Our thoughts and prayers go out today to our emergency response colleagues in Las Vegas, who were called upon to manage one of the deadliest mass shooting events in our nation’s history. We also grieve for the innocent victims of this senseless attack.

The mass shooting, which occurred during the final act of a three-day outdoor music festival near the Mandalay Bay Casino on the Las Vegas Strip, has been reported to have killed at least 50 people, including two off-duty police officers, and wounded more than 200 others.

The gunman, a Las Vegas resident named by the Las Vegas Sheriff at a press conference as Steven Paddock, had cameras set up to see when police arrived and reportedly commited suicide before they breached his hotel room. His roommate, who was a person of interest, has been located and was likely not directly involved.

A special telephone line (866-535-5654) has been established for anyone seeking information on a loved one who might have been involved.

The gunman used a high powered rifle from a vantage point on the 32nd floor of the Mandalay Bay Casino. The gun appears to have been in automatic mode and the gunman obviously had a large volume of ammunition available to him.

Early reports from this chaotic open-air event praised the efforts of the first responders for their quick actions to neutralize the gunman and get EMS units and care to victims under the worst of circumstances, which included EMS crews having to work at an active scene without good cover for protection. There were reports of shooters in multiple hotels as a result of the confusion, sound deflection and panicked callers; a widely-scattered crowd made triage difficult to contain in one central area; and a mass of police vehicles and fleeing attendee vehicles that inhibited EMS vehicle access to the scene.

As an educator who spends a lot of time studying, analyzing and teaching medical response and mass care tactics at incidents of this nature, I feel compelled to make a few points early into the reports on this incident.

This assault is eerily similar to the deadly sniper shooting that occurred on August 1, 1966, when Charles Whitman rode an elevator to the top floor of the University of Texas Tower in Austin, Texas and opened fire, holding the campus hostage for 96 minutes. The death toll in that incident was 16 and three dozen were wounded. The difference in that incident was that Whitman didn’t use an automatic weapon. Instead, he strategically aimed and targeted individuals from his high vantage point.

In this case, the shooter used an automatic weapon and randomly sprayed the crowd with bullets.

Some important points to think about today, in light of this horrific incident, are:

  1. The need for a coordinated response with Law Enforcement, that places units and triage out of harm’s way;
  2. Individual First Aid Kits (IFAKS) in ambulance and police vehicles to ensure ready access to supplies essential at shooting incidents (Trauma dressings, wound clot dressings to be rapidly packed in wounds, chest seals, scissors and tourniquets);
  3. A quantity of IFAKS in ambulances, supervisory vehicles and support vehicles that can be tossed to responders treating gunshot victims spread over a large area. The traditional mode of dropping a single supply box in one area to supply these items to providers is not efficient in a large surface area mass shooting event;  
  4. The need for the availability of ballistic vests and helmets for EMS responders charged with moving into Hot or Warm zones – controversial in many systems at present;
  5. Establishing safe and secure triage and transport areas, away from, or protected from, the shooter(s);
  6. A “fast-track” transportation process that rapidly triages gunshot victims and gets the most severely wounded away and properly distributed to area trauma centers and acute care facilities;
  7. Early hospital alerting of the incident location and scope, particularly because history has shown that people will self-transport to hospitals, bystanders will not wait for EMS unit arrival to transport, and place will attempt to move the mass number of victims to hospitals if a triage funnel system is not in place early.
  8. A line, or rectangle of Fire Department engines can offer a level of protection against high caliber bullets. In the August 2016 Editor Page, I discussed this in detail. Emergency responders need to know that water tanks on fire engines can be a helpful protective barrier during an active shooter event.

To help you prepare for and respond to incidents of this nature, which EMS crews have never before been confronted with, JEMS  published several articles that we believe you should have your crews read or re-read: