By Heather R. Cotter, EMS1 Contributor
Acts of mass violence in the U.S., defined as three or more people killed in a public location, are occurring at an unprecedented rate.
Since October, four different acts of mass violence have occurred in the United States:
- October 1: A lone gunman opened fire on a crowd of concert goers at the Route 91 music festival in Las Vegas, resulting in the deadliest mass shooting in modern U.S. history;
- October 31: An ISIS-inspired terrorist drove a truck down a bike path and killed eight individuals in New York;
- November 5: A lone gunman opened fire and killed 26 during a church service in Sutherland Springs, Texas;
- November 14: Five individuals in Northern California were randomly killed by a gunman.
Acts of mass violence are challenging our nation, our communities and our first responders. While the tactics used by the assailants in each of these four events differed vastly, during each attack the first responders did their best to respond quickly and in a coordinated manner.
With no end in sight to mass violence, first responders and communities must review their preparedness and develop response and recovery training that includes integrated response and civilian trauma care.
Integrated response
First responders need to adopt an integrated response philosophy and train often to ensure a coordinated and effective response. Acts of mass violence are generally unpredictable and often evolve quickly with little warning. Several jurisdictions have adopted the rescue task force concept, as seen in Las Vegas, and more jurisdictions around the nation are applying similar tactics to their training.
Captain Evan Hannah with Clark County Fire Department said that, “The biggest factor in mitigating the October 1 event was the existing collaborative relationship between Clark County Fire Department and Las Vegas Metropolitan Police Department. Countless training hours over the years has not only increased our ability to integrate with each other, but increased our personal relationships with department personnel, easing integration from the Unified Command structure to RTF teams. Events of October 1 revealed areas in our current response policy that will be adjusted due to the size and complexity of incident we faced. Allowing more flexible tactical decision making by on-scene personnel is something we will evaluate in the near future.”
Glen Simpson, special events manager with Community Ambulance stated that, “The mass casualty incident at the Route 91 concert in Las Vegas affirmed the value of our pre-planning and contingency-planning efforts.
“Over the years, we have trained for various active shooter scenarios and have developed a framework for responses that includes discussions regarding egress, ambulance staging and accurate triaging. Such planning and training played a large role in our ability to effectively act/respond to an event none of us could have envisioned in our worst nightmares. While we know there’s no way to imagine every possible scenario we may encounter, we constantly train for an array of possibilities.
“Moving forward, we will take the experiences from ‘One October’ and add them to our framework to be adaptive to all MCI events. As first responders, we must continue to re-examine our experiences and continue to prepare for worst-case scenarios.”
In order to be fully prepared for any act of mass violence, all local agencies (law enforcement, fire, EMS and dispatch) must create trusted relationships between one another. Together they must establish what a comprehensive, integrated response and recovery plan looks like in their jurisdiction. They need to discuss details about establishing unified command and determine cross-disciplinary training schedules.
Civilian trauma care
In addition to integrated response training, first responders must train civilians in basic trauma care, as civilians will be at the scene and potentially able to provide medical aid to victims.
Research shows that an individual can bleed to death in less than three minutes from a traumatic injury. First responders should provide awareness training and hands-on trauma care training (to include tourniquets) to community members at a minimum on an annual basis.
Educating civilians on rapid medical care before an attack will help improve victim survivability.
Actionable next steps
First responders must leverage the lessons learned from recent attacks. While recent studies do address unique components of mass casualty events, there is a lack of research and readily available information about how agencies can create an effective integrated, cross-disciplinary response to dynamic events. Here are some key steps agencies should take:
- Review after-action reports and leverage existing resources and publications about integrated response training tactics.
- Connect with responders who were on scene and find out if you can attend one of their upcoming exercises. I’ve attended rescue task force trainings in major cities in the east and west coast.
- Watch EMS1 Paramedic TV videos and listen to podcasts that discuss current trends.
- Attend conferences hosted by groups like the International Public Safety Association (IPSA), that center on integrated response.
- Apply to serve on national level working groups that address these issues to learn from your peers and shape integrated response policy and training.
Acts of Mass Violence Initiative
IPSA is launching a new Acts of Mass Violence: Public Safety Response and Recovery Initiative and is seeking first responder subject matter experts to be involved. Since federal funding is not currently available, the effort is being kick started through a #GivingTuesday fundraiser. IPSA is currently accepting donations to support this effort.
Recent acts of mass violence have no jurisdictional boundaries. These events evolve quickly, and they occur with little to no warning. First responders know the modus operandi and weaponry will vary and there is a range of assailant planning tactics from impulsively acting to extensive strategy. For jurisdictions to be fully prepared, they must have a comprehensive, integrated response and recovery plan that includes all allied emergency responders.