I came across the article on EMS1 while looking for a different story. This one turned out to be a better subject for a blog post, so the other topic will have to wait.
I don’t know if EMS needs to do this preparation, but it is certainly a good task for somebody.
Here is the most important part of the article, which is worth reading in it’s entirety.
Despite all of our EMS resources, training and capabilities, the incident is essentially over and decided before the police and paramedics arrive.
We need a proactive, citizen-based approach to mass shootings that is comparable to the training and equipment we utilize to address a variety of other emergency situations.
We mitigate the disaster of fire by keeping fire extinguishers readily accessible and having regular fire drills in schools and hospitals. We raise funds and create laws for public access AEDs. This initial citizen response to cardiac arrest and other medical emergencies is so critical, that we have enacted Good Samaritan laws to protect citizens who render first aid. These laws have made it clear that it is more important and better for the citizens to do something, even if it might be wrong, than to do nothing at all.
Yes and no to the bolded part. I think it’s more accurate to say that the incident might be over before police and EMS arrive. That depends on many variables, one of which is if there is an armed and able person on scene who will neutralize the threat. I’ll leave that discussion for another day, or maybe another forum.
The problem is that responses by public safety take time, often considerable time. During that time patients with serious, but survivable wounds, might bleed out and die. Or they might die from bad airway positioning. The point is that they might die while the police and EMS are assembling and formulating a plan to secure the building and search for victims.
A little history is in order here. Before the 1999 massacre at Columbine, there were far more hostage takings than active shooter incidents. Not that there were, or are, a lot of either, but they are high publicity/hyteria incidents. The doctrine for hostage takings was to secure a perimeter, assemble a SWAT team, bring in a negotiator, and try to talk the hostage takers into surrendering. That sounds time consuming, because it is. The idea is to slow down the flow of events, give tensions an opportunity to subside, and get the hostages out safely.
Columbine (and the 9/11 attacks) turned that doctrine on it’s head. In both cases the perpetrators mission was to kill people. They didn’t “want” anything other than to kill as many people as possible. The Columbine knuckleheads engaged the police officer who was on scene, which in itself was not typical for active shooters. The police and EMS responded, set a perimeter, and tried to negotiate a surrender. While that was going on, there were no attempts to rescue or treat living victims. One victim managed to escape, taking a few hours to do so. Another victim bled to death while help was outside the building. People with him even put up a sign begging for help, to no avail.
Which is not a criticism of what the police and EMS were doing, they were doing what they were trained to do and what then current doctrine told them to do. Rushing in John Wayne style was discouraged as being unsafe for everyone. It was hours after the two perpetrators had killed themselves before the police cleared the building and EMS could go in. At that point, the people who were going to die were dead and those who were going to survive were still alive. Some of those had injuries that were made worse by the wait, but they still survived.
Which is an important point and one covered in the article. There are going to be people who have immediately or near immediately fatal wounds. We aren’t going to save them. There are those who will have “minor” injuries and will survive pretty much no matter what. In many cases those people extricate themselves and get to the hospital on their own. EMS can’t help them either. Then there are the people with survivable injuries, but will only survive with prompt treatment and rapid transport to a trauma center. Those are the people that EMS can help, but only if we can get to them in time.
Which is the crux of the problem. Even with the change from sit and wait for SWAT to having the first police and EMS personnel go right into the scene to neutralize the threat and treat patients, there is going to be a significant time delay in getting to the surviving patients.
So, what is the solution to the problem.
From the article,
Our best hope to save lives at active shooter incidents is our citizens. It is our duty to make sure those citizens are ready and capable to take action whenever and wherever an active shooter strikes.
Not just citizens, but staff at likely target sites as well. The three most likely sites for active shooters are schools, malls, and movie theaters. Military bases as well, but that’s a different issue and one that the military could solve easily. Again, not today’s topic.
Teachers, custodians, other school staff, security at malls and movie theaters, and other people should be trained and supplied with what they need to treat victims. As the article points out, many of these same venues have AEDs and require staff to be trained in CPR. It’s a logical and simple extension of that to train and equip them to treat trauma patients.
In addition, there should be pre planning, and this is where law enforcement and EMS come in. Each facility should identify patient collection points where EMS and police can access the facility and immediately treat and evacuate victims. Getting the victims there will for the most part be the responsibility of the staff of the facility. They’ll need training for that as well, and a means to move patients. That equipment is not all that expensive and can be pre positioned as locations in the facility.
This is a form of community based medicine, although we don’t call it that and probably don’t think of it that way either. This is something that the police and EMS can do jointly and will involve site surveys, training of staff, and advising facility management of the best way to save lives in the event of an active shooter incident.
I think it’s a far better approach than cowering and praying that the police and EMS get to you in time.