I discussed in the Dec. 3 Security Weekly how law enforcement agencies are changing their tactics to deal with armed assaults and how citizens can take steps to protect themselves in the event they encounter such a situation. But another critical component of the response to armed assaults lies in how to mitigate such attacks, an area to which the medical response is key. This includes the training given to law enforcement personnel, changes in the deployment of emergency medical service professionals and emergency room procedures. An additional lifesaving component comes in the form of new medical technologies made available to first responders and trauma centers.
Law Enforcement
Battlefield medicine has advanced a great deal over the past several decades, advances well illustrated during the U.S. invasions of Afghanistan and Iraq. Battlefield medical kits carried by combat medics and other soldiers have changed dramatically since 9/11. For example, when I was a young soldier attending U.S. Army basic training at Ft. Leonard Wood, Missouri, in 1983, the only first-aid kit issued to individual troops was a pressure dressing (though we were also taught some battlefield expedient procedures, such as using the cellophane wrapper from a cigarette pack with the pressure dressing to help seal a sucking chest wound).
By contrast, today's soldiers carry an Improved Field Aid Kit (airmen and Marines carry something similar) that contains elastic emergency trauma bandages (a replacement for the old-fashioned pressure bandages), tourniquets, hemostatic combat gauze (gauze treated with a clotting agent such as QuickClot to stop bleeding) and an airway tube. These kits permit soldiers to administer first aid to themselves and others.
The same tools that have saved countless lives in combat in Iraq and Afghanistan are also now being issued to police officers inside the United States. Many officers carry these trauma medical kits in their squad cars along with smaller medical kits attached to their heavy raid vests. Police officers are taught how to use these tools to perform first aid on themselves and to administer aid to fellow officers and civilian victims. However, it is important to remember that in an active shooter situation, the primary focus of law enforcement efforts is to immediately engage the shooter to neutralize the threat and prevent further harm to victims. For police officers, first aid is only a secondary concern until the shooter is neutralized. Even so, the presence of first-aid kits with tourniquets and clotting agents at the scene of a shooting can mean the difference between life and death for a shooting victim who is bleeding out.
Emergency Medical Service
Not only have Emergency Medical Service personnel incorporated newer first-aid equipment developed for the battlefield, they have also changed their deployment tactics in active shooter situations. The April 1999 shooting at Columbine High School was a watershed event that changed the way police departments responded to active shooter situations. For EMS departments, the November 2013 domestic terrorism incident at Los Angeles International Airport, when an anti-government gunman shot and killed Transportation Safety Administration officer Gerardo Hernandez, was another watershed event.
In the Los Angeles airport shooting, first responders from the Los Angeles Fire Department were kept at a safe distance where they waited for the incident to be resolved before entering the shooting scene to render aid to Hernandez and the other victims. In fact, the police reportedly had to transport the wounded Hernandez to medical first responders in a wheelchair. The first responders rendered aid, but they were unable to save Hernandez, who had bled to death.
In response to this attack, the Los Angeles Fire Department has worked with the Los Angeles Police Department to change the way they respond to active shooters. Instead of setting up in a safe area and waiting for the incident to be resolved, they now coordinate with police officers to form rescue task forces designed to move medics to the scene in much the same way that combat medics work in a war zone.
As noted above, under active shooter protocols, the first police officers to arrive at the scene will rapidly form a team to engage the shooter. Officers who subsequently arrive will be deployed to form a perimeter around the scene and then render whatever other support is required. Now, one of these additional support functions is to join rescue task forces to escort medical first responders into the scene and protect them while they begin to administer first aid and evacuate victims.
Firefighters and paramedics will be kept away from the "hot zone," where the assailant is actually being engaged by law enforcement officers and where they could be shot. But efforts will be made to get them into "warm zones," or parts of the scene out of the gunman's line of sight and fire where there are victims requiring aid and evacuation. Rescue task force medics normally perform rapid triage in the warm zone and then attempt to stabilize and evacuate the most gravely wounded. Treatment of lightly wounded people can wait until the incident is resolved or until they can be transported to the cold zone.
Some medical personnel are sent to attend special tactical medic training that will teach them how to operate safely during dangerous events. This not only improves their response to active shooter events, it also enables them to support many SWAT deployments. These medics also participate in active shooter training with their police counterparts to practice forming ad hoc teams and deploying into warm zones. In many places, these tactical medics are provided with body armor and helmets for protection. In reality, however, it may take time to get specially trained tactical medics to a scene, just as it often takes time for SWAT teams to be deployed. Because of this, many fire departments and rescue squads are providing active shooter training to all of their firefighters and medics in the same way that most police departments provide active shooter training to all of their officers. This way, the first fire and rescue units to respond can quickly work as part of rescue task forces.
Hospital Trauma Units
Like police, firefighters and paramedics, the ultimate objective of first responders is to stabilize patients so they can be transported to hospital trauma units, where they can receive more intensive medical care. U.S. hospitals have had ample practice in treating gunshot wound victims, and they have also made considerable efforts since 9/11 to prepare for mass casualty events by implementing mass casualty incident policies and conducting training exercises. In response, most hospitals today are well positioned to respond to a mass casualty incident. This has been reflected by the outstanding performance of hospitals in recent years during events such as the Boston Marathon bombing and a long string of mass shootings.
Today's hospitals are much better prepared to rapidly triage and treat the surge of victims that occurs after a mass casualty event, whether it be a terrorist attack, industrial accident or natural disaster. There is also a great deal of planning and coordination between hospitals and EMS personnel regarding how many victims to take to which hospital and which hospitals should receive which types of victims.
Obviously, the entire emergency medical system is not foolproof, and there are lessons to be learned from every mass casualty event that can help instruct medical personnel elsewhere. But even so, advances in medical equipment and procedures will continue to save many lives.
