April, 2015
Understand the history of school shootings Understand the motivation and similarities regarding school shootings Improve understanding of the planning, training, and equipment required to manage this type of event Understand the most efficient EMS response for the event Review the use of the C.A.T. tourniquet
Lovely, sunny spring day in April A male student has just opened fire with an semiautomatic rifle. First shots occurred near the nurse s office, he is currently walking classroom to class room. The radio is active with multiple police, fire and rescue responses The incident is on-going, and the number of shooters is uncertain.
> 387 school shootings since 1992 Children ages 5-14 in the U.S. are 13x more likely to be murdered with guns than in other industrialized countries.
School shootings have resulted in over 50 deaths since 2012. Majority of states have now experienced at least one school shooting
On the average, someone is shot every 15 seconds Average incident last 12 minutes, 37% last less than 5 minutes* 43% of the events are over before law enforcement arrives* *FBI law enforcement bulletin May 2013
All school shooters are alike The school shooter is always a loner School shootings are always revenge motivated Easy access to weapons is THE most significant factor
Is often a single gunman Statistically uses small caliber arms Is Male 97% of the time Has a history of mental illness May be a current or former student(s) at the targeted school No clear cut stereotype Variable motives Single vs. Multiple Shooters
Attackers make plans Attackers talk about their plans Attackers are often encouraged by others Attacker has chosen one or more targets School staff are often the first responders Preventing School Shootings: A Summary of a U.S. Secret Service Safe School Initiative Report 2002
Short lived (shooting typically over in 12 minutes or less) Confusion delaying 911 calls Response of police Response of the School Staff
Lessons learned from military and civilian events Interagency planning and cooperation Preparation is paramount
By failing to prepare, you are preparing to fail
Multidepartmental : Police, Fire, EMS, Federal and State Agencies Develop SOPs for response Real time communication between communications center and emergency personnel Safety Equipment Remember, Planning is NOT Training
NIMS Multiple Staging Options Check for dead zones with radio communications Real Response Times Access to the building
Vary Staging Sites with Training Screen Area For Obvious Dangers On Site Security
Safety Hot and Cold Zones Rapid Assessment of Needs How many ambulances? BLS? ALS? Helicopters? Buses? Notify hospitals to activate disaster system
Multiple Vehicles - staging Multiple Weapons Establish Unified Incident Command Establish Perimeters
Parents The Press Walking wounded (often psychological) The Community Establish scene control!
Everyone is a potential shooter until patted down and cleared Rapid Triage, as able Establish safe area for triage and treatment Shooting may still be active
Threat suppression Hemorrhage control (C.A.T. tourniquet, as needed) Rapid Extraction to safety Assessment by medical providers Transport to definitive care
WINDLASS OMNI TAPE BAND WINDLASS STRAP
Refer to Code 21: Isolated extremity injury.. For Uncontrolled hemorrhage: Consider the use of a hemostatic agent Use a tourniquet, if needed: 1. Note time of placement 2. Apply as close to the injury as possible 3. DO NOT release once applied. Pain relief measures: Morphine 5-10 mg slow IV, 5mg increments, Nitrous oxide (if available) and patient able to self administer.
Rapidly performed in the warm zone Direct walking wounded to a specific exit with hands up and exposed Notify Triage Officer of impending stretcher/backboard cases Triage is widely known as the colors red, yellow, green, black. New terminology that may be more acceptable to those not familiar with EMS triage guidelines, would be to refer to those patients that are not viable as purple. This new color is not yet widely known. Be aware when used for MCI
CCP may vary by incident or time Warm zone with relative safety Should be to the rear of the event, with armed coverage Access to means of rapid egress
Booby traps Secondary Shooters Pre-planned Secondary Targets Remember, you may become a target as well
Avoid smudging footprints, blood smears/spatters Avoid contact with weapons, spent rounds Use of paper rather than plastic bags.
Triage tag use Similar to other MCIs Initial care in the treatment area Massive hemorrhage Airway Respiration Circulatory Hypothermia, Head Injury
Physical Injury Psychological Injury for both victims and responders
Extends well beyond physical injury Extends beyond those in direct contact with the shooter Increase in depression, suicide, anxiety, fear. Critical Incident Stress Management, for both victims and responders
School shootings are becoming more commonplace, fatalities are not The changing response of EMS: Triage color coding, MARCH, CCP, etc. Who becomes a victim of the event may extend well beyond direct contacts After MANY debriefings for mass shootings, the recurrent key is PRE-PLANNING and MULTI- DEPARTMENTAL TRAINING