The new reality of "scene safe..."

[Veneficus]

For many years, "scene safe" has been the mantra of EMS.

We preached it, we practiced it.

Having said that, I have personally been attacked on more scenes than I could possibly remember. By everyone from grieving relatives of the recently deceased to being corned in the squad by a mob who felt I didn't try hard enough to save the elderly black patient because I was "too white."

While checking out the recent thread about the temple shooting I was wondering.

Are the days of staging outside the scene until the all clear over?

I am not suggesting we should be running into unsafe scenes. I am suggesting the times have changed and no scene may ever be safe as we have come to expect again.

This is not new in the world. Several nations have had to deal with this. From stabbings in England, combat medicine in various theatres, Terrorism in Israel and Russia, and revolutions in the Middle East.

As the future of the world progresses, will it be common in the US not only for EMS to enter an "unsafe" scene, but know even prior to going to work every scene you ever enter will be "unsafe" as we have defined it in the past?

How do we prepare for this future?

 

[rwik123]

The line may be blurry with some calls and the danger to EMS and whether to stage or not.... But active shooter? Hell no. That's pretty clear. I'm not running into an active scene because some rambo cops has tunnel vision, sees a gsw and calls in EMS before the threat is neutralized. Issue the cops blow out kits and have them start treating major life threats.

 

[Veneficus]

The line may be blurry with some calls and the danger to EMS and whether to stage or not.... But active shooter? Hell no. That's pretty clear. I'm not running into an active scene because some rambo cops has tunnel vision, sees a gsw and calls in EMS before the threat is neutralized. Issue the cops blow out kits and have them start treating major life threats.

I once staged "in a safe area" for an active shooter reported in a location.

The person was apprehended just behind the truck as we sat in the cab.

As I understand, LE has finally concluded a swift and powerful offense saves the most lives in active shooter.

Perhaps they figure by the time you even get there, it will either be over or be a standoff?

 

[sir.shocksalot]

I have been thinking about this too. I think the delay the public is seeing with EMS getting on scene of these active shooter scenarios and other potentially volatile scenes is starting to become unacceptable. I think as more comes to light with the Aurora shooting the staging protocols for EMS will come under fire.

Maybe we need to revaluate TEMS? Right now all of TEMS is focused on battlefield stuff, or medics embedded in SWAT teams. My question is, should we provide tactical (and LE) training to a select group of medics in a central area of their district, give them vests (maybe firearms locked in the station), and have them suit up and respond to these active shooter scenes. This way they can start providing immediate care (think tourniquet, triage, airway control etc) while PD is still securing the scene. As soon as the scene is deemed secure EMS will already have a head start on getting these patients treated and transported.

I don't personally see this as any different as what is currently being taught in AHLS (advanced hazmat life support) where they teach people how to provide ALS care in warm/hot hazmat zones. Given the proper safety equipment and training significant risk can be avoided.

 

[PVC]

I once staged "in a safe area" for an active shooter reported in a location.

The person was apprehended just behind the truck as we sat in the cab.

As I understand, LE has finally concluded a swift and powerful offense saves the most lives in active shooter.

Perhaps they figure by the time you even get there, it will either be over or be a standoff?

If you ask me in class, all students will hear is that scene safety is king,

But while working I move up to the "warm" or "hot" zone way to fast. Especially when LE or civilians have been shot or victims of violent crime.

Understanding this is my nature and expectation of myself I invested in tactical training classes.I don't work with a Tactical team but have been trained to work in a Tactical setting.

I probably won't die of old age.

There may come a time when medics are routinely cross trained in police tactics.

 

[Veneficus]

In the event of a mobile unidentified active shooter (or shooters) where is the hot/warm/cold zone?

What about diversion to ambush scenarios like happened in a middle school several years back, where the shooters pulled a fire alarm and started firing as people exited?

In a multiple shooter or "secondary" device situation, how do we prepare EMS providers to be the primary target?

 

[sir.shocksalot]

In the event of a mobile unidentified active shooter (or shooters) where is the hot/warm/cold zone?

Several miles away? There really isn't, if you can see the guy I would call that the Hot zone, everything else is up in the air. Thats why I would suggest training some medics who can get into the hot zone safely and provide care while potentially under fire.

What about diversion to ambush scenarios like happened in a middle school several years back, where the shooters pulled a fire alarm and started firing as people exited?

That's a PD issue that they have gotten better at addressing with the "screw back-up" plan that they have now. In fact that shooting in milwaukee was stopped by exactly that, one hell of a brave PD officer running into firefight and putting his life on the line for the chance of saving a few people or stopping the shooter.

