In Mass Attacks, New Advice Lets Medics Rush In

[unleashedfury]

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.

This,,
When these incidents are going on they may have a secondary device to stop any aid from entering the building, or to meet the "kill number"



When an Active Shooter situation is going on or something like Columbine or the VT incidents these people didn't have a "specific targets in mind" they just go in and fire away. Most of them know they are going to die during the incident so if they don't give a crap about their own life or the life of someone else what makes you much more special. These are still unknown situations

 

[the_negro_puppy]

Time to leave EMS and earn $15 an hour at McDonalds

 

[GaMedic]

When I can carry a duty weapon legally, I will consider this until then... You can find me staged down the block and if that isn't good enough.. You want fries with that?

 

[SandpitMedic]

When I can carry a duty weapon legally, I will consider this until then... You can find me staged down the block and if that isn't good enough.. You want fries with that?

Badda bing!!! Badda boom!!!

Word to yo' motha'!

This right here.... THIS MAN! Has a clue!

Unarmed = no go.

You guys have heard the saying: "you don't bring skittles to a gun fight." Right?
Well you don't bring tourniquets and gauze either.

 

[SandpitMedic]

I also like that he said "when I carry... legally..." Implying that this dude is packing his heat right next to his Adenosine at all times. I like it.

I think we should all be allowed to carry, so long as we're qualified and trained. Security guards do.. We can too. Different topic, different thread.

 

[triemal04]

The privates will never get on board with this. That's all I meant. This will be a fire dept/EMS/govt dept thing.

There is no legitimate reason that any EMS agency, private or otherwise, that has the personnel, resources to provide for ballistic vests, and ability to train their people cannot do this.

Yes, private for profit EMS has all those things. If they choose not to because there would be a minimal drop in profits or because of the apathy of their employees (as is very well shown here) that is an entirely different issue.

To many people are not understanding what the concept talked about in the article is, or how it is implemented, what is actually done while in the "warm zone," and to many people are far overestimating the risks involved. Most likely due to a hero-complex, but I digress.

EMS personnel would be going into areas that had already been swept by a cops but not technically "secured," to find victims and rapidly remove them from the building. The limit of entry for medical personnel would be well behind the areas that had not been initially cleared by police, and the level of risk is realistically low. Though admittedly higher than staging 3 blocks away for an hour.

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.

How is the liability any different for a public/non-private EMS provider? Why can private EMS not be trained and expected to do this? If private EMS is the defacto primary EMS provider in a given agency, if not them, who?

Administrative Note: Post has been removed. --LS5

Just stop. I believe you have said that you are moving to a job where everything is handed to you and you won't have to make difficult choices; perhaps you should speed that process up. Your comments...in all threads...are a perfect reflection of why people may look down on private for profit EMS; you clearly do not understand the situation that is being discussed, clearly are biased, easily excitable, uninformed, overreact, and won't listen to anything new.

As I said earlier, this is an unfortunate reality of the world we live in. In these type of situations many people are dying who otherwise wouldn't because they have gone without initial treatement for 30+ minutes, let alone getting to a hospital. EMS needs to adapt to the times that we live in, just as we need to adapt to changes in medical care. (yes I laughed after I wrote that) Most police agencies figured out long ago that in many active shooter situations it is better to NOT wait for a tactical team, but to form small teams of 2-3 cops and start clearing the building on their own. Why? Because it takes to long to wait, and people where dying.

 

[lightsandsirens5]

Just a warning for everyone, please keep it civil in here. I understand this is a hot and sensitive topic, but lets stay calm, and discuss it out.

 

[wanderingmedic]

One thought. Instead of EMS rushing in...why don't we just let cops do basic bleeding control and drag the wounded out to us? They have tactical training. That was the problem in the last LAX shooting. If one cop would have just picked up that guy and run him the ~50ish yards to the medics he may have survived.

I'm no expert...but this makes sense to me.

 

[triemal04]

One thought. Instead of EMS rushing in...why don't we just let cops do basic bleeding control and drag the wounded out to us? They have tactical training. That was the problem in the last LAX shooting. If one cop would have just picked up that guy and run him the ~50ish yards to the medics he may have survived.

I'm no expert...but this makes sense to me.

It does, and some departments are issuing their officers with tourniquets. What it eventually come down to though, is that everyone has a job in situations like this; when you make someone go outside their role, their job doesn't get done.

