MCI response: How to use armored vehicles to deliver EMS
Fire departments/EMS must carefully coordinate with police to provide rapid initial treatment and patient transport in mass casualty incidents
By Jim Morrissey
As mass casualty incidents continue to challenge public safety agencies, fire, EMS and police response to such events is in a continuous state of evolution. Part of that evolution involves addressing the need for rapid rescue, treatment, extrication and transport of injured victims.
Fire departments/EMS must carefully coordinate with law enforcement officers to provide rapid initial treatment of victims to ensure they get suitable medical care as soon as possible. One option is the use of armored rescue vehicles (ARVs) to deliver police and medical personnel into the hot zone where they can protect, treat and extract victims.
The need for rapid patient transport
We can all agree that the best place for a seriously injured trauma patient is in a trauma center; and the sooner, the better. Point of wounding care and initiation of life-saving interventions on scene clearly makes sense, but on occasions when the threat is still present, putting rescuers in harm’s way might add to the casualty count.
When faced with an active shooter situation with injured people unable to safely extricate themselves, first responders must focus on speed and simplicity, especially if under fire, to save lives. The primary initial responsibility of law enforcement is to neutralize the threat, and all responding officers should be focused on that. In terms of casualties, the goal is get the victims out if possible. In some cases, this can be done safely using an ARV.
If available, responders could use an ARV to provide cover (ballistic protection) between the threat and the casualty, extricate the victim and provide point of wounding care while moving the victim to a safe area for transport. If the situation is such that all of the casualties can be loaded up in the ARV and stabilized, it may be faster to use the ARV to transport the victims to a trauma center instead of off-loading them to a casualty collection point and then transporting by ambulance. The goal of first responders with any trauma victim is to minimize the time between casualties being injured to definitive care, including surgery.
Once the threat has been neutralized, or at least mitigated, all first responders need to focus on quick medical stabilization and rapid transport to a trauma center for the critically injured casualties. The ARV may be the transport of choice for this, assuming it is no longer needed on scene.
Adapting an ARV
Public safety-centric armored vehicles are the result of an evolution of more traditional military armored vehicles and bank delivery armored vehicles. ARVs were originally designed for and are very good at protecting and delivering law enforcement to a specific volatile target location. There have been situations where police have been fired upon while approaching a high-risk target location.
Some ARVs have been specifically outfitted more as a rescue vehicle, rather than an assault vehicle. One of the early designs of a rescue-centric ARV included a trap door at the bottom of the vehicle so that the ARV could drive over and straddle the victim and then the team would pull the victim up into the ARV. This sounded good in theory, but never really became an operational model. Today, ARVs are multi-purpose, and can be configured with hydraulic ramps, ladders, rams and some even have fire suppression capabilities.
ARVs can be outfitted much like an ambulance with features such as O2 ports, suction, IV hangers, cabinets and patient monitors. Another option that has worked for several departments is to have a select amount of modular, trauma care-focused packs that can be on-boarded if the mission is geared towards rescue.
Integrate the ARV into MCI training
Responding to a tactical incident should not be the first time medics get into the back of an ARV. These vehicles tend to have a high center of gravity and loading a casualty takes more personnel and more coordination.
If the use of an ARV is something your fire, EMS and police community is interested in pursuing, then a fair amount of time will need to be dedicated to training in and around these vehicles, before an incident occurs.
About the Author
Jim Morrissey is a former tactical paramedic for the San Francisco FBI SWAT team and the founder of the Tactical Medical Association of California (TMAC). Jim is also the terrorism preparedness coordinator for the Alameda County EMS Agency. Jim has a master’s degree in Homeland Security from the Naval Postgraduate School in Monterey, CA.