By Sarah Calams for EMS1 BrandFocus
Sponsored by Bound Tree Medical
This article was originally posted here on Bound Tree University.
On April 20, 1999, two teenage gunmen entered Columbine High School in Littleton, Colorado, and began a shooting spree.
In 16 minutes, the gunmen had killed 12 students and one teacher and wounded more than 20 others. They later turned their guns on themselves.
At the time, the Columbine shooting was classified as the deadliest school shooting in U.S. history. A detailed report later criticized SWAT officers on scene, saying it took them too long to reach the wounded.
The scene was chaos. Paramedics were treating victims and transporting them to area hospitals. Fire trucks were parked nearby, acting as a shield for responders to inch in closer to the school and provide medical care.
For Capt. Chris Wells, who was on duty during the incident, the frustration, fear and feeling of not being in control was a foreign concept and inconceivable thought. Since then, he said, local responders have made it their mission to never show up unprepared again during an active threat or mass casualty incident.
Planning active threat response
Wells began his fire service career at the age of 21 and is now in his 20th year as a firefighter. During his tenure, he has served as a firefighter and lieutenant, and he is currently a captain with South Metro Fire Rescue in Centennial, assigned to the training bureau.
South Metro, now the second-largest fire department in Colorado, protects half a million people across 285 square miles. Effective Jan. 1, 2019, Littleton Fire Rescue, which responded to the shooting at Columbine, merged with South Metro Fire Rescue, along with Littleton Fire Protection District and Highlands Ranch Metro District.
Wells, who was working out of Cunningham Fire Protection District in Denver before the merger, said the now-defunct department partnered with one of the larger metropolitan sheriff’s departments on implementing active threat response about four years ago.
When the department merged with South Metro, partners from law enforcement, fire, EMS, dispatch and surrounding stakeholders came together to draw up a single agreed-upon active threat SOP.
“All the heads of those organizations signed off on it so that when we get on scene, we’re all speaking the same language and have the same policies and procedures,” Wells said.
South Metro reached out to responders from Littleton Fire Rescue and Aurora Fire Rescue, which was part of the Century theater shooting response in July 2012, to help guide the effort.
“They let us know, ‘This is what really goes down, here’s how it works and here’s why this didn’t work,’” Wells said. “It wasn’t like we were going off of some book that said, ‘This is how you do it.’”
Their real-world experience and insight was invaluable, Wells said, and helped South Metro create a policy they knew would work in the field.
“We definitely won’t show up unprepared ever again,” he said.
The process took over a year and, according to Wells, was successful partly due to active threats that had taken place throughout the area post-Columbine.
“We saw that the rescue task force – where you plant a mixture of fire personnel with law enforcement, they go into the warm zone and they extract – was not being implemented and we felt that we really have to make that a standard,” he said.
Implementing active threat response
Not long after developing a common standard operating guideline based on national standards, responders were faced with two active threat incidents.
“Because we had already implemented the policy and we had trained on it, we were able to save the life of a woman who had been shot by her daughter, who had barricaded herself in the house,” Wells said.
Crews were able to stop the older woman’s life-threatening wounds, immediately extract her from the home and transport her to an area hospital.
“That wouldn’t have been a possibility just two years prior to that,” Wells said. “We would have gone to the area, stood by, waited for an all clear – and in the time that would have passed, she probably would have not made it.”
More recently, South Metro responded to the May 7 attack at STEM School Highlands Ranch, just a few miles from Columbine High School. About 150 fire and medical personnel across the metro area were on scene, putting the policies into action in a coordinated response.
Training for high-stress incidents
Prior to implementing the policy, Wells said there was pushback from personnel who felt that it wasn’t safe.
In response to their concern, the department was able to secure a grant and outfit every riding position on each unit with a ballistic vest, ballistic helmet and extraction bag.
“Now we had the right equipment and the right policy, but we all know that the policy isn’t worth the paper that it’s written on if it can’t be implemented,” Wells said.
South Metro then reached out to the Urban Areas Security Initiative Program for a grant to put together a training video. The department gathered the partners and personnel from the agencies that had signed off on the policy to help create the video, including 13 law enforcement agencies and other partners like Castle Rock Fire and Aurora Fire.
At the same time, the 17th Judicial District, which already had a similar policy in place but was having a difficult time implementing it, also wanted in and helped create the video.
“It was a group effort,” said Wells. “If we didn’t work together, then it wasn’t going to work at all.”
The first part of the training video shows an actual incident as it takes place in real time. Afterward, they go back through each segment in the video and describe what is being seen, why it’s occurring and how it relates to the policy.
Once they had a policy in action and the proper gear, South Metro hosted a training course, staged in five area churches.
“We had hundreds of fire, EMS and police coming,” he said. “They reviewed the policy before they showed up, we went over the video and then we did a full-scale live exercise 16 different times so that we could get all those groups through.”
During the exercise, the department also partnered with area hospitals to create the most realistic experience possible for responders, following the NFPA 3000 standard, which recommends that personnel gain tactical experience in order to function in high-stress environments.
