I am excited to join the Carolina Fire Rescue EMS Journal and introduce a new series, where we will discuss Mass Casualty Incidents (MCIs) and Active Shooter/Hostile Events (ASHE)
In this series we will discuss multiple considerations including:
- Is there really a problem?
- History of MCI Response
- The True First Responder to an MCI or ASHE
- Stop the Bleed
- MCI and ASHE Response
- EMS and Law Enforcement integrated response/ Rescue Task Force (RTF)
- Unified Command Best Practices
- Patient Care for an MCI/ASHE
- Patient Tracking
- Training and Exercise
- MCI/ASHE Documentation
Is There Really a Problem?
Mass shootings are the most common mass casualty events and are the most studied type of mass casualty/active shooter incidents. The FBI defines an “active shooter” as an individual actively engaged in killing or attempting to kill people in a populated area and Congress defines the term “mass killing” as three or more killings in a single incident.
According to FBI data (www.fbi.gov) between 2000 and 2018 in the United States there were 277 active shooter incidents. In comparison, according to the Congressional Research Service between 1999-2013 there 66 active shooter incidents recorded. The number of mass shootings occurring in the past 10 years is almost two and half times greater than the decade prior (1998 to 2007). More than half or 57 percent of all recorded mass shootings occurred within the past 10 years, as reported from the 2018 National Crime Victims’ Rights Week Resource Guide. The data does not include shootings because of gang or drug related incidents.
As we can see with the dramatic increase in Active Shooter/Hostile Event (ASHE) incidents, there is definitely a problem in the United States. The increase in ASHE has forced fire rescue, EMS, and law enforcement to reexamine how to respond to ASHE incidents, as well as how to rapidly treat and remove victims from potentially hostile environments as safely as possible for responders.
When we review the after-action reports of ASHE incidents, there are several common challenges that have occurred. These include the lack of unified command between fire rescue, EMS and law enforcement; communication issues with between fire rescue, EMS and law enforcement; difference in terminology or radio codes; reluctance to respond into an area that has not been deemed safe and secure from law enforcement; reluctance to respond into the “warm zones” with a properly trained and equipped rescue task force; and lack of asset/resource knowledge from neighboring jurisdictions.
History of MCI Response That Has Led to Change
On April 20, 1999, the Columbine High School shooting occurred. Twelve students and one teacher were killed and 24 were wounded. There were two shooters who had self-inflicted fatal wounds within 45 minutes from start of incident but there was no significant law enforcement entry for over an hour and no medical operations for four hours.
After this incident occurred, the law enforcement community had a paradigm shift and adjusted their procedures/tactics to quickly enter an area where shooters are suspected to be and make contact with the shooter(s). However, the incident had little to no change in the way fire departments or EMS responded into an ASHE incident. Fire rescue and EMS assets continued to stage until law enforcement determined the scene was secure — location determined to have no continuing threat and controlled by law enforcement — which can last hours. As a result, there was a significant delay in medical operations and the wounded continued to die.
In April of 2013, after the Sandy Hook Elementary School shooting in December 2012 that killed 20 children and six adults, members of multiple agencies — International Association of Fire Chiefs (IAFC), International Association of Police Chiefs (IAPC), Federal Bureau of Investigation (FBI) American College of Surgeons, Department of Homeland Security (DHS) and many other organizations formed a committee. The committee’s goal was to create a national policy to enhance survivability from intentional mass casualty and active shooter events. The committee’s recommendations are called the Hartford Consensus. The Hartford Consensus concluded that “integrated and coordinated planning, policies, training and team building prior to any incident will ensure effective and successful response.”
Over the next three years the Hartford Consensus developed four additional reports. https://www.facs.org/about-acs/hartford-consensus. The four reports are:
- Improving Survival from Active Shooter Events
- Active Shooter and Intentional Mass Casualty Events
- Implementation of Bleeding Control
- The Hartford Compendium on improving survivability from mass casualty events.
Across the country, we started to see fire department and EMS agencies begin to train with law enforcement for an integrated response. Fire, EMS, and law enforcement thus began to work together to save lives in an ASHE in the warm zone, but there still was no consensus standard in place.
On June 12, 2016, the Pulse Orlando nightclub shooting occurred, in which 49 people were killed and 53 more were wounded. After that incident, the National Fire Protection Agency (NFPA) was requested to develop a standard, multidisciplinary program for preparedness, response and recovery to active shooter/hostile events with 53 members appointed to the committee from a wide range of expertise. The standard was developed and, in 2018, NFPA 3000 Active Shooter/Hostile Event Response (ASHER) Program was released. The ASHER Program focused on bringing all facets of communities together to provide a unified prevention, response and recovery plan. The program offered comprehensive criteria for organizing, managing and sustaining a multidisciplinary ASHE standard based on an organization’s or community’s level of risk. NFPA 3000 2021 Edition was approved as an American National Standard on April 4, 2020.
The NFPA 3000’s main objectives are to prepare a single set of requirements to be used by a whole community addressing unified command, integrated response and planned recovery. The standard explains these principles further:
- Unified Command – How and why the unified command structure at an operations level needs to be in place, practiced and physically in the same location.
- Whole Community — Providing training and education to community members, preparedness information, bleeding control and emergency action plans for facilities.
- Integrated Response — All responding public safety agencies must have operational plans that incorporate the objectives of other agencies, and they must function as a cohesive, integrated unit.
- Recovery — There are several aspects of recovery — immediate, early, and continued recovery — that need to be planned for.
I hope this has been a good review of MCI/ASHE response that has created additional discussion and research. I look forward to the next magazine’s MCI/ASHE article where we will continue this discussion. – Stay Safe