Mass Casualty -- Active Shooter Incident

[RustyShackleford]

As an Army vet who would love to say ya let's rush in with our fancy vests on, it's just not feasible, and this whole medics having ballistic vests and helmets is pointless unless medics are willing to wear plates in them, the plate is the only thing offering ballistic protection, I have seen the smallest of rpg fragments pierce soft armor so don't go thinking that your fancy black police style vest is going to even come close to slowing down an assault rifle round. I don't know about where you work but a lot of the medics I run into can barely lift a 300 pound patient on a stretcher let alone run around with their ballistics and their ALS and airway bags. Helmets in the military roll are for debris and not stopping rounds, as much as popular culture would have you believe, for ballistic protection you might as well put on a tin foil hat. As medic's we aren't armed and therefore unless a police officer is standing over top of me actively engaging a target I don't plan on entering an active shooting unarmed.

Now I must return to my street corner begging for change and screaming at passers by about my tours in Nam.

 

[shiroun]

NYC has had one or too memorable MCI situations... Now we have a good portion of an island with spare vehicles dedicated to the next disaster.

Definitely late to reply on this, but youre 100% right. During 9/11, we had enough EMS on scene within the first 60 minutes that everyone was transported as soon as they were uncovered. Granted, every EMT who was free and saw the news reported to their stations, whether they were on or not, to help, but that's a different story.

I didnt know about the spare vehicles though, that's interesting.


Edit:

I also entered this thread thinking there was another shooting going on. I got kinda scared and clicked into it REALLY quickly.

 

[Bullets]

My town would be taxed even with 8 ambulances, but our county system with support from the state task force could handle this. We can have 2 MCI buses capable of transporting up to 60 patients on scene in about 20 minutes. Mass casualty response units with supplies to treat up to 100 patients on scene in 30 min. TEMS teams on site in 15-20 which will enter warm zones with overwatch.

Trauma center in town. 2 hospitals in 15 minutes 3 in 20

Now how will our PD handle this? Im scared to think about that

FD would have a very limited role unless there was an actual fire.

 

[atropine]

yes my department can handle MCI's, if you remember passenger train v.s. freight train was in our first in.

 

[NYMedic828]

Definitely late to reply on this, but youre 100% right. During 9/11, we had enough EMS on scene within the first 60 minutes that everyone was transported as soon as they were uncovered. Granted, every EMT who was free and saw the news reported to their stations, whether they were on or not, to help, but that's a different story.

I didnt know about the spare vehicles though, that's interesting.


Edit:

I also entered this thread thinking there was another shooting going on. I got kinda scared and clicked into it REALLY quickly.

Randall's Island Fire Academy, otherwise known as "The Rock" is home to a few box trucks and tractor trailers outfitted as emergency command vehicles and mobile decon centers. One of the box trucks is stocked floor to ceiling with Mark1 kits. Every FDNY EMS employee is issued a bulletproof vest and gas mask.

They took everything slightly out of control after 9/11, but I guess you never know...

 

[EpiEMS]

Randall's Island Fire Academy, otherwise known as "The Rock" is home to a few box trucks and tractor trailers outfitted as emergency command vehicles and mobile decon centers. One of the box trucks is stocked floor to ceiling with Mark1 kits. Every FDNY EMS employee is issued a bulletproof vest and gas mask.

They took everything slightly out of control after 9/11, but I guess you never know...

Wow, I didn't know that. Speaking of EMS in NYC, doesn't NYPD ESU do some EMS?


Regarding entering the hot zone, I'd be surprised if there wouldn't be enough officers on scene fairly quickly to escort EMS in, even in a rural area.

 

[the_negro_puppy]

I will go into a hot scene if I am allowed to wear a red bandanna and have dual M60s

 

[NYMedic828]

Wow, I didn't know that. Speaking of EMS in NYC, doesn't NYPD ESU do some EMS?


Regarding entering the hot zone, I'd be surprised if there wouldn't be enough officers on scene fairly quickly to escort EMS in, even in a rural area.

NYPD ESU has many EMTs and paramedics. They also have their own ambulance that floats around the city. Actually, in general, NYPD ESU has some CRAZY vehicles. They literally have a vehicle for every situation short of actual warfare.

BUT, they do not respond to 911 EMS calls. They only act as EMS providers in a tactical manor, usually only treating their own personnel in scenes which are too dangerous for non-LEO trained EMS workers. (active gunfights and whatnot)

ESU often works in conjunction with/butts heads with firefighters on rescue assignments.

FDNY EMS also have haz-tac and rescue-medic units which have class B suit capable EMS workers permitted in the hot zone and rescue-medics have everything haz-tac does with the addition of confined space rescue equipment and some other nifty toys you won't see on the average ambulance. Both of their ambulances carry a pair of SCBAs.

 

[EpiEMS]

NYPD ESU has many EMTs and paramedics. They also have their own ambulance that floats around the city. Actually, in general, NYPD ESU has some CRAZY vehicles. They literally have a vehicle for every situation short of actual warfare.

