By Daniel Moran, Davie Fire Rescue
The National Fire Protection Agency (NFPA) 3000 Active Shooter/Hostile Event (ASHE) standard’s main objectives are to provide a single set of requirements to be used by the whole community addressing Unified Command, integrated response, and planned recovery.
• Unified Command – When and why a Unified Command needs to be in place, practiced, and institutionalized by the Authority Having Jurisdiction (AHJ).
• Whole Community – Providing training and education to community members, preparedness information, bleeding control, and emergency action plans for facilities.
• Integrated Response – All public safety agencies that may be involved in a response collaborating to develop common operational plans to function as a cohesive, integrated unit.
• Recovery – Planning for each of the Recovery Phases (immediate, early, and continued recovery) is essential.
In this month’s article, we take a deeper dive into “Whole Community” preparation and response for an ASHE and provide recommendations for best practices.
Who is the real first responder for an ASHE incident? Police, Fire, EMS, Security, Special Weapons and Tactics (SWAT) (the list of sworn and private responders could continue,) but the real answer is the members of the public (uninjured or minimally injured) that are already at the location of the ASHE incident are the first to respond and are the “immediate responders.” It is imperative that these immediate responders be educated on how to initially respond to these emergencies. There are also several steps that the public safety community should consider helping the public get prepared. Let’s break down the whole community approach into three stages – Community Preparation, Response, and Facility Management.
Preparation – Training the public in severe bleeding control techniques is incredibly important, in fact, an entire campaign was built around that topic known as Stop the Bleed®. By teaching everyone the challenges of uncontrollable hemorrhage and the basic principles of stopping bleeding, lives will be saved. A best practice would be to incorporate the Stop the Bleed® training into all Cardiopulmonary Resuscitation and Automated External Defibrillator (CPR/AED) courses. If you’ve already incorporated bleeding control training into all CPR courses, great! But the next question is, how do the public gain access to the equipment needed during the emergency? A best practice is to create a city/county ordinance that requires a bleeding control kit located in each AED cabinet that is required by code. Just as it is commonplace to see fire extinguishers and AEDs required by code, the future should be to require bleeding control kits in the same establishments as AEDs.
Response – Stressing the public’s safety and using the Federal Emergency Management Agency (FEMA) Run, Hide, Fight® approach to ensure their safety will always be the first step in an ASHE. After the threat has been eliminated, the focus for the public and first responders is saving lives through treatment.
The number one preventable cause of death in an ASHE is uncontrolled external hemorrhage. The focus for bystanders should be the application of a tourniquet, pressure dressing, and/or a hemostatic agent until transport and definitive treatment can be implemented. All of the myths around tourniquet application (losing the limb, loosening the tourniquet, etc.) have been proven to be false.
The second preventable cause of death is respiratory/cardiac arrest from a tension pneumothorax. Education should be provided on occlusive dressing application “chest seals” to seal the chest wound.
Finally, we should teach wound packing, a skill that is often not covered in-depth for EMS providers. Performing this skill fast and accurately will slow bleeding in junctional locations where most tourniquets cannot be used.
Facility Management – Facility emergency action plans should be reviewed by their local public safety agencies. Vulnerability assessments may be required for certain facility types, but whether completed or not, the public safety agencies that will respond to those facilities need to be aware of their plans, this is extremely important for identified target hazards.
Hospital facilities have added challenges for emergency action plans, they need to develop a plan for an Mild Cognitive Impairment and Active Shooter/Hostile Event (MCI/ASHE) internal to the hospital as well as victims arriving unannounced at the ER. It would be important for responding agencies to know where the hospital incident management team will be located is an important part of planning for an MCI/ASHE or any other critical incident.
The hospitals need to be prepared to be overwhelmed by private vehicles or police bringing victims to the hospital many times arriving prior to ambulances and maybe before even hospital notification of an MCI/ASHE has occurred. Hospital staff should be trained in rapid triage of victims at the hospital ER entrance/ambulance ramp. Mass bleeding control kits should be located at hospital main entrances, triage entryways, and the ambulance ramp. Having to retrieve tourniquets and bleeding control products from an inventory system will waste precious time. Hospital staff needs to be ready to enact their plans and treat large quantities of injured.
During an ASHE a best practice that has been identified is to have a Fire/EMS liaison(s) report to the hospital(s) victims are being transported to. The liaison(s) can keep the hospital(s) staff up to date on the anticipated victim counts (once established the transport officer or medical communications will provide updates on the victim count and conditions). The liaison can also assist with the victim tracking that arrives from private vehicles or police transports. A gap identified by many fire/EMS agencies is following up from the hospitals after receiving a hospital capability report on how many victims they will receive. The hospital liaison will be able to close that gap and provide real-time information.
For more information on the Stop the Bleed program, visit www.stopthebleed.org
For sample ordinances requiring bleeding control kits, visit https://www.davie-fl.gov/1080/Stop-the-Bleed
Daniel Moran is the Assistant Fire Chief for Davie Fire Rescue (Florida). He has been a firefighter/paramedic for over 20 years. For the last 7 years as a Chief Officer assigned to administration, he has functioned as a lead judge and evaluator for dozens of MCI exercises. He manages the ASHE and RTF drills between Davie Fire Rescue and Davie Police and is currently developing a training platform on MCI response for all of Broward County. He is also the Co-Chair for the Fire Chiefs Association of Broward County EMS Subcommittee.