April 16, From the EMS Perspective. Captain Matthew Johnson Lieutenant William Booker

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1 April 16, 2007 From the EMS Perspective Captain Matthew Johnson Lieutenant William Booker

2 Virginia Tech Rescue Squad Established in 1969 by four VT students Received the EMS Service of the Year, 1988 Received Governor s Award for Outstanding EMS Agency, 2000 Recognized by American Ambulance Association with Stars of Life Award, May 2007

3 Virginia Tech Rescue Squad Volunteer Student Run Organization Approximately 40 members

4 Virginia Tech Rescue Squad Three ALS Ambulances One ALS Response Vehicle Mass Casualty Trailer CERT Team Gator 6x4 Special Operations Trailer

5 Virginia Tech Rescue Squad The Virginia Tech Rescue Squad averages >1000 calls annually. Our members cover campus emergency calls 24/7 year round, covering their share of duty during University breaks. VTRS serves its community by providing EMS coverage at University sponsored functions such as sporting events, concerts, and commencement ceremonies.

6 Virginia Tech Rescue Squad Coverage Area 2,600 acres 19 miles of roadway 10,000 residents 10,000 person coliseum 68,000 person football stadium BSL 2 & 3 labs Corporate airport 3 4 minute response time

7 Organizational Structure Operational Administrative

8 VTRS Positions Attendant Member provides supportive care to TL/AIC Driver Member is cleared to operate all VTRS units Attendant in Charge (AIC) Member is cleared to be in charge of patient care Team Leader (TL) Member is cleared as an AIC and Driver All Operational Officers are TL s

9 VA Certifications EMT Basic Provides Basic Life Support interventions EMT Enhanced Can initiate Advanced Life Support interventions such as IV fluids and first line cardiac drugs EMT Intermediate Provides a full range of Advanced Life Support interventions including IV fluids, cardiac monitoring, etc. EMT Paramedic Same level of care as Intermediate. However, protocols are Standing rather than Online for certain procedures.

10 Regional Hospitals Montgomery Regional Hospital Level III Trauma Center ETA: 5 minutes Carilion New River Valley Medical Center Level III Trauma Center ETA: 15 minutes Lewis Gale Hospital ETA: 25 minutes Carilion Roanoke Memorial Hospital Level I Trauma Center ETA: 35 minutes

11 Training & Preparedness Probationary Members attend semester long introductory course Introduced to Incident Command System (IS 100/700) Active Members required to attend EMT Basic course Active Members precept multiple calls TL/AIC candidates are administered a set of drills: Medical Trauma Cardiac Arrest Motor Vehicle Accident Tabletop Mass Casualty Drill

12 Training & Preparedness Organize annual Mass Casualty Drill with Life Member Association Participate in County MCI exercises Train on various MCI exercises using a tabletop approach

13 Training & Preparedness Determined need for revised Operational Plan for Large Scale Incidents October 2006 Approved revised Operational Plan March 2007 Process of Implementing Ops Plan in progress on April 16 Annual MCI Drill was scheduled for early May

14 The Shootings

15 7:21am Virginia Tech Rescue Squad [VTRS] dispatched by Virginia Tech Police Department [VTPD] 4040 Ambler Johnston West for a female subject who had fallen from her loft bed. Resident Advisor made 911 call.

16 7:24am VTRS Rescue 3 Responding ALS Crew with 3 on board

17 7:26am Rescue 3 arrives on scene at WAJ

18 7:29am Rescue 3 crew begins treating the patients

19 7:31am Rescue 3 requests Second Ambulance for second patient

20 7:32am Rescue 3 requests All Available Virginia Tech Rescue personnel to respond to WAJ

21 7:35am Rescue 2 Responding to W. Ambler Johnston Basic Life Support with 2 on board EMT Enhanced on scene Virginia Tech Rescue Lieutenant on scene

22 7:36am Virginia Tech Rescue Squad Officer contacts Montgomery Regional Hospital [MRH] with 1 traumatic cardiac arrest and 1 critical trauma alert patient VTPD to request additional Advanced Life Support from Blacksburg Rescue Squad

23 7:43am Rescue 3 en route to MRH with first patient Rescue 3 staffed by EMT Paramedic EMT Intermediate EMT Enhanced EMT Basic

24 7:48am Rescue 2 requests Carilion Lifeguard medevac helicopter VTPD advises 40 minute ETA from Rural Retreat VTPD is advised to send Lifeguard to Montgomery Regional Hospital

25 7:49am Rescue 2 en route to MRH with second patient Rescue 2 staffed by EMT Intermediate EMT Intermediate EMT Enhanced EMT Enhanced Virginia Tech Rescue Lieutenant contacts Carilion dispatch Lifeguard helicopters are not flying due to weather

26 9:02am Rescue 3 returns to service Rescue 2 remains at Montgomery Regional Hospital for restocking

27 Approximately 9:40am Rescue 3 in quarters Approximately 8 personnel in station Overhear call for active shooter in Norris Hall over VTPD radio frequency

28 Approximately 9:42am Implement VTRS Operational Plan Virginia Tech Rescue Squad Lieutenant assumes EMS Command internally Rescue 3 staffed with Advanced Life Support Crew Standing by at VTRS Station per EMS Command

