In Mass Attacks, New Advice Lets Medics Rush In

[DrParasite]

[T]he Obama administration has formally recommended that medical personnel be sent into “warm zones” before they are secured, when gunmen are still on the loose or bombs have not yet been disarmed.

Mr. Mitchell, the [FEMA] fire administrator, said the gunmen and terrorists who mounted attacks in the United States over the past decade rarely made targets of first responders. But, he said: “We know that this possibility does exist, and part of the training of the fire and E.M.S. is to be observant and aware and to be on the look for suspicious activity and so forth.”

"These events like the shootings are usually over in 10 to 15 minutes, but it often takes over an hour for everyone to get there,” said Dr. Lenworth Jacobs, a trauma surgeon who created the Hartford Consensus[.]“We’re seeing these events in increasing frequency, and unfortunately we have to change how we approach them to keep death tolls down,” Dr. Jacobs said.

read the rest here: http://www.nytimes.com/2013/12/08/us/in-mass-attacks-new-advice-lets-medics-rush-in.html?_r=0

 

[unleashedfury]

It dosen't say HERO on my paycheck, And when it does it better come with a hefty raise.

I understand the whole concept, but to send a unarmed EMS worker in to an uncleared area to find out their could be dirty bombs or whatever behind door #1, could be a little more risky.

I think it would be reccomended to have a Tactical EMS team, trained to the same level but priority is to respond to Acts of Terrorism, Active Shooters and their priortiy is to treat the Victims.

 

[SandpitMedic]

It dosen't say HERO on my paycheck, And when it does it better come with a hefty raise.

I understand the whole concept, but to send a unarmed EMS worker in to an uncleared area to find out their could be dirty bombs or whatever behind door #1, could be a little more risky.

I think it would be reccomended to have a Tactical EMS team, trained to the same level but priority is to respond to Acts of Terrorism, Active Shooters and their priortiy is to treat the Victims.

I completely agree. As I was reading all I could think of was "I'm getting a raise; (sigh) that'll never happen." Likely it will be fire dept medics or special designated units (TEMS, etc.)
I think you'd be hard pressed to find AMR, RM, Acadian, other privates, etc enacting a policy forcing crews into active shooter or bombing scenes. I also believe even they did it wouldn't come with any additional compensation; maybe a pat on the back and a tacticool vest may get some new guys fired up to take a bullet though. The (terrorists/what have you) haven't really "targeted first responders." LOLz- well guess what, thanks for giving them the idea. Lets put our response plans and guidelines for sensitive incidents out for all to see.

Additionally, "our firefighters aren't taking any more of a risk than they already are fighting a structure fire," is about the dumbest thing I have ever heard. Forgive me, but getting sniped by a crazed gunman or blown to bits by a terrrist (yes, pronounced trrrrrist) awaiting your arrival is not the same as risking a lot in a structure fire. While I agree that we need to adapt responses to better suit the increasing frequency of these events, I also think the Obama administration should start gearing up and applying tourniquets on the next big scene if they want to advise me to do so. I have no issue with helping the injured, but as we are all taught as pups, what good are we if we become victims. Not to mention @ a whopping $11 bucks an hour on average.

I dunno, I like action, but I like going home at the end of my shift as well. Scene safety--- first thing on the school sheets, first thing in reality.

 

[Handsome Robb]

I'd do it.

My job is to care for people. You're generally going to be safer surrounded by armed LEOs while also wearing ballistic gear than you are on that abdominal pain call with no FD or PD back in the ghetto at 0300.

Think about it... You've got 4-6 bullet magnets around you, all able to shoot back, wearing ballistic vests so you've basically got a wall of armor and they're going to be the target of the shooter not you.They operate under the same principals as we do: "eliminate the threat eliminate the problem". We as EMS are not a threat, PD with the guns are.

Just my two sense. I realize our safety is paramount but I personally wouldn't stand by idly while people bleed to death. I'd never ask my partner to do it though. Ill make the conscious decision to put myself in harms way but I refuse to tell someone else to.

The medic at Sparks Middle School is a TEMS medic and was my old partner for a bit, did some rides with him during my internship as well.

 

[DrankTheKoolaid]

The thought of sending any healthcare provider into a warm zone with a suspected terrorist attack is ridiculous.

Years of conflict in war torn countries have shown over and over the first attack is to lure people in including health providers only to hit with a second to take out the first responders.

That's war 101. And no matter what the Geneva Convention dictates it's a reality. I was a Forward Observer in the military and was trained to do the exact same thing. So to think a terrorist isn't planning on doing that exact same thing is simply irresponsible.

