As far back as the early months of the year 2000, active shooter response plans were developed as society demanded a shift in law enforcement response to the events as everyone saw them on national television at Columbine High School. Early on, as was reasonable to expect, the response plans focused on getting officers inside of the school to find and neutralize the attacker(s) with very little consideration given to any injured victims along the way. That was necessary and by design. It was vital that the responding officers focus all of their energy on getting to the shooter and stopping him to minimize the number of casualties created.
Since that time, though, law enforcement has come to realize that the aftermath of the situation, scene management, and recovery has to be planned for. Policy for such has to be developed, constantly evolve, and be trained as thoroughly as initial response is. How do we go about that?
Step one
The first step, acknowledge and document the need. Most agencies won’t allocate budget dollars for a training increase, or even a change in focus unless the need can be proven. In this case, it’s easy enough to look back at the plethora of active shooter events in quite a number of locations and document how officers with higher levels of medical or first-aid training have saved lives. The key item to look for is the response time for the emergency medical personnel and what injuries were survived by victims that they might not have survived if the response time had been any longer.
While every officer should be trained to an advanced first-aid level, time and budget often prevent agencies from maintaining that level of recertification.
Once those events have been documented, you can make your case to the chain of command to increase the medical / trauma / first-aid training budget. While every officer should be trained to an advanced first-aid level, time and budget often prevent agencies from maintaining that level of recertification. Training beyond that to a basic EMT level or a Trauma Medic level requires even more time and even more budget. While most SWAT teams have properly trained medics, outside of those special units most agencies don’t have officers trained to such high medical care standards.
Step two
When the “higher-ups” have approved training, time, and budget for this increased focus on medical training, the second step is for the training staff to develop the curriculums to go with it. That doesn’t only mean finding properly qualified instructors to teach the medical knowledge and practical skills. The staff members who are active shooter response instructors need to develop the curriculum for a response protocol that is structured to focus on the medical/rescue responsibilities and the conversion to such from the initial response focus of shooter neutralization.
- The curriculum should parallel the most common contemporary response protocol to the point of neutralizing the shooter. Two transitions should be included:
- Transition to a hostage barricade situation. (Most curriculums already include this one but it needs to be reinforced.)
- Transition from “secure the scene” to “treat the wounded.”
Step three
The third step would be to secure and schedule the instructors with the proper qualifications to teach the trauma care / first-aid components. While it’s beneficial to have an instructor cadre that can speak to both the tactical implications of response and scene security while treating the wounded, it’s not always necessary. If necessary, tap into the expertise of instructors available to your local fire and emergency medical departments.
Some of the skills that should be included:
Assessment.
Performing the necessary assessment of a victim to determine which injuries should be treated first. This process can also be used to triage victims and determine which are in the greatest need of life-saving treatment. It’s easy to understand that a person with an arterial bleed that might kill them in a few minutes or less should be treated before the person who has a bump on their head or a small laceration on their arm. It is an unfortunate reality that being able to prioritize treatments by potential for fatality is a skill all officers should have.
Applying a tourniquet. This is a skill every law enforcement professional should have anyway. If your agency isn’t providing a tourniquet and the training for proper application thereof, it behooves you to go out and get this training on your own. A study of fatalities due to extremity wounds performed in the Afghanistan and Iraq war fronts, revealed that as many as 80% of the fatalities could have been avoided with proper use of a tourniquet. “Proper use of a tourniquet,” however, requires having one available, easily and quickly accessible, applied properly and fast enough to save the life. In an active killer response situation, it’s reasonable (unfortunately) to expect more than one victim to treat for bullet wounds. Indeed, just one victim might have several injuries to treat, so having more than one tourniquet is an obvious need. For that reason alone, you should have multiple tourniquets in your active killer response kit.
Applying a hemostatic agent, how, and when. Most officers are familiar with a variety of hemostatic agents; those powders, or impregnated gauze that cause blood to clot. Should an injury occur in a body location with blood flow that cannot be stopped by the use of a tourniquet, then stuffing the wound with a hemostatic agent is an option. What type of hemostatic agent, how, and when it can be used is all training that would need to be included in the curriculum.
Applying a pressure bandage. There are certain circumstances wherein an officer may need to apply a strong bandage, but a tourniquet and a hemostatic agent would be inappropriate. In those instances, some gauze and a tight bandage which places pressure over the wound should be sufficient. How to stack the gauze to put pressure on the wound site and then apply the bandage to apply proper pressure is a learned skill and should be included in any medic-type or advanced first-aid training curriculum.
Maintaining an airway. Using a nasopharyngeal airway or NPA to ensure a victim has an open breathing throughway is easy to learn. There are an assortment of injuries that can occur to the face, mouth, or cheek structures that might impair a victim’s ability to breathe. The application of or more specifically insertion of an NPA ensures an open airway at least past the tongue. This is done for unconscious victims who cannot act to maintain their own airway.
The necessary equipment items just to accomplish these actions don’t take up much room and can be carried as part of the usual response kit. The challenge is not in getting the equipment—several commercial companies sell active shooter/killer response kits that have as many as two dozen tourniquets, the same number of hemostatic dressings/agents, pressure bandages, and NPAs. The challenge is in making sure that officers have the right training to first transition from neutralizing the shooter(s) to treating the victims and then second to delivering the necessary emergency trauma care in a timely fashion.
While it is always preferable for those with higher training and certification levels of medical skill to deliver such care, the officer on the scene has a responsibility to deliver that level of care they are trained to provide. The more we can provide, the more lives we can save. That is an equal, if not more important, consideration to enforcing the law. Neutralizing the shooter is the primary means of saving lives as it stops them from causing more harm. The immediate mitigation of harm already caused—the treatment of injuries already existent—should then become the primary focus.
Joshua Borelli
Joshua Borelli has been studying active shooter and mass attack events over the course of the past several years, commensurate with receiving training on response and recovery to natural disasters and civil disturbances. Joshua started to outline this series of articles in an attempt to identify commonalities and logistical needs patterns for response.
