A new report by the U.S. Department of Homeland Security’s Office of Health Affairs, The First Responder Guide for Improving Survivability in Improvised Explosive Device and/or Active Shooter Incidents (PDF), outlines recommendations to better approach these types of incidents. If implemented, this guidance will contribute to saving lives.
Recent incidents demonstrate an IED or active-shooter incident can occur anywhere. No town, county or city is immune from such incidents. The IAFC’s Terrorism and Homeland Security Committee encourages all fire chiefs to review the Guide and address its recommendations.
The document provides guidelines and a baseline for first-responder response to IEDs and active-shooter scenarios. The guide also provides essential elements for first responders to adequately plan for in anticipation of experiencing such an incident.
Guide Recommendations
Many of the Guide’s recommendations come from evidence-based response strategies from the U.S. military’s extensive experience responding to these types of incidents and its research and practice in combat casualty care that are applicable in our first-responder environment. It also incorporates civilian best practices and lessons learned from similar incidents that have occurred in the United States and abroad.
The recommendations are grouped into three categories: hemorrhage control, protective equipment and response and incident management.
Hemorrhage Control – This section emphasizes the importance of controlling severe bleeding to reduce the death rate before a victim is transported. EMS must rapidly and accurately triage casualties at the incident site and expeditiously transport those identified for immediate care to an appropriate hospital. Tactical emergency casualty care (TECC) is discussed as the best practice recommended for casualty management at incidents requiring mass care.
Protective Equipment – This section discusses the need for first responders to develop interdomain tactics, techniques and procedures for response to IED/active-shooter incidents. As technology improves, first responders also should adopt proven protective measures to reliably shield personnel from IED fragments and shock waves. Also addressed is the need to remain vigilant for potential secondary IEDs or additional shooter risk.
Response and Incident Management – This section promotes the essential interactions of fire, EMS, hospitals and law-enforcement agencies, including training, coordination and communications institutionalizing the National Incident Management System. The application of unified command is particularly necessary for the coordinated response of multiple emergency support functions.
Guide Scenarios
Included in the publication are 10 threat-based scenarios that recommend medical and planning considerations; in other words, what arriving first responders can except to observe and encounter.
Discussion points include
- expected injury patterns
- protective equipment and barriers
- response and incident-management considerations
- medical response system
- prehospital EMS considerations
- hospital-based trauma system considerations
- patient movement and patient transfer considerations
The practice of fire and EMS personnel in hot and warm zones is addressed. The publication outlines different models of providing hot and warm zone medicine and recognizes the discretion of the jurisdiction to decide which model is best for their department or region.
The Terrorism and Homeland Security Committee concludes that the publication addresses the key issues of potential incidents well. Fire chiefs should consider their planning based on the document as a good starting point for developing tactics, techniques and procedures.
The guidance is also an effective reminder of the importance of outreach with response partners. Share the guide to discuss and plan around its recommendations with your partners in law enforcement, emergency management, healthcare, education and others. The evidence is clear; communication and coordination between partners before a response to an IED or active-shooter incident benefits scene management and the safety of the public and first responders.
The Terrorism and Homeland Security Committee intends to build on the publication for more specific, detailed and advanced recommendations for the fire service and EMS.
IAFC Resources
The IAFC has published its positions on Active Shooter and Mass Casualty Terrorist Events and Coordination of Responses to an Act of Terrorism.
Fire chiefs should also be familiar with and make use of the IAFC’s Terrorism Response: A Checklist and Guide for Fire Chiefs and Community Preparedness Leaders.
Check out the IAFC’s Disaster Management & Homeland Security Resources webpage for more information and tools.
You can also search the IAFC website for “active shooter” for further information.