Firefighters Support Foundation Rapid Response and Treatment Model (R2TM) for Active Shooter Incidents Operational Detail v3.0

About FSF The Firefighters Support Foundation is a 501c3 non-profit organization whose primary mission is to develop, produce and distribute training programs to firefighters and first responders. All of our programs are distributed free of charge. 2R2TM - Operational Detail

Permission Permission is granted to reproduce or distribute this material so long as the Firefighters Support Foundation is credited as the source 3R2TM - Operational Detail

Accompanying Video This PowerPoint presentation accompanies the video presentation of the same title. This program is a follow-on program to our introductory program on the R2TM (Rapid Response & Treatment Model) active shooter response model, titled: Active Shooter: the Rapid Treatment Model (note the name change of the model). We encourage you to view the earlier program first because familiarity with the basic elements of the R2TM is assumed in this program. 4R2TM - Operational Detail

Presenters Jeff Gurske is an Engineer and Acting Lieutenant in the Portland metro area. Jeff is a training contractor/consultant, contributing author and adjunct college instructor. Craig Allen is serves as Training Sergeant in the Portland metro area. Craig holds numerous instructor certifications in firearms, defensive tactics, less lethal weapons and other tactical subjects. 5R2TM - Operational Detail

Lots of good work being done nationally Still a long way to go How do we integrate? What impacts does this integration have on training, protocol and sustainability? Integration of Public Safety Welcome 6R2TM - Operational Detail

2007 – 2013 Highest numbers of incidents 2014 – On track for a record setting year Historically these events have taken > 12 min % under 5 minutes Rumors of a 2 nd shooter usually high Time & Intensity What We Know 7R2TM - Operational Detail

Public safety response not integrated Condition of our SOPs or SOGs Tradition and culture Incident Friction 8R2TM - Operational Detail

The Principles Hot Zone: Exclusion Warm Zone: Reduction Cold Zone: Support The Problem: #1 most common A.A. item Causes a progress friction point – Fire/EMS is waiting for the “all clear” Zone Response 9R2TM - Operational Detail

Level I Trauma Hospital – 14 years: ,167 cases Blunt and penetrating trauma Results found: –Increased mortality rate with scene times ≥ 20 min Trauma Study Orange County, CA McCoy CE, Menchine M, Sampson S, Anderson C, Kahn C. et al. Emergency medical services out-of-hospital scene and transport times and their association with mortality in trauma patients to urban Level 1 trauma center. Ann Emerg Med Feb;61(2): R2TM - Operational Detail

Data driven answers: 1.Mitigate the threat / saving life on the front end 2.The life-saving timeline continues 3.Mitigate time loss / saving life on the back end 4.Meaningful integration has the best chance to impact life-saving across the spectrum Law Enforcement Goal 11R2TM - Operational Detail

Data driven answers: 1.Access patient as quickly as possible 2.Address critical-fixable injuries 3.Get patient to definitive medical care ASAP EMS Goal 12R2TM - Operational Detail

Engineer the Response You may be able to use your current resources to operate efficiently Do not be distracted by tactics – Tactics require a functional system to be effective Engineer your response to work – Embed a “Warm Zone” 13R2TM - Operational Detail

Friction Psychological Physiological Environmentally Uncertainty Remedy Experience Training Nature of Conflict 14R2TM - Operational Detail

A combined effort putting the caregiver at the patient’s side within minutes of wounding to maximize life saving – Agency expertise – Clearly defined roles – Familiarity – Simplicity – Unification of Command Systemic Problem-Solving 15R2TM - Operational Detail

“Everything in war is simple, but the simplest thing is difficult. The difficulties accumulate and end by producing a kind of friction that is inconceivable unless one has experienced war.” Carl Von Clausewitz R2TM Response 16R2TM - Operational Detail

3 Tenets: 1.Rapid LE response 2.EMS securely introduced into a warm zone 3.Rapid treatment and transport of the victims Keep closest to normal SOPs R2TM Foundation 17R2TM - Operational Detail

R2TM LE Overview R2TM - Operational Detail18 Response Rapid Response Tactics Threat mitigation Initiate Sergeant / Battalion Chief link-up Assessment Establish foothold (FOB) Identify Casualty Collection Point (CCP) Security Internal / External security Police bring wounded to CCP Introduction of Fire EMS

R2TM Fire/EMS Overview R2TM - Operational Detail19 Stage Out of line of sight Prepare for response entry Link-Up Establish Unified Command Security escort Enter Warm Zone Begin MCI protocols

Immediate introduction of LE assets Move quickly to last known area of suspect / verification? Understand “sweeps” vs. “clears” What are immediate threat indicators? FOB’s can be useful LE Response 20R2TM - Operational Detail

