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MMRS Active Shooter Response Plan: What is an Active Shooter & an Introduction to ConceptsDayton MMRS Mumbai CommitteeWright State University Division of Tactical Emergency Medicine

by Jason Pickett, MDCaptain Alan Hill, Oakwood Public SafetyBrian Springer, MD

CONFIDENTIAL - FOUOPresentation is CONFIDENTIAL (non-classified) and For Official Use Only (FOUO) Security record under ORC 149.433NOT a public record NOT subject to mandatory release or disclosure to press or public

What is an Active Shooter Event?

As we will discuss this may encompass many different scenarios. This may range from the isolated seemingly uncoordinated effort of a single shooter like the Texas Tower incident at Wayne State University or involve a multi shooter incident as evidenced by the Columbine Tragedy or escalate to a full scale terrorist attack with multiple locations and targets.3Active Shooter IncidentIncident in which one or more people use deadly force on others, and continue to do so while having unrestricted access to victims

Mass Shooting: >5 casualties, one or more shooters, time frame or = to 5 casualties, one or more perpetrators in a time frame of less than 24 hours. 4SOP DEFINITION:

Active Shooter(s) (AS): person(s) continues to use deadly force while having unrestricted access to additional victims.

Active ShootersType 1: one or two individuals with probable multiple weapons and minimal or poor planning

Type 2: One or more individuals with multiple weapons and better planning, including use of IEDs or devices to hamper LE interdiction such as chaining doors

Type 3: Full blown terrorist incident

There are three categories that attempt to address the COMPLEXITY of the event. This is different from the SCALE of the event which is addressed separately in the Mass Casualty Plan. The three types are as follows.Type 1 is one or two individuals with probable multiple weapons and minimal or poor planning examples may include the Texas Tower incident at Wayne State university consisting of a single gunman planning that consisted of elevated positioning without escape routes.Type two is one or more individuals with multiple weapons and better planning, including use of IEDs or devices to hamper LE interdiction such as chaining doors. Columbine and Virginia Tech would be examples of a Type Two incident.Type 3 would be a full blown terrorist incident. This may include multiple locations, multiple groups of perpitrators and extensive planning. An example of a Type 3 incident would be the terrorist take over of a school at Beslan or the Mumbai incident.6Mass Shooting StatisticsMost common weapons used: Hand guns 36% Rifles 53%Shotguns 11%

Handguns and shotguns had higher rates of mortality.

Many weapons have been used in Active Shooter incidents. We have seen high powered hunting rifles, military style rifles, handguns, explosive devices, knives and shotguns.In general handguns and shotguns have had higher mortality rates. This could be due to the type of weapon, skill required for use (shotguns have a wider area of effect) or proximity to victim (e.g., handgun) high power rifles require more expertise to employ accurately and long guns are much less concealable than handguns in regard to sneaking them into a venue versus a handgun. Generally the closer the shooter is to the victim the higher the mortality rate.Closer range= greater mortality7Law Enforcement (LE) ResponsePrior to Columbine: Cordon off areaWait for SWAT

Allows for greater number of victims and delays access to medical care

Law enforcement response has evolved primarily since the Columbine Tragedy. The old school of thought was to cordon off the area, secure the perimeter, call for SWAT or Special Response team and then attempt communication and lastly make a tactical entry.Our experiences over the last 15 years has taught us many lessons on dealing with Active Shooter scenarios. 1st lesson is that time is of the essence. Active Shooters often select soft targets. Schools are easy targets since they have prominent weapons free school zone signage across the country. Some but not all schools may have a school resource officer or similar armed security. Places likes banks, military and government instillations make seem like high value targets terrorist attacks but for most active shooters they are simply looking for a place they can create the most carnage with minimal resistance. In fact most active shooters have either committed suicide, stopped the killing, or been stopped by Law enforcement on first contact or resistance. Simply waiting for SWAT only allows more time for continued killing and delayed care for the wounded.

8Law Enforcement ResponsePost-Columbine:Immediately pursue, establish contact with, and neutralize the killerResponding officers form 3-4 man teams (wedge or diamond)May be a single officer

The current standard for LEO training in response to Active Shooter incidents is now to have the first responding officer or officers to proceed to the sound of gunfire and attempt to neutralize the shooter and end the carnage.In some locations this may be comprised of the first officer if he decided to proceed or local policy may require two or more officers before entering the area. This will vary.Bottom line is that as soon as policy in a jurisdiction allows LEOs will proceed to the sound of gunfire or last know location and attempt to contact and neutralize the threat.This terminated the threat to additional people as soon as possible and allows medical treatment and evacuation to begin.This is really no different than a firefighter entering a burning building to save trapped victims. The burning building poses a significant risk to the firefighter but they make a calculated judgment of the risk to themselves versus the possibility of saving lives.

