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Operations

Among the Targets

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“A large number of law enforcement officers started walking toward the triage area, and they said we had to move because they’d found an explosive device. They also said they didn’t know where the shooter was at that point. So I went from functioning in an oversight capacity and monitoring operations to worrying about the personnel who were on scene. We didn’t know where the shooter was, and the officer said there was an explosive, and we didn’t know what that meant—how many or how big. All he said was we had to move.” —Dave Molloy

In last December’s terrorist attack at San Bernardino’s Inland Regional Center, shooters Syed Rizwan Farook and Tashfeen Malik killed 14 and wounded more than 20 at a workplace training event-slash-holiday gathering.

Answering such a call, with shooters still on the loose, is unnerving enough for responders. In this case their anxiety was magnified by an explosive device found inside afterward and threats sent to emergency personnel.

Radicalized Muslims without known connections to terror groups, Farook and Malik were quickly killed in a shootout with police. Farook, a county health inspector, had initially attended the event at the IRC, then left following an argument before the pair returned in ski masks and tactical gear and opened fire. Their attack took less than four minutes.

Left behind was a bag containing three crude linked explosive devices rigged for remote detonation. This could have been meant to be exploded first and create easy targets as people ran from the building, a la Columbine—or could have been meant for responders. As they fled after the shooting, Farook and Malik drove back near the IRC and may have tried to detonate the bomb. An earlier unrealized plot, according to a criminal complaint against their associate Enrique Marquez, also would have targeted emergency personnel.1

The IRC IED didn’t work and was neutralized by police. But whether emergency personnel were targets of preference or just convenience, this was a case where many could have died.

“That was one of the things that plagued me in the weeks after and I had to work through,” says Carly Crews, RN, BSN, MICN, EMS coordinator for the San Bernardino City Fire Department. “I had employees in that building and many other people I cared about around there. It was terrifying. It was hard to face that we could have lost them. I’m grateful we didn’t.”

“It’s disheartening to think,” says Dave Molloy, local operations manager for AMR, who responded that day and described the abrupt forced relocation in the opening, “that there are people out there who would try to hurt us while we’re trying to help others. It’s very frustrating.”

Finding the IED wasn’t the only challenging aspect to the San Bernardino incident. But a smooth and well-crafted response by the San Bernardino City Fire Department, AMR, law enforcement and other partners helped minimize casualties, aid the wounded quickly and distill some valuable lessons for when the next mass shooting occurs.

Controlled Chaos

The first report of shots fired that day came at 10:58 a.m. A paramedic engine from nearby fire station #231 was on scene and staged within nine minutes of initial reports and four of dispatch. Another 11 units rapidly joined it.

Crews arrived in that wave, having learned en route that the incident was an in-progress shooting with at least 20 patients. The FD’s on-scene incident commander, a battalion chief, began assigning ICS roles over the radio then.

“Having those predetermined assignments was really a key” to the response going well, says Crews. “Knowing what we were going into while we sat there staging or were en route didn’t allow chaos to form. We were very controlled on scene because we knew exactly what our objectives were and what needed to happen. I credit our battalion chief for thinking ahead and determining those assignments ahead of time.”

It’s never a good day for a terror attack, but on this day department personnel were already stretched. Two stations had recently closed, and several leaders were busy elsewhere: The fire chief was in a meeting at city hall, and a deputy chief and two battalion chiefs were away in Rialto (ironically attending an educational event on terrorism). Some equipment had been set aside for a forthcoming drill. Available were Crews, the EMS coordinator, and an engineer on light duty. More battalion chiefs came in to assist, and a SWAT medic who was training with police near the incident scene also got there quickly. A fortunate break was that the local EMS agencies, dispatch and hospitals all had meetings or training events going on that day, making extra personnel available.

With an MCI declared, triage, treatment and transport areas were quickly established outside the shooting site. The SWAT medic had begun initial triage, with officers dragging victims out and to care. More resources arrived with assignments in hand, averting duplication and delay. The IC assigned another battalion chief to unified command and oversaw operations himself.

