Not if; when: Factoring for violence during mass gatherings

7 steps to factoring in violence as a possible variable at special event EMS response and incident command


Recent acts of mass violence during active shooter events and other incidents in schools, churches and businesses continue to highlight the need for a multi-pronged strategy for both training and response.

This special EMS1/Lexipol guide outlines lessons identified from past incidents that can direct EMS involvement in pre-planning mass gatherings, improve multi-agency cooperation, and inform incident command and response strategies on the ground: Mass violence: How lessons identified inform training, response

By Glen Simpson and Janet E. Smith

Due to political and economic pressures, many special event medical services providers are looking at how they can accommodate what we hope will be quickly filling event calendars for 2021 and beyond. State and local governments hold the reigns for easing gathering restrictions as well as how crowds can gather at all (i.e., locating spectators in pods or sections and eliminating cross traffic between sections or pods).

And, in light of recent events where active shooters, persons using a vehicle as a weapon or where escalating civil unrest violence has erupted, planning for future crowd safety/crowd management during full-scale attendance at arenas, stadiums, convention centers and showrooms includes a special emphasis for factoring in violence as a possible variable.

Planning for future crowd safety/crowd management during full-scale attendance at arenas, stadiums, convention centers and showrooms includes a special emphasis for factoring in violence as a possible variable.
Planning for future crowd safety/crowd management during full-scale attendance at arenas, stadiums, convention centers and showrooms includes a special emphasis for factoring in violence as a possible variable. (AP Photo/John Minchillo)

This article outlines Community Ambulance’s approach to factoring violent outbreaks as part of the company’s Special Event Medical Division’s practices on the world stage in Las Vegas, Nevada.

Pre-planning for an outbreak of violence

Event planners and their contracted special event medical services providers must first decide who will get a seat at the event’s pre-planning table. Often, the event’s location, weather, attendees’ politics, event size, the availability of alcohol at the event and the event’s inherent hazards play a role for deciding who and what agencies might be part of event planning. For instance, the inherent hazards at an inside, climate controlled, limited audience concert performance are much different than those presented by a large outdoor music festival or NFL game with tailgating/camping, 100 plus temperatures and access to alcohol.

One strategy Community Ambulance employs to set personnel apart from all other agencies responding to an act of violence is to deliberately uniform personnel in contrast to law enforcement personnel.

Event producers set the stage for pre-planning for every contingency

Event pre-planning Is typically in the hands of event producers. However, special event medical providers can influence and often direct event crowd management/crowd safety measures and strategies for dealing with violence by making pre-planning recommendations for notifying local officials about upcoming events. At the very minimum, Community Ambulance pre-plans for any event with local law enforcement and local fire department public partners.

Event pre-planning across departments, local partners

During pre-planning, Community Ambulance meets with The Las Vegas Metropolitan Police Department and the event location’s jurisdictional fire department. All three entities are part of the event’s ICS pre-planning, including discussions about the violence potential at the event.

Together, the EMS, fire and police planners will agree on how the ICS plan will be implemented should an incident occur at the venue. The incident commander will make the decision as to when to bring in more resources, move resources, etc. Jurisdictional fire department leaders will discuss the possibility of fire threats as an act of or result of violence and if fire threats are inherent to the event’s type or location.

Community Ambulance also notifies local hospital emergency departments’ leaders about the size and proximity of large scale events so they can be aware of and prepared to treat victims of trauma or violence even in the slight chance an incident might occur.

Do not forget to factor the media’s incident response as part of event pre-planning. Community Ambulance factors in the media’s response to any incident that might occur at an event. The company’s pre-plan typically includes PIO services and deciding on key messages to ensure that any statements conveyed by company personnel, the event promoter and the company’s local partners are mutually agreed upon and consistent. Robert Richardson, CEO at Community Ambulance, noted, “we have achieved the greatest success in this regard when we collaborate on a mutually agreed script or key messages during the pre-planning process.”

