MEDICS RUSHING IN BEFORE SCENE SECURE

[VOODOO MEDIC]

[ERDoc]

I can't see anything.

[paramedicmike]

Try this link.

[Just Plain Ruff]

EMS the new canaries

But I digress that's not really what I read out of this

But when I went through orientation here at UMMS in maryland the security director came in to our orientation class and gave us the new Mass Shooting class.

The new guidelines are as follows (condensed here for brevity)

1. Try to escape

2. Hide if you can't

3. Fight your attacker - try to take him out before he takes you out because if you make it to this step - you are either going to die or the shooter is going to die.

I like these new guidelines only because it makes it no longer that you are a sitting duck. I fully plan on trying to escape, then hiding if I can and if my life is on the line and it's the shooter or me, well, the shooter is going to have one hell of a time with me because well, my life is forfeit to him anyway and so is his. If I can take him out, then so be it.

I don't consider it being a hero but I consider it that I will go out on my terms and i'm not going to cower and just let the shooter kill me.

But unfortunately, I have NO freaking clue how I'd actually react when faced with the reality of the situation but I'd like to consider that I'd like to be the one to stop the guy but yanno, I don't know how I'd react.

But back to the issue at hand, you really don't know when entering the scene whether it's truly safe. The health care professionals at the boston bombing didn't but they went anyway. I've seen countless EMS crews say Screw Scene safety and go in and they are all still alive today.

Scene safety is a great mantra but too bad it's not followed as stringently as I myself have followed it.

[triemal04]

I'm going to do a cut&paste job with my posts from another EMS website. The comments aren't directed at anyone here, so don't take offense. If it doesn't make complete sense it's because I didn't include some of the things that I was directly replying to.

Love the attitudes, love 'em.

What is being talked about sounds more like a concept that has been in place in some departments for several years; I think that it's just gaining wider traction because there have been quite a few (relatively speaking) active shooter/bombings in the last 2-3 years. There was a write up done (may have been in JEMS but I don't remember) on what a few places in Virginia started to do after the VT shooting; essentially sounds like this.

Aside from the normal issues you get with large scale incidents (large numbers of patients, patients running and turning up far from the scene, crowd control, etc) the issue with active shooters and such is that the most seriously injured people who might otherwise have been salvageable end up dying because it takes 30+ minutes for them to reach treatment. This sort of response is geared to fix that problem.

The goal of this isn't to send paramedics up to the very front, or if there is still firing to where that is, but to provide them with body armor, group them with several officers, and send them into areas that have been rapidly swept through but not technically "cleared" by another team to bring out any victims; ie they are going into the warm zone. Is there some added risk? Sure, but in reality not as much as people will think. It is also very worth remembering that in larger buildings, it will literally take hours for the entire building to be "clear," if it ever truly is; think of how large a mall is; do you really think it is appropriate to wait until the entire building has been formally cleared before EMS should enter?

With a bombing it is still a little different; secondary explosions are a real and definite risk. The only way to truly mitigate that is to be very, very far from the initial blast. Which still leaves the issue of how do you get patients to ambulances, and who will be doing that.

The risk to EMS in these situations can and should be minimized as much as possible, but the simple reality of the world we live in is that these types of situations will likely continue. EMS will either evolve and change to fit into the role that it is now needed in, or it won't. At face value this isn't a terribly complex concept, it just takes some practice and the involved groups buying into it.

Unfortunately, due to misinformation, misunderstanding, apathy, and a long history of the same, it probably won't happen.

And:

Partially that was done because it wasn't clear what was going on, or where exactly the scene was in relation to the building.

To be clear: the concept talked about in the article DOES NOT mean that EMS would drive directly to the scene and rush blindly in; that is still a terrible idea. It just means that medical resources would be moving into areas that they previously wouldn't have, and in a quicker manner.

edit: should have said "secured" not "cleared" in my last post.

And:

There is no legitimate reason that any EMS agency, private or otherwise, that has the personnel, resources to provide for ballistic vests, and ability to train their people cannot do this.

Yes, private for profit EMS has all those things. If they choose not to because there would be a minimal drop in profits or because of the apathy of their employees (as is very well shown here) that is an entirely different issue.

To many people are not understanding what the concept talked about in the article is, or how it is implemented, what is actually done while in the "warm zone," and to many people are far overestimating the risks involved. Most likely due to a hero-complex, but I digress.

EMS personnel would be going into areas that had already been swept by a cops but not technically "secured," to find victims and rapidly remove them from the building. The limit of entry for medical personnel would be well behind the areas that had not been initially cleared by police, and the level of risk is realistically low. Though admittedly higher than staging 3 blocks away for an hour.

How is the liability any different for a public/non-private EMS provider? Why can private EMS not be trained and expected to do this? If private EMS is the defacto primary EMS provider in a given agency, if not them, who?

Just stop. I believe you have said that you are moving to a job where everything is handed to you and you won't have to make difficult choices; perhaps you should speed that process up. Your comments...in all threads...are a perfect reflection of why people may look down on private for profit EMS; you clearly do not understand the situation that is being discussed, clearly are biased, easily excitable, uninformed, overreact, and won't listen to anything new.

