When news breaks about a mass shooting, I think many of us imagine or visualize at least these three scenarios.
Visualizing responder roles
First, if I were a teacher, how would I have taken action to protect the students in my care? Would I have been able to calmly and quickly escort them to an exit or guide them into a hiding place that offered concealment and cover?
Second, as a parent, how quickly can I get to my children’s school? Would I cover the mile between me and my children on foot or with a vehicle? Once at the school, what would I do?
Finally, as a paramedic — and probably like all of you — I feel an urge to do what I am trained to do. Did you visualize applying a tourniquet to stop severe bleeding or inserting an oral airway?
Do you imagine these scenarios? Do you discuss the active shooter scenario in training and with your partners in law enforcement?
Active shooter response
The response to active shooter incidents is evolving. Law enforcement is training the first arriving officers to move quickly towards the sound ofgunfire rather than establishing a perimeter or waiting for a SWAT team.
Another emerging change is that paramedics are escorted by a second wave of police officers into the warm zone to seek out patients. The paramedic treatment role is straightforward — triage, stop severe bleeding, BLS airway maneuvers, and pocket mask or bag valve mask ventilation.
But before you can do any of that you need to be able to reach the patient.
Paramedic physical readiness
I know of many organizations that are mentally preparing paramedics with training to respond into the warm zone with police officers, but I am not sure if we are physically ready for the task ahead. Have you practiced and are you ready to:
- Rapidly exit your vehicle with a kit that contains triage tags, tourniquets, wound dressing, oral airways, and pocket masks?
- Move under the command of police officers at a pace from a fast walk to a sprint for distances up to a quarter mile?
- Drop to the ground or dive behind cover when ordered by your police officer escort.
- Kneel at the side of a patient, after sprinting to reach them, on a hard surface for 30-60 seconds to assess circulation, airway, and breathing?
- Spring back to your feet with your gear and move forward with the officers to reach more patients?
- Defend yourself from a hand to hand physical attack?
- Help one or two others drag or team carry a 180 pound patient behind cover and or concealment?
Readiness is multifaceted. There is a mental component of education and visualization. There is a technical component of applying lifesaving skills. The above physical readiness is not just the domain of only tactical medics. Every member of every ambulance crew needs to be physically ready.
Normally, I am strong believer that paramedics are at their best when they saunter into a scene, slowly walking and looking for clues and risks. But an active shooter incident is going to require repetitive bursts of significant physical activity.
What are you doing to make sure you are ready?
Author’s note: I appreciate the review and feedback of a final draft of this article by Chief Skip Kirkwood and Bryan Fass.
