Tactical Training For Medical Responders

The Department of Health and Human Services (DHHS) recognizes active shooters as a threat to healthcare facilities and encourages them to incorporate planning and preparedness into their emergency operation plans. A guide was developed, and backed by the DHS, FBI, US Department of Justice, and Federal Emergency Management Agency, focused on prevention, protection, mitigation, response, and recovery, as well as stressing the importance of plans

Policies have changed since the shooting happened in Littleton, Colorado. Before Columbine the primary goal of law enforcement officers before and during a shooting was to set up a perimeter and await arrival of SWAT members (Erickson, 2001). This policy has changed in many states including Pennsylvania where police had been preparing for active shooters with local schools. Police are not able to wait the twenty minutes to an hour for SWAT to arrive at a scene which is why the state mandated that local police receive active shooting training (Coughlin, 2012). This response and a brochure that the Department of Homeland Security came out with are allowing schools a better chance of eliminating a shooter with less causalities and injuries. This brochure goes into to profile of an active shooter, how to respond to an active shooter, how to respond when law enforcement arrives, training staff for an active shooter, preparing for and managing an active shooter situation, recognizing workplace violence, managing the consequences of an active shooter, and lessons learned (DHS, 2008).

The terrorist attacks on September 11 changed America forever. The attacks led to President Bush creating the Department of Homeland Security which tried to centralize the federal response to all terrorist threats. However, local police, firefighters, and emergency medical technicians will still be the first to arrive at the scene of an attack. These first responders face a unique and increasingly dangerous task when reacting to a terrorist attack on US soil.

The active shooter incidents that the FBI used for this study occurred between 2000 and 2013. Although most of the 160 shooting would be considered to have happened in gun-free zones, the focus here will be on the 24.4% (39 shooting) that occurred on educational grounds. The study indicates that even though there were only 39 shooting at educational facilities these 39 shooting had some of the higher casualty counts at 117 deaths and 120

Many Law Enforcement Professionals point to the Columbine High School shooting in Columbine, Colorado as the defining incident with regards to active shooters. Montgomery County, MD Police Chief Thomas Manger stated clearly and simply that “Columbine was a wake-up call” (Police Executive Research Forum, [PERF], 2014). Baltimore County Police Chief James Johnson went on to explain that “In the past, the strategy was to respond - initial patrol units respond, and secure both inner and outer perimeters; and wait - sometimes a lengthy wait; for more equipped, response-type units from tactical, for example” ("How Columbine Shaped Police Response to Shootings",

·       Adjunct instructor for the Louisiana State Police Training Academy; training staff and personnel in basic life support such as cardiopulmonary resuscitation (CPR), tourniquet administration, basic first aid, and the medical component of surviving an assault. Daily and weekly activity reports were submitted to management.

According to the Texas Health Presbyterian Denton Emergency Operations plan their objective “is to maintain the continuity of patient care operations and meet the medical needs of our members and the community.” In order to accomplish this goal they assert that maintaining the safety and security of the organizations staff and volunteers is the top priority, as the safety of their staff ensures they will be able to accomplish their mission of providing care for patients, visitors, and the larger community. In addition to their primary goal, they have also identified a secondary objective of providing supplies and assistance to other Texas Health facilities.

Law Enforcement Officers, Firefighters, EMS personnel and other first responders serving in the United States of America face many daily challenges and concerns regarding their safety and well-being while performing their assigned duties. In the past two decades first responders in the U.S. have increasingly been subjected to threats and incidents of terrorism. Both domestic terrorism and international terrorism incidents have occurred with increased frequency in the United States. Domestic terrorism events have occurred more often than international terrorism, and therefore are more of a significant daily threat for first responders

The assailant’s intention is to assault as many individuals as possible with no hope of surviving. According to the New York City Police Department report on active shooters, 46% of active shooters are stopped by law enforcement officials, or other bystanders, and 40% of the active shooters either commit suicide or attempt suicide. (NYPD, 2011) Police departments nationwide are training their officers to confront the active shooters quickly and as aggressively as possible. (Cain, 2010) Police departments have begun introducing various tactics in concealment, entering doorways, and working in small groups to have a tactical advantage in eliminating the assailant. Police agencies have been working closely with their local schools to avoid future massacres. Many police agencies have implemented various approaches to ensure their response times are sharp. Daviess County, Kentucky Sherriff’s office began offering a 2-day training program that demonstrates various entry and movement techniques when confronting an active shooter (Cain, 2010) Many other agencies have introduced live-fire scenarios using artificial projectiles, and the use of ballistic shields. (Law Staff, 2008) As school shootings can never be predicted it is imperative that the education institutions and law enforcement agencies are ready and vigilant at all times to avoid other nationwide massacres.