Pre-planning: The earlier, the better

An event producer’s level of expertise can be measured in part by how seriously and how soon the producer factors special event medical services and violence contingencies as part of the overall crowd management/crowd safety plan. As for almost anything; the sooner-the better.

However, it is the event promoter that dictates the pre-planning timeline based on the size of the event. Local law enforcement will typically plan to address the public’s safety during any event-related protest or related violence for several days before, during and after the event itself.

The Community Ambulance special event medical division typically plans to address violence using the following guidelines:

  1. Plan for contingencies. There is no cookie-cutter plan that will work for every event. That means it is important to plan for each and every event’s typical and atypical contingencies, including an outbreak of violence. The goal is to deliver best practices special event medical services and follow the pre-planned incident action plan. As part of the pre-planning process, consider current crowd threat trends (i.e., active shooter; the potential for someone to use a vehicle as a weapon; the potential for someone to use chemicals or fireworks as a weapon; etc. Factor the event’s location and non-attendees’ access to seated and un-seated audiences. Every plan at Community Ambulance includes EMS crews’ use of portable, easily accessible EMS supplies in a backpack and locating the company’s event ATV patient movement vehicle where it can be most effectively deployed to reach patients in areas where using an ambulance is impractical.
  2. Ensure EMS crews fully understand the venue’s crowd entrance and egress points. It is also important to establish a casualty collection point or points. While these very important crowd management mainstays are well thought out and decided early on in the preplanning process, company leaders have learned to always be prepared to make changes quickly. Entrances and exits should always be well marked, visible and easily accessible.
  3. Establish an incident action plan (IAP) aside from an event’s global IAP that includes all event resources. Community Ambulance crews receive an operational order that ensures they have the specific event’s known threats/potential threats information they need to get through the event.
  4. Ensure large events benefit through a joint operations center. Because EMS personnel/teams are typically stationed at a first aid tent/room as well as at various access points throughout a venue, large scale events benefit by having an operations center where event personnel and special event medical leaders can convene to discuss the status of any ongoing incident. By so doing, the event’s staff can quickly transition from private or internal crowd management to welcoming additional local public safety management/ICS resources in the case of a mass casualty incident.
  5. Establish a chain of command to follow during an act of violence. Every EMS system in America uses a declared chain of command during all types of violent incidents where EMS is called to care for victims or to participate in crowd management/crowd safety. Most EMS agencies, in cooperation with local law enforcement and fire agencies, use ICS procedures dictated by local disaster plans.
  6. Protect personnel. With an eye on employee safety, Community Ambulance has found some success with having ballistic gear available at events. Additionally, the company offers employees access to psychological counseling post any traumatic incident as part of the company’s commitment to employee safety and wellness.
  7. Communicate with event attendees. Stop the bleed kits and instructions about assisting victims before help arrives are a part of EMS services’ community education efforts nationwide. These instructions have also been imparted with more frequency at large mass gatherings in arenas and stadiums and other event venues. After the Oct. 1, 2017, Las Vegas shooting, Community Ambulance began storing a cache of these stop the bleed supplies at every large scale event.

Top lessons learned from pre-planning for event MCIs

  • Clearly mark entrance, egress and EMS access points at the event location
  • Communicate with event audiences regarding crowd management/crowd safety measures
  • Make ballistic gear available for personnel as well as post-incident psychological support
  • Don’t forget to plan how you will consistently address the media in the case of a violent outbreak
  • Distinctively uniform medical personnel in contrast to law enforcement personnel
  • Stage medical personnel at easy access points throughout a venue, not just at a medical tent
  • Develop strategies and/or purchase equipment/vehicles that allow for quick, precise and effective patient movement from difficult locations throughout the venue.

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About the authors

Glen Simpson is director of special operations at Community Ambulance, based in Henderson, Nevada. Janet E. Smith is president/EMS consultant at JS&A-On Assignment.

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