1. Firefighters Support Foundation Active Shooter Response -------- The Rapid Treatment Model Introduction and Overview v1.0 1 The Rapid Treatment Model of Active Shooter Response

2. About FSF The Firefighters Support Foundation is a 501c3 non-profit organization whose primary mission is to develop, produce and distribute training programs to firefighters and first responders. All of our programs are distributed free of charge. 2 The Rapid Treatment Model of Active Shooter Response

3. Permission Permission is granted to reproduce or distribute this material so long as the Firefighters Support Foundation is credited as the source This PowerPoint presentation accompanies the video presentation of the same title. 3 The Rapid Treatment Model of Active Shooter Response

4. The need for this program Since Columbine active shooter response has focused on law enforcement neutralizing the shooter. This approach fails to get medical attention to victims soon enough The Rapid Treatment model of active shooter response allows for simultaneous shooter neutralization and victim treatment 4 The Rapid Treatment Model of Active Shooter Response

5. Presenters Jeff Gurske currently holds the rank of Engineer and Acting Lieutenant, and is also a Technical Rescue Team member for the Hillsboro, Oregon Fire Department. Craig Allen is serves as Training Sergeant with the Hillsboro, Oregon, Police Department. Craig holds numerous instructor certifications in firearms, defensive tactics, less lethal weapons and other tactical subjects. 5 The Rapid Treatment Model of Active Shooter Response

6. Our obligation The Rapid Treatment Model of Active Shooter Response 6

7. Criminal Mass Casualty Incidents (CMCI) 1949 - present Howard Unruh, Camden NJ first widely publicized active shooter CMCI *2012 record year with number of occurrences 98% male 98% carried out by a single attacker Average number of deaths 3.5 Average number of wounded 5.8 Predominately commit suicide on site 80% use rifle, shotgun 75% bring multiple weapons 98% occur during daytime Offenders are preoccupied with obtaining a high body count before police arrive They almost never take hostages and do not negotiate 85% incident over in under 6 minutes 2007 – 2012 majority of incidents occurred under 3 minutes 06/07/08/09/10/11/12 highest grouping The Rapid Treatment Model of Active Shooter Response 7

8. Schools – 24% Office Building – 11% Open Commercial – 24% Factory/Warehouse – 12% Other – 29% Location of CMCIs 8 The Rapid Treatment Model of Active Shooter Response

9. What’s the immediate need? The Rapid Treatment Model of Active Shooter Response 9 93% of incidents were over prior to the first responding asset, police or fire/EMS, arriving on scene. 31 incidents police actually arrived in time to interrupt the shooting. Hot Zone or Warm Zone?

10. Columbine - April 1999 13 killed 20 wounded 10 The Rapid Treatment Model of Active Shooter Response

11. WDMET study 90% of deaths occurred prior to definitive care – 42% immediately – 26% within 5 minutes – 16% within 5 and 30 minutes – 8‐10% within 30 minutes and 2 hours – Remainder survived between 2 and 6 hours during prolonged extrication to care Only 10% of combat deaths occur after care initiated The Rapid Treatment Model of Active Shooter Response 11

12. Time counts The Rapid Treatment Model of Active Shooter Response 12 WWI WWII Korea Vietnam Gulf War War on Terror 30% 60% 70% 80% 90% 95-98% EraSurvivability Majority of fatal combat injuries die within 30 minutes

13. The greatest benefit will be achieved through a combined effort that puts the caregiver at the patient’s side within minutes of wounding to maximize life saving – Agency expertise – Clearly defined roles – Familiarity – Simplicity – Unification Systemic issue 13 The Rapid Treatment Model of Active Shooter Response

14. January, 2013: Make contact with local or state law enforcement officials to become familiar with their strategies and tactical operations. Some possible subjects for discussion and planning follow: Potential roles and equipment law enforcement expects from fire and EMS assets. Review command, control and communications operations. Review of NIMS terminology along with any technical law enforcement terminology fire and EMS personnel may have a need to know. Discussion of how survivor triage will occur and if law enforcement desires training in same. How will injured law enforcement officers be managed? Early on in the incident a protected area should be declared and communicated to EMS leadership. Casualty collection points for citizens, EMS triage and how transportation and communications with area hospitals occur. Once the plan is developed, it should be exercised and updated annually. USFA position 14 The Rapid Treatment Model of Active Shooter Response

