“Our world in EMS and fire has changed once again as it relates to active shooter incidents, and we’ve been dragged along, sometimes kicking and screaming.”
Chief Norris Croom, fire chief and emergency manager for the Town of Castle Rock (Colorado) Fire and Rescue Department, shared this observation as part of a discussion of how fire and emergency medical services must adapt to the “new normal” of the all-hazards response model. “Not that long ago, we would have never thought that we would be issuing ballistic PPE to our members, that we would be entering scenes where shots are still being fired, and that we’d be dealing with large numbers of casualties with horrific injuries normally relegated to a battlefield,” he added.
Croom – who also serves as the EMS section rep on the IAFC board of directors – acknowledges that there are some EMS and fire personnel who still believe that we shouldn’t be doing any of these things, that we should continue to stand by until the scene is safe and not put our personnel at risk. But Croom argues that we must adapt: “We’ve done it before with EMS, then hazmat, then urban search and rescue, and then with terrorism response. This is just another evolution in our profession in which we find ourselves having to improvise, adapt and overcome to ensure that we can protect and provide service to our residents to the best of our ability.”
FireRescue1 connected with Croom to learn more about fire and EMS preparations for active shooter events, and resources first responders can use for training.
FireRescue1: With active shooter events top of mind for public safety agencies right now – and increasingly over the past few years – what advice do you have for agencies regarding preparing and training for such events?
Chief Croom: My advice to agencies is not to fall into the mental trap of “it can’t happen here.” As we’ve seen numerous events in Colorado, as well as across the United States, no community is immune to these types of incidents. With this in mind, the time to start preparing for these events is now. From PPE and EMS equipment to policies and procedures to training and relationship building, all of these items take time to acquire or develop. This is not something that can be done overnight, and it will take a concerted effort by all involved to ensure that your agency is properly prepared for this type of incident.
How can EMS agencies best work with fire and police departments to ensure coordination of efforts?
If you don’t already have a good working relationship among EMS, fire and law enforcement, then extend the olive branch and start the planning process. As we all know, it is much easier to work any type of incident when you know, or are at least familiar, with each other. Active shooter events require a team response, and no one agency can do it all by themselves. In addition to EMS, fire and law, consider including your local emergency management agency, hospital, school district, and public and private businesses, as these events are not restricted just to schools.
The coordination needed for these incidents extends far beyond what we are used to in a standard EMS or fire response. We have to ensure that each team knows exactly what the roles and responsibilities of each other are, and what to expect before, during and after an incident. This is not something that can be thrown together in an ad hoc fashion, and it will require a considerable amount of effort by every participating agency. Hopefully, everyone will leave their egos at the door and recognize the need to approach this from a team perspective.
What special training do EMTs and firefighter/paramedics receive related to active shooter events? Similarly, what are the key training points that EMTs and paramedics should focus on related to these unique calls where there may be multiple gunshot victims?
EMS and fire personnel should already be well trained in mass casualty incidents (MCIs), but even the best prepared agency can be quickly overwhelmed by a large number of patients (i.e., Route 91 in Las Vegas). Smaller agencies can be quickly overwhelmed by just a couple of patients so, again, proper planning will be a key issue in successfully managing an incident.
In addition to MCI training, agencies should make sure their personnel have received refresher training in trauma specific to gunshot wounds, and they need to be proficient in rapid triage. The military’s Tactical Combat Casualty Care (TCCC) has been modified to a civilian version called Tactical Emergency Casualty Care (TECC), and this is an excellent training program that directly addresses care in active shooter incidents. Whether it is one patient or 30, the ability to rapidly triage and then treat these patients will have a direct impact on survivability.
Finally, and completely outside the scope of what EMS and fire personnel are used to doing, active shooter response training has to be done for all personnel. Working in conjunction with your local fire and law enforcement agencies, you need to train together on a regular basis in order to remain prepared to respond to these incidents. This training should include incident command system establishment, rescue task force (RTF) deployments, stop the bleed (STB) for all personnel (not just EMS and fire personnel), triage, treatment, transport, improvised explosive device (IED) recognition, and the all-important communications system. Start with one or more tabletops and progress to a full-scale field training exercise (FTX), ensuring that an after-action report (AAR) is done after each exercise so that critical issues can be addressed.
What safety considerations should firefighter/paramedics/EMTs keep in mind when responding to such events?
Safety is paramount to all personnel, and it should always be at the center of your attention. We used to “stand by” until the scene was declared “safe,” but that is not the case, nor expectation, anymore.
Starting with training, the proper PPE and the necessary patient care equipment, personnel must be comfortable operating in these types of environments. When I say “comfortable,” I mean that personnel should be confident in their ability to respond and provide care. My hope is that no one would ever be “comfortable” because they have had to respond to these types of incidents on numerous occasions.
Situational awareness (SA) is key to operating in these environments, and it must be constantly updated. These incidents are low frequency, yet high risk, and you must use all your senses, including your “gut feeling,” to ensure that you maintain accurate SA. Listen to the radio, both fire and law if possible, observe what is going on, use the proper PPE, follow directions when given, and then adjust accordingly. Have your local law enforcement agency teach you the difference between cover and concealment. And, always have a backup plan. If you have not trained for these incidents, at a bare minimum, you can easily apply the wildland acronym of LCES – lookouts, communications, escape routes, and safety zones – to establish a basic level of safety for you and your teammates.
