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Rapid Response: Do we need a tactical military medicine approach to MCI response?

Preparation, practice, standardization and community involvement will enable your EMS agency to act quickly and decisively in response to MCIs


A police officer dressed in SWAT gear walks through the first aid center at Gilroy High School following a shooting at the Gilroy Garlic Festival in Gilroy, Calif., on Sunday July 28, 2019.

AP Photo/David Royal

Within the span of a week, 34 people have been killed in three active shooter events; 22 in El Paso, Texas; 10 in Dayton, Ohio; and three in Gilroy, California. Learn more about what EMS agencies should take away from these tragedies with expert analysis from industry leaders.

What happened: On July 28, the day the popular Gilroy Garlic Festival in Santa Clara County, California, was about to close, a gunman opened fire, killing three – including two young children – and injuring 15.

Less than a week later, 20 people were killed and more than two dozen injured in a shooting at a Walmart shopping center in the Texas border town of El Paso.

Less than 24 hours later, police say a 24-year-old white man was behind a mass shooting in Dayton, Ohio. He allegedly killed his sister and eight others before he was fatally shot by police.

Why it’s significant: We are – practically speaking – now being asked to operate in the realm of tactical military medicine. The frequency of these mass shootings seems to be increasing. Over the course of these most frequent events, Americans were more likely to be killed in a mass shooting here in America then in combat over in Afghanistan.

Top takeaways on recent mass shooting events

Mass casualty incidents resulting from acts of violence are no longer rare events. Your agency must fully prepare now, because they can happen anytime and anywhere. Here are top takeaways on how your EMS agency can prepare for a mass shooting MCI.

1. Practice your EMS response to an MCI

Regularly review and practice MCI skills that will ensure all EMS personnel are ready to act when a major incident happens. Set up command, triage, treatment and transport stations, and practice mobilizing resources.

2. Standardize mass casualty triage systems

The SALT triage system is the foundation of the new MUCC Instructional Guidelines for training paramedics and EMTs in mass casualty triage. Which ever triage system you use, know it well. The time to get comfortable with a triage system is not the day you need to use it for real.

3. Have the essential supplies for MCIs on hand

Determine what equipment and supplies are essential for incident management, triage and mass casualty response and training. Have essentials pre-packaged in an easy-to-deploy method. Check expiration dates of supplies periodically and restock as needed.

4. Help your community prepare for violent acts

Train and empower citizens to control severe bleeding. They will be first on hand and bleeding control training will help them save lives before emergency responders arrive.

Preparation, practice, standardization and community involvement are all keys to effectively managing one of these horrible situations in your community.

Additional resources on mass shooting response has compiled some best-practice suggestions for preparing for and responding to a mass shooting MCI that merit review: columnist Dan White has designed many emergency medical products since entering the profession in 1977. White’s “Insights on Innovation” will focus on the latest trends and advancements in the EMS product industry.