Mass Shooting Multi-Casualty Response San Bernardino City Fire Department

Mass Shooting Multi-Casualty Response San Bernardino City Fire Department

At the end of the session, the participant will be able to: Familiarize with the events and response to the Waterman/IRC Incident from the eyes of the San Bernardino City Fire Department Recognize and discuss lessons learned to use in building and maintaining programs within various organizations

The December 2 nd, 2015, terrorist attack at the Inland Regional Center is still an active Federal criminal investigation. This presentation will only cover the medical response, and lessons learned during the incident to help better prepare first responders.

Mass Shooting: FOUR or more shot and/or killed in a single event (incident), at the same general time and location, not including the shooter. 2 Active Shooter: An individual actively engaged in killing or attempting to kill people in a confined and populated area. 1 1.Ellifritz, G. (2016). 10 lessons learned from the new FBI study on active shooters. Active Response Training. Retrieved from http://www.activeresponsetraining.net/10- lessons-learned-from-the-new-fbi-study-on-active-shooters 2. Mass Shootings. (2016). Retrieved from http://www.shootingtracker.com/main_page

July 18, 1984 San Ysidro, California 21 killed, 19 wounded August 20, 1986 Edmond, Oklahoma 14 killed, 6 wounded June 18, 1990 Jacksonville, Florida 10 killed, 4 wounded October 16, 1991 Killeen, Texas 22 killed, 20 wounded March 24, 1998 Jonesboro, Arkansas 5 killed, 10 wounded April 20, 1999 Columbine, Colorado 13 killed, 24 wounded April 16, 2007 Blacksburg, Virginia 32 killed, 17 wounded November 5, 2009 Fort Hood, Texas 13 killed, 32 wounded July 20, 2012 Aurora, Colorado 12 killed, 58 wounded December 14, 2012 Newtown, Connecticut 27 killed, 1 wounded October 1, 2015 Roseburg, Oregon 9 killed, 9 wounded December 2, 2015 San Bernardino, California 14 killed, 23 wounded Los Angeles Times. (2015). Deadliest U.S. mass shootings: 1984-2015. Retrieved from: http://timelines.latimes.com/deadliest-shooting-rampages/

8 medic engines with 3 personnel 2 medic trucks with 3 personnel 1 Battalion Chief in the City 2 Battalion Chief s in a anti-terrorist class in Rialto Deputy Chief in a anti-terrorist class in Rialto Fire Chief in a meeting in the City EMS Coordinator Engineer on light duty Swat medic in training 2 Battalion Chief s came in to assist

Terrorists enter a holiday gathering of County employees at the IRC and begin shooting Most Active Shooter incidents end within 5 minutes1 The IRC provides support to those with developmental disabilities A total of 33 victims were struck by gunfire, 14 of the 33 died Weapons used were AR-15 rifles The terrorists left an Improvised Explosive Device Response to the incident was rapid The terrorists were killed hours later in gun battle with officers One officer suffered a gunshot wound to the thigh 1: Ellifritz, G. (2016). 10 lessons learned from the new FBI study on active shooters. Active Response Training. Retrieved from http://www.activeresponsetraining.net/10-lessons-learned-from-the-new-fbi-study-on-active-shooters

STAGING NORTH STAGING SOUTH STATION 11/ SECONDARY TRIAGE/TREATMENT

10:58 Initial reports of shots fired 11:03 ME 231 dispatched to stage 11:07 ME 231 arrived on scene/staged 11:04-11:11 11 additional units dispatched/on scene 11:12 MCI declared by ME 231 11:15 MCI Treatment Area established 11:17 Comm Center Reddinet poll initiated 11:21 AMR responding with 15 units 11:24 Bed Availability provided to Med Comm 11:36 3 AMR supervisors responding 11:47 Last critical patient transported off scene 11:54 2 ALS/8 BLS Symons units responding 11:59 Treatment area moved to 231 12:03 Possible explosive device in building

