The Evolving Role of EMS in Active Shooter Hostile Events
by Wren Nealy
Cypress Creek EMS
IPMBA President
It is 2019, and America continues to experience Active Shooter Hostile Events (ASHE). Several of these incidents have occurred at special event venues. On October 1, 2017, the Las Vegas Route 91 Harvest Music Festival took place at the Las Vegas Village, located diagonally across from the Mandalay Bay Casino and Resort. A shooter used the high vantage point of his hotel suite at the Mandalay Bay to fire remotely on a group of 22,000 festival attendees, making it the first ASHE of its kind. In all, 59 were killed, and 851 were wounded (422 by gunfire) during the attack before the shooter killed himself. On July 28, 2019, in Gilroy, CA, a shooter turned his gun on people attending the Gilroy Garlic Festival, at Christmas Hill Park, a 51-acre community park operated by the City of Gilroy, killing three and injuring thirteen others. It was a more typical ASHE, and law enforcement officers were able to quickly engage the shooter, striking him multiple times and nullifying the threat before the gunman turned his gun upon himself.
To stop the dying, emphasis must be placed on empowering those present at the crisis. Following the 2013 Sandy Hook School shooting, the American College of Surgeons convened the Joint Committee to Create a National Policy to Enhance Survivability from Intentional Mass Casualty and Active Shooter Events. The goal was to establish a protocol for national policy to enhance survivability from active shooter and intentional mass casualty events. The outcome was the Hartford Consensus.
The Hartford Consensus III: (1) states that uncontrolled bleeding is the most significant preventable cause of death in the pre-hospital environment; (2) directs all responders – civilian and professional – to have the education and necessary equipment for hemorrhage control; and (3) strongly endorses civilian bystanders to act as “immediate responders.”
Hartford III recommends public access to bleeding control bags that include pressure bandages, safe and effective hemostatic dressings, effective tourniquets, and personal protective gloves, and that that these resources be placed in locations that are widely accessible, readily visible, and available for use within three minutes of need. While efforts to isolate and stop the active shooter remain paramount, this early hemorrhage control is critical to improving survival.
The actions taken by immediate responders are the essential first steps towards the goal: Stop the Dying.
In both the incidents mentioned above, the events had on-site medical support provided by local EMS. These trained and equipped First Responders were force multipliers for the “immediate responders” present at the crises when they occurred. Given the more confined space of the Las Vegas incident, medical teams worked on foot, in golf carts and on UTVs. The perimeter of the venue was fenced, with limited controlled access and egress routes. The Gilroy layout was larger and more open, including the town streets, and local EMS had deployed their Bike Medics to support the event, which placed them in the role of “immediate responders”.
The cover story, reprinted from FireEngineering magazine, explains how demands on EMS are changing. Regarding ASHE incidents, it explores the integration of EMS with law enforcement using the Rapid Treatment Model (RTM) and/or Rescue Task Force (RTF) model; the need for medical personnel to add ballistic protective equipment to their Personal Protective Equipment (PPE) standards; and a culture change with respect to assessment and intervention strategies.
As you read the article, think about how these demands will affect the role of Bike Medics assigned to provide special event medical support at mass gatherings. It is your responsibility to yourself, your agency, and your community to prepare yourself for the day you have to respond to this type of incident. Unfortunately, it is not a matter of “if”, but “when”.
We hope to explore this topic in a future issue of IPMBA News and welcome input from IPMBA Bike Medics and Officers who have been on the scene of ASHE incidents. Please email info@ipmba.org if you would like to contribute to this body of knowledge.
(c) 2019 IPMBA. This column appeared in the 2019 Conference Highlights issue of IPMBA News.