In Mass Attacks, New Advice Lets Medics Rush In

[Meursault]

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.

The casualty collection model for mass shootings seems based on a fairly traditional school/workplace shooting; as a hallway (seriously, that's how the presenter was breaking the scene down) is secured, a couple officers already in the area start moving victims back to the casualty collection point. Presumably, the first few officers coming in go try to make contact and then as more come in, they're assigned to secure and evacuate areas, expanding into the building one hallway at a time. Any aspects of the LE response more complex than this got filed under "tactical stuff I don't need to worry about", so I can't really defend it any better.

This probably slows down LE in securing the scene, but it greatly speeds the movement of victims and creates a clearly-defined warm zone. It's faster, more flexible, and less confusing than using separate teams that need to move from a staging area and be directed to patients.

 

[mycrofft]

If you study these sorts of incidents, the severely injured patients who make it are often carried out in the arms of a LE officer, thrown in the back of a patrol car, and hauled code 3 to a hospital. I'm sure this method has its share of DOA's too, but taking the time to make things nice and organized can cause deaths through "triage by Time".

That is why organic response* is useful.

*EVERYONE possible has the skills to try to rapidly stop bleeding with little set-up time and no specialized stuff besides a dressing kit etc. Hence it is "organic" (an organ, like a spleen?) to and organization.

 

[mycrofft]

The casualty collection model for mass shootings seems based on a fairly traditional school/workplace shooting; as a hallway (seriously, that's how the presenter was breaking the scene down) is secured, a couple officers already in the area start moving victims back to the casualty collection point. Presumably, the first few officers coming in go try to make contact and then as more come in, they're assigned to secure and evacuate areas, expanding into the building one hallway at a time. Any aspects of the LE response more complex than this got filed under "tactical stuff I don't need to worry about", so I can't really defend it any better.

This probably slows down LE in securing the scene, but it greatly speeds the movement of victims and creates a clearly-defined warm zone. It's faster, more flexible, and less confusing than using separate teams that need to move from a staging area and be directed to patients.

Removal of patients from the "hot zone" (or as we called it in the Cold War, the FEBA or "Forward Edge Battle Area") to a CCP (or "dressing station" as they called it in WW I and II) is an old military model from before asymmetric/insurgent and urban warfare.

In Fallujah the former "safe area" medical facility (aka "Second Echelon", or now "Role 2") was shoved up as tight with the hot areas as possible.

In our urban areas with closely hospitals and uncontested lanes of transport, and mobile treatment in ambulances, it takes a third paradigm.

 

[broken stretcher]

I make 10.50 an hour...
I'm not superman...
I'm not a hero...

Ill be down the block in the ambulance reading the paper. Call me when the scene is secured.

 

[mycrofft]

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.

yes.

 

[Handsome Robb]

The casualty collection model for mass shootings seems based on a fairly traditional school/workplace shooting; as a hallway (seriously, that's how the presenter was breaking the scene down) is secured, a couple officers already in the area start moving victims back to the casualty collection point. Presumably, the first few officers coming in go try to make contact and then as more come in, they're assigned to secure and evacuate areas, expanding into the building one hallway at a time. Any aspects of the LE response more complex than this got filed under "tactical stuff I don't need to worry about", so I can't really defend it any better.

This probably slows down LE in securing the scene, but it greatly speeds the movement of victims and creates a clearly-defined warm zone. It's faster, more flexible, and less confusing than using separate teams that need to move from a staging area and be directed to patients.

You just described EMS's roll in a shooting. If your dead set on officers doing extracts fine but you need a medically trained provider at the CCP.

A hallway is a :censored::censored::censored::censored:ty CCP by the way, too many directions to cover and no way to isolate yourself and the casualties.

 

[mycrofft]

You just described EMS's roll in a shooting. If your dead set on officers doing extracts fine but you need a medically trained provider at the CCP.

A hallway is a :censored::censored::censored::censored:ty CCP by the way, too many directions to cover and no way to isolate yourself and the casualties.

Yes a hallway is only good in that there is good access and egress and lack of over-compartmentalization, but not only is it drafty and exposed, but the patients are strung out laterally.

I'm not dead set on anyone in particular doing extractions, but the faster they get out and to a hospital the better they will do. The next best in a fluid confused situation may be someone will slap on a pressure dressing or TK, put them in recovery or HAINES position, and flag them or radio in their location for pickup, then go on looking for the threat.

 

[triemal04]

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.

It's not medical care that is the primary goal; like I said, that aspect is very limited. The goal is to get the patient's out of the building and on the way to the hospital in a much faster way than what is happening now.