Established Incident Command Predesignated assignments to incoming units Assigned 2 nd Battalion Chief to Unified Command and assumed Operations Coordinated with other agencies for treatment and transport of victims Assigned resources for 2 nd incident (shoot out)

4 months on the job Declared a MCI Reddinet Communication

Ribbon process - initial triage Triage tags secondary triage

Triage/Treatment Area Shooting

Injury Triaged Treated Transported Gunshot 33 19 19 Other 3 3 2 Total 36 22 21 * Data is from initial incident only

Number of Transported to Hospital Mode 22 Ambulance 2 Air Rescue 1 Police Vehicle 3 Private Vehicle or walked 28 Total

Patient Transportation Record Patient # Ambulance Company Priority Destination Disposition 1 AMR Minor SARH Discharge 2 AMR Minor SARH Discharge 3 PD (Probation) Immediate ARMC Discharge 4 AMR Immediate ARMC OR Admit Discharge 5 AMR Immediate ARMC Admit Discharge 6 AMR Immediate ARMC OR Admit Discharge 7 AMR Immediate ARMC OR Admit Discharge 8 AMR Immediate AMRC Admit Discharge 9 AMR Minor CHSB OR Admit Discharge 10 AMR Immediate LLUMC OR Admit Discharge 11 AMR Immediate LLUMC OR Admit Discharge 12 AMR Minor KHO Discharge 13 AMR Minor KHO Discharge 14 AR Immediate Riverside County OR Admit Discharge 15 AR Delayed Riverside County OR Admit Discharge 16 AMR Immediate LLUMC OR Admit Discharge 17 AMR Immediate LLUMC OR Admit Discharge 18 AMR Minor CHSB OR Admit Discharge 19 AMR Minor KHF OR Admit Discharge 20 AMR Immediate HSTB OR Admit Discharge 21 POV HSTB Discharge 22 AMR HTSB Discharge 23 AMR HTSB Discharge 24 AMR HTSB Discharge 25 AMR HTSB Discharge 26 POV Minor KHF Discharge 27 POV Minor KHF Discharge 28 AMR LLUMC Discharge

Injury Severity Number Death 14 Gunshot Wound/Critical 11 Gunshot Wound/Complex 5 Gunshot Wound/Soft Tissue Only 3 Orthopedic 9 Total 42 Definitions: Death Triaged on scene as dead Gunshot Wound/Critical Patient required emergency surgery Gunshot Wound/Complex Patient had wounds involving multiple systems, i.e., soft tissue with fractures or soft tissue with neurological deficit Gunshot Wound/Soft Tissue Only Did not require surgical repair or was not accompanied by lifethreatening blood loss Orthopedic Non-life threatening wounds not caused by gunshots, i.e., trip and fall

Hospitals All critical patients off site in approximately 15 minutes Last critical patient arrived at hospital within 57 minutes of extrication EOC s set-up within 20 minutes with surgeons, pharmacy and blood bank Hospitals commended for protecting the privacy of patients

Engines and ambulances staged Reduced force protection (Waterman) IED s/pipe bombs found in SUV Cross fire and/or innocent bystanders Four (4) patients injured in TC secondary to car chase and shoot-out (all minor)

Set up unified command between Fire/EMS and LE immediately Interoperability for Communication Set up triage/treatment immediate to control use of POV s Predetermine assignments PTA Set up triage/treatment as close as possible to casualty collection point for easy egress in and out Perimeter Control for triage/treatment Areas Utilize apparatus as safety barriers for triage/treatment areas TIME! Effectiveness of treatment

Ellifritz, G. (2016). 10 lessons learned from the new FBI study on active shooters. Active Response Training. Retrieved from http://www.activeresponsetraining.net/10- lessons-learned-from-the-new-fbi-study-on-active-shooters Los Angeles Times. (2015). Deadliest U.S. mass shootings: 1984-2015. Retrieved from: http://timelines.latimes.com/deadliest-shooting-rampages/ Mass Shootings. (2016). Retrieved from http://www.shootingtracker.com/main_page