The recent tragedy in a high school in Minnesota again brings to light the need for EMS agencies to review their procedures for responding to multiple causality incidents as the result of violence at a school. Even before the events at Columbine High School in Jefferson County, Colo., we had a history of incidents that resulted in multiple students being injured and killed in school shootings. However, since that event in April 1999, EMS agencies have developed and refined their protocols and procedures for responding to school shootings with multiple patients. Such incidents present a complex response scenario that requires regular review and improvement.
I would urge all agencies that provide emergency medical response to develop a strategic response plan specific to each school in your response area for an incident in which multiple students or teachers may be injured or killed.
Steps to develop an effective response plan
The following is a checklist for developing or reviewing response procedures.
Meet with school officials and discuss your MCI response plan specific to each school. Request pre-plans of the buildings drawings that should include all key information, such as offices, classrooms and exits within the buildings. This floor plan will assist you in the development of your response plan.
Organize with other public safety agencies to discuss these emergency response plans. Law enforcement, fire, EMS and dispatching representatives should be familiar with each other s procedures at such incidents. A key aspect is to have all agencies work under a unified command structure, using the national incident management system.
Ensure that a common radio frequency is established to allow your agency to communicate with the police and fire departments. If this has not been established, obtain additional frequencies if necessary.
Host a meeting with other EMS agencies from outside your jurisdiction that could be called to respond to a school-related incident that would exceed your resources. Brief them on procedures and protocols your agency will be following when they are called to help treat or transport patients. Items to discuss include communications, triage and medical protocols.
Meet with members of your organization and discuss possible scenarios. Review the pre-determined staging area and identified potential safe zones for each school location. Assess and evaluate current triage procedures and hospital destination protocols. Review the protocols and procedures that other responding agencies will be using and what those agencies will be expecting your agency to use.
Ensure and emphasize that your procedures do not permit self-dispatch to any such incident. A coordinated response is critical.
Meet with your medical director to review procedures. Unless circumstances dictate otherwise, physicians and nurses should not respond to the scene. In most cases, they won t be familiar enough with field procedures or equipment to be effective.
Because law enforcement will establish control of the scene and the area around the school, ensure that all your personnel have some form of identification that indicates their affiliation with your organization. Only persons with clear identification and proper protective equipment should be permitted into the scene.
Conduct a separate training program to review procedures for dealing with an MCI that is also a crime scene. Although the first priority is to attend to victims, emphasize that extreme effort should be made to protect the integrity of any potential evidence that law enforcement may need to process.
Review appropriate safety equipment. If the possibility exists for your personnel to be at an incident where violence is continuing, like a school shooting, do they have proper protective equipment, like body armor? Although your agency may not be able to provide body armor for all its members, pieces for each member should be carried on a responding apparatus, at a minimum.
Determine if your providers would be able to care for multiple patients with the supplies carried on each ambulance or if they would need to bring additional equipment to the scene. Does your agency have a multiple casualty medical cache of equipment and supplies?
Review rehab procedures for use during the incident and stress debriefing for members after the incident.
This will be a media event, so have a policy in place about who makes statements to the media on behalf of your agency. If you have a designated public information officer (PIO), they can work with media personnel during and after the event. Responding personnel should not be confronted with media representatives requesting incident details.
A school shooting is an act of domestic terrorism. People who commit these acts could conceivably intend to hurt emergency responders in addition to students and teachers. At Columbine, several explosive devices had been placed outside the school to harm responders and slow their overall response to the incident. Your providers should significantly raise their awareness levels to protect themselves and their coworkers.
Such an event as a school shooting is one of the highest crisis management events your service could be involved in. As is often the case, your personnel s first response actions can decisively affect the incident operations. The single most important key is to be prepared. Preparation regardless of the maturity or experience of your responders will help them effectively manage this stressful event. If they have been prepared with specific, adaptable strategies that help protect themselves and other agency members, their confidence and abilities will help provide the best outcome for the patients and the responders.