1. POLICE, FIRE, AND EMS
Rapid Treatment for a Hostile Action/Active Shooter Response
Introduction and Overview
v1.0
The Rapid Treatment Model of Active Shooter Response

2. Major L/E Paradigm Shift
Since Columbine L/E made a major shift in tactics in an active shooter response Law enforcement has focused on neutralizing the shooter with first responding PD Both approach's fails to get medical attention to victims soon enough for major bleeding
The Rapid Treatment Model of Active Shooter Response

3. Concept Addresses Unified Command Concept of L/E FOB
Designating and securing a Warm Zone
Treatment in the Warm Zone w/ TCCC & PPE
Establishment Casualty Collection Point
Communications
The Rapid Treatment Model of Active Shooter Response

4. Mass Casualty Incident (MCI)
Mass Casualty Incident Defined - A Mass Casualty Incident (MCI) can be defined as an incident that has produced more casualties than a customary response assignment can handle. Types of incidents that can produce mass casualties include:
Multiple vehicle accidents
Building collapse
The Rapid Treatment Model of Active Shooter Response

5. Criminal Mass Casualty Incidents (CMCI)
The Rapid Treatment Model of Active Shooter Response

6. Criminal Mass Casualty Incidents (CMCI) “active shooter”
98% male
98% carried out by a single attacker
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
Average police response time from the first shot 9 to 12 minutes
More than 700 incidents in the past thirty years
The Rapid Treatment Model of Active Shooter Response

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

8. Stats on LE Engagement
93% of incidents were over prior to the first responding asset, police or fire/EMS, arriving on scene.
7% of incidents police actually arrived in time to interrupt the shooting.
The Rapid Treatment Model of Active Shooter Response

9. Percentage of Survivors
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

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

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

12. The Rapid Treatment Model of Active Shooter Response
IAFF Supports Concept
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.
The Rapid Treatment Model of Active Shooter Response

13. The Rapid Treatment Model of Active Shooter Response
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,
The Rapid Treatment Model of Active Shooter Response

14. Current fire/EMS response
Traditional Methods
Stage away from incident
Waiting for “all clear”
Forms of Tactical Medicine
TEMS, TCCC, SWAT Medic
Not fast enough, complicated
“The fate of the injured often lies in the hands of the one who provides the first care to the casualty” –Arlington VA Fire
The Rapid Treatment Model of Active Shooter Response

15. Unified Command
Commanders from various jurisdictions or organizations operating together to form a single command structure.
The Incident Commanders within the Unified Command make joint decisions and speak as one voice. Any differences are worked out within the Unified Command.
Physical link up (face to face)(does not require formal “command post”)
The Rapid Treatment Model of Active Shooter Response

16. 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 Forward Observation Base (FOB)
ICS Operations Officer
LE requires little training for victim rescue
Drags and Carries easy to learn
Tourniquets being taught already
The Rapid Treatment Model of Active Shooter Response

17. Rescue Task Force Concept
RTF
FD’s answer to the issue of rapidly providing stabilizing medical care in areas that are clear but not secure .
Task Force
NIMS compliant name, any combination of single resources, but typically two to five, assembled to meet a specific tactical need .
The Rapid Treatment Model of Active Shooter Response

18. The Rapid Treatment Model of Active Shooter Response
PPE
The Rapid Treatment Model of Active Shooter Response

19. The Rapid Treatment Model of Active Shooter Response
Blow Out Kits
The Rapid Treatment Model of Active Shooter Response

20. The Rapid Treatment Model of Active Shooter Response
TCCC
The Rapid Treatment Model of Active Shooter Response

21. The Rapid Treatment Model of Active Shooter Response
RTF TRIAGE
The Rapid Treatment Model of Active Shooter Response

22. RTF TRIAGE
The Rapid Treatment Model of Active Shooter Response

23. The Rapid Treatment Model of Active Shooter Response
Hazard zones
Cold is relatively secure out of line of sight
Warm, area cleared, not secured, dedicated L/E posted for security
Hot, Active zone, L/E Contact Teams engaging assailant
HOT
WARM
COLD
The Rapid Treatment Model of Active Shooter Response

24. The Casualty Collection Point “CCP”
A defensible location inside a warm zone with access to the outside for victim transport
Provides a bridge between LE and EMS
Allows for simultaneous LE and EMS operations
The Rapid Treatment Model of Active Shooter Response

25. Casualty Collection Point benefits
Simultaneous operations
Efficient prioritization
Centralized location
Forward Observation Base (FOB)
Simplicity
Manageability
Security
Resource allocation
“Quick decision making”
The Rapid Treatment Model of Active Shooter Response

26. The Rapid Treatment Model of Active Shooter Response
Police response
Rapid Response Tactics ( initial assault team)
Threat mitigation ( Neutralize, barricade )
Initiate Police CO, OIC / Fire Command link-up
Response
Establish foothold (FOB)
Identify Casualty Collection Point (CCP)
Declare warm zones
Assessment
Internal Security for CCP
Corridor Lockdown Security
External Security for Fire (over watch / escort)
Security
The Rapid Treatment Model of Active Shooter Response

27. The Rapid Treatment Model of Active Shooter Response
Rescue Task Force
Move in to warm zone treat rapidly
Move victims to CCP
Initiate/manage multi agency EMS response
Categorize the severity of victims
TEMS Triage
Move victims from CCP to Treatment in Green Zone
Transfer
Traditional MCI Treatment Section
Coordinate with ems/local hospitals
Transport patients to definitive care
Treatment & Transport
The Rapid Treatment Model of Active Shooter Response

28. Life-saving timeline Definitive Medical Care Mechanism of Injury LE
Response
FOB
Identify
CCP
RTF treat & move to CCP
Medical
Transport
MCI
Wounded to
Treatment
Establish
Security
The Rapid Treatment Model of Active Shooter Response

29. Lessons learned by training together
Benchmark timer (trigger points to move to the next goal)
Willingness to compromise and work with other agencies
Daily operations improvement
911/ radio communication improvement
Cross agency appreciation
The Rapid Treatment Model of Active Shooter Response

30. Treatment and Transferred
Victim 1, Adult, No Bleeding Apneic & Pulseless
Victim 2, Child w/ minor GSW to arm from ricochet
Victim 3, Heavy Bleeding L Leg
Victim 4, Heavy Bleeding L&R Leg
Victim 5, No Bleeding, Unconscious, Abdominal GSW
The Rapid Treatment Model of Active Shooter Response

31. RE-SUPPLY
CCP
The Rapid Treatment Model of Active Shooter Response

32. Once RTF operational, Fire/EMS Command will establish:
RTF re-supply near point of entry
External/Internal casualty collection point
Dedicate non-RTF assets to assist in transfer of patients from RTF assets for external evacuation
The Rapid Treatment Model of Active Shooter Response

33. COMMS Dual communications
Police communicate with Tactical Police Command
Locations of injured and team
Threat and other tactical information
Medics communicate with Fire Command
Location of injured and team
Casualty information
The Rapid Treatment Model of Active Shooter Response

34. RTF Goal
Stabilize as many victims as possible using TCCC principles in the WARM Zone
Will penetrate into building as far as possible until they run out of accessible victims or out of supplies
“Stabilize, position, and move on”
Once out of supplies or victims, move victims to CCP
The Rapid Treatment Model of Active Shooter Response

35. Practical skills Unified command establishment
FOB/CCP location, setup, security
Rescue Task Force (triage, treat, transfer)
Over watch protection
L/E Tourniquets
RTF Triage with MARCH not START
The Rapid Treatment Model of Active Shooter Response

36. The Rapid Treatment Model of Active Shooter Response