 

[EpiEMS]

The thought of sending any healthcare provider into a warm zone with a suspected terrorist attack is ridiculous.

The line between healthcare and public safety/health is very grey.

 

[triemal04]

Love the attitudes, love 'em.

What is being talked about sounds more like a concept that has been in place in some departments for several years; I think that it's just gaining wider traction because there have been quite a few (relatively speaking) active shooter/bombings in the last 2-3 years. There was a write up done (may have been in JEMS but I don't remember) on what a few places in Virginia started to do after the VT shooting; essentially sounds like this.

Aside from the normal issues you get with large scale incidents (large numbers of patients, patients running and turning up far from the scene, crowd control, etc) the issue with active shooters and such is that the most seriously injured people who might otherwise have been salvageable end up dying because it takes 30+ minutes for them to reach treatment. This sort of response is geared to fix that problem.

The goal of this isn't to send paramedics up to the very front, or if there is still firing to where that is, but to provide them with body armor, group them with several officers, and send them into areas that have been rapidly swept through but not technically "cleared" by another team to bring out any victims; ie they are going into the warm zone. Is there some added risk? Sure, but in reality not as much as people will think. It is also very worth remembering that in larger buildings, it will literally take hours for the entire building to be "clear," if it ever truly is; think of how large a mall is; do you really think it is appropriate to wait until the entire building has been formally cleared before EMS should enter?

With a bombing it is still a little different; secondary explosions are a real and definite risk. The only way to truly mitigate that is to be very, very far from the initial blast. Which still leaves the issue of how do you get patients to ambulances, and who will be doing that.

The risk to EMS in these situations can and should be minimized as much as possible, but the simple reality of the world we live in is that these types of situations will likely continue. EMS will either evolve and change to fit into the role that it is now needed in, or it won't. At face value this isn't a terribly complex concept, it just takes some practice and the involved groups buying into it.

Unfortunately, due to misinformation, misunderstanding, apathy, and a long history of the same, it probably won't happen.

 

[ExpatMedic0]

The line between healthcare and public safety/health is very grey.

You can say that again, and one of EMS's identity crises issues.

 

[DrParasite]

As a side note, during the Aurora Colorado movie theater shootings, Police & Fire went directly into the scene before the shooter was identified or contained. The radio traffic confirmed it.

Both agencies had one thing in common during the operation: they had victims down, and needed EMS on a rush. EMS was staged a block away (in a parking lot somewhere, at the direction of their supervisors) awaiting the signal that the scene was secure before they entered.

Just thought I would mention it

 

[triemal04]

As a side note, during the Aurora Colorado movie theater shootings, Police & Fire went directly into the scene before the shooter was identified or contained. The radio traffic confirmed it.

Both agencies had one thing in common during the operation: they had victims down, and needed EMS on a rush. EMS was staged a block away (in a parking lot somewhere, at the direction of their supervisors) awaiting the signal that the scene was secure before they entered.

Just thought I would mention it

Partially that was done because it wasn't clear what was going on, or where exactly the scene was in relation to the building.

To be clear: the concept talked about in the article DOES NOT mean that EMS would drive directly to the scene and rush blindly in; that is still a terrible idea. It just means that medical resources would be moving into areas that they previously wouldn't have, and in a quicker manner.

edit: should have said "secured" not "cleared" in my last post.

 

[DrankTheKoolaid]

As a side note, during the Aurora Colorado movie theater shootings, Police & Fire went directly into the scene before the shooter was identified or contained. The radio traffic confirmed it.

Both agencies had one thing in common during the operation: they had victims down, and needed EMS on a rush. EMS was staged a block away (in a parking lot somewhere, at the direction of their supervisors) awaiting the signal that the scene was secure before they entered.

Just thought I would mention it

Yeah and if memory serves the first crew to get paged to this never responded because they were to scared to get anywhere near it.........

Regardless of duty to act, each responder in a matter of seconds after hearing a page like this go out is going to have a million things go through their minds including their life and family

Their own safety and going home at the end of shift HAS to be priority number 1 for the crews and the companies that manage them.

 

[rescue1]

With proper training and equipment, I think it's a great idea. I'm sure larger paid departments could easily pull this off, even smaller ones.
After all, these aren't medics going in with the initial SWAT and police teams, we're talking about going in to areas that have been cleared with a primary search, to use the fire department term, with an armed escort.
Like was said earlier, the most dangerous calls are the innocent sounding ones that go wrong, not the ones when you're surrounded by police officers.

Without proper training and equipment, it's perhaps less great. I would never except my old, rural, volunteer ambulance company to be able to rapidly and effectively deploy providers with proper PPE and training to an MCI.

