Q&A: Crossing borders – fire department MCI preparedness locally and abroad
The fire service writes the doctrine of stop the killing, stop the dying and start the healing after a terrorist attack or mass casualty incident
“The fire service is a federal stakeholder in the war on terrorism and there is not a terrorist attack or active shooter act that that doesn’t get a fire service response.” Kevin McGee, chief, Prince William County (Va.) Fire Rescue, notes. “We are the first responders and we work closely with partners in the response community, IACP, the Department of Homeland Security and the FBI.”
As Chair of the IAFC Terrorism & Homeland Security Committee, McGee traveled to Paris after the 2015 coordinated shooting and suicide bombing terrorist attacks left 129 people dead and 352 injured across the City of Light to learn from local responders how their preparedness efforts and training saved lives.
IAFC Terrorism & Homeland Security Committee is comprised of the top terrorism and Homeland Security subject manner experts in the national fire service, and hosts a library of documents and materials that can assist fire departments with preparedness efforts, including a Large-Scale Response toolkit.
Fire Chief sat down with Chief McGee to discuss MCI preparedness, training and collaboration in the wake of recent violent attacks.
FIRE CHIEF: How has the Las Vegas Oct. 1 shooting changed the fire service?
Chief Kevin McGee: The Las Vegas After-Action report will be the definitive document we’ll learn from. We continue to learn and adapt our response procedures from every attack, but specifically for Las Vegas attack, we know the shooter position from a remote elevated platform prevented security interference. This is a scenario that we now know we must include in our community threat assessments and identify the means to mitigate this type of risk. Event staffs must be trained on activity reporting, evacuation procedures and bleeding control.
We also need to identify new first responder personal protecting equipment and procedures, for those rare but high risk situations where firefighters, EMS personnel and law enforcement officers find themselves operating at least a portion of the time in the hot zone. How do you mitigate risk associated with those kinds of scenarios?
We also need to emphasize the role of citizens to report suspicious activities. There’s a continuum of activities that perpetrators will be involved in from the planning process to deploying their weapons, positioning themselves. Somewhere along the line, if someone sees suspicious activity, if they can report it, it has a great potential of preventing such an incident from occurring.
What were your biggest takeaways from your visit to Paris after the terrorist attacks?
There were many takeaways from our visit to Paris:
- Multi-pronged attacks complicate response. The terrorists used low technology tactics, automatic weapons and person-borne explosive devices, but the situation was made complex by three teams of three terrorist commandos targeting seven locations in a coordinated attack plan.
- Responders considered as targets resets the hot zone. Responders are considered targets, and hostages that are taken are intended by terrorists as doomed because of their attack methodology of martyr. The elite hostage rescue teams were specific targets of one commando group. When these terrorists are prepared to martyr, they will confront law enforcement and are willing to die in an attempt to kill the responders. We learned that determining where the borders are between the hot and warm and cold zones in situations like this isn’t always clear.
Preparedness efforts save lives. The preparedness efforts that took place in France prior to the terrorist acts in Paris resulted in saving many lives. They were under a state of emergency since the Charlie Hebdo attacks and there was extensive planning that occurred not only in Paris, but throughout France, and civic collaboration among response agencies and the hospitals. They had substantial use of intelligence to better understand the threats they face. They had a requirement for weekly terrorism preparedness training from first responders through the hospitals. They used the intelligence to harden security and the procedures at the Stade de France, where one of the commando attacks occurred and they also pre-staged fire and medical assets.
This was a surprise to the terrorists, and it foiled the intent that they had to enter into the stadium and to ignite their body-borne explosives. The preparedness efforts they made resulted in very high survival rate. There were 302 patients, 100 of which were critical. Their triage system refers to the critical patients as “absolute emergencies.” There was a 98.7 percent survival rate. They had great success with addressing surge capacity.
- Build first responder and community resiliency. Build first responder and community resiliency. These events have tremendous psychological impact on the public and first responders. The incident was made more difficult by large numbers of good faith calls from throughout the city. When they heard a noise, the reaction of many members of the public was to call the emergency line and report it. There were also long-term psychological impacts. The way that they’re dealing with it and what they found to be beneficial was preparing the public through first aid training so citizens can feel empowered to act as immediate responders if they find themselves in a situation where they’re within the scope of the attack or in the perimeter of the attack. We’re doing more in the fire service with psychological first aid so that we’re building the resilience of first responders and the public. Training citizens to intervene with such actions as Stop the Bleed builds a level of resilience in the community.
