Fire/EMS Change Active Shooter Response

The National Fire Protection Association (NFPA) announced in January, 2018 the approval of the first active shooter/mass casualty standard for Fire and EMS services. The NFPA 3000 is currently a “provisional standard” (PS), and will still require a significant amount of review before final approval as a full NFPA standard.

However, this move by NFPA is monumental! Previous standards for Fire and EMS response was always a stage until the scene is cleared by police. Recent horrific mass casualty events have forced NFPA to re-evaluate this stance, and the new NFPA 3000 provisional standard is an enormous step in the right direction.

Here is a statement by the NFPA Standards Council on the release of the NFPA 3000 provisional standard:

“Provisional standards are developed when there is a serious life safety concern that warrants an abbreviated standards development process. The typical standards cadence is condensed so that a standard can be issued in a shorter time period in the interest of the public; and in this case, first responder safety. The tragic trend of hostile events in the United States prompted the NFPA’s Standards Council to authorize processing of the provisional standard.”

NFPA Provisional Standard 3000

The move of NFPA to adopt more aggressive responses to active shooter/mass casualty events is a monumental shift in protocol. For years Fire and EMS would stage in a safe location until Law Enforcement personnel responded, contained and controlled the scene, and called the scene “secure” for Fire and EMS to move in. This was considered staging in the “cold” area, and waiting for law enforcement to clear the “hot and warm” zones to establish “secure” environments for Fire/EMS to work.

The NFPA 3000 standard addresses the all-too-real failures of emergency medical response to these high-profile, mass casualty events, and will likely revolutionize the cooperative efforts of Law Enforcement and Fire/EMS to save lives in the critical first moments. The changes in response protocol put forward by NFPA 3000 account for the best potential to provide a relatively safe location for Fire and EMS to perform life-saving interventions and transport, while allowing Law Enforcement to actively work the scene to isolate, contain, and control violent suspects.

This new NFPA approach recognizes law enforcement’s standard response of aggressively addressing the killers, to either contain and control them in isolated locations, or eliminate their threat through capture or lethal force. As soon as LE reports the accomplishment of one of those two goals, Fire/EMS will respond into the still “warm” area to begin triage and emergency medical intervention.

From the NFPA:

”Hostile events are happening with greater frequency and ferocity today. It’s critical that we take steps to protect people from this increasing threat,” NFPA President Jim Pauley said. “By employing the unified response outlined in NFPA 3000, first responders, facility managers, hospital officials, and community members can minimize risk before, during and after these devastating incidents.” Pauley added, “We were clearly hearing the need for such a standard from those on the frontlines. Through this process, we are able to respond quickly to provide a critical body of knowledge to those who are faced with such horrendous events, ultimately making them and the public safer.”

NFPA 3000 establishes preparedness, response and recovery benchmarks with a focus on integrated protocol, and civilian and responder safety. When issued, the standard will provide guidance for organizing, managing, and sustaining an active preparedness and response program so that the risk, effect, and impact of hostile events can be reduced.

Efforts to establish NFPA 3000 began in October 2016, shortly after the Pulse Nightclub incident.  A new NFPA Technical Committee comprised of representatives from the Department of Homeland Security; Department of Justice; the FBI; NSA; national police, fire and EMS organizations; hospitals; private security; and universities, was quickly formed. Initial public comments on the issue were gathered in just four months; the NFPA Standards Council unanimously approved the new standards project; and development of NFPA 3000 began in June (2016).

Pre-NFPA 3000 Fire and EMS Response

Prior to the introduction of NFPA 3000 Fire and EMS services typically followed previous NFPA standards guiding Fire and EMS personnel to stage a safe distance away from the critical incident, in a “cold” area. Fire and EMS would wait in this nearby “cold” area for police officers to announce the volatile scene, “hot” and “warm” areas, was “clear” and stable enough for Firefighters and Paramedics to respond.

The following video is an example of Fire and EMS personnel staging in a “cold” area to await a critical incident scene being declared “secure” by Law Enforcement.

These standards were designed with good intentions for everyone, and are not wholly without merit as written. During many active scenes of violence it is wise to have law enforcement respond first and stabilize a scene prior to several Fire trucks and Ambulances responding into the scene. This allows police to apprehend violent offenders, identify and separate victims and witnesses, and generally provide a more smooth transition into emergency medical assistance when the Fire and EMS personnel respond.

