Redefining Active Shooter Response

Agencies across the U.S. are developing unique teams to support the increasing need for rapid response during active shooter events. From Wake County EMS in Raleigh, NC, to the Arlington County (VA) Fire Department to a joint fire-law enforcement program in Oregon based on military techniques, agencies are finding ways to safely insert EMS personnel alongside—and even before—SWAT teams, so they can treat victims faster.

These agencies represent just a snapshot of the types of programs growing across the U.S., but they each provide a blueprint for a different way agencies can respond to active shooter incidents in their service areas.

Arlington County Fire Dept. Rescue Task Force

According to Jim Schwartz, chief of the Arlington County (VA) Fire Department (ACFD), the decision to form their rescue task force (RTF) required a complete paradigm shift in how EMS traditionally performed its function during an active shooter situation.

Unlike conventional TEMS teams, which join SWAT teams as secondary responders, RTFs consist of first-arriving crews who venture beyond the cold zone to assist law enforcement in getting help to casualties fast.

Arlington County is unique, in part, because of its proximity to Washington, D.C., and the heightened potential for threats that poses.

A highly urbanized community of 26 square miles, Arlington County has a population of 212,900, served by the 320 uniformed personnel of the ACFD. Operating out of 10 stations across the county, ACFD personnel are all cross-trained in fire and EMS, and the agency boasts hazmat, tech rescue and bomb teams.

Schwartz notes the paradigm shift for EMS really began with the 1999 Columbine High School shooting in Colorado. In that event, there was no significant law enforcement entry until one hour after the start of the incident, whereas both shooters, Eric Harris and Dylan Klebold, suffered self-inflicted fatal wounds within 45 minutes of the start of the event.

The delayed response continued with EMS, as no medical operations took place inside the school until four hours after the incident began. During the shooting 12 students and one teacher were killed, while 24 others were wounded. That teacher, Dave Sanders, bled out for more than two hours before he died. Earlier medical intervention could have saved his life.

Since 2013, the new paradigm at ACFD is for initial EMS/fire medical responders to work with law enforcement assets to rapidly deploy into areas that have been cleared but not secured, to initiate treatment and effect rescue of injured victims, Schwartz says.

Schwartz says the RTF concept is for first-arriving EMS personnel—NOT tactical medics—to team up with two patrol officers—NOT SWAT—and move quickly into the “warm” zone along cleared areas to initiate treatment and evacuation of victims. These teams consist of:

• 2 police officers—1 front security and 1 rear security;
• They DO NOT assist medics with care.
• Responsible for security and movement ONLY.
• Two fire department personnel;
• Outfitted with ballistic gear.
• Carry only medical supplies for tactical emergency casualty care (TECC).
• Tasked with point-of-wound stabilization and/or victim extrication.

Schwartz notes the ACFD has experienced a number of benefits from the creation of the RTF. It strengthens the relationship between police and fire/EMS personnel; improves day-to-day operations, allows for faster victim triage, treatment and evacuation; and familiarizes fire/EMS personnel with police operations.

Hillsboro (OR) Rapid Response & Treatment Model (R2TM)

Sgt. Craig Allen of the Hillsboro (OR) Police Department and Engineer Jeff Gurske of the Hillsboro Fire Department developed the Rapid Response & Treatment Model (R2TM).

They understood that the shooter(s) are typically dead in an active shooter incident by the time law enforcement actually arrives on scene. That means locating and neutralizing the shooter isn’t always the most appropriate first priority for responding officers. If the shooter is already dead or not shooting, that priority needs to shift to caring for victims.

With EMS often unable to enter a hot zone by protocol, Allen and Gurske hit on an old military concept—a secured casualty collection point (CCP) within the hot zone. This “embedded” warm zone features armed law enforcement personnel standing watch while EMS crews triage, treat and transport victims.

In 2006, the Hillsboro police and fire departments performed their first full-scale, joint active shooter training based on a standard rescue team concept of four police officers escorting two firefighters to victims through areas already cleared of threats. The training proved police and fire/EMS were being asked to operate outside their skill sets in these incidents.

In 2010, Hillsboro PD and FD began active shooter response training based around the CCP concept, and perfected the technique over the next two years. The result was both police and fire/EMS were able to perform their familiar job functions via the connection of the CCP, without personnel being asked to step out of their comfort zones in an already-tense situation.

“Our jurisdiction has not experienced a quintessential criminal mass casualty event,” Gurske says. “We have experienced one active shooter, and certainly elements in other calls rely on the above capabilities. Our active shooter protocol is the same response as our integration to an assault call—or any other stage for law enforcement. We operate under the same radio procedures, security, etc. Aside from an active shooter, the response model also has benefited by adapting our agencies to any large-scale call type.

“We do not diminish the importance of TEMS (tactical EMS) and TCCC (Tactical Combat Casualty Care) programs,” notes Gurske. “TEMS works great in the application of SWAT. TCCC is great for self- and buddy-care. TECC has done a great job of translating military practices to civilian practices. Agencies may find another response model works well for them. Our model uses aspects of these programs. However, we focus on maintaining the individual strengths of each discipline to stay within our ‘swim lanes’ to decrease the fog of war.”

Gurske adds Hillsboro’s response plan is simple, by capitalizing on the inherent strengths of police, fire and EMS, and minimizing the need for complicated cross-training. In short, he says, “Let paramedics be great paramedics, and let cops be great cops.”

Wake County Tactical EMS

The Wake County (NC) Tactical EMS (TEMS) Team was formed in 2004 to provide medical support to the Wake County Sheriff’s Office and Raleigh Police Department special enforcement teams.

Wake County’s tactical medicine focuses on two parts. First is the rapid, on-site medical care to injured team members, bystanders and suspects, treating them until they can be transported to definitive medical care or until the operation is complete. Second is the general medical support for the team. This involves treating minor illness or injury, and advice on food and nutrition, hydration, as well as environmental issues.

While the TEMS team has a limited membership, other Wake personnel at all levels are trained to function alongside law enforcement as part of rescue task forces before SWAT and TEMS arrive.

In order to qualify for the TEMS team, paramedics are selected through an application process. Team members must be off probation and proficient in their EMS skills before they can apply. Once selected, the candidate must complete a rigorous physical agility test and medical screening.

Team members are sent to specialized training, Counter Narcotics Tactical Operation Medical Support (CONTOMS) or equivalent, which includes entry/movement, K-9 emergency care, weapons familiarization, wounds and ballistics, and explosive entry. After completing TEMS training, members refine their skills with monthly training with each special enforcement team. This creates a close working relationship between the officers and paramedics, which is essential to the success of the operation.

For Wake County, all that training has paid off. In 2007, the Wake County TEMS medics accompanied the Wake County’s Sheriff Office Special Response Team to the International SWAT Olympics, where the team placed seventh, and to the North Carolina SWAT Competition, where the team placed first in the state.

For more on tactical EMS response, read “Officer Down,” from the March issue of EMS World.