# Paramedics barred from saving Orlando shooting victims because club was deemed too dangerous



## MMiz (Jun 24, 2016)

*Paramedics barred from saving Orlando shooting victims because club was deemed too dangerous *

Paramedics responding to the Orlando, Fla., nightclub shooting never entered the building throughout the three-hour standoff because it was considered too dangerous, officials said Wednesday.

The attack at the Pulse nightclub left 49 dead and more than 50 wounded.  It’s unclear how many could have been saved had paramedics been able to enter the gay club between the time the shooting was reported at about 2 a.m. and when it ended shortly after 5 a.m..

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## SandpitMedic (Jun 24, 2016)

I'm not sure how I feel about this one. I'll have to think about it a little more.


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## NomadicMedic (Jun 24, 2016)

From what I understand, armed police didn't enter, either.


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## OnceAnEMT (Jun 24, 2016)

Train LEOs first aid, triage, and extrication skills and make patient evacuation an objective. Correct me if I am wrong, but I doubt any ALS skills would be used in that environment. The last thing we need is defenseless personnel starting IVs around the corner from the shooter's unknown location.


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## Gurby (Jun 24, 2016)

Grimes said:


> Correct me if I am wrong, but I doubt any ALS skills would be used in that environment. The last thing we need is defenseless personnel starting IVs around the corner from the shooter's unknown location.



I couldn't find any data from a quick Google search, but if I remember correctly, the military did a study and found that tension pneumothorax was one of the leading ways people die in combat.


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## SandpitMedic (Jun 24, 2016)

I'm going to have to say that given the current state of the _average_ EMS provider, that EMS as a whole should not be allowed in active shooter scenarios. 

Large picture is that most EMS providers are moderately to severely out of shape, do not carry the traits of continuous situational awareness, prone to complacency, could not handle the intensified stress to properly execute TTPs in a nonpermissive environment,  couldn't be trusted with a squirt gun - let alone a firearm, not interested in learning/training adequately to perform such rare operations, and are not in this game to do such things. Generally, tacticool medicine and tactical medicine are vastly different from each other and vastly different from regular EMS calls. Not to mention- some EMS folks wouldn't walk into that building anyways with shots being fired- no matter what- it just isn't in them. 

Trained tac medics train continually and are versed and reheared for such action, and even they don't get it right everytime (we're all human). Plucking a few "badass" heroes off the engine and putting a vest and helmet on them does not a tactical medic maketh.

Now if you want a few medics to rush in under a protection element (SWAT guys covering you) and put TQs on folks and needle decompress folks- that's still something that requires more than a vest and helmet, to avoid becoming a casualty yourself. 

Proficiency in such operations require personnel of a higher caliber than that of your average EMS provider. Notwithstanding, sometimes it is the people who no one imagines anything of that do the most unimaginable things. But in the larger scale- tactical medicine is not our business. 

Intense physical conditioning, firearms training,  small team tactics training, movement under fire... Etc... 

I'd suggest if you are truly interested in tactical  medicine you take a TCCC course -which is a VERY minimalistic entry level view into the concepts surrounding care under fire. It's not a tactical medic cert or patch or some BS.

Anyways.

Would I volunteer to be one of those guys? Sure I would... In a damn second... But I would train like my life and my teammates lives depended on it, because it will.  Not to mention, I'm not going into an active shooter environment without being armed- cut and dry, that's non-negotiable. I don't give a **** if I have a full body Ironman suit- no personal weapon, no go. 

"Everyone wants to be an operator, until it's time to operate."


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## Jim37F (Jun 24, 2016)

In my mind, the situation was roughly analogous to a structure fire, in the sense that you don't provide much (if any) treatment to the victim where they're found. Instead you grab and drag them out of the danger zone to the safe zone where the medics are. Sending medics in to triage, treat THEN extricate and transport, with a barricaded shooter still insode the same structure would have been just as bad as doing so if the victims were down from smoke inhalation and active fire somewhere you don't know where inside.


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## SandpitMedic (Jun 24, 2016)

In my opinion it does not equate to that. 

Not at all. Both are dangerous events, but they are not of the same danger. 
Fire is dangerous, smoke is dangerous, debris is dangerous. However, none of those things are consciously and actively attempting to kill you with precision. 

Additionally, some here are thinking of this one isolated incident with one shooter. Not taking into account and adding in scenarios where there are multiple shooters, explosive devices, secondary waves, and/or paramilitary state or self trained hostiles, etc etc etc. 

When these things unfold, they happen fast, and details are scarce. There are ways and tactics to prepare and deal with these threats and potential threats... OODA loop, anyone?

Equating the dangers of people shooting at you and or actively attempting to blow you up (combat) and the dangers of a structure fire is short sighted and it is apples to oranges.


