EMS Response to Mass Shootings

     There have been a number of high-profile mass shootings in recent years, and in each incident, EMS providers treated and transported victims in an orderly and systematic fashion. But such smooth responses can't be taken for granted. In responding to mass-shooting incidents, initial arriving crews are faced with horrific scenes that test even the most seasoned medics. Those first-in crews set the stage for the entire incident. This is where solid training and practice pay off.

     It all starts with the mass-casualty drill most EMS communities hold once a year. These drills usually consist of numerous simulated victims surrounding a crashed bus or airplane, or a model of some other disaster that could happen in the community. Occasionally these drills do nothing more than get people excited and produce nothing beyond a report saying the drill was successful. But how can you honestly evaluate the capabilities of a rescue community unless its services are really put to the test?

     Say your community is holding its annual mass-casualty drill next week and notifies all participating emergency services of the exact time and date. The drill depicts 20 high school students in a simulated bus accident. The students are strewn around and in a bus that has rolled over and crashed into a tree.

     The call goes out, and the first unit to arrive is Medic 1, with an EMT and paramedic on board. The paramedic does a quick sizeup and calls for more help. You know you're going to need 20 c-collars, 20 backboards and numerous straps to package these patients for transport. Did you actually have the c-collars, backboards and straps on the scene, or were they simply simulated? What about bandages, splints and IV supplies? Granted, you may not have used this equipment during the drill, but was it readily available and transported? How will you transport all these patients? Are you planning on using air assets? What if the weather is stormy and helicopters aren't flying?

     Chief Russell Lanson of the DeKalb (IL) Fire Department believes in what he calls the PPP (practice, preparation and partnership) principle. When his department responded to Northern Illinois University last Feb. 14 in response to a shooting that killed five and injured at least 15, his principle was severely tested. But having been practiced--most recently during a mass-casualty drill three weeks earlier--it fared beautifully. "I wouldn't change a thing" about the NIU response, Lanson says.

     How you practice is going to define how you handle the real thing.

INITIAL RESPONSE
     Perhaps unaware a mass shooting has taken place, a first-on-scene crew may be overwhelmed by the chaos, confusion and sheer number of victims. Their initial actions will directly affect the outcome of the operation. Although the first desire is always to provide treatment, command must be assumed first, before trying to make order from the mayhem.

     Early on the morning of April 16, 2007, the Virginia Tech Rescue Squad's VTRS3 was dispatched to West Ambler Johnston Hall on the Virginia Tech campus in Blacksburg for a report of a person falling out of a loft. Upon arrival crew members discovered two persons had been shot. Per SOP, they called for a second unit and requested an "all call" be broadcast for all off-duty personnel and to place all county EMS units on standby.

     Once this call was complete, as VTRS3 and the responding second unit, VTRS2, were getting back in service, police radio reported a mass shooting at Norris Hall. Having all personnel already at VTRS base saved time and increased the number of units available for a fast response.

     The incident command system (ICS) provides structure and works well for organizing a frenzied scene. In 2004 the ICS was integrated into the National Incident Management System (NIMS). It is required by federal law to be used at all incidents regardless of type or size. ICS can be utilized by that first-on-scene crew to get the ball rolling, as long as they don't allow themselves to become rattled. Read, learn and practice your organization's protocols until they are firmly fixed in your mind.