Why an active shooter event is different from a traditional MCI.

By Ryan Scellick

 

            In this month’s article we are going to discuss why an active shooter event is different from your traditional MCI, and how treating these events the same can lead to a multitude of problems. Furthermore, we will address why utilizing standard MCI treatment and triage modalities can lead to further fatalities.

Looking at traditional MCI protocols on how we triage and treat patients is best summed up by saying that we mitigate these scenarios through carefully coordinated action plans. Though a traditional MCI can be chaotic and challenging, there are three major differences between an active shooter event and an MCI. These differences are: patients possibly located in a hostile environment, patients being scattered across a large geographical area, and almost all patients being exclusively red criteria with penetrating gunshot wounds. These three reasons are why applying traditional MCI protocols to an active shooter event can be catastrophic. In this article we will discuss the best practices to mitigate these three extenuating circumstances.

How do we best treat patients located in a hostile environment? To best treat patients in a hostile environment we must first understand that traditional treatments that we perform when you have five responders and one patient, no longer become appropriate when you have five patients and one responder. Having an adequate hostile environment response training (HERT) program with providers trained in tactical emergency casualty care is the first step. As the incidence of active shooter events continue to increase on a daily basis, departments need to be realistic that staging is no longer an option. Providing responders with appropriate ballistic gear, medical supplies, and frequent training with law-enforcement is the only way to better treat patients in hostile environments.

Once you have responders in the appropriate PPE and carrying the appropriate medical equipment (only the gear recommended by the Hartford consensus, talked about in next month’s article), how do you best respond to an event where patients are scattered across a large geographical area? The best way to reach as many patients as possible, as fast as possible, is the rescue task force (RTF) concept. The RTF concept is further broken down in our last article (https://activeshootersolutions.wordpress.com/).

The RTF concept of placing Fire/EMS responders with law-enforcement officers readily able to move with speed from patient to patient as fast as possible is the most efficient and effective way to keep these patients alive. The idea of law enforcement officers grabbing patients and pulling them back to a casualty collection point proves of little effectiveness in a large area warm zone, where patients are scattered long distances apart. However, the RTF concept proves very useful in this situation. Moving through a building treating life-threatening injuries and moving onto the next patient, provides for the best opportunity to keep patients alive who would have otherwise blead out or succumb to a hypoxic injury. Based on size and manpower, multiple RTF’s can even be deployed.

The final problem encountered in an active shooter event versus an MCI, is the modality and criticality of patient wounds. This is the most common misconception in treating an active shooter event like a standard MCI. Standard MCI patients have a multitude of injuries ranging from sprained ankles and broken arms to head injuries. In an active shooter event there are only patients that have penetrating gunshot injuries that are likely of a critical nature. I think any EMS provider would agree that even a minor gunshot wound left untreated for a prolonged period could prove fatal. The most effective way to treat these victims is utilizing the tactical combat casualty care guidelines set forth by the US military and PHTLS. These consist of: placing tourniquets on all appendages that have suffered a GSW, placing a nasopharyngeal airway in unconscious patients, performing a needle decompression on any patient with a GSW to the chest, covering sucking chest wounds, and placing abdominal dressings on any wounds to the head, neck, or torso. To summarize our treatment priorities as stated in TCCC, “stop the bleeding and keep them breathing”. There are two important caveats to utilizing the RTF concept: the first, is that to move rapidly from patient to patient treating as many injuries as fast as possible, the RTF must leave these patients behind when moving on to the next patient. They then must coordinate with a separate team to perform extraction while still under law enforcement force protection. The second, is that responders must treat injuries with suspected outcomes, not current signs or symptoms. What this means is that you must treat injuries not symptoms as we would do in traditional medicine, i.e. performing a needle decompression because somebody was shot in the chest, instead of waiting to have a confirmed tension pneumothorax. The reason this becomes important is because if a tension pneumothorax develops while the patient is waiting to be evacuated, that could prove fatal.

In summary, having the right equipment and the right training can mitigate an active shooter event far more efficiently than trying to apply a cookie-cutter concept to a complex event. Equally as important is understanding that the right treatment at the right time can save lives, however, the wrong treatment at the wrong time can harm patients and further casualties.

Please email us at ryan@activeshootersolutions.us to set up training or purchase one of our custom rescue task force medical bags!!!