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## SandpitMedic (Jun 24, 2016)

To add, I forgot, most of EMS... Are not firefighters. So there's that too.


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## EpiEMS (Jun 24, 2016)

Gurby said:


> I couldn't find any data from a quick Google search, but if I remember correctly, the military did a study and found that tension pneumothorax was one of the leading ways people die in combat.



I believe the figures are:
Of preventable combat deaths, 60% are due to extremity hemorrhage, 33% from tension pneumo, and 7% from airway obstruction. See: http://archsurg.jamanetwork.com/mobile/article.aspx?articleid=1107258

Good BLS knocks most of that right out -- and good shooting all of it. The key, I think, in all this, is good solid EMR-type training for LEOs and supporting them in their all too vital suppression of the threat.


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## NysEms2117 (Jun 24, 2016)

I honestly cant agree more with EPI and Grimes, I am in LE (granted its parole, but we still get action contrary to popular belief) and it's almost shocking how little medical training we get(you guessed it, none). However I also understand the tactics part, and while your under the stress of gearing for a warrant or to breach, you have 1 thing on your mind and it is to "get" the bad guy. However you want to define get is up to you(shoot,arrest, what have you). I understand a need for a tactical medic, but they can not be part of any breaching team IMO. The breaching team needs to do their job and complete it safely, and you can't do that 100% while having to body guard a medic. And sandpit medic is correct about one thing, most EMS i see are not physically fit enough to be doing something like that.


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## cruiseforever (Jun 28, 2016)

DEmedic said:


> From what I understand, armed police didn't enter, either.


 
Active shooter drills and planning must be only for schools.


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## Dennhop (Jul 5, 2016)

Theres a big difference between our corpsmen that served with us in the Marines and the EMT/Paramedics I work with now.  The first difference was that our corpsmen were armed.  The second was they trained with us day in and day out.  They new our tactics, they new our drills, but even then, unless we absolutely needed them, they weren't on entry teams with us.  Why?  Because making entry is the most dangerous part of clearing a building.  Why put the one guy you're going to need if everything goes wrong in a position to also be the first casualty?
That all being said, civilian medics at BEST may get a bulletproof vest issued to them by their department.  Many don't.  You're not going to solve anything by sending medics in to treat victims in an active shooter incident when they are potentially going to be the next victim.  It's also not going to be good if they have to be protected on the way in, and someone else goes down.  
Does it suck to be the families of those victims?  Absolutely.  Should we potentially create more bereaved family members in a misguided attempt to save others?  It doesn't make sense.  Like was stated above, even armed police didn't enter the building for a while.  Your typical officer isn't equipped to handle a hostage rescue situation by himself, or even with a group of patrol officers.  (No offense meant to any that may be here on these forums) there's a reason why SWAT/HRT/TAC teams exist...they train together for these situations.  They know exactly how each other works, and they have the skill set to perform the required tasks.  
Every Marine a Rifleman.  Just because that's true, even more so now, it didn't mean I as ever going to go on a HVT or hostage rescue, or even a reconnaissance mission.  At most, I performed security sweeps, patrols, and a few low value/routine raids while I was in Iraq.  I knew where I stood, and understood that I did not have the training to perform the higher level missions.

Between the Corps and my EMS education, one thing that's drilled into our heads from day one is Safety First.  Youre no good to anyone else if you can't protect yourself.  What's the point of sending in medics into a volatile scene of any sort, especially if their safety can't be guaranteed?  At that point you end up creating more casualties than doing any good.

Sorry for the long rant.  I'll stop now.


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## MrJones (Jul 5, 2016)

Interesting. What did you do in the Corps?


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## Dennhop (Jul 5, 2016)

My primary job was as a 2841/2862...ground repair.  My second deployment to Iraq I went as the satellite comms section chief, where we would set up out terminals at remote OPs to allow them data signals.  4 of us on a team, 6 hour shift, we got bored quick, so we would end up attaching to what ever unit we were with and helping them out when we could.


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## Daniel G (Jul 8, 2016)

Its because they are not Combat Medics.


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## sack jears (Jul 11, 2016)

Rule #1: scene not safe. I'm not going in there


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## RocketMedic (Jul 11, 2016)

I'm with Grimes. Short of a tank or a full body Ironman suit, I'm not entering an enclosed active shooter scene like the club without a weapon and friends with weapons. Outside, where I can move and escape to anywhere, is a different story


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## johnrsemt (Jul 11, 2016)

In the opposite thinking I understand that fire medics and fire crews pushed in under fire in Dallas to work on the officers shot, and get them out of the area.


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## luke_31 (Jul 11, 2016)

johnrsemt said:


> In the opposite thinking I understand that fire medics and fire crews pushed in under fire in Dallas to work on the officers shot, and get them out of the area.