Having Fire and EMS personnel respond in too quickly can provide many safety and logistical nightmares for the entire scene. Fire or EMS becoming casualties because the scene is not secured is counter-productive. Fire or EMS personnel treating and removing victims too quickly eliminates important first-hand witness accounts for critical intelligence on the suspects. A scene flooded with emergency responders significantly reduces command and control, and unnecessarily highlights competing priorities.

However, in the case of active shooters/spree killers, there simply is not enough time to sit and wait until the scene is fully secure. Police officers across the nation are trained to rush towards the sounds of gunfire and quickly engage the suspect(s).

The dynamic nature of these events simply do not fit previous models of response. This is one of the many reasons I have strongly encouraged officers to carry multiple tourniquets in their active shooter response kit since fire/EMS response could be delayed.

The Aurora, Colorado Theater Shooting – Pre NFPA 3000

In the Aurora theater shooting you can hear the chaotic attempts of Fire Dispatch, and Fire Command in establishing staging areas, victim numbers and locations, separate Divisions, triage, and extraction protocols. During this time Fire Dispatch advises Command several times the Police are requesting immediate EMS response for multiple gunshot victims, and Police can provide security for them. Despite this, Command focuses on staging organization.

(By 1:45 in the audio multiple Fire and at least 3 EMS units have been dispatched to a known shooting at the Alameda Theater with multiple victims. A Fire commander can be heard ordering units to stage “away from the scene.” By 13:00 Police have requested multiple times for EMS to respond in for victim care, but staging control continues to be priority).

In the immediate confusion of what just happened, and who or how many were responsible, the police officers on-scene knew the traumatic injuries were too severe for their limited training and capabilities, and there were enough officers on scene to “secure” the “warm” zone. Unfortunately, the Fire and EMS personnel followed the old standard and remained several blocks away, staged in lines of emergency vehicles too far from the emergency medical crisis that desperately demanded their presence.

In the Police response video below officers can be heard immediately moving towards the threat, and identifying the primary theater of the killings. In addition, command officers can be heard ordering officers to move into the theater, but also covering the rear to attempt to prevent the killer’s escape.

https://youtu.be/d2iiUru1lUs

While some officers report injured parties and request immediate EMS response to the theater itself, other officers report locating the suspect by 3:31. In just another minute, at about 4:40 officers can be heard giving orders to transport injured to area hospitals by police car. Finally, a police commander can be heard around 5:02 taking charge, requesting Fire/EMS to respond to the adjacent parking lot and bring liters (stretchers) into the “warm” zone to begin immediate triage and transport. Shortly thereafter another officer authorizes officers to transport injured by police car, and this action begins. This type of immediate scene awareness came about through the extensive Active Shooter/Spree Killer response training following the Columbine incident.

Understanding that traditional response models are ineffective, aggressively moving to neutralize the threat, and then quickly assessing injury needs are standard procedures for law enforcement now. Thinking outside the box is emphasized in the Active Shooter training, and recognizing the need to “act now” is heavily emphasized. I’m confident this training led to the police officers quickly realizing there was no time to wait for Fire to organize and then move in with EMS – they had to transport victims themselves if a rescue was going to work.

A report commissioned by the City of Aurora after the killing had these direct and pointed comments concerning the response:

This level of police transport was unplanned and unprecedented. If the police cars had not been used for rapid transport of seriously wounded victims, more likely would have died (emphasis added).

Of the 60 injured victims of the Aurora theater shooting, 27 were transported to area hospitals by police officers. Only 20 were transported by ambulance, the remaining self-transporting.

The Boston Marathon Bombing – Pre NFPA 3000

During the Boston Marathon Bombing there were literally hundreds of Police, Fire, EMS, and other emergency services personnel on scene for one of the world’s most well-known and premier sporting events. Despite all the security, the desire for spectators to line the streets allowed the killers to walk up to the very edge of the event to drop their homemade bombs.

When the first bomb exploded, videos show the police officers in the area stunned but quickly responding to assist the victims and assess the situation. However, when the second bomb explodes only seconds later, the initial shock changes to pre-trained emergency action as dozens of officers rush to the two bombing scenes to assist. Though not an “Active Shooter” event, the protocols by law enforcement remain similar – immediately move to the threat area, try to identify and neutralize the cause of the threat, contain and control the scene, and finally take emergency action to remove victims to medical care.

Sadly, like in Aurora, Fire and EMS had dozens of apparatus and personnel staged a couple of blocks from the finish line (near the bombing sites). However, the response would be similar as in Aurora, most of the Fire and EMS personnel did not immediately respond to the mass casualty area, but instead stayed in their staging area.

