Midday on Dec. 17, 2013, 911 dispatchers received frantic phone calls from Renown Regional Medical Center in Reno, Nev., telling them an active shooter was on the loose. Within four minutes, police and specially trained tactical medics from REMSA (Regional Emergency Medical Services Authority) were on scene.
Two of REMSA’s tactical medics entered the medical center with the first four police officers. Police had a strong suspicion where the shooter was from the 911 calls, but they couldn’t be sure. “They went into this knowing there was potentially an active shooter in the room,” says Mike Williams, former vice president of operations for REMSA.
Moments later, the forward team spotted a, man down, a 12-gauge shotgun nearby. They quickly surmised he was the shooter. (Later identified as Alan Oliver Frazier, 51, he died of a self-inflicted gunshot wound.) Near the shooter was a victim who was shot in the stomach but alive. One tactical medic stopped to provide treatment, while the second medic continued searching the building with police.
They soon came upon a second victim who was also alive. In this case, the police officer—who had just completed a tactical critical care course taught by REMSA—applied a tourniquet. The second medic continued on with police.
The last room they came to contained a third victim, who was deceased. “From the time the call went out that there was an active shooter to the time the two injured patients were in the trauma center was 12 minutes,” Williams says.
Since 1997, REMSA has worked closely with law enforcement on its Tactical Emergency Medicine Support (TEMS) team, which dispatches specially trained street medics and paramedic-certified critical care nurses with SWAT teams to the scene of active shootings, hostage situations and high-risk arrest warrants. To prepare, REMSA’s eight tactical medics and nurses must maintain a high level of physical fitness and attend all SWAT trainings. They’re integrated with the Sparks Police Department, Reno Police Department and Washoe County Sheriff’s Office SWAT teams, and provide tactical medical support to federal law enforcement agencies, including the FBI, the U.S. Marshals Office and the DEA.
But REMSA is also taking the reverse approach: training law enforcement officers responding to mass shootings to do tactical combat medicine so police can render aid to victims, too.
There’s been a lot of focus recently on active shooter protocols that train firefighters and other EMS responders to get to the victims of shootings more quickly by entering “warm zones” where active shooters may be present instead of staging in “cold zones” and waiting for police to bring victims to them. But just as important is arming police with the skills they may need to save lives. “We always make the assumption that law enforcement is to seek out and take care of bad guys and medics are there to seek out and take care of victims,” Williams says. “We’re kind of turning it a little on its head right now. We need to have our police officers be able to do victim care, too … they need to be integrated into EMS the same way we’ve been integrated into law enforcement.”
Three years ago, REMSA began offering a four-hour combat casualty care course modified for law enforcement; some law enforcement agencies get as many as eight hours of training. REMSA has trained nearly all police officers and sheriff’s deputies in their area, as well as some members of the Nevada Highway Patrol, federal agencies and neighboring cities. All police officers who have gone through the training receive a small first-aid kit and tourniquet.
The Renown Medical Center incident wasn’t the first active shooting REMSA tactical medics have responded to. In October 2013, a student at Sparks Middle School shot and killed a teacher and wounded two students. Seven minutes after the 911 calls came in, the REMSA tactical medic was on scene, where he rushed to the front door of the school and was directed by police to search for victims near a basketball court. The paramedic evacuated two wounded students to ambulances—both of whom survived.
“Our tactical medic on the first ambulance that responded joined up with law enforcement, and their mission was literally to go find the patients,” Williams says.
New comedy launches about EMS
“Sirens: A Life or Death Situation Comedy,” a new TV show about three Chicago EMTs, premiered on the USA Network in March. Based on a show that first aired in the U.K. in 2011, the U.S. version has Denis Leary—co-creator of the “Rescue Me” TV show about a New York fire department that aired from 2004 to 2011—as executive producer. “Silly, self-righteous and even self-destructive personalities make them unqualified for sustaining relationships, friendships and most occupations,” the USA Network description reads. Watch a full episode at usanetwork.com/sirens.
Book details silly 911 calls
A paramedic in the United Kingdom has compiled 101 silly calls to 911 and 999 (the U.K.’s emergency line). There are some doozies--, including a woman who called 911 three times to complain that her favorite fast-food restaurant was out of chicken nuggets; a man who cryptically said he needed a barber, fast; several calls regarding spiders in the house; one caller who wanted to know how to cook a turkey; and another who was distressed because he had shampoo in his eye.
Paramedic Stuart Gray spent several years collecting published stories and audio recordings to write 101 Dumb Emergency Calls, which was illustrated by fellow paramedic Paul Dodd. Though the book is meant to be humorous, “everyone knows the mantra—each time a hoax or irrelevant call is placed to the emergency services, someone who really needs help could be denied it,” Gray says. The book is available as an e-book at Amazon.
Volunteer agencies exempted under ACA
Fire and EMS agencies that rely on volunteers breathed a sigh of relief after the U.S. Treasury Department announced in January that they won’t have to provide health insurance coverage for volunteers. The Affordable Care Act (ACA) requires employers with 50 or more employees working at least 30 hours a week to offer health coverage, which many volunteer departments feared they couldn’t afford. According to a statement from Mark Mazur, assistant secretary for tax policy, his office received numerous comments from fire and EMS stakeholder groups and members of Congress to the proposed regulations issued in December 2012.
On Feb. 10 of this year, the Treasury Department issued the final regulations, putting the volunteer matter to rest. The final rules also provide an additional year for employers with 50 to 99 full-time workers to comply with rules to offer coverage. Beginning Jan. 1, 2015, only employers with 100 or more full-time employees and/or full-time equivalents must comply with the final rules; businesses with 50 to 99 full-time workers have until Jan. 1, 2016, to comply or face fines.