In a multiple shooter or "secondary" device situation, how do we prepare EMS providers to be the primary target?

Again, training some medics to enter dangerous tactical situations and giving them equipment to keep them safe (relatively) would be the only way to prepare for this kind of thing. The same thing is done in Israel and Russia, medics put on vests and just get in there and get to work.

 

[Veneficus]

Just my opinion, and certainly doesn't solve the problem...

I think ballistic vests need to be mandatory. Not "self provided" or optional.

If you are caufght not wearing it, you go home for the day kind of stuff.

Uncomfortable, sure, but how many cops complain?

It is sort of like insurance, if all goes well, you will never need it.

The other thing I was thinking is sort of a "sniper team" mentality.

Since EMS usually works in pairs, one person treats, the other "looks out" and doesn't get involved in anything else but looking out.

 

[sir.shocksalot]

If you ask me in class, all students will hear is that scene safety is king,

But while working I move up to the "warm" or "hot" zone way to fast. Especially when LE or civilians have been shot or victims of violent crime.

I would never ever do this. You may have training, but you lack some of the equipment necessary to keep you safe. Plus you have a partner who probably has no tactical training. I understand wanting to help but putting yourself, your partner, your ambulance, and the officers who may have to come help you in jeopardy is dangerous. No one currently expects you to run into a shooting scene, so I would advise against it.

 

[PVC]

In the event of a mobile unidentified active shooter (or shooters) where is the hot/warm/cold zone?

Active shooter scenes are very fluid and changing. The very best you can hope for is for LE to stand guard with medics while they prep patients for extraction.

What about diversion to ambush scenarios like happened in a middle school several years back, where the shooters pulled a fire alarm and started firing as people exited?
In a multiple shooter or "secondary" device situation, how do we prepare EMS providers to be the primary target?

If things were to change, and EMS were to be expected to quickly advance into hot or warm zones then training would have to be modified and tactical equipment provided for the EMS personnel.

The truth is that if we decide to work in those kinds of environments, we have to accept the risk we are taking because there are some things that no amount of training can prepare us for.

 

[shiroun]

Several miles away? There really isn't, if you can see the guy I would call that the Hot zone, everything else is up in the air. Thats why I would suggest training some medics who can get into the hot zone safely and provide care while potentially under fire.

Put a vest on a medic, and teach them how to boogie and take cover and follow orders. That's it. I don't know about you, but in my opinion teaching medics how to shoot back is actually the opposite of what our job description is.

Now yes, there are some EMTs and Medics who will run into a scene, even with an active shooter, if someone they care about or a LEO has a gsw. The scene certainly isn't safe, but by giving them a gun it becomes even MORE unsafe. We carry knives, pepper spray, mace (in some cases), or other things that are lethal, but not long range. Firing a gun is easy, hitting the correct target isn't. If it's solely your target, then it becomes a bit easier (albeit shooting under fire can be quite an issue for some people). But when youve got an MCI, with multiple active shooters in the crowd, giving a medic a gun is going to do more harm then good.

 

[Veneficus]

The truth is that if we decide to work in those kinds of environments, we have to accept the risk we are taking because there are some things that no amount of training can prepare us for.

The point of the thread is that we may no longer get to choose what scenes we enter or not.

In my opinion we need to start facing that as a reality.

The question really is: How?

 

[PVC]

I would never ever do this. You may have training, but you lack some of the equipment necessary to keep you safe. Plus you have a partner who probably has no tactical training. QUOTE]

My partner is good on the training but equipment is a problem.

I understand wanting to help but putting yourself, your partner, your ambulance, and the officers who may have to come help you in jeopardy is dangerous.

To be honest, it is not a matter of wanting to help, I really would rather not. It is of solidarity to society and policia. We do not initiate action, just backup when. Everyone are adults and are aware of the risk.

And yes, it is dangerous.

 

[DPM]

Instead of training the Medics to be some kind of cop-lite, is it not easier to train PD?

They manage in the Army with Battle Field First Aid, and I believe something similar to this ended up happening at Virginia Tech.

Medics are a valuable and expensive resource and I don't think they are best utilized running into a scene to extract casualties. After all, isn't this what ICS etc teaches us?

 

[Bullets]

The EMT class pounds scene safety into the students.

As soon as I get them on the truck into their precepting pound that concept out of them. No scene is safe

In a town where the PD does not go to every EMS run the only safety is your partner. Watch your back, treat with your back to the wall. Take note of alternate exit routes.

