1. Marysville Pilchuck School Shooting Tragedy Eric Cooper, MD, FACEP, Snohomish County EMS Medical Program Director

2. OBJECTIVES The system The event Lessons learned from prior incidents Timeline Aftermath Take home points

3. Marysville Population 63,000 20 square miles Marysville Fire District covers 55 sq miles and 72,000 people 7,000 EMS calls per year (19/day) 3 AID cars and 2 Medic Units MPHS 2,600 students

4. Shooting 5 deaths, 1 survived 4 transported to hospitals 1039: Fire alarm at school and reports of shooting 1047: 6 injured need Aid 1051 Unified command set up 1058: First pt transported 1114: Last pt transported

5. WHO RESPONDED EMS: – Marysville – Everett – Arlington – Snohomish – Airlift Northwest LAW ENFORCEMENT (Local): – Marysville – Snohomish County Sheriff – Everett – Monroe – Lake Stevens – Snohomish – Gold Bar (SCSO) – Arlington – Stanwood – Sultan (SCSO) – Darrington (SCSO) WSP Federal – FBI – Dept of Homeland Security – Secret Service – Fish and Wildlife – ATF

6. 9:35:43 First 911 call to the CSP Centralized Dispatch comes in. 9:40:03 Ambulances requested to stage at Methodist Church. “I will need two ambulances at this time.” 9:46:06 “Roger, safe to send EMS in?” 9:47:02 “S4, the building is not secure, so we can’t have anybody, uh, ambulances coming in.” 9:57:08 CSP Lt. Davis requests EMS to stage at the scene – injured being evacuated. 10:08:27 “A2 is transporting one patient [“Jane Doe from room #10] to Danbury Hospital.” 10:23:21 “We need to get MCI kits to school parking lot – we’re setting up triage.” The primary deficiency was the failure to immediately control traffic on Dickenson Drive, the only access and egress route to the school, but that was ordered by the state police 22 minutes after their arrival on scene and implemented by the Sandy Hook Fire Department. Sandy Hook School Shooting

7. Aurora Colorado Shooting The first arriving fire and EMS units found a chaotic scene, with a large number of injured and uninjured theatergoers fleeing the theater on foot, civilian vehicles trying to leave, police cars blocking parking lot road access, and uncertainty as to whether the theater was reasonably safe for rescuers to enter. Two significant challenges inhibited patient transport. First was confusion as to whether ambulances were to stage or proceed into the scene. Second was that ambulance access was limited by parked police cars from the initial wave of officers going after an active shooter, and moviegoers trying to leave in their cars. EMS Medical Directors and EMS Managers determined that the patient care decisions made at the incident were reasonable and prudent.

10. Snohomish County Fire Chiefs Association DOCUMENT 40-02-14 ACTIVE SHOOTING SCENARIO RECOMMENDED GUIDELINES FOR FIRE/EMS AGENCIES IN SNOHOMISH COUNTY

11. Active Shooter Situation Goals Establish safe standby area and initiate MCI plan Proper Equipment (protective and treatment) Goal is to stop bleeding and rapidly extricate Have units ready to receive patients and transport Maintain a transportation corridor Police and EMS must be coordinated

12. Fire official defends choice of Everett hospital for shooting victims DECISIONS AND CARE WILL BE DISSECTED

21. SITUATIONAL AWARENESS

22. MCI EVENT ED availability Surgical coverage OR availability Lab and blood bank resources Barriers to transport – Weather – Traffic patterns All dependent on the time of day Back up coverage – No one goes back to work after caring for multiple critically injured children – Stress debriefings

23. TEAMWORK Learn from debriefings Develop seamless transitions of care

24. Shooting Disaster Info will be in cyberspace and public when or before you are aware of event Penetrating trauma more likely in need of immediate OR Need real time situational awareness of available resources May have self triage of medical resources during daytime events In additional, in large scale events, law enforcement and self extricated/privately transported patients may not get included in tracking/triage data and identification Need inter-facility trauma transport agreements Need to know your limitations There will be a detailed timeline that will get dissected

25. When the outcome is bad, someone will suggest you did something wrong!