Jim Schwartz, Chief
Arlington County Fire Department
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Located directly across from Washington D.C.
Highly urbanized community of 26 square
miles; population if 212,900
• Columbine High School Shooting –April 20, 1999
• Eric Harris & Dylan Klebold
• 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
• 12 students & 1 teacher killed
• 24 wounded
• Coach Dave Sanders
• Bled for > 2hrs before dying
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IAFC, IACP, FBI and DHS Host meeting to
discuss medical response to active shooter
IAFF, Metro Chiefs and USFA also in
attendance
Discussion also covered use of ICS during
incidents
Conclusion -“integrated and coordinated
planning, policies, training and team building
prior to any incident will ensure effective and
successful response”
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Initial EMS/Fire medical responders should work
with Law Enforcement assets to rapidly deploy
into areas that have been cleared but not
secured to initiate treatment and effect rescue
of injured victims
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NOT tactical medics but first arriving EMS assets
Security and/or escort provided by LE teams
Requires appropriate equipment and PPE
Should utilize TECC medical principles
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One answer to the issue
of rapidly providing
stabilizing medical care in
areas that are clear but
not secure
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NIMS compliant name
 Task Force: Any
combination of single
resources, but typically two
to five, assembled to meet
a specific tactical need
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First arriving EMS providers (NOT tactical medics)
team up with 3 patrol officers to move quickly into
“warm” zone areas along cleared corridors to
initiate treatment and evacuation of victims
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3 patrol officers for front and
rear security
 Readily available resource
 Do NOT assist medics in care
 Responsible for security and
movement only
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2 street medics in ballistic
gear with supplies to treat
up to 14 patients
 Readily available resource
 Able to initiate TECC care and
rapidly evacuate
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Comprehensive document summarizing
commonalities, trends, and events
Total qualifying cases from 1966-2012: 230
Some common characteristics found but also
a large degree of variation across broad
categories
 Age, Sex, Planning, Location, Relationship to
victim, weapons used
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Duration of event
 Average <10 minute duration
▪ Most as short as 3-4 minutes
 Average 12-15 min response by Police
93% of incidents in academic institutions were over
prior to the first responding asset, police or
fire/EMS, arriving on scene
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After review of combat and post-incident data:
 The immediate threat is rapidly mitigated in almost all
incidents well prior to Fire/EMS response
 The sooner the first responders start medical
treatment, the greater the chance that victims will
survive
 The risk from active shooter incidents is very low in
areas that are clear but not secure
Mumbai Attack November 26-28, 2008
• 10 terrorists –6 killed / 4 arrested
• 171 killed
• Multiple attack sites
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TajMahalPalace andTower –50 killed
OberoiHotel –30 killed
NaramanHouse –8 killed
Other incidents
• Overcoming the ‘us vs. them’ mentality
• Who ‘s in charge of the scene
• Cost sharing concerns
• Emphasize the force multiplying benefit
during ASEs
• Emphasize improved operational relationships
• During both ASEs and normal day to day operations
• Public image of collaboration between police &
fire
• Teach TECC –Tactical Emergency Casualty Care
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Evidenced-based best practices medical
guidelines for care at or near the point of
wounding in high risk operations
 NOT Law Enforcement tactical medic specific
 For use by any first responder who is providing
medical care whenever and wherever there is
increased risk to provider and patient
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Goals:
 Provide principles for point of wounding
management of trauma for response to ALL
atypical and high risk civilian emergencies
 To balance appropriate medical care with
the threat, the required tactics, and the
civilian scope of practice, equipment, and
population
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Initial responding patrol officers form 2-3 contact
teams that all enter building along same corridor
and move quickly to engage shooter
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Contact teams essentially are clearing the
primary corridor as they move to sound of
shooting
 Identify and notifty command of threats (IEDs, etc)
 Do not open locked doors unless sound from behind would
indicate threat
 Do not aide or assist injured
 As victims encountered, notify Command of location
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Need for RTF identified by 2nd contact team
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Initial RTF team formed and quickly moves
into area down the corridor cleared by the
contact teams
 Will not move into un-cleared areas or get in front
of contact teams
RTF
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Goal of initial RTF team is to stabilize as many victims
as possible using TECC principles
 Will penetrate into building as far as possible until they run
out of accessible victims or out of supplies
 “Stabilize, position, and move on”
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Once RTF operational, Fire and Police Unified
Command will establish:
 RTF re-supply near point of entry
 External casualty collection point for transfer of
patients
 Warm Corridor for evacuation away from area
 Dedicate non-RTF assets to assist in transfer of
patients from RTF assets for external evacuation
C
C
P
Resupply boxes
Questions?