15. On April 2, 2013 the Department of Homeland Security and the Federal Bureau of Investigation, in cooperation with the International Association of Fire Chiefs (IAFC) and the International Chiefs of Police, convened a meeting to address, “Responding to Mass Casualty Shootings – Strengthening Fire/Law Enforcement/EMS Partnerships.” Based on the proceedings of this meeting, there is a real and present threat and an obvious need for all organizations involved to work together when confronted with an armed individual who has either already killed and injured people or is threatening to do so. The position statements are relevant to IAFF locals in fire departments that are changing response protocols or SOPs in an effort to embrace a more assertive approach to rendering life-saving care and rescuing viable victims in areas considered to be "warm zones" (not fully secured) during such an event. IAFF position 15 The Rapid Treatment Model of Active Shooter Response

16. “Those of us who chose the fire and EMS side of public service over law enforcement probably never considered we would need to be trained on how to respond in the event of an active-shooting incident. Active-shooter situations are left to law enforcement professionals, but we now live in a time when fire and EMS must be better prepared in the event we're first due.” From Reactive to Proactive: Why We Must Address Active Shooter Issues Now, June 2013 IAFC position 16 The Rapid Treatment Model of Active Shooter Response

17. IACP position “First responders must prepare for, protect against, and respond to these threats collectively because not planning for the event will find responders fighting them together unprepared.” The Police Chief, July 2013 A Paradigm Shift for First Responders: Preparing the Emergency Response Community for Hybrid Targeted Violence, Frazzano and Snyder, 17 The Rapid Treatment Model of Active Shooter Response

18. National Center for Disaster Medicine and Public Health position “It is unlikely that any single component of the public safety infrastructure will be able to effectively and comprehensively respond to those threats posed and casualties inflicted during a hostile mass casualty shooting incident. Despite the impact of tactical medicine, there is an urgent need for greater cooperative planning, education, and training among law enforcement, fire, EMS, public health and the emergency health care system to develop enhanced preparedness for and response to these types of incidents.” Disaster Medicine and Public Health Preparedness, Spring 2013 Role of Tactical EMS in Support of Public Safety and the Public Health Response to a Hostile Mass Casualty Incident Dr. Nelson Tang, Department of Emergency Medicine, Johns Hopkins University 18 The Rapid Treatment Model of Active Shooter Response

19. Fire/EMS integration varies widely Forms of Tactical Medicine – TEMS, TCCC, SWAT Medic, Rescue Teams – Not fast enough, complicated Waiting for “all clear” “The fate of the injured often lies in the hands of the one who provides the first care to the casualty” –Arlington VA Fire Current fire/EMS response 19 The Rapid Treatment Model of Active Shooter Response

20. What’s hampering our response? Hazard zones Embedded Warm Zone 20 The Rapid Treatment Model of Active Shooter Response

21. Combined effort 21 The Rapid Treatment Model of Active Shooter Response

22. Best utilization of resources Large response by Law Enforcement – Trained to work in the tactical environment Use proven principles – Economy of force – Resource driven Establish FOB LE requires little training for victim rescue – Drags and Carries easy to learn – Tourniquets being taught already 22 The Rapid Treatment Model of Active Shooter Response

23. Provides a bridge between LE and EMS Allows for simultaneous LE and EMS operations Proven military tactic for categorization The Casualty Collection Point 23 The Rapid Treatment Model of Active Shooter Response

24. Police response Rapid Response Tactics Threat mitigation Initiate Sergeant / Battalion Chief link-up Response Establish foothold (FOB) Identify Casualty Collection Point (CCP) Assessment Internal Security for CCP Corridor Lockdown Security External Security for Fire Security 24 The Rapid Treatment Model of Active Shooter Response

25. Fire/EMS response Identify the number of wounded Categorize the severity of victims Triage Provide minimal life saving interventions Treatment Coordinate with local hospitals Transport patients to definitive care Transport 25 The Rapid Treatment Model of Active Shooter Response

26. Casualty Collection Point benefits 26 The Rapid Treatment Model of Active Shooter Response Simultaneous tracks Efficient prioritization Centralized location FOB Simplicity Manageability Low cost Security Resource allocation “Quick Connect”

27. Life-saving timeline The Rapid Treatment Model of Active Shooter Response 27 Definitive Medical Care Mechanism of Injury LE Respons e FOB Identify CCP Wounded to CCP Medical Transport MCI Fire Inbound CCP Establish Security

28. Lessons learned by training together The Rapid Treatment Model of Active Shooter Response 28 Benchmark timer Willingness to compromise Cross agency appreciation Daily operations improvement Tradition 911/Comms

29. Getting started/more info Reach across departments and find a like- minded person ??? Sgt. Craig Allen – Craig.Allen@hillsboro-oregon.gov Craig.Allen@hillsboro-oregon.gov Lt. Jeff Gurske – Jeff.Gurske@hillsboro-oregon.gov Jeff.Gurske@hillsboro-oregon.gov The Rapid Treatment Model of Active Shooter Response 29