Make cops remove people. Ok. But then who's going to be clearing the building, finding/stopping the shooter, setting up a perimeter, doing crowd control and such?

 

[mycrofft]

1. We've settled the stateside "let's get strapped, dude" discussion. Sheer childishness.
2. Private ambulances should meet the same criteria as public ambulances for 911 work, and the bar needs to be high enough. Especially if they are being integrated into armed responses. (Security guards, indeed).
3. Training for active shooter events is really, very good, but the ops plan goes out the window with first contact etc etc. Mastering component skills and having sound integrated overarching principles of response are better, they can be molded to serve instantly.
4. IF the shooter(s) are counted and localized, bring in the EMS. Usually in the confusion that takes a while.

How about doing what the armed forces did starting in the Eighties? Integrate and train each responder with the basic of addressing likely injuries, when to bypass a subject, and a basic dressing kit.

What causes death before hospitalization? Bleeding, airway. Teach rapid bleeding control and airway positioning, report the location, move on and secure the area.

OR, actually stand up tactical EMS.

 

[triemal04]

1. We've settled the stateside "let's get strapped, dude" discussion. Sheer childishness.
Well, unfortunately it's not a completely dead issue, more's the pity.
2. Private ambulances should meet the same criteria as public ambulances for 911 work, and the bar needs to be high enough. Especially if they are being integrated into armed responses. (Security guards, indeed).
They should, but this doesn't happen rather often for many reasons.
3. Training for active shooter events is really, very good, but the ops plan goes out the window with first contact etc etc. Mastering component skills and having sound integrated overarching principles of response are better, they can be molded to serve instantly.
I agree. This type of concept, as I said, is actually very simple, and can be changed as needed, based on personnel, locations, hazards, transport issues, et al.
4. IF the shooter(s) are counted and localized, bring in the EMS. Usually in the confusion that takes a while.
That's what this is for; in a large building (think a mall) it will take a LONG time for that to happen. But once a given area has been swept through and the potential shooters pushed deeper into the building, why shouldn't EMS move in?

How about doing what the armed forces did starting in the Eighties? Integrate and train each responder with the basic of addressing likely injuries, when to bypass a subject, and a basic dressing kit.
See the above post.

What causes death before hospitalization? Bleeding, airway. Teach rapid bleeding control and airway positioning, report the location, move on and secure the area.

OR, actually stand up tactical EMS.

Replies in red.
The problem with tactical EMS is the same as the problem with tactical police teams; they take time to mobilize and reach the scene. The whole point is to rapidly find and extricate people from the building.

 

[mycrofft]

Make cops remove people. Ok. But then who's going to be clearing the building, finding/stopping the shooter, setting up a perimeter, doing crowd control and such?

Explorer Scouts? (kidding).

 

[Meursault]

One thought. Instead of EMS rushing in...why don't we just let cops do basic bleeding control and drag the wounded out to us? They have tactical training. That was the problem in the last LAX shooting. If one cop would have just picked up that guy and run him the ~50ish yards to the medics he may have survived.

I'm no expert...but this makes sense to me.

I'm told the latest doctrine is exactly that. Of course, it's going to be a while before that filters down to every police department, and good luck getting everyone together to train on it. That said, Urban Shield 2014 is coming up...

Make cops remove people. Ok. But then who's going to be clearing the building, finding/stopping the shooter, setting up a perimeter, doing crowd control and such?

The several dozen other cops on-scene? I don't think I've ever read a mass casualty AAR where anyone concluded, "You know, we just didn't have enough police officers."

 

[wanderingmedic]

Make cops remove people. Ok. But then who's going to be clearing the building, finding/stopping the shooter, setting up a perimeter, doing crowd control and such?

I totally understand that, and it makes sense. The only thing that gets me on it is it seems like there can be an abundance of resources on a scene. I get this if there are multiple casualties, but if there are limited casualties (one or two) then I have a hard time seeing why one cop cant take the ~30 seconds to drag someone outside to a medic. I understand this is not always feasible due to staffing/manpower shortages on scene, but to use the LAX shooting as an example, it seems like it would have been a reasonable thing to do. I do not want to be an armchair quarterback and slam the guys who responded to the LAX shooting either, just trying to see if there is anything we can learn.

From a cost standpoint I have trouble seeing how training medics to be "tactical" justifies itself when it takes one or two cops to start dragging the most critical outside while doing basic bleeding control.