As I said earlier, this is an unfortunate reality of the world we live in. In these type of situations many people are dying who otherwise wouldn't because they have gone without initial treatement for 30+ minutes, let alone getting to a hospital. EMS needs to adapt to the times that we live in, just as we need to adapt to changes in medical care. (yes I laughed after I wrote that) Most police agencies figured out long ago that in many active shooter situations it is better to NOT wait for a tactical team, but to form small teams of 2-3 cops and start clearing the building on their own. Why? Because it takes to long to wait, and people where dying

The new guidelines are as follows (condensed here for brevity)

1. Try to escape

2. Hide if you can't

3. Fight your attacker - try to take him out before he takes you out because if you make it to this step - you are either going to die or the shooter is going to die.

Actually, the new guidelines that are being taught in a lot of places would go 1-3-2.

Running is still always best; if you can get out do so and don't stop until you can't run anymore.

Fight. If you have no other option confront and attack the attacker. What has been seen with many of the recent mass shootings/active shooters is that as soon as someone did something to disrupt the shooter from their "game plan" they lost it, and in several instances killed themselves.

Hide if you have can't get out and have no other option. Unfortunately, what we have also seen is that in these type of situations the shooter is going through the common places to hide...and killing those people.

[Just Plain Ruff]

Triemal, I'll bet you probaly are right on the order, I may have gotten it mixed up, I don't compltely remember the order but I do remember that it was to fight the attacker which was sort of well common sense. If it's him or me then I'm going to fight. But I'm going to run my ass off to get the hell out of there first.

But I am pretty sure that they said it was 1-2-3 but again I might be wrong.

I might email the security guy and ask for his powerpoint that he used for us.

I'll ask for his permission to post, it might be of use to someone here.

[ERDoc]

I realize that EMS is not going into a hot zone, but with so many of these situations, the zone is moving. There is a difference between the first responding officers going in immediately in vests and with weapons and EMS going in wearing their white button down shirts and khakis.. Unless EMS is given gear and a weapon, I think you are just creating more potential victims. Part of it comes back to the fractured nature of EMS in the US. Some form of tactical training is needed and I just don't see that being possible with so many volleys. Yes, there are many that would do it (I would have given my left lung to do it back in the day) but then there are those that shouldn't be in a scene like that. I guess if you are being called into an area that has been kind of cleared it wouldn't be so bad. I guess the only way to know is to do it and see what happens.

[triemal04]

Triemal, I'll bet you probaly are right on the order, I may have gotten it mixed up, I don't compltely remember the order but I do remember that it was to fight the attacker which was sort of well common sense. If it's him or me then I'm going to fight. But I'm going to run my ass off to get the hell out of there first.

But I am pretty sure that they said it was 1-2-3 but again I might be wrong.

I might email the security guy and ask for his powerpoint that he used for us.

I'll ask for his permission to post, it might be of use to someone here.

Some of that also needs to be taken with a grain of salt and mixed in with common sense; obviously there might be times that it would be better to hide before fighting. I think it just something that's worth remembering and considering, if that's possible for most people in the heat of the moment.

I realize that EMS is not going into a hot zone, but with so many of these situations, the zone is moving. There is a difference between the first responding officers going in immediately in vests and with weapons and EMS going in wearing their white button down shirts and khakis.. Unless EMS is given gear and a weapon, I think you are just creating more potential victims. Part of it comes back to the fractured nature of EMS in the US. Some form of tactical training is needed and I just don't see that being possible with so many volleys. Yes, there are many that would do it (I would have given my left lung to do it back in the day) but then there are those that shouldn't be in a scene like that. I guess if you are being called into an area that has been kind of cleared it wouldn't be so bad. I guess the only way to know is to do it and see what happens.

Yes and yes. While a simple enough concept, as I said, it takes buy-in from all involved, EMS and police. If both aren't on the same page and aware of what's expected of them, and more importantly, what's NOT expected of them, this concept won't work well. I think what will happen, despite the grandiose-bullshit-let's sell more papers-let's make statements that aren't true title of the article is that it will fall, as it usually does, to individual departments to decide if this is the path they want to go down or not.

It's also worth keeping in mind when this would really be used; we aren't talking about someone's private dwelling, this is really for an active shooter in a LARGE building. The perfect example (unfortunately) is a school, with the idea being "we have had officers clear this hallway and classrooms on each side up to the next hallway. They are currently moving down those hallways. Move down the first hall and check for/remove victims from the hall and classrooms. Obviously the is always the possibility that the shooter, like the victims, could be hiding, hence why EMS must stay with, and behind armed cops, and why, when done right, the cops are doing a better search of each enclosed space before calling EMS in.

[ERDoc]

Overall, I don't think I would be worried about the gunman hiding. It seems like in all of the cases we hear about, the gunman is ready to die and will just keep shooting until that time comes. I see your point in a building like a school or large office building. Then I think about the situation in Aurora where it was a small building and a large area that is difficult to clear.

[triemal04]

Overall, I don't think I would be worried about the gunman hiding. It seems like in all of the cases we hear about, the gunman is ready to die and will just keep shooting until that time comes. I see your point in a building like a school or large office building. Then I think about the situation in Aurora where it was a small building and a large area that is difficult to clear.

It is still something to consider, but yeah, I think it less likely that the shooter would truly be hiding. But...it is still a possibility, so better to have EMS kept with and behind cops regardless.

I don't know how well it would work in a theater; for the areas outside the actual theaters themselves it would be fine, but for a large open area like that, with lots of places to hide...it would be harder. At that point it really becomes a much more difficult risk vs reward situation; do you wait until the whole theater is clear, or do something similar to my previous example, which would still potentially leave EMS in the line of fire?