Totally different scenarios between the two. Inside a building you have less room to maneuver versus outside with multiple paths of egress and various cover and concealment available.


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## 46Young (Jul 11, 2016)

EMS has no business going into a hot zone. LE needs to clear your area, make it a warm zone, and then bring EMS in.

We carry special kits with 5 tourniqets, 5 chest seals, 5 tension pneumo kits, 5 hemostatic  gauze, 5 npa's, 5 compressed bandages, and that's about it. We get ballistics gear as well.

Going into a hot zone as EMS is just dumb. The LEO's need to babysit you, and you could get blasted as well.


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## Daniel G (Jul 11, 2016)

Watch the Dallas footage of the cop getting flanked and blasted. If I was a gunman, id aim for medics. I learned that the hard way from Iraq


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## RocketMedic (Jul 11, 2016)

johnrsemt said:


> In the opposite thinking I understand that fire medics and fire crews pushed in under fire in Dallas to work on the officers shot, and get them out of the area.



Hell, there's a very fair chance that a sufficiently bold fire crew could actually facilitate extraction from the point of contact by using that gigantic fire truck as a rolling wall. That's something that's a lot harder to do with a house.


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## NysEms2117 (Jul 11, 2016)

EMS has no reason to be in a hot area at all. even outside, too many variables. Inside is completely out, with no discussion. Inside buildings you can only enter from certain points, which is much easier to focus on then 360 degrees. Maybe have EMS in the "in between zone" so LE can simply drag, and get them close enough for treatment, but no EMS should be going into a live fire scene. LE does not need to be babysitting somebody while getting shot at either.


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## Handsome Robb (Jul 26, 2016)

Homeboy was barricaded in the bathroom...most of the club wasn't a hot zone, it was a warm zone, where EMS should absolutely be operating with lethal cover. 


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## Chimpie (Jul 26, 2016)

Handsome Robb said:


> Homeboy was barricaded in the bathroom...most of the club wasn't a hot zone, it was a warm zone, where EMS should absolutely be operating with lethal cover.


I have not read the AAR for this. Was LE in the main part of the club while the suspect was in the bathroom? I was under the impression they were not.


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## Handsome Robb (Jul 26, 2016)

Chimpie said:


> I have not read the AAR for this. Was LE in the main part of the club while the suspect was in the bathroom? I was under the impression they were not.



The way I understood it they were. If they weren't then I'd agree EMS should not be there. 

From what one of our Tac guys told me the response/rescue operations were much better than the media has made them out to be.


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## Bullets (Aug 18, 2016)

Handsome Robb said:


> The way I understood it they were. If they weren't then I'd agree EMS should not be there.
> 
> From what one of our Tac guys told me the response/rescue operations were much better than the media has made them out to be.
> 
> ...



Interesting, at our most recent RTF training last month our lead instructor, a LEO, said they screwed the pooch in multiple ways, EMS response was one of them


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## zzyzx (Sep 11, 2016)

I'm getting to this late, but I have to say that this article is such nonsense, and so are the opinions of the paramedics quoted in the story.

Along these lines, a paramedic recently wrote an editorial for the Washington Post advocating for paramedics to be trained to enter active shooter scenarios such as the Orlando night club:

https://www.washingtonpost.com/post...shootings-they-should/?utm_term=.930c4a2f0770

It's such nonsense because the only thing a shooting victim inside a hot zone needs is rapid extrication. There is nothing that a paramedic can do to save someone's life in the 1 or 2 minute it would take for a police officer to pull the victim out of a building. (Needle decompression? Really? Think about it.)

Why not just train the police officers that part of their primary mission in these incidents is to extract victims and take them to a triage area, rather than trying to make the scene safe for paramedics to enter. Perhaps they mistakenly fear that if you move a trauma victim you might cause them further harm.

All this is funny considering that not too long ago it was not uncommon for police officers to throw shooting victims into the backs of their cruisers and drive them directly to the hospital.


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## RocketMedic (Sep 11, 2016)

Handsome Robb said:


> Homeboy was barricaded in the bathroom...most of the club wasn't a hot zone, it was a warm zone, where EMS should absolutely be operating with lethal cover.
> 
> 
> Sent from my iPhone using Tapatalk



Strong, strong disagreement. 

EMS's role in that is outside. "Lethal cover" is no substitute for safety.


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## Handsome Robb (Sep 11, 2016)

RocketMedic said:


> Strong, strong disagreement.
> 
> EMS's role in that is outside. "Lethal cover" is no substitute for safety.



Except with ballistic protection and armed officers around you you're safer than the vast majority of scenes we make on a daily basis. Especially knowing that the vast majority of active shooter incidents end within the first few minutes either before PD arrives or immediately after. Not all but the majority do. 


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