9Immediate LE Action Rapid DeploymentIndividual or multiple officers move to and neutralize threat

Casualties are bypassed until threat neutralized

For the initial contact team the LEOs will not stop to render aid to wounded persons. Their singular initial goal is to stop the shooter and prevent further loss of life.This may be hard for some LEO/Medical personnel to comprehend. To put it another way, the best medical care that can be provided when under fire is to have LE stop the threat and its ability to inflict further harm. The idea is to end further loss of life that may occur if the shooter is allowed to continue. Once the threat is isolated or unable to continue shooting then we will be able to provide care to those already wounded.10Contact TeamIdentify and move to threat e.g., sound of gunfire

Eliminate or isolate threat

Reiterate the points. Drive it home.11RTFProvides care and evacuation from within the Warm ZoneTwo EMS personnelTwo LEOs

Training NeedsInteraction and movement with LEOWorking in body armor/helmetsMental preparation for bypassing a casualtyLife-Saving Interventions (LSIs) onlyEffective and proficient tourniquet (TQ) applicationLifts, Drags, and CarriesSOP

Specific training for RTF members must include how to interact and move in conjunction with the LEO security team. Specific SOPs and tactics may differ from jurisdiction to jurisdiction and should be rehearsed ahead of time within your local community with LEO partners.EMS is not traditionally used to working in body armor and helmets. They provide us with protection from certain weapons but are not perfect and can be defeated. The extra protection also comes with trade offs to include limitations of mobility vision dexterity and added weight.As previously mentioned, there must be some mental preparation for the prospect of having to bypass a casualty. This is not something that is really ever taught in traditional civilian EMS courses. Stopping the threat is the #1 priority.Once the situation is controlled and considered a warm zone and the medic can enter the tactical field phase we must also switch from traditional civilian A-B-C mentality and utilize the SALT Triage algorithm and utilize LSI interventions only on our initial assessment. This will allow the most appropriate use of resources until additional resources become available or casualties can be evacuated to EMS.RTF members and LEOs should be proficient in the use of tournaquets. As discussed in the TECC lecture Tournaquets are the single most effective life saving intervention in the setting of Preventable Battlefield deaths. Make no mistake, an Active Shooter scenario is essentially a battlefield. There is someone shooting and people being wounded and dying. It may not be Gettysburg or the Sangin River Valley in Afghanistan but the came tested principles still apply.Also both traditional and improvised Lifts drags and carries should be well ingrained with RTF members. There will never be enough stretchers or stretcher bearers to move everyone perfectly. These are dynamic situations and a warm zone may become a hot zone on a mere moment. RTF members must be able to keep their situational awareness and improvise when the situation demands.13Wright State University Division of Tactical Emergency MedicineEquipment NeedsRifle Plate Body ArmorBallistic HelmetSufficient supply of TQ/Dressings/NPA Decompression NeedlesLess need for IV fluids O2 canisters etc.Triage Ribbon Kits

Specialized Equipment Should include at least the following listRifle plate body armorBallistic helmetAmple TQ, dressings/NPA/chest decompression needles.There is a lessened need for IV start kits and fluids in the tactical environment.We are more concerned with stopping life threatening hemorrhage, basic airway maneuvers and addressing tension PTX in the immediate tactical environment.Also Triage ribbon kits for mass casualty incidents and triage tags for the CCP and treatment/transport sections.The triage ribbon kits and tags will be covered in detail separately.14SummaryLEO response to Active Shooter incidents has evolvedMedical response must also evolveBest medicine when there is still shooting is to neutralize/isolate the threatMedical RTF members require specialized training and equipment

Reinforce the points covered15AWARENESS & TRAINING: Dayton MMRS will provide:Video and Job Aid for non-RTF Fire and EMS personnelVideo and handout materials for all LEOs

AWARENESS & TRAINING: Draft language for LE SOPs with emphasis on:Expectations for LEOs assigned to RTFsLE focus (ignoring victims) until absolute certainty all perpetrators containedJob Aid for public safety dispatchers

TACTICAL EQUIPMENT:

Level IIIA Tactical Vest Large amount of overall chest and back coverageAdjustable to fit multiple medics Identification with Dayton MMRS patch, and Rescue TF patch on front and back

TACTICAL EQUIPMENT:

Level IIIA ballistic HelmetLightweight with high-cut backFour-point harness