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Anthony Leidenbor
Professor Skutar
English 2089
22 September 2015
An Evaluation of a Scholarly Article called “Rapid Assessment Medical Support for Active
Shooter Incidents”
An active shooter is defined by the FBI as “an individual actively engaged in killing or
attempting to kill people in a confined and populated area” (Mechem, Bossert and Baldini,
213). With the unfortunate rise in active shooter incidents, emergency first responders had to
join together to save lives. In the past, paramedics and emergency medical technicians (EMT)
would stage in a safe area while police searched the location and ultimately stopped the
shooter or cleared the scene (Mechem, Bossert and Baldini, 214). In the last decade new and
improved methods have been proposed for emergency medical service (EMS) personnel and
police first responders to work together to assess the scene for safety, assess victims, and
provide life saving measures if needed and possible. The article that I am evaluating, “Rapid
Assessment Medical Support (RAMS) for Active Shooter Incidents”, provides an evidence based
argument from experts in the field, for the implementation of the “Tactical Paramedic”
program for fire and police departments around the nation.
The above article was published in the peer-reviewed Journal of Prehospital Emergency
Care in 2015 by Dr. Crawdford Mechem, Richard Bossert, and Christopher Baldini (Mechem,
Bossert and Baldini, 213). The article speaks to both EMS providers as well as law enforcement.
The article focuses on a “collaborative program undertaken by the Philadelphia Fire
Department (PFD) and the Philadelphia Police Department (PPD)” to have police officers and
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paramedics working side by side during an active shooter incident (Mechem, Bossert and
Baldini, 213). The purpose of this article is to describe the implementation of this Rapid
Assessment Medical Support program for police and fire organizations to use around the
nation.
First, the authors do a good job of introducing and setting the background for the need
for this program by mentioning incidents where it could be implemented and deployed.
Specifically to Philadelphia, the West Nickel Mines Amish School, and an incident at the Kraft
Foods facility both are shown to have lacked such a tactical paramedic program (Mechem,
Bossert and Baldini, 214). In the first incident, a man entered the West Nickel Mines Amish
School and after allowing all male students to leave, he gathered the female students ultimately
shooting and killing 5 and injuring 5 others (Mechem, Bossert and Baldini, 214). Likewise, the
Kraft Foods incident involved a disgruntled employee who shot and killed two of her co-workers
and injured one other. It is discussed in this article that during the Kraft Foods shooting, the
previous method of dealing with shooting situations left the EMS crew unknowingly in a “hot
zone” putting the medical crews at risk (Mechem, Bossert and Baldini, 213). It is addressed that
with the tactical training situations such as this can be avoided and dealt with more
appropriately. Both of these incidents were located either within Philadelphia or nearby also
showing that the need for the program is prevalent for the Philadelphia area. The authors use
those shootings, along with others around the world, to show the need for a more systematic
plan to approach an active shooting and to provide fast care to the wounded. The need to train
and appropriately equip paramedics is paramount in order to provide care faster to the victims.
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After introducing the need for such a program, the authors specifically describe their
setting, Philadelphia Fire and Police department, as well as the RAMS program. They talk about
the process of making the program fully operational by discussing the roles of EMS personnel
and law enforcement. To add credibility to their viewpoint the authors provide referenced
evidence from the Tactical Emergency Casualty Care (TECC) principles, which is derived from a
military model called Tactical Combat Casualty Care (TCCC) (Mechem, Bossert and Baldini, 214).
The authors hit every point, from the cost of equipment to the hands-on training and creation
of further protocols. It also discusses the need for joint training, hiring, and policies needed
between the Philadelphia Police and Fire/EMS departments (Mechem, Bossert and Baldini,
215). The authors show the extensive research that was necessary to start the program as this
was a large task. Overall it appears that the material presented in this section was organized,
referenced appropriately, and focused on the topic at hand thus allowing the reader to
understand a firsthand account on the start of the program.
While the authors provide a good description of the program, the reader must
remember that this is only describing how a larger urban department has devised the plan to
have the program implemented. If the reader is a member of a smaller, more rural department,
the article may not answer some of the questions the reader is attempting to solve since it only
discusses issues that may be specific to the Philadelphia Fire and Emergency Medical Services
Department. The article’s title “Rapid Assessment Medical Support for Active Shooter
Incidents” makes it seem like it will be an overall viewpoint or standardized process on
implementing a generalized program to be a guide for many departments but shows only how
it works within the larger City of Philadelphia.