Police officers, nurses, military personnel, and many civilians made most of the early victim transports the couple of blocks to the awaiting emergency medical care they needed. Only later, when the scene was somewhat more “secure” did the Fire and EMS personnel respond in force with ambulances and personnel.

Lessons Learned From Aurora and Boston

Fire and EMS can no longer rely on an old standard of stage and wait during critical medical emergencies, even when the source of the trauma is violence from deranged killers. The new NFPA 3000 standard recognizes the cost in human life will be too great to bear, and firefighters and EMS personnel will be encouraged to respond into “warm” zones to treat/evacuate critically injured personnel with law enforcement escort.

NFPA 3000 acknowledges once the threat has been contained, controlled, apprehended, or neutralized, the critical medical emergencies far beyond the training level of most police officers require immediate action. The new NFPA 3000 standard recommends Fire and EMS move into “warm” zones and closely coordinate with law enforcement officers on scene to provide that immediate emergency medical care while the officers provide security.

Several years ago during a City-wide Field Training Exercise (FTX) involving mass casualties from an Active Shooter, the Fire Command of my City refused to move their ambulances and trucks in close to the structure to provide emergency medical care. Even when police reported the known killer was contained in a far off corner of a large building, other areas had been cleared of potential other threats, and other officers had moved injured parties to a staging area at an exit on the opposite side of the building, Fire Command refused to budge – even requesting officers load up wounded in police cars and drive them several blocks away to awaiting Fire and EMS units.

During the debrief Fire Command had their books open, and were quite confident of their stance on previously established National standards. The moderator allowed the Fire Chief to justify their lack of response, quoting standards by number. When finished, the moderator asked the Fire Chief how he was going to respond to the national media questions on why so many victims died that could have been saved. He emphasized an event of the nature of our FTX (Active Shooter, some bombs detonated, and dozens of casualties) would absolutely attract national and international media attention.

The moderator pointed out the local news helicopters would record the long line of Fire trucks and ambulances remaining stationary several blocks away, while police radio transmissions (heard on scanner) would clearly document requests for Fire/EMS to respond to the casualty collection point. The moderator asked the Fire Chief if he believed his stand on the current National standards would hold up to citizen review, media inquiry, and the dozens of victims’ families demanding answers and likely pursuing legal remedy.

I was a part of the Command structure for that FTX, and literally watched the color in the Fire Chief’s face drain away. It wasn’t until the imagery of what that chaotic and horrific human tragedy would look like from the video of media helicopters did it sink in to him. Trying to stand on a National standard not designed for active shooter/spree killer events would be completely unavailing to the public, the media, the victims and their families, and finally – to himself and the Firefighters he proudly commanded. How could he or his firefighters live with themselves for being so close to help, and yet doing nothing!

Birth of the Rescue Task Force – NFPA 3000

The Fire/EMS services are finally starting to understand the complexities and dangers of responding to an active shooter/spree killer situation with mass casualties. It is my firm belief the Aurora theater shooting (killed, wounded); and the Boston Bombing (killed, wounded) were the Fire/EMS equivalent of Columbine to law enforcement.

Within months of that FTX, Commanders from our Police and Fire Departments were meeting regularly to hammer out a plan that would allow police to aggressively seek out the killers to contain, control, and neutralize their threat, while providing a semi-safe area for Fire and EMS to respond in close to the carnage and deliver the emergency medical care they wanted and desperately needed to provide.

The Rescue Task Force concept was not developed by our City, but in talking to officers from New York to Florida to Colorado and beyond, we were among the earliest to establish it into accepted protocol – even before NFPA 3000. This was a huge step forward in critical incident response for our entire City, and the ripple effects of our Fire Department’s willingness to respond into the warm zone to provide emergency medical care was felt loud and clear to neighboring agencies.

The Fire Department in my city is combined Fire and EMS. Our ambulance crews are fully trained firefighters, hired by the Fire Department, and simply assigned to the ambulance as a pay incentive for advanced EMT and Paramedic certifications. Our Fire Department has an excellent reputation in our major midwest metropolitan area. When our FD began to accept, train, and implement the Rescue Task Force concept the idea swept into neighboring Fire and EMS services like water into dry sand. It was like the other Fire/EMS Departments had been anxiously waiting for someone to take the first move, knowing they needed to get into the warm zone to save lives, but not having the courage to jump outside of National standards.

