It’s December 2012 and Americans are reeling from the tragic events of the Sandy Hook mass shooting. Politicians and leaders at state and local levels are feeling the pressure of well over a decade of active shooter events that have left emergency services un-equipped to handle such incidents. In response to the pressure, the American College of Surgeons is tasked with bringing together national leaders from the government, emergency medical services, law enforcement and the military. This would become known as the Hartford Consensus.
Promptly in 2013 the Hartford consensus released the first ever call to action for emergency services and law enforcement to re-evaluate response planning and medical treatment considerations for these types of incidents. Fast forward seven years and emergency services and law enforcement have made a course correction that can only be adequately described as exceptional. In this article we will discuss the many improvements related to industry standards as well as how to develop a program that best fits your emergency services organization.
Now it is 2020 and emergency responders have made un-precedented progress in re-defining how we respond to and mitigate hostile events. While this success is deserving of some well-earned praise for creating new national standards and practices, let us not lose our resolve to adapt, mold and implement these practices to our individual agencies. One of the challenges we face today is that we went from a time of having no direction on how to deal with these complex issues, to today, where the information and resources are significant but often contradictory and overwhelming. It is my hope that this article can provide some direction on where to go when developing or even refining your current polices and response procedures.
To start this process, you should first appreciate the massive complexity and undertaking creating a multi-agency, multi-jurisdiction response plan will be. In my own region, we have been implementing and revising our regional response procedures and training since before the Hartford Consensus existed. We must appreciate that all the tactical knowledge and understanding in the world will be of little use without sound relationships between regional partners in fire, EMS and law enforcement.
The big players in the game of response have all come out with their recommendations or training programs: The Federal Emergency Management Agency (FEMA), National Fire Protection Association (NFPA) and The National Association of Emergency Medical Technicians (NAEMT). When building a hostile event response plan, it is useful to first dissect the critical four components: national reference standards, strategic level procedures, and medical and tactical level operations.
National Reference Standards
NFPA 3000 has created a national standard regarding numerous components of responding to and training for what they title as an ASHER (Active Shooter/Hostile Event Response). This article will discuss a few of these important standards, you can view the full standard for free or purchase a printable version on the NFPA web site.
The first notable standard is a requirement for minimum personal protective equipment (PPE). Many programs have failed before they ever got started due to a lack of understanding and commitment to provider safety. Administrations putting response protocols in place without purchasing appropriate PPE is a sure recipe for failure. If you don’t expect your firefighters to fight fire without turnouts, don’t expect your responders to respond to a hostile event without appropriate PPE. NFPA has delineated the appropriate PPE as a level IIIA ballistic vest, with helmets being optional. Level IIIA is the national standard for law enforcement patrol vests.
The next important standard they have set, is the clear identification of control zones. These consist of hot, warm and cold zones. The hot zone is designated as an area with a known hazard or direct and immediate life hazard. The warm zone is an area with a potential hazard or indirect threat to life. The cold zone is an area with little or no known threat. The last standard we will discuss is the recommendation for care standards. NFPA as well as the FEMA programs denote the Tactical Emergency Casualty Care (TECC) programs as the standard for hostile incidents. NFPA 3000 is a robust standard that can be incremental in developing an agency response plan. This standard is well worth reviewing to maximize your hostile event program.
FEMA’s PER 335 course “Critical Decision Making for Complex Coordinated Attacks,” is a comprehensive course covering strategic level decision making and incident management. This training takes you well beyond the single active shooter incident, into the complexities of sophisticated multiple coordinated attacks similar to the tragic events in Paris in 2015. This course is offered in two- and three-day durations with different instructors around the country. These courses are designed to put multi-agency players into one room and develop their ability to manage a unified command as well as complex incidents.
Medical Treatment and Equipment
The medical treatment component of your response planning may be the easiest step forward for your organization. With every national program recommending TECC as the gold standard, there is little challenge to finding the right resources. With that being said, medical training and equipment is frequently underappreciated and overlooked. While fire and EMS are really good at treating one or two gunshot victims with five responders to every patient, we are not as good at treating 20 patients with two responders, with limited gear, in a hostile environment. The good news is NAEMT has solved the training component of this problem for your agency.
The NAEMT Tactical Emergency Casualty Care curriculum was derived from its big brother Tactical Combat Casualty Care (TCCC). TCCC was created by Navy Seal and medical doctor Frank Butler in the mid 1990s. Dr. Butler created an extensive program that identified the causes of preventable death on the battlefield that could be mitigated with minimal training and equipment. NAEMT adopted the TCCC program and subsequently created the civilian version TECC. This is a two-day course and will benefit your organization as much in day-to-day operations as it will help your responders understand the nuances of medicine in a hostile environment.
The second component of the medical portion is equipment selection. Bulky cardiac kits and airway bags are of little use in austere multi-casualty incidents. The TECC program identifies the equipment you will need in hostile events; you just need to decide in what manor and quantities your agency will want to carry them. To put it simply, you need a small variety of gear in a large quantity that can be quickly accessed while treating and moving.
Tactical Operations and Training
Unfortunately, this is where the list of referenced standards and programs comes to a screeching halt. While all of the above references touch on rescue task force (RTF) operations, they do little more than give you generic concepts. This is in part because of the diversity in your local resources, as well as the variances in the potential scope of an incident in your area. What will be profoundly successful in Seattle, Washington, may be of little use in rural Iowa. The most important concept in the tactical and strategic realm is understanding that the sooner EMS can treat patients, the more successful the incident will be. What this means is that once the threat has been mitigated or diminished, the law enforcement mission must rapidly shift to a mission of life saving. This consists of putting fire, law enforcement and EMS supervisors in one command post. Once this is accomplished, law enforcement should immediately start dedicating resources to get fire and EMS responders safely inside the warm zone to begin treatment.
To identify what tactical operations will work best for your size organization, start with the three following recommendations:
- Research what other organizations are doing tactically, and compare that with your area and resources.
- Initiate conversations with your law enforcement partners and start discussions on what resources they have, and what their commitment to supporting treatment and rescue operations will be.
- Reach out to the national instructors who have been implementing programs and get their recommendations or solicit their services.
As many of us know, building a new program in fire and EMS can be daunting by itself. Add in a topic that is new to fire and ems, then make it multi-agency, and daunting seems to be an understatement. Just remember these programs are built one area at a time with the end goal of producing something that is comprehensive and adaptive to a large number of incidents.
Hopefully this article will be helpful in directing you towards some resources to start building your program, or fill in some holes in your current program. The subsequent articles in this four-part series will better address the specifics of medical treatment and rescue task force operations.