What is the proper role of EMS in mass shootings?
Early on in EMT training, then again, in paramedic school, students are exposed to a lot of training scenarios. They cover a wide variety of situations, medical, trauma, and psychiatric emergencies. No matter what the scenario, be it chest pain, a seizure, vehicle collision, fall, or anything else, we teach new students two things.
Is the scene safe? By this mean are there any hazards that might harm the providers? At a vehicle crash, that could be fire, fluids, airbags that might deploy. At fire scenes that means staying out of the collapse area of the building, and not getting hit by debris falling or thrown from the building. It can also mean are there agitated people that might attack the providers. The list goes on and on, so I won’t try to cover all of the possibilities.
Use appropriate Body Substance Isolation (BSI). Which is an amorphous term that means gloves, and masks or gowns if necessary. We used to call that Personal Protective Equipment, and before that Universal Precautions. No matter what term we use, the idea is to protect ourselves from dangers at the scene.
The term “BSI, is the scene safe?”, has become a mantra of sorts and is used at the start of every scenario. The problem is that it’s often little more than a phrase with little actual teaching behind it.
In my days as an instructor, I would sometimes say “No, the scene is not safe.” and then go on to describe a threat. The type of threat didn’t matter, the idea was to get the students to stop and think about what was going on as they were about to enter a scene.
Sadly, I’d often get a blank look and then the student would march on through and start to address the patient. At which point, I’d stop the scenario, fail the student, and tell them they were dead.
In EMS, and likely other professions, we often get into routines and forget the fundamental rules of protecting ourselves. That afflicts experienced and new providers, and some people find it difficult, if not impossible, to understand that there are real world dangers that won’t stop just because someone has called 9-1-1 for a “medical emergency”.
Some 35 or more years ago, back when I was working at the BLS level, my partner and I were dispatched for an “injured person.” We had no details because dispatch didn’t have any, so it might as well have been dispatched as an “Unknown Emergency”.
As we entered the apartment building we stopped at the bottom of the stair case and listened. We listened for about 30 seconds. What we heard was two people arguing at the top of the stairs. One male, one female. We couldn’t make out what they were arguing about, but they were arguing. The scene was not safe, so we made our exit and called for the police to respond.
There are two calls that police hate above all others. One is a “Domestic Dispute”, the other is “Unknown Trouble.” Both have almost unlimited potential to go bad without warning.
This turned out to the the former and once the police quieted the scene, we entered and treated the patient.
I’m sure other crews would have gone in and interrupted the argument. That might have worked out okay, or it might have resulted in an attack on the crew. Going to help someone and ending up on a fight is not how EMS is supposed to work. It happens, because people are often unpredictable, but minimizing the risk is part of what we are supposed to do.
Which brings us to the today’s topic. There has been a lot of controversy over the shooting at Douglas High School in Parkland, FL since it happened almost two weeks ago. It appears, but has not been totally confirmed, that the response by the Broward Count Sheriff’s Department was poor. I’ll leave that to Law Enforcement experts to decide, maybe after the heat dies down.
If it does.
It turns out that the confusion at the scene extended, as it often does, to the EMS response.
Three high-ranking Florida officials close to the law enforcement response at Marjory Stoneman Douglas High School tell Fox News there was a delay in Emergency Medical Service getting into the school in the critical moments after Nikolas Cruz allegedly opened fire, killing 17 people and wounding at least 14 others.
Two separate sources told Fox News some of the EMS teams who requested to enter the school were told they could not. One source said it was the Broward County Sheriff’s Office – which was the commanding office – that ordered some of the EMS crews not to go into the school when they requested to enter.
At any large incident, someone has to be in charge. At Parkland, because it was a crime, it was the Sheriff’s Department. Other responding agencie, LE, Fire, EMS, all are subordinate to the Incident Commander. In this case, it’s possible maybe even likely, that the IC made the wrong decision.
“When you have a police agency saying we don’t want you going in, that’s a problem,” another Florida official said. “The training since Columbine has been [that] first responders, police go in immediately with paramedics.”
This is in fact the doctrine and standard operating procedure for many departments. The problem is that sometimes it just doesn’t happen that way. In 2013 there was a shooting at Los Angeles International Airport (LAX). The specified procedure was that the first responder officers should go in and engage the shooter. Once the initial threat is eliminated, police are supposed to escort and protect EMS personnel to do a search and rescue operation.
Sorta Big City Police and EMS started training for this a couple of years before I retired. The final plan was not released before I retired, but to the best of my knowledge, it is the official plan.
That didn’t happen at LAX in 2013. The police agencies established a perimeter and sent officers in to find the shooter or shooters. Even after the area where the shooting occurred was secured, EMS was not allowed to go in and treat the person who was shot. As a result, he bled to death.
The reason given at the time was that the scene was not secure and thus it was unsafe for EMS to enter. At the time, several different agencies and individuals proposed training all of their EMS employees as “tactical medics” and issuing each one body armor, helmets, and other equipment.
That sounded good until someone got out a catalog and a calculator. It turns out that it would have been very, very expensive to outfit all of the EMS providers of any agency, regardless of size of the agency.
So, what are we to do?
Multiple high-ranking sources told Fox News police officers and deputies were bringing victims out to EMS workers to be treated instead of allowing EMS inside. One fire official said that “sometimes” that’s just how it would happen, but at least one emergency responder wondered if the response was detrimental to the victims.
If this is so, it’s not a bad way to handle the situation. After all, EMS would not be likely to go into a burning building (although they have on occasion) to rescue people. That might happen if the fire department wasn’t yet on scene. The difference being that fire, while not discriminate in who it hurts, does not deliberately hunt down it’s victims. Even so, it’s a far less than ideal situation when EMS goes into known dangerous areas.
The problem in this case is that becoming rescuers takes police officers away from their primary function. Which is to stop the bad guy from killing more people.
As I mentioned in an earlier post, the keys to saving people with survivable wounds is controlling the bleeding and maintaining an open airway. That should be followed by rapid extraction from the scene and transport to a hospital with surgeons.
The airway and bleeding control parts can be taught to just about anyone, as can the extraction. Combine that with prepositioned equipment and a plan and a lot of lives would be saved.
It appears that there was no plan in place for any of this. Or, it there was, it wasn’t implemented. Plans only work if people train on them enough to be proficient. That, and actually using the plan when the time comes.
Again, that didn’t happen. Or at least it doesn’t appear to have happened. This is all the worse because the fire and EMS systems for much of the county come under the purview of the Broward County Sheriff.
There a going to be a lot of lessons learned from the tragedy. One of which is that there has to be a plan in place before the event happens. The other is that when the even does happen, the plan has to be implemented and followed.
Read the complete Fox News article at the link bet a better idea of what did and didn’t happen at the school on the day of the shooting.