Commentary, Terrorism & Active Shooter, Training

Thousand Oaks, Calif., Bar Shooting Underscores Several Points for EMS to Consider

The shooting at Borderline Bar & Grill, a country music bar in Thousand Oaks, Calif., the second-largest city in Ventura County, highlights several key areas EMS/Fire/Rescue/police agencies should consider during similar incidents.

1. Formal mass casualty incident triage may be delayed.
According to the FBI, most shootings are over in five minutes. First-arriving EMS crews must be ready to take on, triage, treat and transport patients immediately upon arrival. Therefore, crews coming in minutes later may be the ones required to set up formal triage, patient collection and treatment areas.

This image made from aerial video shows Ventura Fire Department EMS Command in the vicinity of a shooting in Thousand Oaks, California, early Thursday, Nov. 8, 2018. Photo KABC via AP

2. Each and every rig should be well-supplied for triage.
Because of the speed of injury presentations at active shooter incidents, it’s critical that personnel carry—and be ready to deploy—triage tags and supplies from active shooter/stop-the-bleed caches in each ambulance. Every kit carried/used by crews should be well-stocked with at least 10 triage tags (in addition to 100 others carried for massive MCIs), so there’s no delay in starting and performing triage.

3. Be ready to immediately treat law enforcement personnel.
EMS crews must be cognizant of the fact that officers will converge and enter active shooting areas quickly. At this incident, Ventura County Sheriff Sgt. Ron Helus arrived in just three minutes, heroically-entered along with a California Highway Patrol (CHP) officer, engaged the gunman directly and was mortally hit by several .45-caliber rounds. The CHP officer performed a rapid extraction, pulling Helus “directly out of the line of fire,” according to the Ventura County Sheriff’s Office. Therefore, EMS was tasked with trauma resuscitation of the officer immediately upon arrival.

Download and share the special JEMS editorial supplement, Special Focus on Active Shooter Incidents & Tactical Emergency Casualty Care, to review tactical operations and special extraction lifts and carries with your crews.

4. Free egress of ambulances is critical.
Staging of ambulances with free egress at these fast-evolving scenes must be a priority, so crews can load and go rapidly and without delay.

This image made from aerial video shows ambulances staged in the vicinity of a shooting in Thousand Oaks, California, early Thursday, Nov. 8, 2018. Photo KABC via AP

5. Intra-agency and tactical training for large-scale incidents is crucial for active shooter readiness.
As in this case, joint MCI and active shooter training between agencies like Ventura County Fire Department, the Los Angeles County Fire Department, American Medical Response, Ventura County Sheriff’s Office, Los Angeles County Sheriff’s Department, California Highway Patrol, area hospitals and all of the involved communications centers, as well as involvement of EMS and fire personnel in tactical training pays dividends when incidents like this occur.

6. Be ready for distracting hazards used by shooters.
Shooters like 28-year-old Ian David Long are now using distracters or confounders such as smoke bombs to mask the scene and assist in their escape. This presents extra hazards to emergency personnel who may not see a shooter(s) exit or move around an incident scene. Smoke can also make finding injured victims more difficult.

7. Alert hospitals immediately to prepare them for self-transports.
As was experienced in the Las Vegas Route 91 Harvest Festival and multiple other mass casualty active shooter incidents, as many as 50% of the victims at shooting scenes of this nature will self-transport themselves to hospitals prior to ambulance arrivals or EMS crew contact. Therefore, EMS command officers and communications centers must alert area hospitals ASAP, particularly the hospitals closest to the incident. Inform the hospitals that victims will probably be arriving at their EDs in personal vehicles, law enforcement vehicles, via Uber, etc., to allow them to ready their staff and facilities.

8. Educate personnel on safely interacting and treating people with post-traumatic stress disorder (PTSD) and mental health challenges.
We live in a time of reduced mental health services and are seeing an increase in the volume of patients experiencing emotional disturbances, including many armed services members with post-traumatic stress that’s not properly and expeditiously managed. Crews must be alert for—and prepared for—calls involving these patient populations. In this shooting incident, Ventura County Sheriff Geoff Dean reported that the shooter was a Marine veteran who suffered from PTSD and was known to the police as troubled, having been reported as “yelling, screaming and throwing things around” his apartment in April of 2018. However, the Sheriff’s deputies involved determined that Long did not present a threat to himself or others and could not be involuntarily committed. Why is this important? Because EMS crews that are threatened by patients like Long must document and report it appropriately, so the troubled person is taken off the street and properly treated so they will hopefully not erupt and kill others needlessly.

9. Identify patients needing extra emotional care, such as double-traumatized victims.
Early reports from this shooting indicated that as many as 25 of the young adults at the scene were also in Las Vegas at the deadly mass shooting last year at the Route 91 music festival. If an EMS crew encounters and cares for a “double-traumatized” victim, it’s important that they attempt transport and alert the hospital that the patient might require additional emotional care and counselling.