 

[Christopher]

One thought. Instead of EMS rushing in...why don't we just let cops do basic bleeding control and drag the wounded out to us? They have tactical training. That was the problem in the last LAX shooting. If one cop would have just picked up that guy and run him the ~50ish yards to the medics he may have survived.

I'm no expert...but this makes sense to me.

Nothing out of Iraq or Afghanistan suggests that anything more than basic first aid saves lives in the initial minutes after an event.

Slapping plate carriers on paramedics or EMT's and pushing them to the folks is a waste of money and time, and is an unnecessary risk even if the scene is relatively secure. I'm not going to do anything more than first aid when you bring me to the patient prior to moving them out of the warm area...so why not have the people who would be there anyways do that?

Good first aid training for officers will provide the largest effect on survivability without blurring the lines between TEMS and EMS.

 

[triemal04]

I totally understand that, and it makes sense. The only thing that gets me on it is it seems like there can be an abundance of resources on a scene. I get this if there are multiple casualties, but if there are limited casualties (one or two) then I have a hard time seeing why one cop cant take the ~30 seconds to drag someone outside to a medic. I understand this is not always feasible due to staffing/manpower shortages on scene, but to use the LAX shooting as an example, it seems like it would have been a reasonable thing to do. I do not want to be an armchair quarterback and slam the guys who responded to the LAX shooting either, just trying to see if there is anything we can learn.

From a cost standpoint I have trouble seeing how training medics to be "tactical" justifies itself when it takes one or two cops to start dragging the most critical outside while doing basic bleeding control.

I don't completely disagree; an active shooter in a large building with a potentially unknown location is a very fluid situation. There very well might be a situation where it makes more sense for the cops to be taking someone out. To some extent it really will vary. Hell, during the Aurora Theater shooting at least 1 (and I think several) people were not just removed, but transported to the hospital in police cars because EMS was not on scene, and the cops had the ways and means to do so.

The thing to remember about this is that it's really not for a small building, but for a large one; a school, campus, mall, industrial complex, airport, that sort of thing. Despite what some think, it still takes the police time to respond (just like it does EMS) and to clear a building that size, let alone truly secure it takes A LOT of cops. Not to mention that depending on the building layout, the location of the victim may be very far from the nearest way out; pulling police away from what should be their primary responsibility makes less sense than training EMS responders to do this.

 

[triemal04]

Nothing out of Iraq or Afghanistan suggests that anything more than basic first aid saves lives in the initial minutes after an event.

Slapping plate carriers on paramedics or EMT's and pushing them to the folks is a waste of money and time, and is an unnecessary risk even if the scene is relatively secure. I'm not going to do anything more than first aid when you bring me to the patient prior to moving them out of the warm area...so why not have the people who would be there anyways do that?

Good first aid training for officers will provide the largest effect on survivability without blurring the lines between TEMS and EMS.

Because the people there first have a different job to do.

The goal (where I am anyway) isn't to treat people in the building beyond immediate and easily correctable injuries; place a tourniquet, needle a chest or open an airway with a NPA/OPA. The goal is to get them out of the building to where they can get any other needed treatment and be transported to a hospital (which is really the best treament).

 

[Christopher]

Because the people there first have a different job to do.

The goal (where I am anyway) isn't to treat people in the building beyond immediate and easily correctable injuries; place a tourniquet, needle a chest or open an airway with a NPA/OPA. The goal is to get them out of the building to where they can get any other needed treatment and be transported to a hospital (which is really the best treament).

I understand the goal, just if you've got enough officers to secure an EMS crew to make patient contact...you've got enough officers to perform first aid.

 

[Handsome Robb]

One thought. Instead of EMS rushing in...why don't we just let cops do basic bleeding control and drag the wounded out to us? They have tactical training. That was the problem in the last LAX shooting. If one cop would have just picked up that guy and run him the ~50ish yards to the medics he may have survived.

I'm no expert...but this makes sense to me.

Because they've got a job to do. That job is not medical care. Medical care is a responsibility of the Emergency Medical Services provider for the affected area.

 

[Handsome Robb]

The several dozen other cops on-scene? I don't think I've ever read a mass casualty AAR where anyone concluded, "You know, we just didn't have enough police officers."

Have you been on a mass shooting scene before? Resources are grouped and deployed as they arrive. The overabundance of resources doesn't occur until midway to the end.