But yes, I do think that cops should be carrying a tourniquet and don't see much of an issue of stopping for 30 seconds to place one. Beyond that though, the responsibility shifts away from them to...well...us.

 

[Handsome Robb]

It's not medical care that is the primary goal; like I said, that aspect is very limited. The goal is to get the patient's out of the building and on the way to the hospital in a much faster way than what is happening now.

But yes, I do think that cops should be carrying a tourniquet and don't see much of an issue of stopping for 30 seconds to place one. Beyond that though, the responsibility shifts away from them to...well...us.

That's exactly how our system works.

Every LEO in our county is issued an IFAK by us as well as a class similar to CLS.

I've been on multiple scenes where PD has placed a TQ, pressure dressing or NPA and placed someone in the recovery position while they control the situation before we enter.

Beyond that though it is OUR job to get these people to the hospital. Not the police department which unfortunately has happened more often than it should.

Hell how many people went to the hospital by squad car in Aurora?

 

[chaz90]

I make 10.50 an hour...
I'm not superman...
I'm not a hero...

Ill be down the block in the ambulance reading the paper. Call me when the scene is secured.

I don't think it's about being a hero or reckless behavior. When it comes down to it, we work in EMERGENCY Medical Services. Not all scenes are going to be 100% risk free. We can take the necessary steps to reduce this risk as much as possible and keep ourselves safe, but calculated risks are, and should remain, part of the job description.

MVAs on the highway are dangerous, yet we do our jobs in those situations every time. We need to make contact with the patients, provide minimal on scene care as necessary, and extricate them. Asking PD to do our job in addition to their own is as ludicrous as asking us to do theirs.

We all want to go home at the end of our shift, but we also all signed up to do this job. Entering warm zones in these situations after initial law enforcement entry is simply part of it. Train us and equip us for it, and then add it to our expectations. Asking fire or LE to risk themselves when we're unwilling to do the same is unforgivable.

None of us want to have to go into something like this, but it's the nature of what we do. We should expect and train for this kind of manmade disaster and do what we can to minimize losses. Simply standing by the sidelines and whining that it's not safe enough to risk ourselves while others are shouldn't be tolerated.

Those who don't want to do this can and should be given the opportunity to turn it down in advance. There are plenty of opportunities in EMS besides 911 response. Transition into education, scene standbys, or IFT only. Those of us who continue to respond to 911 calls however should no more be able to refuse to do what their job description entails in this situation than they would in any other.

 

[mycrofft]

that's exactly how our system works.

Every leo in our county is issued an ifak by us as well as a class similar to cls.

I've been on multiple scenes where pd has placed a tq, pressure dressing or npa and placed someone in the recovery position while they control the situation before we enter.

Beyond that though it is our job to get these people to the hospital. Not the police department which unfortunately has happened more often than it should.

Hell how many people went to the hospital by squad car in aurora?

+1……………

 

[mycrofft]

I don't think it's about being a hero or reckless behavior. When it comes down to it, we work in EMERGENCY Medical Services. Not all scenes are going to be 100% risk free. We can take the necessary steps to reduce this risk as much as possible and keep ourselves safe, but calculated risks are, and should remain, part of the job description.

MVAs on the highway are dangerous, yet we do our jobs in those situations every time. We need to make contact with the patients, provide minimal on scene care as necessary, and extricate them. Asking PD to do our job in addition to their own is as ludicrous as asking us to do theirs.

We all want to go home at the end of our shift, but we also all signed up to do this job. Entering warm zones in these situations after initial law enforcement entry is simply part of it. Train us and equip us for it, and then add it to our expectations. Asking fire or LE to risk themselves when we're unwilling to do the same is unforgivable.

None of us want to have to go into something like this, but it's the nature of what we do. We should expect and train for this kind of manmade disaster and do what we can to minimize losses. Simply standing by the sidelines and whining that it's not safe enough to risk ourselves while others are shouldn't be tolerated.

Those who don't want to do this can and should be given the opportunity to turn it down in advance. There are plenty of opportunities in EMS besides 911 response. Transition into education, scene standbys, or IFT only. Those of us who continue to respond to 911 calls however should no more be able to refuse to do what their job description entails in this situation than they would in any other.

I worked in a jail setting (1500 inmate situation), responded and set up for the results of fights and mass response for extractions, mass arrest, and was not on hazardous duty pay because my duties did not include doing anything hazardous per se. It was not a sense of "I'll do what I'm paid for", it was a sense of "This is my post, I'll do my job here the best I can and support the plan and the team and the patients".

