In April 2018, the FBI’s Office of Partner Engagement released a report on active shooter incidents in the United States in 2016 and 2017. The FBI defines an active shooter as one or more individuals actively engaged in killing or attempting to kill people in a populated area. The FBI designated 30 shootings in 2017 as active shooter incidents. Compare this figure to the one active shooter incident in 2000, and 26 active shooter incidents in 2010.
Casualties from active shooter incidents are also on the rise, according to the FBI’s statistics. Back in 2000, there were seven casualties from active shooter incidents. In 2010, there were 86 casualties, and in the years 2016 and 2017 there were a combined total of 943 casualties from active shooter incidents.
No areas of the country are immune to these incidents. We’ve seen them in big cities and small towns, at concerts, supermarkets, movie theaters, high schools, office buildings, apartment buildings, neighborhoods and even at an Amish schoolhouse. There’s growing public outcry, and the public expects that all first responders will do more to prevent loss of life.
What this means is that every EMS agency and individual EMS practitioner must be prepared to respond to active shooter incidents. To address this need, the National Fire Protection Association (NFPA) recently released NFPA 3000, the Standard for an Active Shooter/Hostile Event Response (ASHER) Program.
The first thing we’re all taught in EMS courses is scene safety. When it comes to responding to active shooter incidents, however, there needs to be a degree of rapid intervention to assist those in urgent need of medical care and to prevent loss of life.
What we’ve learned over the years is that waiting for a SWAT team costs lives, and that it’s important to 1) get immediate information from the victims and persons evacuating; 2) rapidly deploy first responders; and 3) aggressively act to contain or eliminate the shooter.
To accomplish these goals in active shooter situations, many areas have developed tactical EMS teams. The problem with tactical EMS is that these are limited programs; not all areas have them, which means they might not be available in an area where an active shooter situation occurs.
Even if a tactical EMS team is available, they’re generally still coming from a good distance away, and may arrive on scene too late to be of much assistance. Additionally, the costs of training and gear for a tactical EMS team can be high.
New Guidelines & Standards
In April 2013, FEMA representatives from a select group of public safety organizations met in Hartford, Conn., to develop a consensus regarding strategies to increase survivability in active shooter events. The result of that meeting became known as the Hartford Consensus.
It includes the acronym THREAT, which is used to describe the needed response to active shooter and intentional mass casualty events:
1. Threat suppression;
2. Hemorrhage control;
3. Rapid Extrication to safety;
4. Assessment by medical providers; and
5. Transport to definitive care.
Shortly after the Hartford Consensus, FEMA released its Fire/EMS Department Operational Considerations and Guide for Active Shooter and Mass Casualty Incidents.4 This guide discusses the Hartford Consensus as critical to maximize survivability at active shooter incidents. Both the 2013 FEMA Guide and the NFPA 3000 standard discuss the use of hot, warm and cold zones, and recommended tasks to be conducted in each of these zones.
From an EMS liability standpoint, the takeaway from both the 2013 FEMA Guide and the NFPA 3000 standard is that there’s an extremely short window of opportunity to make tactical decisions in an active shooter situation.
Those decisions can and will be subject to scrutiny by the public, the media, affected families, and even a jury if you and/or your EMS agency ends up getting sued over your response (or your lack of response) to the incident.
Immunity for Emergency Responders
Many states provide a limited or qualified immunity for emergency responders, 9-1-1 dispatchers and governmental employees responding to emergencies. However, this immunity isn’t absolute. For example, emergency responders will lose their immunity when they fail to perform the requisite emergency medical services; some courts have deemed such inaction to be “gross negligence” or acting in “bad faith.”5
To limit EMS liability at active shooter incidents, it’s important to understand and follow the 2013 FEMA guide and the NFPA 3000 standard. Both discuss using an incident command system and establishing a “unified command.” They also recommend establishing hot, warm and cold zones when arriving on scene, as well as establishing and directing qualified personnel and assigning specific tasks to each zone.
To limit liability when rendering care, use the THREAT principles and try, to the greatest extent possible, to render threat-based care in a secure location, in either the warm zone or the cold zone.
It’s important for every EMS practitioner and every EMS agency to be prepared to potentially respond to an active shooter incident by developing a policy on active shooter incidents, weighing the risks to the safety of EMS providers against the risks to injured civilians.
EMS needs to work with fire and law enforcement officials to discuss their plan for a coordinated response in advance of having an incident and conduct joint training exercises and protocols to prepare for possible future incidents.
Active shooter incidents aren’t the usual types of incidents to which EMS providers respond, and it’s important to develop unique protocols and policies for handling these situations, and minimizing risk to patients, providers and agencies.
The public’s expectations are changing; waiting to stage until the scene is declared “safe” may no longer be what the public demands.
Nonetheless, it’s still important for all EMS providers to act within their scope of practice and provide care in accordance with medically approved protocols. Most important of all, EMS providers should always use common sense when responding to active shooter incidents; sometimes this can be the best liability prevention measure of all.
1. Mitchell v. County of San Diego, United States Court of Appeals, Ninth Circuit. 243 Fed. Appx. 242 (9th Cir. 2007).
Pro Bono is written by the attorneys at Page, Wolfberg & Wirth, The National EMS Industry Law Firm. Visit the firm’s website at www.pwwemslaw.com or find them on Facebook, Twitter or LinkedIn.