As a result, they created a movie-like set – complete with real victims who had cut suits on. “We could do chest venting and cricothyrotomy, and we actually transported those victims to area hospitals so that the trauma centers could get training on how they were going to deal with this.”
The victims in the exercise were taken all the way to the operating room and had bullets lodged in their cut suits in order for surgeons to simulate what their surgery would entail.
After the exercise, the department explained how to set up unified command and rescue task forces, how to move through and traverse the area, the importance of speaking the same language while on scene and how to work with purpose and safety in mind.
Later, South Metro streamlined their own policy – taking the heart of the main policy but grounding it down to what was important for their district.
“We didn’t deviate from the initial SOG, so that all of our policies could reflect the greater policy,” Wells said. “When we implemented our streamlined policy, we went back and did another in-house training.”
Once personnel went through training and had practical experience, the department spearheaded an after-action training.
“We talked about lessons learned, what we did right, what we need to work on and how South Metro is serving as fire support,” Wells said. “Law enforcement throughout the state has been contacting us to help them on how to set up incident command, what a rescue task force looks like and guiding them on how to get ballistic gear.”
A gap the department found during training, Wells noted, was unfamiliarity with partnering agencies.
“When we come into their training – whether that’s working as a rescue task force or we’re consulting with them – we’re building those relationships, so when we do go to an actual incident it’s not, ‘Who are you and what do you do?’” he said. “It’s, ‘Here’s what we’ve got, let’s do it just like we did in training.’”
The policy has worked so well that the department is currently in the process of rewriting their mass casualty incident policy to mimic their active threat policy.
“It falls almost identically in line with how we do active threat, minus the component of a rescue task force,” Wells said. “It just takes the known into what used to be an unknown, and we can function at a high level in a different type of atmosphere.”
The final piece of the puzzle, Wells said, was educating the public on how to save a life before responders arrive.
Stop the bleed, save a life
May 2019 marks the first Stop the Bleed month observed in the U.S. South Metro, identifying the importance of educating the public on bleeding control, worked with area hospitals to push the Stop the Bleed campaign.
“As quickly as we can assemble, we’re still talking four minutes, at best, before they have any first responder that shows up,” Wells said. “We’ve worked with the hospitals, we’ve been out in the schools, and that’s why we partnered with the churches because the training happened right after several church-involved active threat incidents. They had come to us and said, ‘What can we do?’”
The department now has an outreach program and educates the public at schools, churches, offices and anywhere else they’re called to.
“We train them how to apply tourniquets, and we’re partnering with law enforcement to teach them about Run, Hide, Fight,” said Wells. “We want to make them as prepared as possible so that when we get there we can just continue that care and they’re not just waiting for us to come in and solve the problem.”
In addition to focusing on public outreach, South Metro also emphasizes the importance of setting up casualty collection points inside versus outside during any training session.
“A lot of these patients are in hypovolemic shock. They’re losing a lot of blood. As soon as we introduce them to the elements and they’re on the cold concrete, they go into shock and die,” Wells said.
In addition to bleeding control training, he makes it a point to remind responders about the recovery position and keeping patients warm while treating them. “We talk about how to actually pack a wound, how to put a tourniquet on, where to put a tourniquet on,” he said. “We’ve really been aggressive on arming people with good information so they’re empowered.”
The knowledge gained from the process, however, did not come without mistakes made and lessons learned along the way.
‘Stop the killing, stop the dying’
For South Metro, the biggest lesson learned was the importance of unified command.
“We did a case study on the Parkland school shooting, and that shows where, I would say, the majority of the nation is at,” Wells said. “They understand the concept of a rescue task force, that we don’t wait for SWAT to come in, secure the perimeter and then go in. But when you don’t train on it, you don’t have a methodology in place and you haven’t worked with your partners, then you go back to what you’re familiar with.”
The biggest game-changer for South Metro was showing personnel what unified command looks like and why it’s set up the way it is. “We told everyone to do unified command often and frequently so when you do have that large event, it won’t be a foreign concept.”
Another important concept was identifying that an actual scene starts with non-command personnel. “That’s a difficult thing, because these situations really work from the inside out, not the outside in,” Wells said. “From a tactical standpoint, that was probably the hardest hurdle that we had to overcome.”
For example, if a rookie patrol officer is closest to the scene, that officer will be the first to go in and assume command. When fire and EMS arrive, the first company officer links up with that officer – whether a ranked supervisor or not– from law enforcement, and they start the unified command inside the warm zone.
Once the department was able to show that it was better to have someone in charge than no one at all, everyone quickly realized how important it was. Simplifying the process to two critical factors made it easy, said Wells.
“The first critical factor is to stop the killing. Once the act of killing is over, the next critical factor is to stop the dying,” he said. “That’s when law enforcement becomes the tactical supervisor, and they call in for fire and EMS response to help extract patients and take them to the hospital.”
At the end of the day, getting started was the hardest part. However, Wells hopes other departments will take what South Metro has learned and apply it within their own agencies.
“Here we are, 20 years later, and I really do feel like we’re leading the way in our response,” Wells said. “And that’s our tribute – in a small way – to let them know that those lives were not lost in vain.”