At AMR Molloy had been on a conference call when his supervisor rang in with the news and a request for more hands. They quickly mustered 15 units and three supervisors toward the IRC.

As they approached, news helicopters hovered overhead, and “Are you OK?” texts from worried loved ones were already arriving. The area was packed with cars, many unmarked law enforcement. Molloy looked up to see sheriff’s deputies with automatic weapons moving up the street, followed by a fire chief with lights and siren. They trailed them to the scene. By now covered bodies lay on the roadside there. From a golf course across the street, a helicopter lifted off.

“It was the most intense scene I’ve seen in the 21 years I’ve been here,” Molloy says. “What was interesting, though, was that although it was chaotic, I felt like everybody who was there—EMS, fire, PD—was in control.”

The patients were coming. In all 33 were struck by gunfire. Their care generally consisted of hemorrhage control, occlusive dressings for thoracic injuries and airway maintenance. The number of seriously wounded was popularly reported as 22, but that omitted one who turned up at a hospital by personal vehicle. A total of 20 were transported (including an officer injured in the shootout), and three others took themselves. Two of those had orthopedic injuries; the third presented some 30 hours later with shrapnel and bullet fragments in the chest.

Real-time hospital information communicated through the regional ReddiNet system helped guide destination decisions. Facilities relayed bed availability information to the comm center, and FD and AMR leaders collaborated on where to send whom.

Triage, treatment and transport moved rapidly. Police and air resources joined AMR in getting patients to initial care and on to hospitals. Thirteen fire agencies were ultimately represented, as well as multiple ambulance companies and law enforcement jurisdictions (to the tune of around 300 officers in 17 minutes). The feds showed up too; FBI personnel in flight from Los Angeles to Pomona for training were diverted and on scene within 26 minutes.

The last critical patient was taken from the scene at 11:47 a.m.—less than 50 minutes after the first report of shots fired.

Then the IED was found.

‘Something’s Going On’

The ordered retreat to a safer distance (down Waterman Ave. and around a corner to fire station #231) was orderly. “The only way to describe it,” says Molloy, “is like having a bath or sink full of water, and you pull the plug and the water drains out. It’s like we drained down the street all in one motion. That’s something very specific I remember. I’d never seen anything like that in all the MCIs I’ve been on.”

By that point, however, the seriously hurt had been helped, and only a few minor patients showed up at the new site. But a large contingent of LEOs arrived for protection, and rooftop snipers underscored that things remained dangerous and dynamic.

The shooters were still on the loose. And someone was making threats.

“We’d started receiving these tweets on our fire department Twitter account,” says Crews. “It looked like Arabic writing, and then there were pictures of carnage and messages like ‘Ha ha ha, we got you, San Bernardino City Fire Deparment!’ and things along those lines. We immediately went to homeland security and said, ‘Something’s going on.’ That’s when I realized this was a terrorist attack. Before that we didn’t know what it was, if it was workplace violence or something else.”

Authorities responded by sending extra security to all fire stations. The culprit(s) behind the tweets has not been identified, though they came before Farook and Malik were killed.

That’s the kind of thing that makes you really appreciate some extra protection, and force protection and perimeter control were among the lessons culled from the IRC event.

“It could have been very easy,” notes Crews, “for the shooters to have obtained an unmarked car and come right back into the scene. CHP was watching the perimeter, but there were so many people coming in and out, and we weren’t sure who they were or what their role was. That was one of our biggest concerns.”

On the whole, though, things went smoothly, due in no small part to the training conducted and relationships developed among fire, EMS, law enforcement and other local players. In 2013, in fact, they’d all conducted an active-shooter drill over three days at a local high school. This prolonged exercise let them try different approaches and tweak details to make their MCI operations more efficient.