BUT, they do not respond to 911 EMS calls. They only act as EMS providers in a tactical manor, usually only treating their own personnel in scenes which are too dangerous for non-LEO trained EMS workers. (active gunfights and whatnot)

Very interesting stuff!
By the way, are NYPD patrol officers CFR-Ds like the firefighters? Any idea what their prehospital training is regarding GSWs and other combat-type injuries?

 

[Tigger]

Wow, I didn't know that. Speaking of EMS in NYC, doesn't NYPD ESU do some EMS?


Regarding entering the hot zone, I'd be surprised if there wouldn't be enough officers on scene fairly quickly to escort EMS in, even in a rural area.

After listening to the PD dispatch tape of the Aurora shootings, I am inclined to disagree. Though many officers were outside with victims, that does not constitute much in the way of security. The scene was still quite chaotic at the 15 minute mark with command calling every few minutes to ask for more cars, eventually even calling for units from the county and Denver. It sounded like they had no officers to spare even after they had the shooter in custody as there were conflicting reports of multiple shooters and the theater had to be searched. I'm not much of a student on LE tactics, but I suppose maybe some of the officers that would be setting up a perimeter could be used to assist EMS first? It seems like most ICs call for a perimeter pretty quickly in such an incident and make it a priority.

 

[Sandog]

As an Army vet who would love to say ya let's rush in with our fancy vests on, it's just not feasible, and this whole medics having ballistic vests and helmets is pointless unless medics are willing to wear plates in them, the plate is the only thing offering ballistic protection, I have seen the smallest of rpg fragments pierce soft armor so don't go thinking that your fancy black police style vest is going to even come close to slowing down an assault rifle round. I don't know about where you work but a lot of the medics I run into can barely lift a 300 pound patient on a stretcher let alone run around with their ballistics and their ALS and airway bags. Helmets in the military roll are for debris and not stopping rounds, as much as popular culture would have you believe, for ballistic protection you might as well put on a tin foil hat. As medic's we aren't armed and therefore unless a police officer is standing over top of me actively engaging a target I don't plan on entering an active shooting unarmed.

Now I must return to my street corner begging for change and screaming at passers by about my tours in Nam.

Wait! Does Canada have an Army?

 

[NYMedic828]

Very interesting stuff!
By the way, are NYPD patrol officers CFR-Ds like the firefighters? Any idea what their prehospital training is regarding GSWs and other combat-type injuries?

No they have no medical training requirement past basic first aid and do not carry so much as an O2 tank.

There is rumor firefighters may be force upgraded to EMT and do a way with CFR-D. (the class is hardly any longer, 40 hours maybe)

 

[mycrofft]

Study-learn-reflect, repeat.

The reaction we have to such incidents is to get another kit, buy some more gear, raise a regulatory bar, and step all over the folks making quiet headway, or quietly and desperately losing the struggle to make medical and EMS structures meet even the standards mandated for them as is.

How often has an active shooter left the primary scene to purse and further assault a patient or responders (except some murders which had discrete individuals as their targets)?

How often has police instantaneous but unsupportive transport brought in a viable patient who otherwise would have died (waiting for real EMS to arrive)?

And the question raise over and over, how much care can you actually give while armored up and under fire? Isn't the actual sequence under fire to survive, render care as quickly as it can be done practically, then transport to the next level of care (or "Role" as the military now refers to it)? It isn't like TV or movies like, "Blackhawk Down", any more than real life is like TV's E.R." or "EMERGENCY!". We might need armored litter bearers (hello, robot companies?), but sitting down in armor (which the pt does not have) and beginning care while being pinged with bullets, smoked with tea gas, etc. is not practical. Shorten recovery and transport time to get the best outcome (those are the big lessons from WII versus Korea versus Vietnam versus Gulf War II).

1. Establish data gathering to see what has been repeatable and hence susceptible to preplanning and system changes.
2. Compare this to the extant systems (the ideal not the steal life deal), and correct them.
3. THEN fairly, without bias/favor, examine and rate the facilities and EMS elements to see if they and each component person or system meets the standard?

 

[EMDispatch]

In total we have 14 ambulances (5 county ALS, 6 volunteer BLS, and 3 spare county) and 2 MCI trailers spread out across 557 sq. miles. Hopefully this whole incident can spark some training exercises about how we could effectively handle any major incident along these lines.

Shorten recovery and transport time to get the best outcome

That's where I'd love to see data, which is probably impossible, for the Aurora shooting. Listening to the tape, FD/EMS are staging when the first LEO announces that he's transporting. While rapid transport is important, were the LEOs making any attempt to stabilize pt's before they transported, and would it have made a difference?

 

[RustyShackleford]

Wait! Does Canada have an Army?

I was wondering how long until an ignorant American statement was made.....you made it a whole page, congratulations.

 

[AnthonyM83]

Yes, I do think our system would be able to handle the scene, both in terms of law enforcement and EMS (maybe not trauma beds). We have had a recent MCI with 85 transported before (46 critical). No outside agency ambulances were required. It was just a surge in operations with way more personnel than needed, all standing by, but never used.

On the note of safety, I fully advocate staging out. BUT reality of the matter is, the scene is never going to be fully safe until incident is far over. At SOME point, there is going to be some risk involved. Apply the true "scoop and run" mentality here. Both for patient's safety and your own.