Does not require 100% confirmation of suspect location Fled, Dead, Captured Once Immediate threat indicators have lapsed, transition to victim assessment / retrieval Can continue sweep operations and CCP identification Threat Mitigation 21R2TM - Operational Detail

Brings stabilization to operations Provides for dual operations Aids UC and point of contact on interior Increases efficiency of interior sweeps Aids with decentralized tactics FOB Purpose 22R2TM - Operational Detail

When immediate threat indicators have subsided LE lockdown hallways, architectural features, large geographical areas Sets the stage for victim transfer Minimal resource allocation can have significant impact Corridor lockdown builds on itself Aids in scene stabilization Corridor Lockdown 23R2TM - Operational Detail

Paramount! Needs to be physical is design Sgt / BC ideal Fire Understands / Police need to embrace and execute Only one location for UC Don’t view UC as a monolithic entity Unification of Commands 24R2TM - Operational Detail

Efficient prioritization Centralized location Simple Concept Manageability Low cost Enhanced Security “Quick Connect” Benefits Casualty Collection Point 25R2TM - Operational Detail

Provides a bridge between police and fire Allows for simultaneous operations Proven military tactic for categorization Minimal UC Command & Control Can have multiple CCPs if necessary and aids in incident control – Use caution on adding unnecessary layers of ops Casualty Collection Point 26R2TM - Operational Detail

Law Enforcement Identifies Fire Establishes Not necessarily victim dependent Ease of vehicle access / transport priority Ability to Secure Adequate Space Should be located on the interior Can establish CCP with barricade / hostage CCP Location Key Elements 27R2TM - Operational Detail

Make a clean workspace – Identifiable treatment zones Reduce the desire to over complicate the MCI – i.e. Internal triage zone to external treatment zone Only essential personnel – “Greens” and other non-injured: elsewhere “Scoop and Run” vs. “Stay and Play” Casualty Collection Point 28R2TM - Operational Detail

Limited to rapid and easy intervention – i.e. Tourniquets – Follow TECC recommendations Victims transferred to CCP via LE – Hasty field triage Get critical patients to EMS first Having LE transfer victims to the CCP is resource driven and supported by the 9 principles of warfare Hot Zone Medical Care 29R2TM - Operational Detail

Extremely effective to combat extremity bleeding Easy to train and inexpensive Studies indicate upwards of 90% associated survival rate Tourniquet Use Kragh JF, Walters TJ, Baer DG, et al. Survival with emergency tourniquet use to stop bleeding in major limb trauma. Annals of Surgery. 2009;249: R2TM - Operational Detail

Stage resources out of line of sight Limit first responding fire/EMS resources – Reconnaissance; Pave the path Take only needed equipment to get the job done Prepare for Entry 31R2TM - Operational Detail

Request link-up over interoperable channel Location to be out of hazard zone Capable members – Fire: officer, BC, Chief; LE: Sgt, Lt., Commander Should be physical – Cautious of non-physical link up Simplify the ICS structure Command Link-Up 32R2TM - Operational Detail

Must have radio interoperability – Ability to talk and listen – Critical for intelligence, integration and safety LE and Fire/EMS should conduct entity specific operations on separate channels/frequencies – Do not impede critical operations Use short succinct communications Communications Plan 33R2TM - Operational Detail

Apparatus Security – Escort – On Engine – NFPA Guidelines Overwatch CCP Security Components of Fire Security 34R2TM - Operational Detail

Will your triage method hamper time? Triaged patients may shift categories on you Fix major problems – TECC guidelines – PHTLS Work trauma codes? Monitor available medical resources MCI Operations 35R2TM - Operational Detail

Increase victim scene times Increases total out-of- hospital time Requires more resources Creates damage Interference with Transport 36R2TM - Operational Detail

Do not shift the MCI to another location – Refrain from blind transport (last resort only) Assign someone to communicate with receiving facilities – Example: Medical Resource Hospital Document as much patient info as practical – Use technology Destination Etiquette 37R2TM - Operational Detail

Stop further harm from occurring What is the weather? – Keep in doors if appropriate – No return: 32*C / 89.6*F Need for decontamination? Environmental Concerns 38R2TM - Operational Detail

Create a response that your jurisdictions can use on a daily basis – i.e. Assault Make sure your neighbors can plug in Keep it simple and highly functional Train on a reoccurring basis – All hands on deck This is a “three legged race” Commit to the Response 39R2TM - Operational Detail

More info Craig Allen – Jeff Gurske – 40R2TM - Operational Detail