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The evolving threat of active shooters: How EMS needs to change its approach

As active shooters target different locations and mass gatherings, first responders need to adapt their preparation and response from the rescue task force model


Students exit an ambulance at a recreation center for students to get reunited with their parents after a shooting at a suburban Denver middle school Tuesday, May 7, 2019, in Highlands Ranch, Colo.

AP Photo/David Zalubowski

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.

By Thomas Beers

In the past 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.

As someone who has studied, lectured and consulted for local, state and federal governments on active shooter incidents and the EMS response to these events for nearly a decade, I’ve noticed a shift in tactics and target selection by the perpetrators of active shooter events. The definition of an active shooter and how we pre-plan, discuss and respond to these events will have to change as a result.

We used to think and plan quite a bit about the concept of active shooters in schools, and that was appropriate. Schools were a common target of these perpetrators and prepared for threat disposition, mindful of the innocence associated with children and schools as a safe place.

Since the watershed incident at Columbine High School, through the multitude of school shootings that followed, and the refining and propagation of rescue task force (RTF) response as the answer, public safety professionals have regularly been training in schools and discussing educational institutions as primary targets for active shooters.

Over time, EMS will adopt new tactics, techniques and procedures to respond to and mitigate these MCIs as the threat matrix changes. Right now, RTF is still the national standard and jumping point for forward deployed medicine, but what is changing is the selection of targets by bad actors.

As an industry, we need to begin thinking about the next evolution in active shooter response and changing the mindset of the “it will never happen here” perspective that sometimes permeates an agency, to a viewpoint of “how are we prepared today” for the soft targets located in every village, township and city that are being selected by domestic, foreign and lone-wolf attackers.

Changing active shooter incident targets

Studying and preparing for RTF deployment at schools, with their long hallways, multiple classrooms, and multiple entrances and exit points is a challenging tactical puzzle to solve and we have done a stellar job as an industry to adapt to and overcome that variability. Yet, with the new uptick in soft targets, such as big box stores, open bars, night clubs, outdoor festivals, etc., RTF may not be the correct response, at least in concept, since there are no hallways, there are no hidden corners left for victims to secure themselves in, or for the shooter to find cover and concealment.

As Columbine was the impetus for change toward an RTF model, it was the Las Vegas music festival in 2017 that gave pause to those of us in homeland security and antiterrorism, causing us to ask, is this considered an active shooter or is this a barricaded sniper in an elevated position? This is not a matter of semantics, but rather important to address how the problem should be approached and how the tactical puzzle can be solved.

In recent response to the evolution of active shooter tactics, such as the Las Vegas shooting, the FBI and DOJ changed their definition of an active shooter from, “an individual actively engaged in killing or attempting to kill people in a confined and populated area,” to, “an individual actively engaged in killing or attempting to kill people in a populated area.” The parameter of a confined environment has been removed from the definition and no longer applies to all active shooter incidents.

Active shooter incidents now often encompass a large box, a large room, an open floor plan or an outdoor space with a deceased gunman and several victims

History had shown us that we would find victims in smaller spaces, such as classrooms, office meeting rooms, bathrooms and even closets. The populace has been instructed to alert others, to lock themselves in barricaded rooms, and to hide, with a last resort of fighting back as a last hope when danger is a few steps away. We’ve trained the public to wait for the RTF to enter, triage and treat in spaces that are broken by walls, partitions and doorways.

Preparing for several victims with a COOP

In recent history, agencies have equipped RTF medics with ballistic vests and a small supply of forward deployable medical equipment [e.g., tourniquets, decompression needles and chest seals], giving each team the ability to treat about four to six wounded.

With the new definition of active shooter and the new selection of soft targets, a change in the number of victims that need treatment requires a conversation of “how are we prepared today” to meet this new physical environment in which active shooter events are taking place.

One of the lessons learned years ago at Virginia Tech was to have a solid continuing of operations plan (COOP), and this is important more than ever today with the redefining and conceptualizing of where active shooters may strike.

Agencies should have their RTF gear ready to go and be turned out, but that only allows for us to treat what we historically have prepared for: four killed and six wounded. We need to expand our capabilities to meet the evolving physical and threat environments first responders are encountering.

The maxim that, “Every system is perfectly designed to achieve the results it gets,” simply validates that if you are not prepared to account for the variable environments active shooter incidents can occur in, then you will not achieve the goals of mitigating the event to an optimal outcome. We have a perfectly designed system with RTF to meet confined space active shooter events. The next evolution, as dictated by the perpetrators, is to address open venues and large box-like physical structures. We can start by preparing large amounts of bulk dressings and trauma equipment (e.g., sheers, cling-wrap, duct tape, nasopharyngeal airways, oropharyngeal airways, soft stretchers and mylar blankets – none of which is expensive) to be quickly deployed to MCIs. Simply having these items stored together in plastic tubs/containers in your station or support vehicles will allow you to be prepared and check off that you have a COOP in place for these events.

Additionally, agencies should perform a threat assessment on any gathering of significant size in their districts. Consider gatherings or festivals that may bring a surge of people into your area of responsibility.

Further, fire company inspections for fire prevention should look evaluate large buildings not only for fire code violations and building hazards, but also in the context of best locations for casualty collection points, staging areas and other considerations unique to your needs and capabilities.

RTF will only carry us so far for many events, as the number of victims are increasing and, more importantly, the types of environments in which they are being injured and killed are evolving. Supplemental and forward deployed resources and equipment should be a consideration on paper and in practice in order to be prepared for the evolving environmental variables of active shooter incidents.

There are only two states of being: ready and not ready. Which is yours today?

Be safe, be prepared and be your best.

About the author

Thomas Beers is an IAFF paramedic/firefighter in greater Cleveland and the EMS manager for the Cleveland Clinic. He is a graduate of the University of Dayton and currently a graduate student at Anna Maria College. Tom is a former US Army officer and is involved with strategic planning in pre-hospital medicine, tactical medicine and antiterrorism at various government levels and in the private sector. Follow him on Twitter: @OneTallMedic.

This article is dedicated all first responders but especially to the men and women of the Dayton Fire Department, who forever have a very special place in my heart.

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