Main Street Is the ‘New War Zone’ - Major Incidents - @

Main Street Is the ‘New War Zone’

EMS providers should know the hazards of Main Street America



William K. Atkinson, PhD, MPH, MPA, EMT-P | | Monday, October 15, 2012

For many years, disaster training in the U.S. focused mainly on natural disasters—weather, fire, “accidents” and related events. The reasoning was simple: There’s never a question as to whether natural disasters and accidents will occur, only when and to what severity. The magnitude of the need in the wake of the event is the critical unknown.

Unfortunately, manmade disasters seem to be occurring with increasing regularity and painfully devastating results. With these manmade disasters, there are more unknowns than with natural disasters. Main Street is the “new war zone,” and first responders are making it a priority to be prepared for whatever happens. These violent mass casualty events are often associated with gang crime and acts of urban terrorism, and we’re clearly seeing these events occurring with disturbing and increasing frequency.

The Reality of Shooting Events
Perhaps the most shocking—yet so clearly predictable—is an active shooter event. One of the most recent major examples of urban terrorism was the July 20 Aurora, Colo., movie theater shooting rampage. As the events unfolded in the early morning hours of that Friday 20, my thoughts immediately turned to my time in the city. In my early career and for nearly 10 years, I served as president and chief executive officer of Aurora Regional Medical Center and Denver Presbyterian/St. Luke’s Medical Center. In addition, I chaired the Aurora Gang Task Force and had daily and deep interface with many components of the Aurora Police Department, Aurora Fire Rescue and local EMS providers.

Aurora and the metro Denver area are fortunate to have a phenomenal array of dedicated, highly trained public safety professionals.  Likewise, Aurora and the surrounding areas have invested a remarkable amount of time, energy, and public and private resources into emergency services, communications, education and training. Additionally, Aurora and metro Denver are medically rich, with a number of area hospitals and medical professionals available to respond on extremely short notice.

I listened to 90 minutes of radio traffic from the Aurora Police Department and 90 minutes of radio communication from Aurora fire and EMS agencies recorded during the movie theater shooting response. As in any such situation, much of the action isn’t captured in radio traffic alone, but the trained ear does get a feel for the ebb and flow of individual responding agencies as a growing array of units, personnel and equipment are called in to assist across several counties.

The communication demonstrates how clarity is wrested from chaos in such situations. Progressively, various command center personnel understand, the best they can, a rapidly changing situation. In this case, victims were spread across a geographic zone large enough to represent a mini tornado.

To make matters worse, it was impossible to say at first whether more than one shooter was involved. Given past experience with active shooters at Columbine High School in the Denver suburb of Littleton, it’s unlikely that too many people think of a shooting event as being executed by a single perpetrator. Therefore, it was impossible to establish safe triage areas without having people stand guard to make sure caregivers and patients wouldn’t be traumatized by a second round of violence from gunfire or perhaps explosive devices. Moreover, this incident happened at night.

I also watched and read with particular interest the national media coverage of the event. Reporters, most likely for purposes of selling papers or enticing viewers, reported that the hospitals were “overwhelmed.”  This coverage brought me back to a time when I was serving as president of New Hanover Regional Medical Center on the coast of North Carolina when I observed a news reporter filming a story hours before a hurricane was to hit the Wilmington area. For dramatic effect, the reporter doused himself with water before filming the story. This scene was forever frozen in my mind and reinforced that reality isn’t always as it appears.

Preparation Is Our Professional Responsibility
However, in reality, any and all emergency response systems are swamped when an emergency of this magnitude occurs. Planning and preparedness can’t take a break because—as demonstrated by the coordinated response in Aurora—in planning and real-world scenarios, experience matters. As we have learned from thousands of disaster scenarios, patients in need of care are only the tip of the iceberg for any disaster response. Our professional obligation, and by this I mean for each and every one of us in EMS and emergency services, is to imagine the unimaginable and to prepare as if people’s lives depend on it.

In the end, people’s lives do depend on it.

The ability of any community to deal with a natural or manmade disaster is directly linked to planning, human and supply resource availability, prevailing conditions and a bit of old-fashioned luck. With all this in mind, congratulations is due to all the emergency providers, including law enforcement, fire, EMS, hospitals and communications centers, in Aurora and metro Denver for the remarkable work on the night of July 20, 2012, and the following days. Although no community ever wants to deal with a manmade disaster of this magnitude, we can and should pay attention and learn from the experience of others. 

Unfortunately, it appears that our nation now has no shortage of calls to manmade disasters. Planning for and responding to such events really isn’t an option, it’s a professional responsibility.

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Related Topics: Major Incidents, WMD and Terrorism, Aurora shooting, Aurora MCI, active shooter

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William K. Atkinson, PhD, MPH, MPA, EMT-Pis the president and CEO of WakeMed Health & Hospitals and a JEMS editorial board member. He has devoted more than 30 years of his career to improving our nation’s emergency medical and prehospital care system.


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