Tactical medics made life-or-death difference to San Bernardino shooting victims By Beatriz Valenzuela San Bernardino County Sun SAN BERNARDINO, Calif. When Ryan Starling and the rest of the members of the San Bernardino Police SWAT team heard the crackling chatter of shots fired over the police scanner on the morning of Dec. 2, many thought it was part of a training exercise. That day, Starling and the team were taking part in an active-shooter training at the Arrowhead Springs Hotel, less than 10 miles from the Inland Regional Center. Just before 11:30 a.m. they heard the call over the scanner. We were missing about six guys from the team and thought maybe they re setting up another scenario, he said. When we heard multiple people down, that s when we knew it was real. The SWAT team members were among the first officers on scene that day and Starling was the first medic to assess the wounded and the dead. With the help of other medics who arrived a short time later, Starling was able to successfully triage 17 seriously wounded people some struck several times by the rapid fire of Syed Farook and his wife Tashfeen Malik s assault rifles. All 17 survived. They did a great job, said Dr. Michael Neeki, a tactical surgeon with the Inland Regional SWAT team and emergency room physician for Arrowhead Regional Medical Center. The embedding of tactical medics and physicians into SWAT teams over the past few years has proved to be an invaluable change to the emergency personnel response and the ability to treat mass casualty situations. Golden hour of trauma
What we re trying to do is to decrease that golden hour of trauma, said Neeki, referring to the hour immediately following a traumatic event, during which there is the highest likelihood that medical treatment will prevent death. What we want to get to is golden minutes of trauma. We re trying to have a better chance of survival in the field to some degree. If you can get someone to the hospital within that first hour then they have a better chance of surviving their injuries. Having paramedics inside instead of waiting for police to secure the scene helps, Starling said. Both Starling and Neeki have undergone an initial year and a half of tactical training to be part of the teams. They carry the same firearms and wear the same body armor as the officers. As the number of emergency situations that law enforcement have to respond to increases, so does the need for well-trained boots-on-the-ground medical personnel. In 2013, the Obama administration and the International Association of Firefighters endorsed a study from the Federal Emergency Management Agency that recommended medical first responders enter the hot zones in mass shooting situations to provide the most immediate help for victims. In the past, paramedics would wait for law enforcement to clear a scene before entering. Today, Starling is the tactical medic on the San Bernardino police SWAT team and Neeki is the sole trauma physician with the Inland Regional SWAT team. We need more people, Neeki said. It was Starling s quick work and training that helped keep the survival rate of those taken to area hospitals, including Arrowhead Regional Medical Center, at 100 percent. In less than 15 minutes, all 17 of the most critically injured were pulled from the IRC and were on their way to trauma centers. And they all survived, said Neeki. They did a great job.
Precious moments Since the massacre at Columbine High School on April 20, 1999, there has been a push to have more medical personnel embedded with SWAT teams. On that day, SWAT officers followed protocol at the time and took several hours to secure the high school. They went room to room making sure there were no additional shooters and in that time, one of the wounded, teacher Dave Sanders, died. The shootings began at 11:19 a.m. and it was after 3 p.m. when some of the final victims were brought out of the high school s library. Among them was 18-year-old Lisa Kreutz, shot in the shoulder, arms, hand and thigh. She survived. That showed how you need to have trained tactical medics on the teams to help get medical help to victims and officers, said Starling. Everything is progressing and now they have SWAT medic schools. It s becoming an industry standard. However, a perfect storm of fire department promotions, retirements and attrition among both the fire and police ranks has led to a drop in medics on the San Bernardino police SWAT team, according to officials. I m the only one left, Starling said. We just had a guy retire so I m the only one. When Starling first joined the SWAT team there were three medics. At the height of the collaborative program, there were six. Currently, Dr. Michael Eby is the department s only tactical doctor. There are three medic applicants going through the certification and background process. (The medics) have proved to be an invaluable resource for tactical teams across the nation, said Lt. Travis Walker with the San Bernardino police. He oversees the department s SWAT team and was at the IRC when the attacks took place. I m proud to have some of the best tactical medics in the industry assigned to our department.
As the only tactical physician on his team, Neeki agrees that more medical personnel on the front lines will have a positive effect. For me, it may be a little harder because I m a volunteer on the team, said Neeki. But it s very important so we can get that care where it s needed to save lives. As a volunteer, Neeki is responsible for obtaining his own firearm and protective gear. I ve gotten a few things donated to me by Rialto police, but I mostly have to find my own gear, said Neeki, who immigrated to the United States from Iran. Right now I don t have a back plate so if someone decides to come up behind me and shoot me, I m done. Neeki hopes the events of Dec. 2 will push the federal government to help fund programs that would make it easier for doctors to become SWAT-trained trauma physicians. You still see their faces Sitting in church on a recent Sunday, Starling was overcome with emotion as the pastor spoke about the 14 victims who perished in the Dec. 2 terror attack. As the pastor said the names of the victims, Starling began to sob. I remembered seeing them and where they were and I just cried, said the San Bernardino firefighter, who only a few days earlier had the difficult task of triaging those gunned down. That was the first time Starling felt the full weight of that day s tragedy, he said. When you re there in the moment, you have a job to do, he said. When we do this, you kind of have to put personal feeling aside and do your job. You look to treat each person, but you still see their faces. In the hours after the attack, those faces resurfaced as news reports began identifying those killed that tragic day.
When everything was done, I had to go back to the fire station and work that night, said Starling, an engineer paramedic with the San Bernardino City Fire Department. The following morning we re watching TV and you see the victims family and you remember. You remember where they were laying, where they were in the room, the people you couldn t help. That s where I broke down a little bit. Dec. 2, 2015 Starling, a five-year SWAT veteran, and his teammates made their way to the IRC, some in their personal vehicles, others in the SWAT armored vehicle. They made the 18-minute drive from Arrowhead Springs Hotel to Inland Regional Center in about 10 minutes, he recalled. In those 10 minutes, he and the rest of the team listened to the voices of the first officers on scene, including that of San Bernardino police Lt. Mike Madden. We knew they were on the east side of the building, so that s where we went, Starling said. We encountered multiple people down in the door and the sidewalk. Like Madden had previously described, Starling remembers the sharp, acrid smell of gunpowder from the shooters weapons still heavy inside the building, especially inside the conference room where just a few minutes before, a group of San Bernardino County employees were enjoying their holiday party. Officers cleared the first floor of the three-story building and were making their way toward the second floor when Starling began the task of helping the wounded and identifying the dead only a few feet from what later was determined to be a bomb. As more officers began to arrive, Starling made sure the most critically wounded were taken to a medical staging area at the entrance of the San Bernardino Public Golf Course, across the street from the IRC. At one point Starling ran outside and noticed his fire crew was standing by. He grabbed three crew members and ran back inside.
I knew they could help me with the triage, he said. With more help, the first responders began evacuating more of the wounded from the building. We were putting people in private cars and driving them out, said Starling. Then a San Bernardino County Probation Department officer arrived in a white pickup truck. That was a great heads-up by probation. Rescuers used the bed and hood of the truck to drive out the wounded to awaiting medical personnel.