Everyone is aware of this on the obvious calls, shooting stabbing accidents. But no one considers seizures dangerous, altered mental, or unknown medical pose risks some might not see. Family and bystanders are hidden threats. We must be prepared to handle threats lnd engage threats.

If you aren't always prepared, you're never prepared

 

[Tigger]

Instead of training the Medics to be some kind of cop-lite, is it not easier to train PD?

They manage in the Army with Battle Field First Aid, and I believe something similar to this ended up happening at Virginia Tech.

Medics are a valuable and expensive resource and I don't think they are best utilized running into a scene to extract casualties. After all, isn't this what ICS etc teaches us?

This makes much more sense to me. The police already have trained extensively on dealing with active shooters. Meanwhile, truly lifesaving interventions can be taught in less than 40 hours I would imagine. Seems more effective to train those with the time already invested in managing these situations to care for victims initially.

I like the idea of a centralized team for protracted incidents, but in an active shooter system by the time this crew arrives on scene, anyone alive will remain alive for a good bit more time. All the critical patients will likely be dead. Even if every provider was tactically trained, TCCC states that 2/3s of these patients die by hemorrhage. EMS (and PD to an extent) arrival is going to be too late all too often.

In terms of vests and helmets, yea that's not changing my operations. Helmets do not stop rounds, and that is not why the military wears helmets. To be even remotely protected from .223 rifle ammunition one needs to wear a carrier with level 3 armor in it, such a thing is not going to be worn frequently. Obviously not every shooter uses a rifle, but it is certainly becoming more commonplace.

"Tactical training" means nothing without being part of a team with guns. You and your partner are not a tactical team, stay out of the way and don't become another patient. We wear uniforms, as soon as you are seen by the shooter you will be shot at, and with no weapons of your own, said person will likely advance on you and likely kill you.

For now I like what the City of Colorado Springs does. A centrally located engine company has every member trained in CONTOMS, and only those with said training can staff the engine on overtime. The engine has at least one, usually two paramedics on board. When a SWAT activation, active shooter, or bomb incident goes out that engine company responds in a specially modified, unmarked sprinter ambulance. All of crew have as close to full body Level III armor as one can get, helmets, and other tactical goodies but no guns. At the incident, they stage at the PD command post in the "warm zone." If their services are needed, officers that are already assigned to them escort them into the warmer zone and care is rendered. The team is trained to operate with the police, and knows to follow orders from the cops that provide their overwatch. At no point does the team operate without police support. The system takes a bit of time to set up, but at least it is not relying on scattered or off duty personnel.

 

[med51fl]

This is an interesting subject because there is no easy answer. I work in an urban system and have been shot at, held at gun point, cut with a razor, assaulted, and poisoned. Only one of these was at a "high risk" shooting call. Every other incident occurred during a "routine" medical. I think situational awareness is the key here. This skill is not taught during EMT/Medic school and unless you are proactive in seeking the info (or get first hand exposure), these skills will not just appear. Perhaps adding a class on self defense tactics such as using cover / concealment, sheltering in place, etc. would help some. Issuing ballistic vests wouldn't hurt either.

Unfortunately in the current world we live in, there is no respect for the medical caregiver. As stated on here earlier wearing a uniform makes you a target. In some terror tactics, medical providers are purposfully targeted. This is the reality we have to start living with like they have been overseas for quite some time.

How does Israel handle this?

 

[DrankTheKoolaid]

I once staged "in a safe area" for an active shooter reported in a location.

The person was apprehended just behind the truck as we sat in the cab.

As I understand, LE has finally concluded a swift and powerful offense saves the most lives in active shooter.

Perhaps they figure by the time you even get there, it will either be over or be a standoff?

The only effective defense against an active shooter, is accurate outgoing fire. This was hammered home early into Tactical Medic school.

 

[Christopher]

Instead of training the Medics to be some kind of cop-lite, is it not easier to train PD?

This.

 

[DPM]

The Colorado system mentioned by Tigger sounds interesting.

Should the emphasis be more on casualty evacuation? The RPM triage stuff can be taught pretty quickly, as can the military style casualty drills...

PD attend a one day course that teaches them how to use those elastic trauma bandages, tourniquets, chest seals and START triage. Three simple and life saving interventions, which they can use on their colleagues and civilians in any type of shooting. Then based on the START triage status, PD can begin evacuating casualties to the treatment area. If there isn't enough PD to achieve this then I would argue that you don't have the man power to secure the scene and EMS shouldn't be getting involved.