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From researching the authors, they appear knowledgeable in the field of emergency
medicine. The three authors have a strong background in the emergency medicine services
field. First Dr. Mechum is a board certified Emergency Medicine physician who is a member of
numerous professional organizations including, but not limited to, The U.S. Metropolitan Urban
EMS Medical Directors’ Consortium, the Philadelphia Regional Emergency Medical Services
Counsel, and the Philadelphia Fire Commissioner’s Medical Advisory Board (C. Crawford
Mechem, MD, MS, FACEP profile | PennMedicine.org). He also has many publications
pertaining to emergency medical planning and pre-hospital care (C. Crawford Mechem, MD,
MS, FACEP profile | PennMedicine.org). The other authors are both members of the
Philadelphia Fire/EMS department in some capacity. Richard Bossert is a Captain within the
Philadelphia Emergency Medical Services Administration (Emergency Medical Services
Administration). Limited information is available on Christopher Baldini, but according to a selfreported, Linkedin page; he is a firefighter paramedic Captain within the Philadelphia Fire
Department (Christopher Baldini| Linkedin). This article appears to be credible, with the
authors having such a strong background in emergency medical and fire services field.
While the authors are knowledgeable in the emergency medical services and fire field,
one weakness of this article is that not one of the writers is an expert or experienced in the law
enforcement field. This article shows that in the event of an active shooter the paramedics
would be paired with a police entry team, with the paramedics working along the side of the
police entry team to locate and render aide to the victims along the path taken (Mechem,
Bossert and Baldini, 214). Having that knowledge of both jobs would allow there to be a middle
ground for thought processes on the task at hand. The authors show extensive history and
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knowledge in the medical and fire services field, but with the tactical medic program,
knowledge of the how a law enforcement tactical unit operates would be beneficial for both
departments, as well the reader of this article. Having only a medical background could cause
some issues with the timely, safe, and effective job of rescue that is being presented. In the
article it is discussed that the departments would work jointly in each mission, it also stated the
concerns that the paramedics had reference teaming up with police in these situations but I felt
that the issues were brought up but not given a definitive answer for correcting or evaluating
the potential problem at hand.
Through the discussion the authors talk about the need for these joint programs, as well
as the benefits and drawbacks the program provides. This allows the reader to see both the
pros and cons of starting such a program. First, the authors discuss national position
statements such as those from the Hartford Consensus Conference, which states, “The group
concluded that care of victims is a shared responsibility between law enforcement, fire/rescue,
and EMS. As such, emergency response agencies should develop joint protocols and engage in
joint training to improve care of the victims while taking into account tactical and other
operational considerations” (Mechem, Bossert and Baldini, 215). On the flip side, the author
follows a high point with discussing funding, by-in from key stakeholders, and potential labor
concerns. Funding is discusses throughout the discussion as a potential draw back as the
materials and equipment is expensive (Mechem, Bossert and Baldini, 215). Further, when
discussing labor concerns, it is discussed of the potential for this model to decline due to the
lack of the continuing training necessary for each paramedic member but the lack of
deployments could cause a degradation of skills (Mechem, Bossert and Baldini, 215). With each
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issue that the authors discuss a valid rebuttal seems to be given to answer the readers thought
of how can these problems be solved within the unit.
Lastly, the authors lack supporting information that this type of system works. They go
into detail on the need for the program, the specialized training and equipment that is
necessary, the extra funding needing to allocated, and even how to keep the program
standards but they do not discuss any actual deployments which may leave the reader
uninformed on the finished product (Mechem, Bossert and Baldini, 215). If the reader is
utilizing the article to propose creating a program as such for their department, having
information on the operation of the program will be beneficial for the reader and to others
seeking information referencing a RAMS program. On the opposing side, if the reader is looking
for a real life account of an implemented, tried and true program, then this article will not
provide what the reader is looking for.
In conclusion, the authors present a well formed argument for the start of a RAMS
program. While they are lacking expertise in the police field, the authors bring a lot of
knowledge of Emergency Medical Services to the table. The reader would be able to use this
program overview to tailor similar RAMS programs around the nation and the world. The article
is overall very informative and logical the material and subjects covered. It reaches the reader
by covering points from the need of such a program, to the creation of the program, and lastly
covers the pros and cons of creating a RAMS program.
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Works Cited:
"C. Crawford Mechem, MD, MS, FACEP Profile | PennMedicine.org." C. Crawford
Mechem, MD, MS, FACEP Profile | PennMedicine.org. Web. 8 Sept. 2015.
"Emergency Medical Services Administration." www.phila.gov/fire Web. 9 Sept. 2015.
<http://www.phila.gov/fire/pdfs/ems_admin.pdf>.
Mechem, C. Crawford, Richard Bossert, and Christopher Baldini. "Rapid Assessment
Medical Support (RAMS) for Active Shooter Incidents." Prehospital Emergency Care
Prehosp Emerg Care (2015): 213-17. www.pubmed.gov Web. 8 Sept. 2015.
<http://www.ncbi.nlm.nih.gov/pubmed/?term=Rapid Assessment Medical Support
(RAMS) for Active Shooter Incidents>.
Christopher.Baldini. Web. 9 Sept. 2015. <https://www.linkedin.com/pub/christopherbaldini/b/b50/769>.