Tactical EMS and Active Shooter Response

Tactical EMS and Active Shooter Response Cedric Palmisano, NREMT-P Deputy Chief of Special Operations/Logistics New Orleans EMS

Introduction New Orleans EMS Deputy Chief of Special Operations and Logistics. (The coolest job in EMS!) EMS Special Ops Vehicle Rescue, High Angle and Confined Space Rescue, Water Rescue, Urban Search and Rescue, Haz Mat Rescue, and Tactical Medics. EMS Logistics Medical supplies, emergency response fleet vehicles and NOEMS buildings.

Introduction EMS for 21 years. Nationally Registered Emergency Medical Technician - Paramedic Flight Medic in the US Army for 6 years 2005, after Hurricane Katrina, promoted to Lieutenant of Planning Tactical medic in 2009. Promoted to Deputy Chief in Spring of 2014.

Tactical EMS Tactical Medicine is almost as old as war itself! Knights riding into battle with the King s Doctor American Civil War World War I World War II Vietnam War The war in the Middle East

Tactical EMS The start of SWAT Medics in the United States 1970 Los Angeles Sheriff s Office trained the first tactical medics Police Officers sent to EMT school 1979 Miami Fire Rescue EMS started training experienced paramedics how to be tactical operators working with law enforcement.

Tactical EMS 2006 New Orleans EMS and the New Orleans Police Department started its own tactical medic program.

Tactical EMS What is the job of a Tactical Medic? Provide emergency medical care for the team, victims, K9 officers, and perpetrators Operate in the Cold Zone, Warm Zone, and Hot Zone Participate in mission planning and coordinate EMS transportation for casualties Help ensuring mission success

Tactical EMS The NOEMS SWAT Medic Team is made up of 10 experienced and highly trained medics. The NOPD-NOEMS SWAT Team trains together often. We also train with other local/federal agencies

Tactical EMS The NOEMS Tac Medic Team assist with training law enforcement agencies in the area, to include NOPD, ATF, US Marshals Service, SBSO,and JPSO Tactical Medics get called 60 and 80 times a year for SWAT Rolls and High Risk Warrants

Tactical EMS

Active Shooter THIS IS NOT THE JOB OF A SWAT MEDIC

What is an Active Shooter? One or more subjects who participate in a random or systematic shooting spree, demonstrating their intent to continuously harm others. The overriding objective of an active killer appears to be that of mass murder, rather than other criminal conduct such as robbery, hostage taking, etc. It also includes anyone who uses any other deadly weapon to systematically or randomly inflict death or serious bodily harm on others over a continuous or extended period of time. Active shooter as defined by the National Tactical Officer s Association

FBI, A Study of Active Shooter Incidents in the United States Between 2000 and 2013!

The Pattern of Active Shooter Typical pattern: Single white male aged 30 well populated location and opens fire without warning Will be over in less than 5 minutes well before police arrive Shooter Characteristics Will likely be armed with more than one firearm and will fire about 25 rounds 25% will use both handgun and rifle or shotgun After spree, shooter is likely to end up dead, probably by committing suicide Few incidents with females as shooters Age range from 11 70

The Pattern of Active Shooter Victims Shooter will initially target specific people but is very likely to fire randomly before stopping Multiple wounded each with multiple wounds including higher percentage of head injuries

Environment FBI, A Study of Active Shooter Incidents in the United States Between 2000 and 2013!

The Pattern of Active Shooter Duration of event Average 10 12 minute duration Most as short as 3 4 minutes Average 12 15 min response by Police 93% of incidents were over prior to the first responding asset, police or fire/ems, arriving on scene

Active Shooter Case Studies Columbine April 20, 1999: Eric Harris and Dylan Klebold opened fire at Columbine High School, killing 12 fellow students and 1 teacher and wounding 24 others. Both had self-inflicted fatal wounds Occurred within 45 minutes from start of incident No significant law enforcement entry for 1 hour No medical operations inside for 4 hours

Active Shooter Case Studies Amish School October 2, 2006: Charles Carl Roberts IV opened fire in a one-room Amish schoolhouse, killing 5 female students. Roberts barricaded himself in the school before carrying out the attack.

Active Shooter Case Studies Virginia Tech April 16, 2007: Seung-Hui Cho, a Virginia Polytechnic Institute student, opened fire inside a university dormitory and in several classrooms, killing 32 people and wounding 20 others. He committed suicide after the attack. Reports state that Cho had a history of mental and behavioral problems.

Active Shooter Case Studies Sandy Hook Elementary School December 14, 2012: 20- year- old Adam Lanza fatally shot twenty children and six adult staff members in a mass murder at Sandy Hook Elementary School in the village of Sandy Hook in Newtown, ConnecFcut. 26 people killed, 20 were children between 6 and 7 y/o.

Paradigm Shift Law Enforcement Prior to Columbine in 1999, Law Enforcement would set a perimeter and call for SWAT. This outdated school of thought proved to be a bad one which cost many lives. The Columbine Review Commission of May 2001 was responsible for changing the Law Enforcement s response.

