Active shooter incident: Overcome adrenaline to focus on one patient at a time

The lone wolf shooter is our biggest threat, but we need to assess and treat patients just as we would on every other shift

Helplessness is not something I am very good at, yet that is exactly how I feel when the news report of the day is another mass casualty at the hands of a gun-wielding lunatic. I vividly remember two days prior to the Sandy Hook massacre, sitting with 300 ATF, FBI, homeland security, police officers and firefighters during an all-day lecture concerning school shooting and bombings, and how to respond.

There was a ton of information, history of homegrown terrorism, how to make a bomb from household items, the Atlanta Olympics bomb, Columbine and others. Toward the end of the day, the Connecticut state police officer who did most of the speaking addressed the crowd.

"The lone wolf is our biggest danger, because there isn’t a damn thing we can do to stop him."

I used to stay up at night, thinking of everything I would do if I was ever unfortunate enough to respond to a mass casualty incident, especially an active shooter incident. All I could think of was never enough.

When I realized that I would do exactly what I do every minute of every other shift I slept much easier. I respond to emergencies. If the emergency happens to be an active shooter with people down, I shall respond. I will not charge onto the scene looking for victims unless there is a better than average chance of coming out alive. There is always a chance on every EMS call for danger.

Controlled actions in a crisis

When I was a full-time firefighter we approached the job the same way. If there was no chance of survival, we put the fire out from a distance and hoped for the best concerning occupants. If there was a chance of surviving the firefight, and victims trapped, we did what we were paid to do. We took risks, but only when human life was at stake. When there was little to lose, such as property, we risked little. When there was a lot to lose, such as people, we risked it all. To a point.

I have no control over traffic, or train travel, plane crashes or the lone wolf shooter. All I can control is me and how I act in crisis. How I act is directly related to what I learn, and continue to learn.

Trauma is trauma

Knowing how to treat victims and keeping fear and emotion in check is critical. Shootings raise our level of alertness and our adrenaline. Our fight or flight response is usually switched to fight mode and there is not much we can do about that, it is how most emergency responders are wired.

Being prepared for the horrific need not be a burden to carry with us every minute of every day. Having a blueprint of a plan is essential.

Assess and treat one patient at a time, maybe two. Avoid dangerous situations, either on the highway, in people's homes or anywhere they may occur.

Taking care of the people I can, and praying for the rest when the incident is over. That is my blueprint.

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