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Mass Casualty Incidents and Tactical Medical Capabilities Amongst First Responders: 2018 IPSA Study Grant Report

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Mass Casualty Incidents and Tactical Medical Capabilities Amongst First Responders: 2018 IPSA Study Grant Report Official journal of the Australian Tactical Medical Association Mass casualty incidents and tactical medical capabilities amongst first responders: 2018 IPSA Study grant report Jason Hartley1 1 Detective Senior Constable; Western Australia Police Force, Western Australia, Australia Introduction In August 2018, I was awarded the first responders, such as Law Enforcement inaugural Australian Tactical Medical Officers (LEOs), Paramedics/Emergency Association (ATMA) study grant to attend Medical Services (EMS), Firefighters and the International Public Safety Association other emergency personnel. (IPSA) Fall 2018 Symposium in Virginia, United States of America (USA) and Due to operational sensitivities, some conduct research in tactical medical information or conversations from methodologies utilised by first responders. engagements is redacted. This, however, has not affected the substance of this This report outlines the outcomes of my report nor its recommendations. objectives for the study grant: 1) Record the content and lessons My goal for this study grant is to promote learnt by attendance at the awareness and education to groups or International Public Safety organisations which have had limited Association (IPSA) 2018 Fall exposure to tactical medical methodologies Symposium; and or MCIs. Through simple knowledge and 2) Explore tactical medical equipment, survivability amongst victims methodologies, particularly within and first responders can be significantly law enforcement and its application improved. to Mass Casualty Incident (MCI) response. This report is created for the Australian Tactical Medical Association and outlines attendance at the International Public Safety Association The IPSA Fall 2018 Symposium primarily 2018 Fall Symposium and the content of focused on MCIs and the planning, engagements with the United States of America response and recovery to such incidents by first-responder agencies. Journal of High Threat and Austere Medicine: www.JHTAM.org Article published online: 2019 Page 1 Official journal of the Australian Tactical Medical Association Table of Contents Introduction ........................................................................................................................... 1 Arlington County (Police and Fire/EMS) ................................................................................ 3 Metropolitan Police Department of the District of Columbia ................................................... 4 International Public Safety Association 2018 Fall Symposium ............................................... 5 Keynote Speaker - Lieutenant and Chief Medical Officer Alexander Eastman, Dallas Police Department........................................................................................................................ 5 Dr Kari F Jerge MD FACS, Kansas University ................................................................... 6 Intensive Care Paramedic Oliver Ellis, Australian Tactical Medical Association ................. 7 Paramedic Supervisor John Reed, Danbury Hospital EMS ................................................ 9 Federal Bureau of investigation (Critical Incident Response Group) .................................... 10 Recommendations .............................................................................................................. 11 Recommendation 1: Australian first response agencies adopt Tactical Emergency Combat Care (TECC) guidelines. ................................................................................ 11 Recommendation 2: Australian first-responders and emergency departments increase interoperability between agencies. .............................................................................. 11 Recommendation 3: Australian law enforcement and related agencies employ Medical Officers to oversee medical capabilities. ...................................................................... 11 Recommendation 5: Australian Government commission a committee to assess and enhance first responder medical capability at MCIs. .................................................... 12 Recommendation 6: Australian agencies commission timely after-action assessments for MCIs, to ensure that lessons learnt are available with minimal delay. .................... 12 The statements and opinions expressed in this report are those of the author and do not necessarily represent the position, views or policy of any agency, organisation, employer or company. Although the author and Australian Tactical Medical Association (ATMA) have made every effort to ensure that the information in this report is correct, the author nor ATMA take any responsibility for the accuracy of the information contained in this report Journal of High Threat and Austere Medicine: www.JHTAM.org Article published online: 2019 Page 2 Official journal of the Australian Tactical Medical Association Arlington County (Police and training or medical equipment to deal with Fire/EMS) the incident and are reliant on first responders to preserve life and prevent Having developed the Rescue Task Force further injury. (RTF) model, Arlington County Fire Department (ACFD) is at the forefront of A key note is that this is counter to current Tactical Emergency Casualty Care (TECC) Australian civilian first aid methodology and Warm Zone care. ACFD has a where first responders are taught to not put dedicated High Threat Response Program themselves in harm’s way (D for Danger (HTRP) who develop, train and integrate within the DRSABCD paradigm). members of their FD and Arlington County (Australian Resuscitation Council, 2016) Police Department (ACPD) to improve response capability at MCIs. The second fundamental is the driving force of the current mission, which is Annual training provided to ACFD and defined as either Tactical or Medical: ACPD includes refreshers for TECC If tactical, neutralisation or principles and related equipment (such as containment of the threat is the priority tourniquets and chest seals). Scenario- and law enforcement officers (LEO) based training is provided to ACFD & must move past casualties to deal with ACPD by utilising ‘dispatch’ to send the threat. available units to an approximately one- If medical, the threat has been hour event before returning to regular neutralised, contained or is absent and duties. the priority is placed on treating victims and innocent parties. Evident was inter-operability and effective working relationships between agencies, I also noted the following key points in with training being conducted at the same relation to ACPD: location and regularly involving both Tourniquet carriage is mandatory (held agencies. Coupled with this inter- on the tactical vest or support pants- operability training, is the reinforcement by pocket). trainers of ‘Unified Command’. Individual first aid kits (IFAKs) are issued to LEOs, which are normally The training delivery focuses on TECC stored over the passenger’s headrest guidelines, however, I identified two as a ‘go’ bag (immediately accessible). fundamental principles. The first is the Regular active shooter/ Active Armed priorities of life (in descending order): Offender (AAO) training is conducted 1. Victims and Innocent Parties as a one and two-officer response. 2. Public Safety (Police Officers, First Responders etc.) ACFD carry all necessary equipment for 3. Perpetrator/s. warm zone care, including ballistic PPE, specialist medical equipment and triage This fundamental is reinforced to ensure tags. Arlington County demonstrated a first responders understand that the victims well-drilled and developed tactical medical and innocent parties are the first priority. program for Police and Fire/EMS, built on Victims or innocent parties generally have TECC guidelines. This observation is no personal protective equipment (PPE), supported through ACFD delivering TECC Journal of High Threat and Austere Medicine: www.JHTAM.org Article published online: 2019 Page 3 Official journal of the Australian Tactical Medical Association & RTF training to other USA jurisdictions and plain-clothes officers arrived and its reference in TECC/Tactical Medical carrying rifles without being easily publications. identifiable as LEOs. MPDC LEOs had limited appreciation Metropolitan Police Department of of the Navy Yard site and were unable the District of Columbia to locate the scene as it was described as ‘Building 197’ (not cross streets as The Metropolitan Police Department of the LEOs normally use). District of Columbia (MPDC) is the primary LEOs were initially refused entry onto law enforcement agency for D.C. and one the base as it had gone into lock-down. of the 10 largest local police agencies in the Attending LEOs all entered the Hot USA. Zone, including the supervisor who may have been better served by On 16 September 2013, an offender1 creating a command post. entered the Washington Navy Yard, gaining access through his role as a current Information received was inaccurate at contractor. Over the next 69 minutes, he best, attending LEOs did not know how killed 12 people and injured several more many shooters were involved, their (Metropolitan Police Department, 2014). location or their movements. 911 was overwhelmed with calls During this active shooter MCI, the offender resulting in information over-flow to armed himself with a shotgun he legally attending LEOs. owned and a handgun he took after killing Human nature is a “funny thing” and a security guard. Entering Building 197, he you shouldn’t
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