Active shooter: How to get medics to victims faster

Two emerging models of rescue task forces and tactical medics offer different, yet more aggressive approaches to active-shooter incidents than standing by until all is clear


By Jim Morrissey

There have been two major shifts in doctrine related to law enforcement operations in the last 10 years. The first shift is the aggressive pursuit of an active shooter with whatever assets happen to be on hand instead of waiting for a SWAT team.

The second major change is recognizing the need for emergency medical contingency planning. This includes training all tactical personnel and line officers in the basics of self-care and buddy care with the focus on bleeding control and the addition of a dedicated tactical medic.

Photo provided by Josh Kennedy.

Photo provided by Josh Kennedy.

An aspect of this doctrine shift is SWAT teams are increasingly including a dedicated tactical medical component and medical threat assessment as part of their organizational structure. The result is a tactical medic being assigned to the law enforcement team using one of several models.

In addition, law enforcement is at minimum notifying — or ideally involving — local EMS and hospitals about planned or developing law enforcement operations that have a high risk for injuries, like an active shooter incident. This change has given rise to the rescue task force.   

Tactical medic vs. rescue task force
Tactical medics are attached to and considered part of a tactical law enforcement team. Whereas a rescue task force is a trained, but hastily formed group of EMS medical providers (private and/or fire based) that partner with law enforcement on scene. They will enter a newly secured area, such as an active shooter incident, to provide triage, emergent care and casualty extrication.

Both tactical medics and task force personnel provide emergent care in less than ideal situations, often under significant stress and in chaotic, sometimes hostile environments. Both work very closely with law enforcement during planning, training and actual events.

Most task force members are outfitted with ballistic vests and helmets, and likewise, almost without exception, tactical medics are protected with body armor and helmets. Both are specifically trained and equipped to deal with ballistic, blast and other violence-induced trauma.

Task force members wear their usual daily uniform (Fire/ EMS/ law enforcement) and are typically dispatched during their normal shift. Tactical medics wear the uniform of the tactical team they are attached to and are physically located with the team, or just outside of the hot zone.

Rescue task force medics
Historically, EMS providers staged a safe distance away until police methodically secured the scene before permitting EMS to access victims. This practice is being phased out and replaced by the rescue task force, a more patient-centric and life-saving approach.

The should have access to the wounded casualties when the threat has been eliminated, when the shooter is confined to another area, or when the scene has been deemed relatively secure.

In the rescue task force model, providing life-saving interventions is done as soon as possible and is everyone's responsibility. There are four ways to render medical aid in these types of situations.

  1. Bystanders and victims provide care to one another prior to any responder arrival.
  2. Police rapidly extricate and escort victims to a safe area where awaiting EMS provides medical aid.
  3. Police secure the area and provide life-saving interventions at the point of wounding.
  4. Police secure or clear the area and bring in task force medics under a force protection model.

The task force focus should be on quick initial medical assessments and to provide life-saving interventions on scene, at the point of wound. Finding and treating patients should be done in concert with efforts to extricate victims to a casualty collection point where a secondary triage, treatment and transport can be provided.

The task force should use a pre-entry checklist to ensure important issues are addressed. The law enforcement job with the task force is focused on escorting and protecting the medical members.

The rescue task force concept is becoming more widespread and adopted nationwide. However, fire departments, local EMS providers and law enforcement need to collaboratively train, drill and develop procedures and protocols for this concept to be effective.

Tactical medics
A tactical medics is somewhat analogous to a professional sports team trainer who travels with the team and is there primarily to provide medical aid to the team, whether the injury or ailment is serious or not.

On a typical planned SWAT operation there are several phases and steps that take place well before the hit. Most often, the mission is a planned high-risk search or arrest warrant. After getting a warning order, the SWAT team operators and all of the support elements (medical, communications, negotiators, etc.) typically convene at a forward staging area.

A briefing will occur, where mission goals, subjects and target location layouts are reviewed. Depending on the nature of the mission and operations security issues, the tactical medic may coordinate with the local EMS transport provider to have an ALS ambulance stage close to the location.

The tactical medic is the logical liaison to the on-scene EMS assets that support law enforcement operations. Typically, the tactical medic will have a face-to-face meeting with EMS units.

The most common items dispensed by a tactical medic is bandages and pain relievers. However, the tactical medic must also be prepared to provide life-saving interventions to team members and other on-scene law enforcement officers.

The tactical medic will also provide initial medical care as needed to victims, bystanders, and perpetrators once the scene is secured. They will transfer patient care to a standard EMS unit if further care and transportation to the hospital is needed.

Tactical EMS models
Some law enforcement agencies send personnel to EMT school or other comprehensive tactical medical classes. Those officers may become the default tactical medic for the team. That may be a workable solution; however, it is unlikely those individuals have the medical experience and patient-assessment skills needed to be the best medical practitioner in high-risk, high-stress situations.

There are countless workable models for the incorporation of a medical contingency plan for law enforcement operations. These are some of the more common models.

Officer, agent or trooper medic
A sworn law enforcement officer has dual roles as an operator and medic; they have law enforcement powers and can certainly protect themselves from potential threats.

Agency contract
The law enforcement agency has a contract or memorandum of understanding with a local EMS agency to provide up-close medical care. Some agencies put these contracted medics through a reserve officer school so that they can be armed as police.

Individual contract
An individual or a team are under contract or memorandum of understanding with the law enforcement agency for providing medical coverage for SWAT missions and training.

ALS stand by
In this outdated model, there are no tactical medics attached to the law enforcement team, but police will stage a standard ambulance some distance away to respond to the scene after the scene is secured by law enforcement.

Learning about tactical EMS
Many in the EMS field have demonstrated an interest in getting into the field of tactical medicine. In addition to the pre-existing medical training, it is highly recommended to procure specific tactical medical education.

Programs such as NAEMT Tactical Combat Casualty Care, Tactical Life Saver and others like have been well received by the EMS and LE community. The International School of Tactical Medicine offers a two-week intensive program aimed at medical practitioners who need basic training on law enforcement operations and how to work within a law enforcement team as the medic.

For those interested in joining a rescue task force, Urban Shield has been conducting tactical and EMS/medical integrated scenarios each year since 2008. These scenarios are created to be realistic, tactically and medically challenging and to create an obvious nexus between the tactical resolution and providing life-saving care to the casualties in a timely manner.

About the Author
Jim Morrissey is a tactical paramedic for the San Francisco FBI SWAT team and the founder of the Tactical Medical Association of California. 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, Calif. He can be reached at jim.morrissey@acgov.org.

 

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