Past strategies of officer or rescue arrival, establishment of incident command(s), operational planning, and specialty unit deployment (such as SWAT or SRT) simply do not work for the active school shooter critical incident. Time is of the essence, and first responders have to act nearly instantaneously. Progressive agencies have noted the importance of creating policies and procedures that specify the action that first responders will take in the event of an active threat, and for the most part, they are training accordingly on methods which use small teams, or even pairs. In the instance of an active shooter, the school will be locked down upon public safety personnel’s arrival. For the first arriving units, police and rescue personnel have to mesh together and address the threat while keeping open communication with additional responding units. When possible, a fire-rescue medic may be placed with two or more law enforcement officers to assist in rescue and treatment efforts, in addition to serving as an additional observer (Morris, 2014). Rapid entry and quick advancement toward the active threat is absolutely paramount for victims’ survival, and in most circumstances, this will be the responsibility of the first few arriving personnel. These

It is with great pride and without reservation that I write this letter recommending HM2 Malcom for acceptance to Field Medical Training Battalion (FMTB).

You inform the dispatcher that you’re en-route to the location responding in code three which is lights and sirens. When you arrive on the scene, you can see two seriously damaged vehicles and all you see is chaos. The two vehicles appear to be stuck together because they hit each other so hard. The coolant and oil is splattered all over the road and burning and boiling off of the still hot engines. You’re trained to give first aid and basic life support, you are silently thankful that an ambulance is already on the scene. You see a paramedic talking with a driver who is pinned inside the vehicle trying to keep them awake. You notice that the driver is covered in blood and has severe cuts all over his or her body. Firefighters arrive on the scene to use Jaws of Life to cut out the pinned in driver. The other driver in the other vehicle appears to be unresponsive and you see paramedics pulling the driver out of the vehicle to conduct CPR on the driver. The paramedics dispatch that they need flight care to pick up one of the seriously injured drivers. The ambulance takes the other driver to the hospital after being cut out of the vehicle. Flight care arrives on scene to pick up the severely injured driver. One of your main duties is to guard flight care from people and vehicles. Flight care

Thus, emergency physicians cannot rely on earned trust or on prior knowledge of the patient's condition, values, or wishes regarding medical treatment. The patient's willingness to seek emergency care and to trust the physician is based on institutional and professional assurances rather than on an established personal relationship. Fourth, emergency physicians practice in an institutional setting, the hospital emergency department, and in close working relationships with other physicians, nurses, emergency medical technicians, and other health care professionals. Thus, emergency physicians must understand and respect institutional regulations and inter-professional norms of conduct. Fifth, in the United States, emergency physicians have been given a unique social role and responsibility to act as health care providers of last resort for many patients who have no other feasible access to care. Sixth, emergency physicians have a societal duty to render emergency aid outside their normal health care setting when such intervention may save life or limb. Finally, by virtue of their broad expertise and training, emergency physicians are expected to be a resource for the community in pre-hospital care, disaster management, toxicology, cardiopulmonary resuscitation, public health, injury control, and related areas. All of these special circumstances shape the

In essence, outlying COPS are at more risks of getting injured and end up needing medical attention more than most areas and branches in the army. Therefore, the Brigade Support Medical Company can apply some of their operational areas in offering the most needed medical services and health care that the COPs may need. In fact, the BSMC needs to be proactive in the manner in which they provide assistance and help to the COPs (Wunderle, 83). The commanders can provide tactical planning in a proactive rather than a reactive manner since health protection needs to be thoroughly integrated with tactical orders and plans for it to be effective in health and medical care provision. The dynamism in services for the COPs is something the commanders at BSMC need to consider to be able to provide timely services by adapting to the flow of COPs’ operations.

The greatest threat facing the Modern Fire Service is the rate at which firefighters are dying in the line of duty. Excluding the terrible event of 9/11 that occurred in 2001 that forever changed the dynamics of the emergency response services1, firefighter deaths have averaged around 100 fatalities each year for the since 1990. This unacceptable rate of firefighter deaths has found its way to be a benchmark in the industry. The problem is that the benchmark should be zero firefighter deaths while on duty and every year that there is a fatality is a year that the fire service has failed its members. The number one cause of firefighter related deaths yearly is proven to be medical, stress, or overexertion related fatalities2. All of these causes of firefighter deaths can be avoided with implementation of training and awareness.