can we negate this? In this situation specifically, having very clear, defined roles is imperative. Through this article we will look at some of the roles for the primary agencies involved. Now, my disclaimer, this is not a one size fits all plan. Depending on departmental organization, roles may change or be combined. This is just an overview of Rescue Task Force, in the way we have seen it work best.
The Goal of a Rescue Task Force
The ultimate goal of these task forces is to preserve life of casualties incurred during an active shooter, while providing the caregivers the most protection. These teams are entering a “warm zone” of an active shooter situation, to begin the triage and treatment process. These providers are not directly attached to a contact team, or SWAT team. We will cover that a little later. This however is the point which causes the most controversy between departments working together. The warm zone is just that, not hot, however risk is increased. The primary law enforcement team has made its way through a structure, attempting to locate an assailant. During this time, officers have very “hastily” cleared the area being deemed warm. It has not been cleared room to room, but the likelihood of an assailant being in that area is minimal. This is where the task force comes into play. With the protection of law enforcement, care providers enter that area to treat life threats and remove the patients.
The EMS Role in the RTF
The EMS role is pretty straight forward, however we are seeing a paradigm shift from how it was done. The common role of EMS in these situations was to stage far away and await for law enforcement to call the ambulance up to transport patients. What was found, is that patients are dying long before medical care, and that some patients would have lived should help have come sooner. A complete common femoral interruption can cause death within three minutes of injury. More times than not care was not rendered until 20 plus minutes after injury. The best solution, the Rescue Task Force. Bring the care to victims, with the protection of law enforcement. This is not the “typical” treatments that would be rendered by EMS. The treatment occurring is minimal. Treat the life threats, assign a triage category and move to the next patient. As we have discussed in previous articles, we are looking to treat the three most preventable causes of death in high threat environments.
Number one is extremity hemorrhage. If it’s bleeding bad put a tourniquet on, if it’s bleeding some, give the victim a dressing and have them apply it.
The second is tension pneumothorax. Quick assessment and recognition of a patient can give you clues into this. We are simply buying time with our interventions. If there is a hole “neck to navel” place an occlusive dressing on it. If they are in respiratory distress, notable unequal chest rise and fall, decompression can be considered depending on provider level.
The last preventable cause is airway obstruction. In these situations it is treated by either a nasopharyngeal airway (NPA) or positioning. Now while all of these treatments with the exception of one are basic life support (BLS) level, we have found that advanced life support (ALS) providers are an important role of the RTF. The ALS provider skill-wise only offers the addition of the needle decompression. The real difference comes in assessment ability. While not trying to step on toes, the ALS providers consistently were more successful at symptom and category recognition.
The ability of a paramedic to rapidly assess and identify the need for interventions, as well as the victim’s category of 1,2,3 etc. was notably superior. This is not at all knocking the assessment skills of BLS providers or firefighter/EMTs, however it was noticeable in those that routinely assess patients. This is why we have made it the goal to place at least one ALS provider in the Rescue Task Force, and encourage all departments we train to do the same.
There has also been an incredible spike in the issuance and use of body armor for EMS providers. These situations is a perfect use of those resources, or the research to purchase. Body armor and a helmet is much like a firefighter’s turnout gear in these situations.
The Fire Role in an RTF
This section, possibly has the most room for change depending on department structure. Like I stated above, this is the most effective utilization of resources we have found, and may be different for your department. Having the fire department fill an evacuation role has proven to be incredibly effective for multiple reasons. The first of which is manpower; the ratio of personnel to apparatus is double that of law enforcement or EMS.
There is usually four plus firefighters per company, allowing for one large or two small EVAC teams. The goal of these teams is to extract already triaged patients from the structure. These teams would enter, again under the protection of law enforcement, to move patients to a casualty collection point (CCP). This allows for the extraction of patients, while allowing the RTF to continue to triage and treat until they exhaust supplies. The RTF will then extract their most critical patient. The EVAC teams, also allow for more patients to reach treatment quicker after being triaged. The goal of the RTF is to initiate care and triage, and advance as far into the structure as safely possible, until they exhaust supplies and remove their most critical patient.
The Law Enforcement Role
This is arguably the most controversial role when speaking between departments. Law enforcement fills multiple roles in the response to an active shooter incident. The first officers to arrive will become the “contact team.” They will run towards the sound of violence. This team has no other role than suppressing the threat. They are focused solely on containing the assailant. The next teams to enter are moving the same direction towards the sound of violence, however they are hastily clearing corridors or rooms on the way. This does not mean they are completely clearing rooms, side hallways, etc. However, they are the buffer between the hot and warm zone. It is at this team’s discretion the limit of which the RTF can go. These first teams are filling a traditional law enforcement role. It is the officers attached to the RTF that will fill a somewhat new role. These officers are primarily providing protection to the Rescue Task Force.
There is some discussion whether two or four officers should be attached to these teams. The argument for four is valid. Four officers attached to each task force allows for two of the officers to continue to provide protection of the providers while, two other officers may clear rooms that are encountered. This is optimally the safest option, however not always feasible based on resources. The two officer approach has an officer front and rear while moving, to protect the providers. However, when a room is encountered, the rear officer comes forward and clears the room. This of course is only safe when it is either known that the area behind the task force is safe, or there is another task force behind that has rear security. This is just a few of the ways that officers can be organized within the task force. Please consider the safest option when discussing a policy implementation.
I hope this gives a beneficial understanding of the organization of a rescue task force. Again, this is not the only way that these may be organized. Based on resources available, as well as the size of the incident, resources may be allocated differently. The information shared within this article is based on training conducted and the trial of different organizational structures. When considering implantation of a policy, consult with all agencies involved. Proper equipment is also a key, having a bag or kit set up for these situations with the basics, is much more effective in minimizing the time spent treating and evacuating patients. I hope this has been an informational article about the organization of a rescue task force.
Andrew Rowley began his career as a firefighter/EMT at a volunteer fire department. He joined the Army as a medic and is now teaching combat medicine and sustainment at the unit level. He worked in Charlotte, North Carolina for Mecklenburg EMS Agency, as a paramedic. Rowley’s current position is flight paramedic with Wake Forest Baptist Health in Winston-Salem, North Carolina. He is the president of Special Operations Aid and Rescue, LLC.