- Reach beyond borders. Finally – and this was a message that was conveyed to use by the French Interior Minister – if we are to defeat terrorism, we must pledge to reach out across the oceans to our alleys and work together with them. And with our delegation’s trip to Paris, we began that relationship that’s continuing to this day.
How does firefighter training need to evolve based on recent attacks?
Well the fire service has a culture of continuous learning and it’s vital that we continue to learn and adapt from attacks that are perpetrated by either mentally deranged individuals or terrorists. And we need to go a step beyond reacting to terrorist tactics that have already occurred to in order to anticipate what an attacker or attackers might do that’s novel sometime in the future. So there’s a process that we follow that begins with capturing all we can learn from after-action reports and the intelligence processes, then we adapt. The fire service must adapt our tactics and procedures and policies to what we’ve learned from these processes and train our responders in a fully integrated way with our other partner agencies. And then we must evaluate the effectiveness of that training. This process is a continuous cycle. So the evaluation piece involves doing our hot washes and after-action reviews after training and exercises as key steps in the evaluation process, and so that begins the cycle all over.
How would you recommend fire departments best prepare for mass casualty scenarios?
The active shooter scenario has much in common with combat zone environments and we’ve learned a great deal from the military about survivability from weapon inflicted trauma. We’ve adapted the military method of tactical combat casualty care (TCCC), to tactical emergency casualty care that is used in the civilian environment. That involves the use of hemostatic agents, Tranexamic Acid, IVs and tourniquets.
It involves adapting and modifying EMS medical protocols and fire department procedures to conform to the TECC methodology – we often refer to this as warm zone medicine. And we also deploy a rescue task force concept. That’s a process where fire departments and EMS should control bleeding and extricate patients from the warm zone. The primary objective is to do rapid treatment and transport to a trauma care facility where definitive treatment can be administered. These are wounds that require surgery at that hospital.
How is the concept of scene security changing or being challenged by events like these?
These are low frequency, high risk incidents, often similar to those combat conditions. Safety and security of responders is a primary objective and to meet that objective, you have to use unified command with law enforcement, fire and EMS. Law enforcement’s role is to neutralize the threat. Law enforcement’s immediate actions create the ability for unified command to establish the hot, warm, cold zones and rescue corridors.
Fire departments are also evaluating PPE for fire fighters and EMS as the only effective way to respond to active shooter or terrorist attacks, maximize survivability of victims and minimize risk to our responders.
The safety risk of firefighters and EMS when working in hostile working environments is similar to the battle zone. We do consider ballistic protection as a component of personal protective equipment. The Terrorism and Homeland Security Committee encourages fire departments and EMS agencies to confer with their law enforcement partners on proper levels of PPE. Law enforcement are the subject manner experts. There are many considerations, from what level of protection to get, to storage and maintenance decision making, to cost and how that will impact department budgets. No ballistic protection should be deployed without development of policies and procedures, and training for the department.
How does interagency collaboration factor into MCI preparedness?
To maximize survivability of victims and minimize risk to our responders requires that we collaborate with our partners. It’s multidimensional. One dimension would be our partners, fire, EMS, law enforcement, communication centers, emergency management, hospital communities and intelligence agencies. The other dimension would be working at the regional, state, tribal, federal and, as I mentioned earlier, the international level, to collaborate.
We’ve learned by collaborating, we need to build common terminology. One of our findings were definitions for hot, warm and cold zone, and what’s secure, what’s not secure, had different definitions between fire, law and EMS. So we are planning together and training together, in a formal way and an informal way. I encourage our firefighters and EMS personal to invite police officers in when they do in station drills, that command staff meet together and work together to work on new tabletop exercises and our agencies to do functional exercises together.
No community is immune from the risk of active shooter or terrorist attack. We are finding it to increasingly be the case that there are many low tech methods that are highly lethal that we need to prepare to respond to. All departments should have a suspicious activity reporting policy, putting in community engagement of the See Something, Say Something campaign.
I encourage all departments to be familiar with Improving survival from active shooter events: The Hartford Consensus. As a fire service community, we are writing the doctrine to stop the killing, stop the dying and start the healing.