April, 2015
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April, 2015
Understand the history of school shootings
Understand the motivation and similarities regarding school shootings
Improve understanding of the planning, training, and equipment required to manage this type of event
Understand the most efficient EMS response for the event
Review the use of the C.A.T. tourniquet
Lovely, sunny spring day in April
A male student has just opened fire with an semiautomatic rifle. First shots occurred near the nurse’s office, he is currently walking classroom to class room.
The radio is active with multiple police, fire and rescue responses
The incident is on-going, and the number of shooters is uncertain.
> 387 school shootings since 1992
Children ages 5-14 in the U.S. are 13x more likely to be murdered with guns than in other industrialized countries.
School shootings have resulted in over 50 deaths since 2012.
Majority of states have now experienced at least one school shooting
On the average, someone is shot every 15 seconds
Average incident last 12 minutes, 37% last less than 5 minutes*
43% of the events are over before law enforcement arrives*
*FBI law enforcement bulletin May 2013
All school shooters are alike
The school shooter is always a loner
School shootings are always revenge motivated
Easy access to weapons is THE most significant factor
Is often a single gunman Statistically uses small
caliber arms Is Male 97% of the time Has a history of mental
illness May be a current or former
student(s) at the targeted school
No clear cut stereotype Variable motives Single vs. Multiple
Shooters
Attackers make plans Attackers talk about
their plans Attackers are often
encouraged by others Attacker has chosen
one or more targets School staff are often
the first responders Preventing School Shootings: A Summary of a
U.S. Secret Service Safe School Initiative Report 2002
Short lived (shooting typically over in 12 minutes or less)
Confusion delaying 911 calls
Response of police
Response of the School Staff
Lessons learned from military and civilian events
Interagency planning and cooperation
Preparation is paramount
“By failing to prepare, you are preparing to fail”
Multidepartmental : Police, Fire, EMS, Federal and State Agencies
Develop SOPs for response
Real time communication between communications center and emergency personnel
Safety Equipment
Remember, Planning is NOT Training
NIMS
Multiple Staging Options
Check for “dead zones” with radio communications
Real Response Times
Access to the building
Vary Staging Sites with Training
Screen Area For Obvious Dangers
On Site Security
Safety – Hot and Cold Zones
Rapid Assessment of Needs
How many ambulances? BLS? ALS? Helicopters? Buses?
Notify hospitals to activate disaster system
Multiple Vehicles - staging
Multiple Weapons
Establish Unified Incident Command
Establish Perimeters
Parents
The Press
Walking wounded (often psychological)
The Community
Establish scene control!
Everyone is a potential shooter until patted down and cleared
Rapid Triage, as able
Establish safe area for triage and treatment
Shooting may still be active
Threat suppression
Hemorrhage control (C.A.T. tourniquet, as needed)
Rapid Extraction to safety
Assessment by medical providers
Transport to definitive care
WINDLASS
OMNI TAPE BAND WINDLASS STRAP
Refer to Code 21: Isolated extremity injury…..
For Uncontrolled hemorrhage:
Consider the use of a hemostatic agent
Use a tourniquet, if needed:
1. Note time of placement
2. Apply as close to the injury as possible
3. DO NOT release once applied.
Pain relief measures: Morphine 5-10 mg slow IV, 5mg increments, Nitrous oxide (if available) and patient able to self administer.
Rapidly performed in the warm zone
Direct walking wounded to a specific exit with hands up and exposed
Notify Triage Officer of impending stretcher/backboard cases
Triage is widely known as the colors red, yellow, green, black.
New terminology that may be more acceptable to those not familiar with EMS triage guidelines, would be to refer to those patients that are not viable as “purple”. This new color is not yet widely known. Be aware when used for MCI
CCP may vary by incident or time
Warm zone with relative safety
Should be to the rear of the event, with armed coverage
Access to means of rapid egress
Booby traps
Secondary Shooters
Pre-planned Secondary Targets
Remember, you may become a target as well
Avoid smudging footprints, blood smears/spatters
Avoid contact with weapons, spent rounds
Use of paper rather than plastic bags.
Triage tag use
Similar to other MCIs
Initial care in the treatment area
Massive hemorrhage
Airway
Respiration
Circulatory
Hypothermia, Head
Injury
Physical Injury
Psychological Injury for both victims and responders
Extends well beyond physical injury
Extends beyond those in direct contact with the shooter
Increase in depression, suicide, anxiety, fear.
Critical Incident Stress Management, for both victims and responders
School shootings are becoming more commonplace, fatalities are not
The changing response of EMS: Triage color coding, MARCH, CCP, etc.
Who becomes a “victim” of the event may extend well beyond direct contacts
After MANY debriefings for mass shootings, the recurrent key is PRE-PLANNING and MULTI-DEPARTMENTAL TRAINING
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