Below are summaries of important EMS clinical information presented at the 2014 Gathering of Eagles in Dallas on Friday, February 28, 2014.
(Presentations will be made available for download atwww.gatheringofeagles.us following the conference.)
From Sandy Hook, Conn. to Hartford, Conn.: Getting Active about Active Shooters
Presented by William P. Fabbri, MD (FBI Medical Director)
Definition of Active Shooter: An active shooter is an individual actively engaged in killing or attempting to kill people in a conﬁned and populated area; in most cases, active shooters use ﬁrearms(s) and there is no pattern or method to their selection of victims.
1. 98% involve a single shooter.
2. 2% involve improvised explosives.
3. Mean Total Time is 12 minutes (< 5 minutes in 37% of the cases) [Example: Va. Tech shooting lasted 8-9 minutes and 174 rounds were fired.]
4. 50% of the time when police arrive, the shooting is still going on.
5. The name of the game is to rapidly engage the shooter to stop the killing.
6. There’s a one in three chance that the first arriving officers will be injured.
7. Have tactical medical care in place in your community.
8. Use common terminology.
9. Law enforcement needs to do more and better incident command systems.
10. EMS must be trained, coordinated and ready to join law enforcement personnel in a compressed geography (WARM ZONE) to be able to save wounded victims and
Assessment (including triage)
Transport (to definitive care)
Homeland Security Is Addressing Home Town Security: A Report from this Month’s DHS Stakeholders Meeting
Presented by Kathryn H. Brinsfield, MD, MPH (DHS)
1. We must get medical and police responders to work together more frequently.
2. We must get better and faster on hemorrhage control.
3. Proper PPE must be readily available if you are going to work in the warm zone (including ballistic protection), and we need to buy the right things.
4. Be prepared for IEDs in our homeland.
5. Don’t write policy that “puts us in a box.”
6. Teach police to use (and carry) tourniquets. “No one should die from bleeding out in the day and age.”
Tactical Moves: How Philly Firefighters Are Now Preparing for Firefight
Presented by C. Crawford Mechem, MD (Philadelphia Fire Department)
1. Stage in secure areas until police have the threat mitigated.
2. FEMA Active Shooter Guidelines: Read them! They are available online here.
3. Deploy EMS in “cleared” areas (also known as warm zone)
4. Use Rapid Assessment Medical Support (RAMS) Teams—specially trained groups that resemble our tactical teams but are ready ASAP after scene arrival.
5. Use standard tactical medical care in the warm zone.
6. In Philadelphia, all paramedics have gone through one day of special training in a “move through."
7. Philadelphia is deploying combat gauze, tourniquets, chest seals, body armor, helmets, and rapid movement adjuncts on all EMS and Fire units.
8. Some personnel will say “I didn’t sign up for this.”
From Leviticus to the ACS: Revised Guidelines for External Hemorrhage Control
Presented by Peter P. Taillac, MD (NASEMSO and Medical Director of the state of Utah)
The American College of Surgeons Committee on Trauma convened an expert panel (that reviewed 1,600 footnoted documents) and made key recommendations that will soon be published in Prehospital Emergency Care:
- Follow the new algorithm;
- Train with and use commercial tourniquets whenever possible;
- All emergency responders should use hemostatic agents in conjunction with direct pressure; and
- Learn (and use) wound packing—something that hasn't been either taught or stressed to EMS personnel in the past.