Across the United States, first responders are applying lessons from Tactical Combat Casualty Care (TCCC) to high-risk civilian medicine. School shootings, workplace violence, domestic terrorism, and targeted attacks on law enforcement officers (LEOs) and firefighters can require a response that combines emergency medicine with tactical and rescue operations. North Adams is no different and North Adams Ambulance is leading the way for cross agency training.
After two years of planning and training, North Adams Ambulance Service has entered into a new level of operations, but not without expanding operational relationships with North Adams Police, MCLA Campus Police and North Adams Fire Department. The service, led by Chief John Meaney purchased Pointblank tactical body armor and ballistic helmets to be worn during any high risk incident where weapons are known or suspected to be present. “We have been catapulted into a different arena of response and the enhanced relationship between these agencies is at an all-time high.” Said Chief Meaney.
That’s why last summer, approximately 65 civilian responders from four Northeastern states gathered at Drury High School in North Adams, Massachusetts for two days. The event’s organizer, Amalio Jusino of the North Adams Ambulance Service, welcomed LEOs, firefighters, and emergency medical technicians (EMTs) from New York, Connecticut, Vermont, and Massachusetts. He asked them to keep an “open mind” about what they’d learn, and to think of themselves as “a team” rather than as members of separate branches of emergency response.
Breaking down inter-agency barriers isn’t easy, but Jusino’s philosophy has succeeded. “We have a no-borders planning group and it spans from the Mayor of the city to the newest employee when it comes to emergency response,” Jusino said, “Everyone has a voice at the table and that is critical when you are focusing on Tactical Emergency Medical Services.” TEMS involves both classroom instruction and hands-on training where police, fire and EMS all work together.
As the opening speaker, North Adams Mayor Richard Alcombright told the TEMS trainees about his concerns for responder safety. Recent attacks on police officers across the U.S. are well-known, but Mayor Alcombright also noted a 2012 incident in West Webster, New York in which an arsonist shot and killed two firefighters.
A failed bank robbery also informed the Mayor’s support for the two days of TEMS training. A former bank president, Alcombright recalled a May 2008 incident when the Massachusetts State Police (MSP) bomb squad was called-in to clear what was believed to be military-grade TNT and a detonator device from a failed robbery. “North Adams is a small city,” he explained, “but it’s a microcosm of larger urban areas”.
Lead Instructor, Sean Barry of Close Range Tactical Consulting and self-described “hybrid” between an LEO and a tactical medic, Barry has state and local police experience and is graduate of the U.S. Department of Homeland Security’s Counter Narcotics Terrorist Operations and Medical Support (CONTOMS) program with Jusino. “Cops hate medicine,” Barry said, but they need “baseline skills” such as how to apply a tourniquet – even to themselves. At the same time, EMTs can’t wait to administer emergency medical care because “the patients will bleed out” while LEOs secure the area.
Barry taught TEMS attendees by examining attacks on LEOs in Massachusetts, and analyzing MCIs across the U.S. and around the world. Case studies included school shootings at Newtown, Connecticut and Columbine, Colorado; the Boston Marathon Bombing; and the Beslan School Siege in Russia. The MCI at Columbine High School led to major changes in operational procedures, Barry said, because “the shooter had control of the location for a long time” while medics waited to enter the building.
By contrast, medical care in the aftermath of the Boston Marathon Incident was almost immediate. EMTs applied tourniquets, but so did civilians who tore their shirts into strips to create makeshift medical devices. An area near the finish line had been configured to support personnel in the event of an MCI, and five Level 1 trauma facilities were just miles away. Most communities don’t have as many hospitals as Boston, however, so local responders may be a patient’s only medical resource during the “golden hour”, the critical period after wounding.
Barry stated that a terrorist attack on a school is “what keeps him up at night” in the event of such an MCI, first responders in a geographically-remote area like North Adams would have to “hold the fort until outside help arrived”.
Meaney recognizes this concern and credits the Board of Directors for allocating funding for such training and equipment. “As the Chief of this service and within this community I refuse to allow our responders to be ill-prepared and the purchase of this equipment and the constant training with NAPD and NAFD is invaluable.” The national focus is to not delay entry and to provide rapid life-saving medical interventions for massive hemorrhaging, airway management and breathing control. The “warm zone” concept of operations continues to be practiced with force protection teams allowing for EMS and Fire to enter when cleared with the assistance from law enforcement. Chief Meaney praised the work of NAFD, MCLA, NAPD and the Mayor for the inter-agency cooperation to complete a Hostile MCI Policy that has been adopted for each agency, something that he feels is the first in the history of the departments.
Jusino indicated that this training will be elevated in the near future as he continues to secure funding for additional training that will span throughout the region and create a unified system of response. “The next phase is to have all our partner agencies equipped and trained as we can never determine where an incident of this nature will occur” stated Jusino
The equipment is currently placed on all ambulances in the city and there are additional ballistic vests that would be brought to any larger scale incident for additional EMS and Firefighters to wear. The vests are stored at the Ambulance and have their own custom hangers from National Hanger Company of North Bennington, Vermont. Jusino contacted Kyle Danforth of NHC and he was thrilled to provide specialized wooden hangers with North Adams Ambulance logo “We needed a solution for the weight and size of the vests and Mr. Danforth stepped up and made it happen” said Jusino.