The issue with special tactical medics is that it takes time to organize specialty units from across the city and deploy them, which kind of defeats the purpose of rapid removal of critical trauma patients.

 

[SandpitMedic]

Evolve! Class, be quite.and.pay.attention!

Listen, I understand the need. I understand these are big shoes to fill. I'm stating this fact. The privates will never get on board with this. That's all I meant. This will be a fire dept/EMS/govt dept thing.

Not to mention, the first medic to take a head shot--- and we revert back to the old ways. As was mentioned earlier: armored up, surrounded by 8 cops with long rifles, shooting has ceased or is in the distance? Sure, not a bad idea to stop the wounded from bleeding out, although, still incredibly dangerous. How far do bullets go again? is armor good for stopping AK rounds, or just handguns? Hmmm, will we be provided crap vests like we have crap everything else? Governing dynamics come into play. But realistically... Seriously, this is one of those things where people will say either one of two things: I will not stand idly by, or I will not be unnecessarily putting myself in harms way into an unsafe/unsecured scene.

Those of us privates have not taken an oath. Overseas when I worked, should an event like this occur, safety was still number one... Even in a military environment. Where most of the responders had some big weaponry at their disposal. I would have gone in over there, that was the job. Supporting the troops and coalition forces... With a compensation that was as high as the potential for danger.

I hate to be the materialistic weasel, but here at home... Two thoughts will go through my mind when the :censored::censored::censored::censored: hits the fan: I cannot stand idly by, and I don't make enough for this bull:censored::censored::censored::censored:.

 

[DesertMedic66]

I understand the need for it but until there is proper training and safety precautions I more than likely will not be going into an active shooter scene until it is safe.

Allow me to wear a vest and give and train me on using a handgun and I will probably go in.

We have some talk going on at my company about starting a TEMS team for the sherrif office in our area. I can only hope that they send the members thru a TEMS course that is offered by the city (I believe a couple of members on this forum have taken the exact class that is offered).

 

[mycrofft]

What part of "The Obama Administration"? DoD? FEMA? Weights and Measures?<_<

Since the Columbine school massacre, LE dos not want to be (perceived as) sitting on the outside figuratively listening to the screams and the gunshots on the inside.

EDIT: The Adminstration " was "Ernest Mitchell Jr., the Federal Emergency Management Agency’s fire administrator, who released the new guidelines on mass casualty events for first responders in September."

I disagree with the article because it advances a fallacy and fails to note a crucial fact in re the Boston marathon bombing. The fallacy: responding to a bombing is NOT like responding to an active shooter. The dropped fact (about sped of response): due to a failure of EMS response the previous year, they had mui beaucoup ambulances and PHEMS personnel already staged right there.

I DO agree with the premise that response has to be faster. I do not agree with sending in EMS people as scouts or going in and getting tied down with the first casualty they see…or passing the first casualty by to go find others (again, as a scout).

The response seems to be all about public image. Hopefully they stumble onto a viable protocol and don't drop the 99.8% of EMS to spend themselves silly on this.

 

[rescue1]

What part of "The Obama Administration"? DoD? FEMA? Weights and Measures?<_<

Since the Columbine school massacre, LE dos not want to be (perceived as) sitting on the outside figuratively listening to the screams and the gunshots on the inside.

FEMA.

I think LE has done a good job of fixing that and engaging the shooters right from the get-go. I guess the question now is the role of EMS in the same situation.

 

[EMDispatch]

A traditional active shooter is one thing... You generally are going to have a single direction attack.But the second explosive are involved the game changes... Secondary devices, NBC agents, structural hazards, etc. That just creates more victims.

 

[EpiEMS]

Listen, I understand the need. I understand these are big shoes to fill. I'm stating this fact. The privates will never get on board with this. That's all I meant. This will be a fire dept/EMS/govt dept thing.

This is totally true. No private company would (rationally) open themselves up to this. Now, if you're going to pay, equip, and train government (or even volunteer) personnel for this role, then I could see it being operationally feasible.

 

[CFal]

This is totally true. No private company would (rationally) open themselves up to this. Now, if you're going to pay, equip, and train government (or even volunteer) personnel for this role, then I could see it being operationally feasible.

exactly why privates should not be in 911

 

[Bullets]

My agency, a little suburban town of 30k, already train for this. Areas that have been initially cleared of hostiles can be entered with law enforcement protection teams and begin the extracting casualties to a collection point. Not a very difficult thing to do if you have a good relationship with police

Cops train to enter as soon as they have 2-3 on location. The secondary entry team of 3-4 cops form and form our protection detail as we enter the area that the intital entry team already has cleared