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Battlefield Medicine: The Active-Shooter Response

As mass shootings keep coming, the wise EMS provider does all he or she can to prepare for a smooth, safe response that minimizes death and suffering. Ensuring that was the goal of Tuesday’s active-shooter workshop at EMS World Expo in New Orleans.

Led by President Michael Wright, NRP, CP, and his team from Southeast Tactical, the workshop included a briefing on the rescue task force concept and four models of responding to patients, each of which attendees got to practice. Top vendors provided equipment and supplies.

Wright, a captain with the Milwaukee Fire Department, conducted the first active-shooter workshop at EMS World Expo in 2016. The long and growing list of mass shootings since shows the need for such training has only increased. “I immerse myself in this silliness and misery” to help save lives, Wright noted. “It’s not for the money, I guarantee you that.”

He was joined in his opening presentation by colleague James MacGillis, a lieutenant with the Milwaukee Police Department, and the need for EMS and law enforcement to train together for these operations was a constant point of emphasis—never more so than with the rescue task force, which forms the core of the escorted entry model.

Here the RTF moves to the patient and makes initial contact in the warm zone. The plan it initiates is to treat, move, and treat some more—that is, provide immediate stabilization of life threats to those who are salvageable and permit their relocation from their point of wounding to a casualty collection point and ultimately definitive care. The benefit of this model is it provides time to muster resources, but it requires close collaboration when EMS/fire and law enforcement combine for the RTF.

MacGillis explained the formation of a typical rescue task force: a point man in front, right and left flankers, and then a rear guard, arranged in a diamond formation. Ideally these are all police and can protect an EMS care team in the middle, but circumstances may require fewer members and adaptable roles. Communications are vital to working in concert, including calling out movements in advance; the rear guard controls radio comms.

Members must stay as tightly grouped as possible. EMS providers should think of LEOs as their bus, MacGillis said, getting them safely from Point A to Point B. Movement can be difficult and must be carefully choreographed but with practice can become quick and easy. RTFs generally don’t move patients but render scenes safe for evacuation teams that follow. Law enforcement’s only mission here is to protect the team—it doesn’t pursue suspects.

Two other models are simpler: police may simply remove casualties from the hot zone (not preferable, as it taxes resources and prevents triage) or create a protected island for casualty care, such as at a casualty collection point. The fourth method is to create a protected warm zone/corridor area where EMS can work in relative safety.

Triage is critical in mass shootings (Wright expressed a preference for SALT over START, as it’s simpler). Without it, you may waste time and energy moving the dead/dying or be drawn to the loudest or nearest victim, not the one who needs you most. “Manage this as a battlefield,” MacGillis said, “because it is.”

Vendors helping outfit the event included Combat Medical, Gaumard, Graham Medical, Moulage Concepts, Nasco, REX Rapid Extraction, and RCR Medical.

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