Paradigm Shift Law Enforcement Now police are trained to enter the scene of an active shooter as soon as they arrive. The sole purpose is to STOP the killing by neutralizing the threat as fast as they can.

Paradigm Shift Emergency Medical Services and Fire Before Spring of 2013, EMS would wait in a safe (or cold) area until given a code 4 by Law Enforcement. Many people including children have died waiting for that code 4.

FBI, A Study of Active Shooter Incidents in the United States Between 2000 and 2013!

Paradigm Shift: EMS and Fire Greatest opportunity for life saving intervention is early on. 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

Paradigm Shift: EMS and Fire On April 2, 2013 representatives from a select group of public safety organizations including law enforcement, fire, pre-hospital care, trauma care (including Dr. McSwain), and the military convened in Hartford, CT, to develop consensus regarding strategies to increase survivability in mass-casualty shootings. A concept document resulted and became known as the Hartford Consensus.

Paradigm Shift: EMS and Fire What the HarLord Consensus means to EMS? Train to increase awareness and operafonal knowledge about the inifal response to an acfve shooter or intenfonal mass- casualty event It is no longer acceptable to stage and wait for casualfes to be brought out to the perimeter. Training must include hemorrhage control techniques, including the use of tourniquets, pressure dressings, and hemostafc agents. TCCC

Paradigm Shift: EMS and Fire Emergency Medical Services and Fire In September 2013, FEMA and the NaFonal Fire AdministraFon adopted the HarLord Consensus and published the Fire/Emergency Medical Services Department OperaAonal ConsideraAons and Guide for AcAve Shooter and Mass Casualty Incidents

Paradigm Shift: EMS and Fire In September 2013 NOEMS draxed an acfve shooter response guidelines based on the HarLord Consensus, FEMA guidelines, and the Arlington FD. November 2013, the plan was presented to the New Orleans Public Safety Unified Command received aproval. Deputy Mayor Sneed Dr. Elder, NOEMS Superintendent Serpas, NOPD Superintendent McConnell, NOFD

New Orleans EMS Active Shooter Plan The purpose of this guide is to establish the duties and responsibilities of medics who respond to the scene of an active shooter situation. The goal, is to quickly and carefully triage, treat life threats, evacuate, and transport to the closest appropriate emergency department.

New Orleans EMS Active Shooter Plan Definitions Hot Zone: The Hot Zone is the area in which the perpetrator is actively engaged in violence. This area is dangerous until the threat has been neutralized and rendered safe by Law Enforcement. Warm Zone: Zone between Hot Zone and the Cold Zone which doesn t presently have a perpetrator actively engaged in acts of violence. It is clear but not secure. Cold Zone: Zone free of danger, defined by Law Enforcement. This zone is usually where ambulance staging and command posts are located.

Traditional Roles

What is done now - THREAT

New Orleans EMS Active Shooter Plan Definitions Contact Team (Law Enforcement): Is defined as a team of officers who make immediate entry into a location to locate and neutralize the threat posed by the active shooter. Rescue Task Force (Law Enforcement, NOEMS, NOFD): defined as a team of law enforcement officers and armored medics/firefighters who make entry into the warm zone after the contact team to stabilize/triage/evacuate wounded individuals. Casualty Collection Point: A specific location where casualties are assembled to be transported to an ED

New Orleans EMS Active Shooter Plan - Response First unit on scene The first unit on scene should find the cold zone and communicate with Law Enforcement as to what the situation is. Assume EMS Incident Command (IC) until relieved. Prepare to issue NOEMS Active Shooter Response Kits to responding EMS teams. Consider moving EMS communications to an alternate channel. Choose an appropriate radio channel according to size of the incident and mutual aid responding. Establish a Casualty Collection Point with coordination of LE. (Consider using a fire truck to provide cover and concealment) Take accountability of all EMS personnel (Names/Location)

New Orleans EMS Active Shooter Plan - Response Two to four medics (may include firefighters) should link up with the LE to form a Rescue Task Force (RTF). Dawn ballistic protection from the NOEMS Active Shooter Response Kits. The RTF will enter the Warm Zone with armed LE. You should start performing lifesaving techniques to stop bleeding, triaging (if possible) and prepare patients for movement to the Casualty Collection Point (CCP) outside of the target location. When safe and with LE cover, extract patients

Response Rescue Task Force Two patrol officers for front and rear security. Responsible for security of team. Two NOEMS medics in ballistic gear with AS medical kits. Responsible for TCCC care and rapid evacuation of the wounded

Rescue Task Force

New Orleans EMS Active Shooter Response Kit

New Orleans EMS Ballistic Protection

DEMONSTRATION THIS IS JUST A DEMONSTRATION REAL GUNS ARE NOT BEING USED

Questions? Cedric Palmisano Deputy Chief Special Operations and Logistics cpalmisano@nola.gov