One of the things they tested during that time was having a tactical medic enter the hot zone and start getting patients to a casualty collection point. Another was moving the triage and treatment area as close to the action as possible (its distance from the wounded created challenges at incidents like Columbine, Aurora and LAX). Both of those strategies were employed at the IRC. The triage/treatment area was placed by the law enforcement IC at the edge of the hot zone due to its easy access and visibility to the unified command location and casualty collection point.

“Training and trying different things is the key,” says Crews. “It will make a difference what type of building you’re in, what type of city you’re in, how many patients there are. So it’s important not to just rely on one thing in the toolbox, but to utilize many things.”

It remains true, if not new, that relationships matter. You don’t want to meet your FD/EMS/law enforcement peers for the first time at an evolving mass-casualty scene.

“Relationships played a huge role that day,” says Molloy. “We trust each other; there was no question about what needed to be done. We pulled up on scene, and my folks fully engaged by simply asking, ‘What do you need?’ There were so many opportunities for things that could have gone wrong but didn’t, and I think it was because we worked so well together and functioned in that capacity that it went as smoothly as it did.”

Takeaway Points

Still, there are always lessons to learn. To the end of force protection, one was potentially using vehicles to shield personnel at the scene.

“We’re so organized to line up our vehicles,” says Crews. “The police just show up on scene and park where they park, which we criticize at times. But what EMS does is pull into that scene and line up in these perfect little clean walls you see in all the pictures. And it looks beautiful, but it doesn’t really protect us. So we’ve talked about using those apparatus as a safety barrier around that treatment area and blocking ourselves a little bit more from the building.”

There were, as there often still seem to be at complex incidents like this, interoperability issues as well. San Bernardino has its own frequency for police, which isn’t interoperable with the CONFIRE (Consolidated Fire Agencies of San Bernardino County) system used by everyone else.

AMR plans to enhance its internal communications at future incidents with a dedicated dispatcher pulled from other daily calls, and it may start tapping surrounding AMR operations for managers, administrators and other personnel to backfill positions when its leaders are occupied at a big event.

A final point, Molloy notes, is to not let personnel get distracted by what they perceive an MCI should look like.

“People need to have an open mind and be adaptable to the situation,” he says. “We had a lot of law enforcement presence, and it was a difficult thing for some of our folks because they were coming in unmarked vehicles, and we didn’t know who was who. It wasn’t until later that we figured out these were the good guys. But help can come in any shape and form during an incident.”

A lesson not unique to San Bernardino but that bears repeating is not to neglect the emotional and psychological well-being of those who respond to disasters. Responders to the IRC got mandatory group crisis team intervention starting the night of the incident and continuing into the next week. They were also offered and encouraged to accept individual sessions.

Even besides the IED and Twitter threats, there were aspects of the response that lingered for Crews.

“One of them was hearing ‘San Bernardino, California’ all over the news and coming out of the president’s mouth,” she says. “It was so real, I couldn’t handle it. I got mad at that, at hearing it over and over. I didn’t like watching the news; I didn’t want to connect the victims to those faces I saw at the scene. That was very hard.”

It was hard too for Molloy, whose family friend Robert Adams was among those killed.

“You’re frustrated and you’re mad, and what do you do with that?” he asks. “The shooters were dead, so I can’t even say justice was served. But in the days following, you almost have to be like a cheerleader for the troops. You have folks out there who are nervous. I had people come to me and ask, ‘What do we do if we go out on these calls?’ And while I’m thinking I hope this doesn’t happen, you have to rely on your training and say, ‘We’re gonna suit up and go out and take care of our citizens.’ But you’re definitely worrying about scene safety and the area around you.

“You can’t take the attitude that it’s never going to happen to you,” he adds. “Terrorism and IEDs and active shooters are a reality today, and people need to prepare for it. If you train for it and it never happens, then amen to that. But you have to be ready.”

Reference

1. www.washingtonpost.com/apps/g/page/world/read-the-criminal-complaint-against-enrique-marquez-friend-of-san-bernardino-shooter-who-provided-rifles/1917/?refresh&tid=a_inl.

 

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