Normally the role of fire/EMS is to stand by several blocks away in the event of an Active Assailant incident often referred as an Active Shooter incident. This creates one of two problems if injuries have occurred. Law enforcement extracts the injured and, if possible, takes them to the waiting ambulance, or the injured lay waiting for the fire/EMS crews to enter. In a large scale incident this process of law enforcement securing an area can be hours. Neither solution is optimal. The first necessitates emergency medical treatment and takes law enforcement away from their primary mission and the second increases death and serious injury because the injured go untreated.
Successful intervention in the management of casualties is greatest in the first few minutes after wounding. Any plan that delays arrival of the medical provider at the patient’s side, such as having conventional EMS on standby, will have a deleterious effect on outcome and should be avoided whenever possible.
While the Gila River Public Safety group has completed the initial training of fire and EMS crews to utilize tactical PPE and treat patients under Tactical Emergency Casualty Care (TECC) guidelines this program is not training crews in Tactical Emergency Medical Support (TEMS) which is far more reaching and a sub-specialty of EMS in and of itself. TEMS medics, often referred to as SWAT medics are trained to insert with law enforcement and correctional tactical teams and to treat the sick and injured in the hot zone. The current best practice of Active Assailant incidents is to train medical crews to deploy to the warm zone for the treatment and evacuation of critical patients under the security of armed law enforcement officers. EMS Division Chief Kevin Knight and the Gila River Public Safety committee on Active Assailant (Shooter) Incident Planning has dubbed this response as Active Assailant Emergency Medical Support or AAEMS (11/2013). Our training system and protocols are in line with the DHS and InterAgenecy Board Rescue Task Force guidelines.
April 25-27, 2014. The Gila River Public Safety Division sent representatives through a 30 hour “Care Under Fire II” course after months of planning by all four departments. The training was funded through the GRIC Office of Emergency Management. Gila River EMS, Gila River Fire, Gila River Police and GR DRS developed an inter-agency policy that was then provided to Guardian Tactical Concepts LLC as the basis of the training concept. Guardian did a great job in bringing it all together. The following video and photo shows class 01 for “Care Under Fire II”. This cadre of instructors now have the responsibility to train every officer, paramedic, EMT and firefighter in the community on a yearly basis so that in the event something as tragic as this type of event should occur the emergency response, care and evacuation of those injured will be swift and coordinated.
We started the development of this multi-discipline approach to Active Assailant incidents in July/August of 2013. We met with the Gila River Police Department and very quickly they were on board to change our current response protocols. We started developing an inter-agency policy between Gila River EMS, Gila River Fire and Gila River Police. We dubbed this program Active Assailant (Shooter) Emergency Medical Support or AAEMS. We then chose 8 police officers, 5 EMS providers and 3 firefighters to attend a train the trainer course in Care Under Fire through Guardian Tactical Concepts. These trainers have since undergone several more scenario based training and exercises as they assisted in the development of the program. In December of 2014 the inter-agency policy was signed by the EMS Chief, Fire Chief and Police Chief. By early January of 2015 we completed the AAEMS “Introduction” self-study course for all EMS and Fire responders. Between January 5th and 19th we completed 19 on duty “Awareness” level classes covering over 220 EMS, Fire and Police responders. The AAEMS Awareness class consisted of a classroom presented Powerpoint on the basics of the response guidelines, Tactical Emergency Casualty Care (TECC) guidelines and extensive practice in tourniquet self and buddy application. In February of 2015 we held our first 2 day “Operational” level training for 8 officers, 4 EMS responders and 4 fire responders. Our current response guideline calls for 2 officers to provide security for 2 EMS/Fire responders when entering a “Warm” zone to triage and treat victims. For the training this allowed us to create 4 teams to maximize the number of scenarios we could schedule in a two day period. On the first half of day 1 the trainees work though 4 stations that get them used to wearing the new personal protective gear, drags and carries, tourniquet placement and team movement. The remainder of day 1 is scenario based where each scenario builds on the previous ending day 2 with a large scale MCI where all 4 teams are utilized to complete the mission. The training is complete with simunition being used by the assailants, live volunteer victims and incredible moulage techniques. Because of the logistical requirements of this type of training we decided early on that we could only complete 1 training session per month and thus completed the initial 16 Operational level training sessions in July 2016. We were awarded a Tribal Homeland Security grant in August of 2014 with the help of the GRIC Office of Emergency Management which has helped with outfitting our EMS and Fire responders with ballistic vests, eye pro, helmets and with our overall training budget. Our goal is to provide a 1 day scenario based training once a year for all of our public safety responders to ensure we are ready and prepared to protect and serve the community.
Gila River “Introduction to AAEMS”
The Hartford Consensus I
The Hartford Consensus II
The Hartford Consensus III
USFA Active Shooter Response Guide (2013)
DHS First Responder Guidance (2015)
InterAgency Board ASHE Guide (2016)
Active Shooter Training
Rescue Task Force (RTF) Protocols
Swift Assisted Victim Extraction (SAVE)
Rapid Assisted Casualty Extraction (RACE)
Threat (Threat neutralized, Hemorrhage control, Rapid Extrication, Assessment by medical, Transport to definitive care)