Many of the Firefighters were very suspicious of the new doctrine at first. Fighting fires is extremely dangerous but can be approached and attacked in a fairly systematic manner proven to be effective over decades of practice and adaptation. Getting close to human threats, shots being fired and maybe even explosive devices, during an evolving and dynamic situation was not what they signed up for.

However, additional FTX training scenarios opened their eyes dramatically. Having armed officers with them, and assurances the known threats had been contained, give the firefighters enough assurance to respond in and help. Once they responded to the casualty collection point they jumped right into emergency care, and seemed to be confident in their response despite the nature of the beast. Even when one FTX had a previously unknown shooter show up outside the original containment area, the Rescue Task Force officers quickly took up blocking positions, called in assistance and worked with Fire/EMS personnel to ensure the casualty collection point was secure. The Fire/EMS personnel barely raised their heads on hearing the news and stayed focused on their live-saving functions – exactly how the Task Force is planned.

Rescue Task Force Deployment and Command

Our Rescue Task Force is designed to have an on-scene Police Commander make contact with a responding Fire Commander. This can be accomplished at the lowest supervisory level for both agencies – Police Sergeant and Fire Captain. The Rescue Task Force deployment should, as best as possible, unfold in the following manner during an active scene:

1. Initial Police response will adhere to Active Shooter protocols – seek out and contain, control and neutralize the threat (the Hot Zone).
2. Secondary arriving Police supervision will identify a casualty collection point – often close to the exit leading to the best option for the Rescue Task Force (RTF) site (the Warm Zone). Officers will be assigned as casualty collection point security – a permanent role unless absolute exigency requires otherwise.
3. All victims, witnesses, and others inside the affected area will be directed to the casualty collection point. It is understood many will flee sporadically from multiple exits, but directions should still be given for as much order as can possibly be obtained. Perimeter officers will be directed to identify and gather sporadic fleeing persons and direct them to an exterior casualty/witness collection point.
4. Other Police supervision (which can even be a senior officer) will respond to the (RTF) site and ensure it is a viable location – communicating decisions to Fire command.
5. The RTF Police supervisor makes contact with Fire supervision to respond to the approved RTF site while arranging secondary responding officers to establish a perimeter there. Those officers will become the rescue team security – permanent role unless absolute exigency.
6. Upon Fire Department arrival, Fire supervision will direct pumpers and trucks to pull up parallel to the affected location and bumper to bumper (pumpers full of water, and trucks with heavy equipment make excellent cover). Ambulances will be directed behind the cover of the trucks and pumpers (still Warm Zone). The fact Fire Command is willing to possibly sustain damage to their apparatus is no small feat!
7. Police and Fire supervision will coordinate a mobile Police/Fire-EMS rescue team while ensuring some officers remain for the protection of the RTF site. Fire Command will prepare a triage/treatment area in an off-site staging area (the Cold Zone).
8. Police supervision inside the affected area will notify Police supervision at the RTF site when the suspect(s) have been contained or neutralized, and request the rescue team respond to the casualty collection point.
9. RTF Police officers will escort the Fire-EMS rescue team to the casualty collection point in the safest manner possible (single stack is usually easiest, or a tight column). It is recommended Fire-EMS bring as many mass casualty medical bags and stretchers as possible with the size of the rescue team, and have at least one supervisor.
10. Once the rescue team arrives at the casualty collection point the Fire supervisor assumes command of the casualty collection area, establishing triage and treatment protocols. Police officers provide security and direct action to any threats to the CCP.
11. The Fire supervisor will remain at the casualty collection point to provide Fire Command outside updated casualty counts, conditions, and supply needs. Critical medical needs will receive immediate life-saving interventions but quickly be escorted out to the ambulances by the rescue team (escorted by those assigned police officers).
12. Fire Command at the RTF site will determine and coordinate further treatment and transport of victims brought to the RTF, including adding more Fire-EMS personnel and coordinating ambulance response in and out of the RTF site.
13. Only when the location has been reasonably secured by Police (or known suspects are contained in known locations) will Police and Fire Commanders coordinate rescue teams moving through the structure to find, treat, and transport any remaining victims to the casualty collection point for processing.
14. When all known victims have been located and processed through the casualty collection point (CCP), the Police and Fire supervision at the CCP will decide on collapsing medical care to the RTF site, and ultimately to the Cold Zone triage area.

Fire and EMS Chain of Command – Combined or Separate?

Many Fire Departments have incorporated EMS and Paramedics services into the Fire Department, running their own ambulances. Fire Departments running their own ambulances offer a significant advantage to those who do not. These departments use EMT and Paramedic trained firefighters to serve on the ambulances.

