A normal day at work is abruptly changed when you are informed of an active shooter incident (ASI) at a school in a cozy, normally peaceful suburb. The initial report indicates that there are at least three adults and four children injured as you scramble to activate mutual aid and secure the manpower and medical resources for care of these patients with the possibility of more victims.
Seventeen years later, shots ring out the high school of another serenely peaceful suburb. The gunman’s shower of bullets leaves three students dead, one paralyzed, and another injured with a guarded chance for a full recovery.
As you place your irons in the car to go golfing with friends, your cell phone rings and it’s your daughter calling. Despite the fact that she lives out of town, the two of you have always been close and you connect by phone daily.
Although you already had a conversation with her that morning, you answer the phone to share more giggles and dialogue. Instead you hear the sounds of mass hysteria and gunfire in the background, and your daughter is screaming that she’s trapped in a shopping mall with an active shooter. She pleads for your protection that you, as her father, have provided to her since birth. She tells you that she loves you before the connection is suddenly disrupted. The seconds before you answered her call, you were eager to hear her voice; however, now the abrupt silence resounds with the possibility that you may never see her alive or hear her cherished laughter again.
A Sobering Realization
The State Board of Emergency, Medical, Fire, and Transportation Services (EMFTS Board) formed the EMS/Homeland Security Committee within the Ohio Department of Public Safety, Division of EMS nearly 14 years ago, and many impactful initiatives for EMS have been launched by this committee.
During a casual conversation during one of our meetings, we were sobered by the fact that nearly every member of the committee had either been a primary responder to an incident involving an active shooter or had an immediate family member who was involved in an ASI as a responder, survivor or victim.1 Although ASIs have occurred for decades, no one can deny that the frequency of incidents involving active shooters have escalated and more lives are placed at risk or lost as a result.
A Call to Action
We reviewed the history and the after-action reports from ASIs globally, and we took note of the lives lost in scenarios where EMS providers and their response remained staged in the cold zone until the scene was deemed safe by law enforcement personnel. Paired with the reality that nearly every EMS/Homeland Security Committee member’s lives had been intimately impacted by an ASI, stagnation wasn’t an option. The rescue task force (RTF) model that was originated by the Arlington County Fire Department in Virginia was deemed by our Committee as an avenue to explore.
The foundation of an RTF requires a close partnership between the EMS and law enforcement sectors. The psychomotor skills required for EMS providers are within the Ohio EMS scope of practice for EMS providers of all levels of certification and/or licensure. Unlike the tactical EMS model, which is traditionally focused on the paramedic, all Ohio EMS providers are eligible to be trained as RTF members if so desired. For the victims of and responder to an ASI, the RTF model delivers lifesaving treatment in the warm zone sparing critical minutes that may be the difference between life or death.
The Path Forward
Unlike most EMS initiatives, the framework of an RTF requires committed partnerships and productive collaboration between law enforcement officers and EMS providers paired with the legislative landscape that varies among states and municipalities.
In Ohio, the EMFTS Board has the authority over the Ohio EMS scope of practice and local EMS medical directors have authority over the protocols for the EMS providers functioning under their medical direction. In addition, the state EMS office is housed in the Ohio Department of Public Safety rather than the department of health like many other states, and this organizational structure proved to be beneficial for us.
Melvin House, the Executive Director of the Ohio Department of Public Safety, Division of EMS, felt that exploration of a statewide RTF initiative had merit, but knew that the inclusion of other public safety sectors would be required.
Mark Resanovich, the chairman of our EMS/Homeland Security Committee at the time and a seasoned paramedic with vast experience in tactical EMS, and Executive Director House met with John Born, the Director of the Ohio Department of Public Safety.
During his administration, Director Born launched a program called A Safer Ohio. A Safer Ohio tasked every division and employee within the Ohio Department of Public Safety to address the question, “What will you do today to contribute to a safer Ohio?”, and the exploration of the RTF model certainly aligned with his mission statement. Director Born fully supported our committee’s proposal, and he tasked representatives from the Ohio Highway Patrol and the Attorney General’s Office to engage with our committee for this endeavor.
In an effort to maximize a successful outcome of the project, an Active Shooter Response (ASR) Workgroup was created that was inclusive of representation from EMS, fire, police and homeland security organizations, as well those tasked to first responder education and community support.2
Through open, transparent dialogue, the ASR Workgroup was able to identify the facts, myths, challenges and lessons learned regarding ASIs, as well as the role of RTFs and the potential avenues through which support and education could be provided to communities with a desire to create RTFs.
Harness the Power of Knowledge
There’s no doubt that emergency preparedness starts at home, the heart of community resilience. Yet, our ASR Workgroup found that many agencies were either not knowledgeable or were misinformed about the RTF model. We needed to tackle the hurdle of educating first responder organizations and others about the lives that could potentially be saved with an ASI response that doesn’t follow the traditional stance where EMS is staged and inactive awaiting confirmation of scene safety.