29 Command Structure

30 Approximately 9:42am [cont.] Virginia Tech Rescue Squad Lieutenant contacts Montgomery County Emergency Services Coordinator Requests all county squads be placed on standby Requests Emergency Services Coordinator respond to VTRS Station

31 9:46am Virginia Tech Rescue Squad [VTRS] dispatched by Virginia Tech Police Department [VTPD] Second Floor Norris Hall for multiple subjects down

32 9:46am Virginia Tech Rescue Squad Lieutenant establishes EMS Command with VTPD Units are standing by Will not proceed until cleared by VTPD VTPD acknowledges Rescue 2 is responding from Montgomery Regional Hospital

33 9:48am Initial Staging Area established at Blacksburg Station 1 Safety Proximity Emergency Services Coordinator is advised of change in Staging location Is asked to supply All Available county units to Blacksburg Station 1

34 9:54am VTPD advises they will have multiple patients Information is transmitted to Emergency Services Coordinator Emergency Services Coordinator resets pages for county units and identifies MCI situation with Montgomery County Dispatch

35 9:56am First patients begin moving out of Norris Tactical medics from VTRS and BVRS have been inside the building Triage has begun inside Norris Hall by Tactical Medics as rooms are deemed safe

36 9:56am Staging Area designated at Old Turner and Stanger Streets once VTPD cleared EMS to enter Treatment Area established at Barger and Stanger Street Mass Casualty Trailer is deployed to Treatment Area

37 9:57am EMS Command advises all units operating on the scene to switch to Primary Tactical frequency VTAC1

38 9:57am Rescue 3 sent to Old Turner and Stanger to pick up wounded patients that are being extricated from Norris Hall by Police Officers Transported to the Treatment Area VTPD has not cleared the scene for EMS entry No units have entered the scene other than Tactical Medics

39 10:08am Primary Triage is taking place in Norris Hall Tactical Medics Secondary Triage is planned at the entrance to Norris Hall Multiple EMTs, ALS personnel, and CTL Nurses have arrived from surrounding areas Staffing Treatment Area

40 Initial Area Map A/B: Staging Areas C: Command Post D: Treatment Area E: Secondary Triage

41 10:09am VTPD advises that the shooter is down and PD has cleared the building for EMS entry Initial Triage Team enters the area on Rescue 3 and proceeds into Norris Hall with Police escort Secondary Triage established on Norris Lawn

42 Approximately 10:20am Surrounding hospitals have been contacted and capacity numbers are in the Command Post Triaged Red (critical) patients are being transported directly from secondary triage Triaged Green and Yellow (non critical) Patients are being re triaged at the Treatment Area

43 Approximately 10:20am Ambulances are transporting patients to surrounding hospitals per the capacity numbers provided by the hospitals.

44 10:38am Rescue 2 moves from the Treatment Area to Norris Hall with equipment and additional personnel.

45 10:47am Triage Teams have cleared the second floor of Norris Hall of all viable patients. Transport of critical patients is complete. Final Triaged Black Patient count is 31. Total of 57 patients. Triage Teams begin to find patients who had jumped from second floor windows with injuries.

46 10:58am EMS Operations is notified of a third shooting incident in the tennis court area on Washington Street. Triage Teams are staged in ambulances to respond to the tennis court area once VTPD clears the scene

47 Tennis Court Area

48 11:13am VTPD advises EMS Operations there is no additional incident at the tennis court area (the call is unfounded).

49 11:18am The Ambulance Staging Area is relocated to Perry Street.

50 12:22pm EMS Command stages six ambulances at the top of Barger Street in case of another incident. Secondary Staging is at Blacksburg Station 1.

51 3:47pm Units are staged to begin transporting the deceased to the Medical Examiner in Roanoke.

52 8:00pm All of the deceased have been transported to the Medical Examiner in Roanoke.

53 8:01pm EMS Command is terminated and the Virginia Tech Rescue Squad returns to normal operations.

54 EMS Response 14 Agencies 27 ALS Ambulances Over 120 EMS Personnel were on scene

55 Lessons Learned Pre planning Training Execution

56 Pre planning What s involved Hazard assessment Command structure Writing the plan Thousand page plans are good only to the individual that writes it Accessibility Resources (where?, how?) Short/long term

57 Training Introduce the plan Basic components Talk through an incident Run a tabletop often Can be done with 5 people with little to no experience Include everyone (familiarity is key) Run a full scale (bi annual, interagency coordination) Practice with large events

58 Execution Stick to the plan Have faith in your personnel Think big (too many resources is OK) Think toward the final goal

59 Structure Command Staging Triage Treatment Transport Lessons Learned Incident Management Manageable span of control

60 Staging Setup immediately Lessons Learned Staging/Transport Self dispatching units Access/egress Transport Establish a single point of contact with each facility Update capacity numbers

61 Triage Lessons Learned Triage/Treatment State issued tags do work Triage once Triage again Triage some more Treatment Depleted soft supplies Environmental conditions Personnel

62 Summary The EMS response was outstanding All patients were transported within an hour Critical patients were transported immediately Triage system was executed without fault

63 Summary The Virginia Tech Rescue Squad Operational Plan was executed with great success Volunteer Rescue Squads exceptional working relationship Interagency training exemplified

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