The advantage is you have fully trained firefighters who are capable of performing all the firefighter response needs, along with emergency medical services. Another advantage is these firefighters work together under the same policies, procedures and training. In the field, they are using the same radio channels and language. This really is a best-case scenario for efficient Fire and EMS response.

Other Fire Departments must try to establish a working relationship with independent ambulance/EMS services. Though not ideal, separate Fire and EMS organizations can become efficient as they work together gaining a better understanding of each other’s needs, limitations, and abilities. As long as the two are not duplicating efforts, and stumbling over each other, this arrangement can work.

The disadvantages are obvious. Separate Fire and EMS services often result in competing interests, separate operating procedures, different radio channels, and separate chains of command. During critical incidents, this can lead to unacceptable delays in service by one organization blocking the ability of the other to perform to maximum capacity, or even worse, crossing work spaces creating a hinderance to the success of both entities.

Thankfully in the city I work for the Fire Department assumed EMS services decades ago. The ambulances in our City are Fire Department ambulances, manned and equipped with Firefighters who are completely trained in fire fighting and with EMT or Paramedic level certifications for emergency medical services.

This combined chain of command has created a well-oiled machine in regards to critical incident management and delivery of services.

Fire and EMS Response Post NFPA 3000

As the nation continues to move forward in critical incident response it is incredibly exciting to see the Fire/EMS services recognizing active shooter/spree killer incidents require a different response from years ago. The new Rescue Task Force concept and application is an excellent design to answer the needs and concerns of both Police and Fire/EMS, while bringing emergency medical care as close to the scene as reasonably possible.

Boston and Aurora have proven to be the Columbine of the Fire and EMS Services. Despite resistance to change, the acknowledgement of NFPA for a modified response to these critical incidents involving mass casualties is a huge step in the right direction and will hopefully provide Fire/EMS Departments the standing to move out into new territory.

Even the NFPA acknowledges the new 3000 Standard is nearly unprecedented. In over 120 years of existence the 3000 Standard is only the second “provisional” standard ever issued by NFPA, highlighting the importance of the topic and the need for immediate review on response and tactics by Fire/EMS. Hopefully, more Fire/EMS services will jump onto the Rescue Task Force concept of response, until the entire country benefits.

Of course, everyone in the nation is looking at solutions to the root cause of these horrible tragedies – mentally disturbed people with access to firearms, knives, and explosives. Hopefully, the nation will understand and begin to act on estimates showing up to 1 in 5 adults in America (43.8 million people) suffer from some form of mental health issue (National Association of the Mentally Ill – NAMI).

There simply needs to be more focus, research, treatment, and most importantly to first responders – in-patient housing services for those suffering from the greatest mental health disease and illness. Until then, the combined efforts of Police/Fire/EMS Rescue Task Forces can provide the best chances of survival to the casualties in these events.

About the National Fire Protection Association

The NFPA traces its roots back to 1896 (and beyond) during a time in history where the expansion of electricity was beginning its monumental surge. At the same time the debate over Edison’s direct current and Westinghouse’s alternating current (led by Edison protegé Nikola Tesla), there was serious debate and concern over the highly inconsistent implementation of the newly developed and patented fire suppression systems.

Even with advancements in electrical lighting, there were still at least five accepted codes in this pre-20th Century time. In 1896 the “Joint Conference of Electrical and Allied Interests” convened in New York to hammer out a consistent electrical code. The five accepted U.S. Codes, along with the German Code, the Code of the British Board of Trade, and the Phoenix Rules of England were all considered. Best practices from each Code were recommended. Amazingly the 1,200 American reviewers unanimously approved the new American national code in 1897, and the National Electric Code (NEC) was born.

Perhaps surprisingly, the NFPA was not founded by firefighters or even plumbers. The NFPA was established by several key fire insurance providers with deep connections in building inspections for safety (protecting their investments). Despite the very successful transition into fire suppression sprinkler systems, the manner in which these systems were being built was a “plumber’s nightmare.” Eventually, NFPA Standards 1-12 were tweaked and adjusted and finally approved as a National Fire Protection code.

A committee report titled, “Report of Committee on Automatic Sprinkler Protection” would follow closely and become NFPA Standard 13. From this meager beginning, detailing the very basics of building construction and safety codes, the NFPA Code has grown to over 300 standards, including NFPA 70 (the National Electric Code), and is considered an industry-standard not only in the United States but worldwide.