Integrated Response to Mass Casualty Incidents

I enjoyed seeing what to expect from EMS providers and getting to use NIMS/ICS because it had been so long since I used it last.


I recently had an opportunity to attend a one day course called EMS Response to Active Shooter put on by TAC-MED, LLC. outsidePhiladelphia,PA.  TAC-MED offers several courses ranging from Self Aid to Applied Tactical Medicine.  When I received the course announcement, it said that it was designed for Law Enforcement, Emergency Medical Services, and the Military.  I thought this would be a good opportunity to see whatEMSis thinking and how they might handle a Mass Casualty Incident (MCI) or Active Shooter situation.  Once I registered for the course, I received an e-mail welcoming me to the course and attachments were included that contained a recommended equipment list and a short review of NIMS/ICS (National Incident Management System/Incident Command System).

The training day started with sign-in, introductions, and directions to the complimentary donuts and liquid refreshments.  The instructors had varied levels of experience and educations which included doctors, paramedics, EMT’s, and police.  Students in the class ranged from EMT-Basics to Paramedics and police, some of whom were also EMT-Basic providers.  I myself am currently in an EMT-Basic course so this course was going to serve a dual function for me.  Class room instruction included the history of active shooters, the basics of the military’s Tactical Combat Casualty Care course, controlling bleeding, NIMS/ICS review, and some other medical interventions that police are generally not worried about during these types of situations.  TAC-MED also provided pizza for lunch and there were break out sessions during the lunch break for police andEMSto practice various medical skills like applying tourniquets, pressure bandages, nasal and oral airways, advance airways, surgical airways on left over parts from slaughtered pigs, etc.  The break out sessions also exposed the students to different medical products available on the market and how to improvise when supplies start to run low.  The day concluded with an MCI/Active Shooter scenario utilizing the principles of NIMS/ICS.  Numerous volunteer role players were present and medical supplies were given to theEMScrews along with equipment bags. 

During the class room portion, TAC-MED explained their new concept in the EMS realm of sending EMS personnel in to a warm zone without the entire scene being completely safe.  How many times have you heardEMSstage near a call until they get the all clear from law enforcement?  You are still going to hear this in your day to day interactions withEMS.  TAC-MED’s doctrine is that during MCI’s, it can take a long time to secure a large scene and valuable time is lost which can cost a patient their life.  For example:  You are dealing with an active shooter in a three story building and there are patients in need of medical attention on the first floor where you entered.  You have cleared the entire first floor and the shooter is contained in the upper floors where it seems that he has barricaded himself.  TAC-MED is saying thatEMScould enter the first floor, quickly treat life threats, and evacuate the patients.  To do that,EMSis going to need an officer(s) to escort them to the area you have secured.  The officer will need to stay with EMS to provide security, keep all the providers you entered with together, direct them to move their patients to cover or concealment if possible before rendering aid, and then they will need to be escorted out of the warm zone.  The medical interventions byEMSshould be only those to treat life threatening injuries like heavy bleeding, penetrating chest wounds, and inserting a nasal or oral airway.  This is not the time for CPR, AED’s, surgical airways, or anything else that will take up time.  You want to getEMSin and out as fast and safe as possible.  Make sure you take a count of theEMSproviders you take in with you to ensure that you don’t leave any of them behind when you escort them out.

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