How can firefighter/paramedics/EMTs prepare themselves for the emotional elements associated with responding to these types of calls?
Preparing emotionally for these types of calls can be very challenging. While we shouldn’t ignore the potential for this type of call, we shouldn’t dwell on it either to the point that it becomes emotionally taxing. Like any other potential call where we may encounter a significant number of injuries or fatalities, we must be prepared to deal with any type of situation.
Much has been done recently to address health and wellness, to include emotional wellness, and there are several resources currently available that may be used to help you establish a health and wellness program in your agency. From good physical and mental health to having good social and support networks, you must be prepared every day you come into work.
Other mechanisms to help prepare for these types of calls include, as delineated in “First Responders: Behavioral Health Concerns, Emergency Response, and Trauma,” part of the May 2018 Disaster Technical Assistance Center Supplemental Research Bulletin, p.10. Substance Abuse and Mental Health Services Administration (SAMHSA):
- Plan in advance of disaster mobilization, and develop clear written protocols and strategic plans.
- Include all the team members in the development of the protocol, and ensure they are all adequately trained.
- Ask potential responders before the disaster to be aware of the stress they are dealing with.
What should firefighter/paramedics/EMTs know about when to enter the hot zone and when to stage outside, letting police secure the scene?
Proper planning and training are essential on knowing when to stage, when to enter and when to retreat. This must be defined in your policies and procedures, and all responders need to understand who does what and when. Again, we used to stand by for any unsafe scene until law enforcement declared it safe. Lessons learned as far back as Columbine have taught us that this is a flawed practice, and that the sooner we can get to the patients and get them out, the better the survival chance.
Typically, EMS and fire personnel should never be entering the hot zone unless they are participating as part of an entry or tactical team. Often referred to as an “Operator,” participation at this level requires specialized training, to include the use of deadly force, and equipment far beyond what our “normal” personnel receive for rescue task forces. These personnel typically serve as the medic for the tactical team with the intent to treat injured team members, not civilians.
Based on current practice, EMS and fire personnel can enter a warm zone as part of an RTF, provided that they have received the proper training and are equipped with the proper PPE. This will vary by jurisdiction, but again, EMS, fire, and law all have to be operating from the same standard operating guideline (SOG) where roles and responsibilities are clearly defined.
With that said, there are certainly resource limitations in the rural United States. Where an active shooter incident in a metro area will get potentially hundreds of responders, rural agencies may only get a few. Regardless of where you reside, you must be prepared to deal with the situation with the resources that are available to you. What works in the metro may not work in the suburban or rural areas, and you may find yourself operating outside of the scope of a standard. The key is having these potentials identified and in policy prior to an incident.
How can NFPA 3000 assist in training efforts?
NFPA 3000: Standard for Active Shooter/Hostile Event Response (ASHER) Program is one tool that can greatly assist in both policy and training development. While not perfect, it does establish a framework that EMS, fire, and law can use to build a program from the ground up. Agencies using NFPA 3000 as a basis can then tailor their programs based on the resources available to them. As with all standards, NFPA 3000 will go through a revision process, so it will be important to monitor this standard for any revisions that may occur, and be ready to adjust accordingly.
What resources does the IAFC offer related to training for these events?
In performing a quick search of the IAFC’s website, there are over 2,700 different resources available. Some of these are available to anyone, and some are available only to members. Some of these resources includes the Active Shooter Toolkit, a training video, an operational checklist, numerous AARs, multiple articles, links to outside resources, and more examples of policies and SOGs than one can count.
The best resource the IAFC has to offer is the personal connection. While the paper and electronic resources are extremely worthwhile and will get you started down the path, the ability to connect with other fire and EMS professionals, some who have direct experience in this area, are invaluable. There are literally thousands of years of experience available to every member through the member network, and you’ll quickly find that many of those members are willing to help in whatever capacity is asked of them. When you couple this with the other available resources, there is no reason for you not to be able to develop a program that suits your agency.
One other resource the IAFC offers is advocacy. Through the efforts of the Government Relations staff, Terrorism and Homeland Security Committee members, the Board of Directors and other interested members, the IAFC is constantly working on legislative and operational issues with numerous government organizations to address issues associated with active shooter events. Whether it is testifying on the hill, working with Department of Homeland Security (DHS) or Department of Justice (DOJ), or participating in different task forces and focus groups, the IAFC is the leader for fire and EMS officers and chiefs in ensuring that our voice, down here on the front lines, is heard.
Is there anything else you’d like to add about the NFPA 3000 or the role of EMS and fire agencies in active shooter readiness and training?
Fortunately, we are not alone in this evolution as we have numerous partners that we must work with to achieve success. They are in the same position as we, and all of us, are learning as we go. Utilizing resources such as NFPA 3000, TECC, AARs and subject-matter experts, we can develop the necessary training, education, policies and procedures to minimize the chance of failure.
This is the new normal, and it can happen anywhere. How you choose to respond to this challenge is completely up to you.