The need to integrate fire/EMS personnel alongside law enforcement officers during response to mass casualty incidents (MCIs) is critical. Whether the incident is an active shooter, a bombing, an edged-weapon attack or even a vehicular attack, first responders must work together to effectively mitigate such events.
I was recently involved in conducting a Rescue Task Force (RTF) training pilot program primarily for fire and EMS personnel. This 2-day course covered tactical casualty care and an introduction to RTF training integrated with law enforcement officers within a designated warm zone.
For this training, the warm zone was defined as an area that had been visually cleared and was not under a direct threat, although the potential for harm did exist. The mission for fire/EMS personnel was to render aid to those who had received life-threatening injuries. The role of the law enforcement officers was to provide security in the event that a threat emerged in the area of operation.
Once all of the isolation drills had been completed, students were exposed to reality-based scenarios in a stress-induced environment. As we began to conduct the training, issues came to light that surprised both students and instructors alike. We had mistakenly made assumptions related to student training and equipment, as well as identified key lessons that we are sharing here to assist other agencies in preparing for similar programs.
Training highlighted mistaken assumptions
Fire/EMS personnel are currently trained to deal with mass casualty injuries.
It became apparent fairly quickly that these responders were neither familiar with treating massive hemorrhage injuries, nor did they have the equipment. Although some had been provided with a tourniquet, they had not trained with them.
Fire/EMS personnel have the necessary equipment to intervene when they encounter victims with life-threatening injuries in an austere environment.
Most of the attendees lacked personal protective equipment to operate in a warm zone while trying to render aid to victims. It is recommended that fire/EMS agencies acquire ballistic vests and helmets for personnel who would be working in the warm zone.
Providers must carry equipment on their person that includes tourniquets, blood clotting gauze, occlusive dressings (chest seals), pressure dressings and tape (duct tape) and triage markings – enough to treat a minimum of 10 victims.
A portable litter is advisable. After just one or two extractions, students were becoming visibly exhausted. Many started to improvise by using rolling chairs, carts and blankets to assist with extractions of patients back to a casualty collection point.
Training highlighted lessons learned
Fire/EMS personnel have been trained since day one to check the ABCs (airway, breathing, circulation) during their initial patient assessment.
Based on injuries sustained in mass casualty incidents, the MARCH assessment approach is now recommended: Massive hemorrhage, Airway, Respiration, Circulation, Hypothermia/head injury. Based on statistical data, we have learned that massive hemorrhage is the leading cause of fatalities and therefore should be addressed before establishing a viable airway.
Conduct training in a reality-based setting under stressful conditions.
Most of the students were able to grasp the concepts of RTF care, conduct their initial assessments and apply the appropriate treatments during isolation drills in a classroom (non-stress) environment. It was apparent that once stress was induced into the same applications, performance levels noticeably decreased. However, after a progression of scenarios, the performance level rose to the same level it had been during the isolation drills in the non-stressed environment.
The benefits of exposing students to the stimulus they will encounter will, to some degree, inoculate them from stress overload if they were to ever experience an MCI firsthand.
The importance of conducting Tactical Emergency Casualty Care (TECC) training for police, fire and EMS
As stated previously, neither fire/EMS personnel nor police officers are properly trained or equipped to handle a MCI. Responding to an MCI is a unique situation and is rarely, if ever, encountered. All first responders need to be able to respond in a proactive and cohesive manner to mitigate the effects of an MCI.
TECC addresses injuries that are consistent not only with MCIs, but also injuries a first responder could encounter in the field. First responders need to be able to attend to the injuries of others, but also themselves if they were to become injured performing their duties. TECC teaches both self-aid and buddy-aid.
If all first responders are trained in TECC, they can better assist one another during their response. Although law enforcement’s role is to provide security during an MCI, all first responders can be trained in life-saving techniques and rescue carries, and carry life-saving equipment that can be shared among personnel.
Emphasis of RTF is to stop the bleeding – not tactics.
The purpose of RTF training is to get treatment to victims who have been seriously injured but whose wounds, if treated quickly, are survivable. Due to the austere conditions under which these types of incidents occur, it is necessary to assume a significant amount of risk, within reason, when it is likely a life can be saved. For that reason, law enforcement officers are integrated with fire/EMS as a security escort.
Law enforcement operates in the hot zone in order to eliminate the threat, or at least contain it to a specific area. The RTF should operate only in warm and cold zones and should be restricted from entering the hot zone. Because the direct threat has been either eliminated or isolated, the RTF can focus on its primary mission, which is to stop the bleeding. If for any reason the warm zone is compromised, it is now a hot zone and the RTF should evacuate or shelter in place.
The only “tactics” that are addressed during the integration of the RTF, comprised of law enforcement and fire/EMS, is how to merge into a single unit and move “tactically” into the area of operation. Several drills are conducted to establish movement and communications amongst the RTF team. This usually consists of two or three law enforcement officers positioning themselves to shield the two fire/EMS personnel from potential threat areas as they move from point to point.
Conclusion
The October 2017 Las Vegas shooting was an education under fire for many first responders and numerous lessons were learned. First responders need to open lines of communication and share knowledge, experience and resources so we can coalesce all of our assets toward separate, yet mutually compatible, objectives through the combined efforts of a RTF response.
These are just a few of the lessons learned from our RTF training. Hopefully this will aid other agencies as they go forward with their initiatives to train for and prepare their response to mass casualty incidents.
