As someone who spent the last 15 years working as a paramedic in the U.S. and over 3 years in Iraq as an Army infantryman and as a medic for the State Department’s Diplomatic Security Service, I’ve seen the tides change on how we are told to respond to incidents and treat trauma patients.
A new study from FEMA, (PDF) endorsed by the Obama administration and the International Association of Firefighters (IAFF), is recommending that medical first responders should enter “warm zones” in mass shooting situations, instead of waiting until an area has been fully cleared by law enforcement, so that they can begin administering immediate treatment.
It’s a departure from what many people, including EMS personnel, are used to but based on my own experience it’s the right move.
For decades before this, the policy has been for EMS and other medical personnel to wait until law enforcement had cleared every inch of the scene in an active shooter scenario before moving in to treat any casualties. This frequently resulted in dying from treatable injuries like uncontrolled bleeding, collapsed lungs, and airway obstructions. Not coincidentally, these same injuries are also the three primary causes of death that can be prevented on the battlefield if victims are treated soon enough after sustaining their wounds.
The lesson in the FEMA report is one that the military learned at great costs early in our most recent wars: push medics forward into the fight so they can begin treatment as soon as possible and you’ll save lives.
The new approach mirrors what we call in the military TCCC or Tactical Combat Casualty Care. TCCC was born out of decades of evidence-based medicine by military doctors leading to the realization that service members were dying unnecessarily in combat. The result is a very basic but highly effective method that saves lives by emphasizing the fastest way to treat the most life threatening injuries, like bleeding, using tourniquets, gauze, and other simple procedures. It’s a technique so simple that even an infantryman like myself can do it, and since it’s implementation, has proven itself in Iraq and Afghanistan by dramatically lowering the mortality rate among injured service members.
TCCC’s civilianized brother, TECC or Tactical Emergency Casualty Care has emerged out of the need to create a similar program applicable for non-military use. There are already some promising signs about TECC. If FEMA, the IAFF, and the Obama administration can all agree on something this unanimously, you know it’s got to be simple and effective.
Developing a program like TCCC/TECC is a good first step, but without real training and coordination to make medics and law enforcement effective at working together in dangerous environments, it’s nothing but a great idea. The military does a great job of training service members at this critical task, but learning to perform your job while under fire is a full time job in the military and to expect a civilian paramedic to jump into that role will require a comprehensive effort.
When it comes to the civilian side of the house, we’ve got a long way to go to provide adequate preparation for EMS providers who aren’t used to operating in environments with an active threat.
The new approach isn’t about training more cops to be SWAT team members or teaching EMS to operate in the same way as “tactical medics” in the military, rather it’s about training these professionals to take immediate action when faced with an active shooter by adopting some of the simple tactics and procedures that have proved themselves to be effective in combat zones. In these situations the facts show that it’s prior training, deliberate action, and a joint response that saves lives. Keep it simple, stupid.
So how do we take these valuable lessons learned from 12 years of conflict and translate them into a language and format that can be useful to our civilian counterparts?
One example is a class that has been taught for the last 3 years by the National Center for Security and Preparedness and the New York Department of Homeland Security that integrates police officers and EMS personnel into a 36 hour multi-venue scenario with aggressive and non-aggressive role players, IED simulators, and guns that shoot paint bullets.
Originally we constructed this course to simulate a Mumbai-style attack on the US, but has since evolved to incorporate the principles of TECC and how a joint Police/EMS response can save lives, neutralize a threat, and do so quickly enough to treat critically wounded victims. By utilizing instructors with extensive combat experience as well as seasoned public safety professionals, the course is able to bridge the gap between the two worlds and apply valuable lessons learned from both environments.
Few people are better suited to explain what it’s like to operate in a high threat situation than military veterans that have spent years deployed overseas and have learned how to solve problems in dangerous and complex environments. Yet, combat experience alone isn’t enough to solve this problem, technical expertise and local experience are also needed—it’s the police and EMS professionals that bring the balance to the instructor cadre.
To take things a step further, some departments in the US like Arlington County, VA and Orange County, CA have developed and operationalized their “task force model” of response and are leading the way in this charge to save lives through swift action, joint response, and common sense tactics.
Sending civilian medics into fire during a Newtown or Sandy Hook scenario may seem like a dangerous idea, but with proper training it’s actually the best way to save lives. At the end of the day, it’s unfortunate that it takes the sacrifice of so many of our military men and women in combat as well as the deaths of innocent victims of senseless violence in the US to both learn these lessons and have solid evidence-based medicine to draw knowledge from. It’s up to us as public safety professionals, veterans, and policy makers to ensure their sacrifice is not wasted and forgotten.