 

[CFal]

I don't think it's about being a hero or reckless behavior. When it comes down to it, we work in EMERGENCY Medical Services. Not all scenes are going to be 100% risk free. We can take the necessary steps to reduce this risk as much as possible and keep ourselves safe, but calculated risks are, and should remain, part of the job description.

MVAs on the highway are dangerous, yet we do our jobs in those situations every time. We need to make contact with the patients, provide minimal on scene care as necessary, and extricate them. Asking PD to do our job in addition to their own is as ludicrous as asking us to do theirs.

We all want to go home at the end of our shift, but we also all signed up to do this job. Entering warm zones in these situations after initial law enforcement entry is simply part of it. Train us and equip us for it, and then add it to our expectations. Asking fire or LE to risk themselves when we're unwilling to do the same is unforgivable.

None of us want to have to go into something like this, but it's the nature of what we do. We should expect and train for this kind of manmade disaster and do what we can to minimize losses. Simply standing by the sidelines and whining that it's not safe enough to risk ourselves while others are shouldn't be tolerated.

Those who don't want to do this can and should be given the opportunity to turn it down in advance. There are plenty of opportunities in EMS besides 911 response. Transition into education, scene standbys, or IFT only. Those of us who continue to respond to 911 calls however should no more be able to refuse to do what their job description entails in this situation than they would in any other.

well said

 

[Handsome Robb]

I don't think it's about being a hero or reckless behavior. When it comes down to it, we work in EMERGENCY Medical Services. Not all scenes are going to be 100% risk free. We can take the necessary steps to reduce this risk as much as possible and keep ourselves safe, but calculated risks are, and should remain, part of the job description.

MVAs on the highway are dangerous, yet we do our jobs in those situations every time. We need to make contact with the patients, provide minimal on scene care as necessary, and extricate them. Asking PD to do our job in addition to their own is as ludicrous as asking us to do theirs.

We all want to go home at the end of our shift, but we also all signed up to do this job. Entering warm zones in these situations after initial law enforcement entry is simply part of it. Train us and equip us for it, and then add it to our expectations. Asking fire or LE to risk themselves when we're unwilling to do the same is unforgivable.

None of us want to have to go into something like this, but it's the nature of what we do. We should expect and train for this kind of manmade disaster and do what we can to minimize losses. Simply standing by the sidelines and whining that it's not safe enough to risk ourselves while others are shouldn't be tolerated.

Those who don't want to do this can and should be given the opportunity to turn it down in advance. There are plenty of opportunities in EMS besides 911 response. Transition into education, scene standbys, or IFT only. Those of us who continue to respond to 911 calls however should no more be able to refuse to do what their job description entails in this situation than they would in any other.

Preach brotha, preach!!!

If you're that worried about your safety get out of 911. How many EMS personnel are killed standing on the side of the road annually? That's dangerous so should we stage until PD and Tow gets them into a parking lot so we can be nice and safe?

How about responding to that apartment for a p1 breathing problem when he apartment across the way or next door has a crew safety warning on it? Do we wait for PD to make sure a completely unrelated apartment is going to play nice or do we sneakily go past that apartment and lock the door behind us? It's the latter.

What about the homicidal patient getting transferred to the psych facility in restraints? I've seen people get out of restraints. Do you refuse that transport or do you bring some help or double restrain to make it happen? Again, the latter.

This job isn't safe. If you came here to work a safe job turn around and walk away now.

 

[epipusher]

O m g s m h

 

[Handsome Robb]

O m g s m h

What?

 

[epipusher]

Oh My God Shaking My Head. My best response to some of these posts. Its the best I could muster while rolling my eyes and shaking my head.:

 

[Handsome Robb]

Oh My God Shaking My Head. My best response to some of these posts. Its the best I could muster while rolling my eyes and shaking my head.:

I agree.

The fact that all these people will sit by idly while others die appalls me. Then that same person will turn around and tell someone that they got into EMS to help others or to make a difference or some garbage like that.

This is one of the few scenarios where we could actually save someone's life and those that are all about saving lives are sitting on the side of the road a mile a way from the scene.

 

[chaz90]

Oh My God Shaking My Head. My best response to some of these posts. Its the best I could muster while rolling my eyes and shaking my head.:

Which ones in particular? Additional insight and discussion is rarely a bad thing.

 

[mycrofft]

Let's send in doctors. The injuries are the worst, so let's send in doctors.

(Yeah, that'll happen... with a MAW behind them maybe!).

The occurrence of such incidents in any one area is rarer than rare. How do you justify the changes in manpower, training, equipment, firearm certification, ID checks and ID badges through law enforcement, to arm and qualify EMS workers for this? Like all-out preparing for an earthquake in Nebraska.