Over several months, we created a training module that provided a basic foundation of knowledge of the concept of the RTF model. The goal of the training module is to create an awareness of the RTF model. It doesn’t provide nor is it meant to fulfill the required administrative and operational training required for a first responder to be a member of a RTF. The training module was designed to be successfully completed within an hour to minimize the burden on time constraints within the curricula of first responder education programs.
The EMFTS Board and the Ohio Department of Public Safety, Division of EMS, has maintained a long-term commitment to pair the requirements and critical recommendations that they have authorized with support and educational resources at no charge to Ohio EMS providers and EMS medical directors. After much debate, our ASR Workgroup felt that the acquisition of knowledge of the RTF concept was imperative for today’s first responders and that this education should be mandatory. Our proposal was presented to the EMFTS Board, and they agreed.
A Progressive Landmark in EMS Education
On Aug. 16, 2017, the EMFTS Board approved the Ohio Rescue Task Force Awareness training module as a mandatory requirement for initial certification of all Ohio EMS providers. In addition, currently certified Ohio EMS providers will be required to complete the training module once for recertification.
On Dec. 12, 2018, the regulatory language was approved by the EMFTS Board which will ultimately make the completion of RTF concept awareness education a mandatory training requirement in all Ohio EMS education institutions and for all certified Ohio EMS providers effective on Sept. 19, 2019.
We’re also providing collaborative support to our law enforcement stakeholders as they navigate through their established education networks to promote a similar requirement. The Ohio Rescue Task Force Awareness training module includes a set of examinations and a course completion certificate. As this is a novel program, we have added a course evaluation and a survey at the end to the training module to assess the current status of RTF creation and any associated hurdles identified. This data will be utilized to examine, mitigate, and resolve the gaps and hurdles that emergency response systems encounter during the creation and development of RTFs and to assess the establishment of local and regional RTFs within the state of Ohio.
The ASR Workgroup took another important step to produce a white paper as an educational resource for stakeholder organizations, legislators, and laypersons. This white paper, The Evolution of EMS Response to Active Shooter Incidents, provides an overview of the purpose, structure and recommended educational and operational components necessary to generate a functionally effective RTF. This document was approved by the EMFTS Board in February 2018, and it was distributed to the EMS, fire, and police communities through multiple outlets.
Moving Ahead in the Future
The state of Ohio is the first state in the nation to incorporate the rescue task force concept into the EMS education matrix for all EMS students and providers. For the sake of the victims of ASIs and their loved ones, we sincerely hope that we’re not the last state to initiate this measure. Although one may make the argument that most EMS providers will never respond to an ASI, the same can be said about delivering a baby. Although the majority may never encounter this scenario, the knowledge of how to perform this skill is essential for all EMS providers and EMS education curricula.
Our work isn’t done. For those communities that elect to create a RTF, we plan to support their efforts and identify quality resources for administrative and operational RTF education and training. Through our state agencies, we will continue to foster and strengthen the partnership between EMS and law enforcement in the response to ASIs.
It’s Time to Act–What Will You Do?
ASIs have occurred for decades; however, the frequency of them has increased significantly and no community, whether urban, suburban, or rural, is immune or has been spared. As you contemplate the RTF concept for your own EMS system, I would argue that the decision-making process is fairly simple: ASIs aren’t going away anytime soon, but the shift in the paradigm for the response by first responders in an effort to save lives can be implemented immediately. With the proper training, an EMS provider has the capacity to successfully deliver a baby even if they only do this once in their career. Likewise, whether the weapon is a car, a gun or some other device, an EMS provider, with the proper training, equipment and collaborative partnership with law enforcement personnel, can save a life during an ASI.
The decision boils down to two choices. Will you elect to be proactive and enhance first responder preparedness for ASIs? Or will you take the reactive stance with “just-too-late” training following an ASI, after the blood of victims has been shed and lives have been lost? With EMS, fire, law enforcement and other potential RTF partners at the table, the topic, at the very least, deserves a focused conversation.
It’s our sincere hope that planting the seed of RTF concept awareness education will be an important element to foster the growth of stronger community resilience and more interoperable first responder networks in our shared mission to create a safer Ohio. We warmly welcome other national, state, regional and local first responder communities to join us in this effort.
- American Red Cross Scientific Advisory Council
- Aultman College
- Buckeye State Sheriffs Association
- Dayton Metropolitan Medical Response System
- Ohio Medical Transportation Association
- Ohio Association of Emergency Medical Services
- Ohio Association of Chiefs of Police
- Ohio Department of Public Safety
- Division of EMS
- Division of Homeland Security
- State Highway Patrol
- Ohio EMS Chiefs Association
- Ohio Fire Chiefs Association
- Ohio Peace Officers Training Academy
- Ohio Professional Firefighters Association
- Ohio State Firefighters Association
- Ohio Tactical Officers Association