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An editorial on EMS and active shooter incidents
Excerpts from the Washingtonpost.com:
I followed the news of the Orlando Pulse nightclub shooting with a single thought in mind: Where was EMS? During Omar Mateen's three-hour rampage, we later learned that the 80 medics present stayed more than 100 yards away from the club, well outside the so-called "hot zone." Many of the injured were transported to hospitals in pickup trucks.
This same scenario played out during the Columbine school shooting in Littleton, Colorado back in 1999, when emergency responders waited outside for nearly an hour for the SWAT team while a teacher bled out. At the Aurora, Colorado movie theater shooting in 2012, medics were again kept at bay, with police instead transporting victims to hospitals in their squad cars.
After each tragedy, grieving families and friends inevitably ask why the first responders weren't allowed closer. I understand that frustration. As a former paramedic of nearly 10 years, I believed that saving lives was worth putting myself in danger. But EMS departments, rightly prioritizing crew safety, generally kept us on the outskirts of dangerous situations.
This approach is outdated. Paramedics need specialized training to operate safely in hostile environments, equipped with the necessary tools to protect themselves. With the alarming rise in mass shootings across the country, we can't afford to keep them on the sidelines.
Early in my training, our instructor presented a seemingly straightforward scenario: man down in the street. My partner and I rushed to assist, only to be told we'd both "died" too. We hadn't confirmed the scene was safe and unknowingly stepped onto the same downed power line that killed our patient. Now three people were dead.
The lesson was clear - if we don't protect ourselves, we can't save others. Our instructors emphasized that we're deployed into dangerous situations not to control chaos but to preserve life.
But in the field, I quickly realized how challenging this ideal could be. A situation deemed safe at dispatch could rapidly escalate into something far more perilous. Just because no one was armed when 911 was called doesn't mean someone won't be when we arrive.
That's why it's time for EMS personnel to embrace a new model that reflects the realities of modern threats. Some departments are already adapting. Dallas Fire-Rescue and Pennsylvania's West End Ambulance Service have equipped paramedics with bulletproof vests and helmets. In states like Michigan, Virginia, and New York, EMS agencies are teaching medics to enter volatile scenes earlier to speed up treatment and improve survival rates. This rescue task force training, endorsed by FEMA, teaches paramedics how to coordinate with armed police officers to enter buildings where active shooters are still present.
Paramedics learn to identify "warm zones" - relatively secure areas at a shooting scene where patients can be gathered, treated, and prepared for transport. Instead of treating patients in place, the rescue task force model emphasizes rapid triage, stabilizing life-threatening injuries, and evacuating victims as quickly as possible. "We have to get in there to stop the dying," E. Reed Smith, medical director of the Arlington County Fire Department in Virginia, told the Los Angeles Times. "As long as we're standing outside, we have not stopped the dying."
With the increasing frequency of active shooter incidents, this training has become crucial for both law enforcement and medical responders. Between 2000 and 2006, there were an average of 6.4 active shooter events annually; that number jumped to 16.4 between 2007 and 2013.
In numerous cases, people died while help was just beyond the door. Patients treated within 60 minutes of injury have the best chance of survival. Most gunshot victims who receive care within five minutes survive. After the 2013 Boston Marathon bombing, an article in the Journal of the American Medical Association credited the remarkable survival rate - 261 of 264 casualties - to EMS units already being on site when the explosions occurred and beginning treatment immediately.
While it's encouraging that EMS is evolving to meet these new dangers, we must remain focused on our primary mission: patient care. Paramedics shouldn't become cops, nor should they attempt to assist only law enforcement or apprehend criminals.
Imagine if paramedics had entered the Pulse nightclub and begun treating patients right away. Picture medics in tactical gear, working amidst police armed with assault rifles, performing critical life-saving procedures on the dance floor. Would more people have survived if EMS had been able to start treatment sooner? The answer is almost certainly yes.
Another active shooter incident is inevitable. Next time, let's hope the paramedics are ready to step into harm's way and save lives. That's what they're trained to do.