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Downrange EMS: Critical care when the scene isn’t safe

Although many EMS staff feel we should never operate in an active shooter environment until police have removed the threat, delay places the wounded at greater risk

I will never understand the tendency in some locales for police and fire assets to be at odds — we should all be pulling together for the same goal. Especially at active shooter incidents, where so many citizens might become casualties, fire and police agencies need to play from the same sheet of music.

Each discipline has its comfort zone, and firefighters are just as allergic to bullets as police officers are to hazardous materials. One case in point is the Aurora (Colo.) “Batman Movie” slaughter in July 2012. Per procedures, fire/EMS assets staged outside the hot zone until the scene was declared “safe.”

I’m not alleging any lives were lost at Aurora due to a delay in medical treatment, but putting casualties in the hands of paramedics sooner will save lives.

Having Realistic Expectations
Expecting police officers to ferry the injured out to medics in their warm zone staging area is unrealistic. The first-in police officers will be hunting the active killer, and police vehicles are unsuited to transporting wounded. Fire/EMS assets should instead go downrange with police officers to reach victims where they have fallen.

At the same time, police officers need to provide security for a team of trained paramedics who will enter the hot zone for “load and go” tactics. These paramedics will triage, evacuate, and treat those victims whose massive blood loss would be immediately fatal.

These “rescue teams” can assemble and begin work without the need for ICS-level interdepartmental coordination — this is a tactical unit needing only team-level supervision. The rescue teams must train to cohesively move and operate where the scene is not safe.

The police in this rescue team must focus their attention outward, operating in the diamond formation used by a rapid deployment contact team and providing a bubble of security for the paramedics. In turn, the paramedics must wear ballistic protection and become proficient with the weapons used by their police protectors — for self-defense purposes, should the situation become fatally degraded.

Asking a Firefighter
We must learn to trust the decision-making skills of our firefighting brothers and sisters in the big red trucks to assume the incident commander role until senior police officers arrive. The senior fire commander can begin to set/staff perimeters, designate a command post, and order specialized resources.

But don’t just take my word for it. In preparation for this column, I worked closely with Gerard “Jerry” Hammernik, who retired after more than 30 years in the fire service in his home state of Wisconsin.

“The question ‘Is the scene safe?’ is drilled into emergency responders from the first day of training,” Hammernik stated. “But what does it mean? Safe is a relative term. Paramedics operating on a highway are certainly not as safe as they were in quarters. So the question becomes: given the current situation, have we made the scene as safe as we can?”

The same principle should apply during active shooter incidents, according to Hammernik.

“With effective precautions, we can safely operate in an unsafe environment. Although many EMS staff feel we should never operate in an active shooter environment until police have removed the threat, delay places the wounded at greater risk.

“I’ve conducted training with police agencies across the country,” Hammernik said, “and I can assure my fire brethren that police will not continue to tolerate this delay. If solving this problem cannot be done in partnership with fire/EMS agencies, then it will be managed with police resources alone.”

Considering Alternatives
Hammernik said he sees two better courses of action open to EMS agencies:

1.) Train some EMS staff to operate as tactical EMS, where they are trained and equipped to work alongside law enforcement in the hot zone
2.) Train all EMS personnel to operate in the hot zone, with protection provided by police officers dedicated to the protection of EMS

The first option was chosen by Hammernik’s former agency after an active shooter incident placed unprepared EMS personnel in the hot zone. It is an effective plan for preplanned operations, such as serving warrants. In an active shooter situation, the limited number of tactical EMS staff may not be on scene when the incident requires EMS intervention.

At the Oak Creek Sikh temple shooting, tactical EMS were not the first-in EMS units, and the number of victims required more EMS staff than the TEMS team could provide.

Hammernik said that the second option above can be used in addition to the first option. When tactical EMS teams are unavailable or present in insufficient numbers, option two allows police and EMS staff to safely operate in an unsafe environment. This may evolve into providing bullet resistant vests and Kevlar helmets for EMS.

“At the national level, we need a joint fire/EMS/police task force to provide national standards for these joint teams. The fire service holds the patents on mutual aid. They also have a national standard of providing Rapid Intervention Teams (RIT) for firefighter rescue,” Hammernik said.

Hammernik proposes a Gunshot Intervention Team (GIT) be established as a standard element at active shooter incidents. While ICS will still need to manage the incident, establish hot zones, and maintain perimeters, the GIT will provide a standardized response to downrange EMS needs.

“Any mutual aid fire company will know what is required if they are assigned as a RIT at a fire incident. The same level of pre-knowledge should be a part of every police and EMS response to active shooter events,” Hammernik said.

What do you think? Sound off in the comments area below.

About Jerry Hammernik
Gerard “Jerry” Hammernik’s career included service as a firefighter and EMT, HazMat Technician, Lieutenant, Assistant Chief, and Fire Chief/Emergency Management Director. He has a B.S. in Public Administration from Upper Iowa University. He continues to conduct Critical Incident Management training for municipal, college and university emergency responders across the United States and Canada.

Dick Fairburn has had more than 26 years of law enforcement experience in both Illinois and Wyoming. He has worked patrol, investigations and administration assignments. Dick has also served as a Criminal Intelligence Analyst, and as the Section Chief of a major academy’s Firearms Training Unit and Critical Incident Training program.