Tactical Emergency Medical Service in Salt Lake City As Provided by the Salt Lake City Fire Department
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Tactical Emergency Medical Service 1 Tactical Emergency Medical Service in Salt Lake City as Provided by the Salt Lake City Fire Department Karl Lieb Salt Lake City Fire Department Salt Lake City, Utah Tactical Emergency Medical Service 2 CERTIFICATION STATEMENT I hereby certify that this paper constitutes my own product, that where the language of others is set forth, quotation marks so indicate, and that appropriate credit is given where I have used the language, ideas, expressions, or writings of another. Signed: Tactical Emergency Medical Service 3 ABSTRACT The integration of Tactical Emergency Medical Services into law enforcement special operations is becoming more common throughout this country. These personnel are often drawn from fire department ranks given their common public safety responsibility, their training in emergency medicine, and their experience in providing emergency care in various environments. Such programs allow emergency medical responders prompt access to patients who may be in need of immediate medical intervention. The Salt Lake City Fire Department currently has no established program to provide tactically trained emergency medical personnel (EMS) to SWAT members, patrol officers, or members of the public in SWAT or active shooting incidents. In the interest of public safety, Salt Lake City Fire Department needs to provide trained tactical medical personnel as an integral element to any Salt Lake City Police Department tactical operation. The purpose of the following research was to identify and provide both Salt Lake City Police and Salt Lake City Fire with a practical means to provide tactical EMS service to police department operations during these types of responses. Action research will be used to answer the following questions: A. How do other agencies effectively integrate tactical EMS (TEMS) into their operations? B. What are the parameters of the training? C. What are the common obstacles to such programs? D. What type of TEMS program would be most beneficial to Salt Lake City? A simple survey was used to generate data regarding the existence of such programs and their basic organization. Public safety organizations of similar size to Salt Lake were solicited to provide relevant data that was valuable in the development of a program for Salt Tactical Emergency Medical Service 4 Lake City Fire Department. The results indicated a significant percentage of public safety organizations integrate the two disciplines in varied models. Recommendations incorporated this data into a practical two-phase plan that would address the need for both SWAT medics and TEMS trained firefighters who may be the first responders to this type of incident. Tactical Emergency Medical Service 5 TABLE OF CONTENTS Abstract ................................................................................................................................... page 3 Table of Contents .................................................................................................................... page 5 Introduction ............................................................................................................................. page 6 Background and Significance ................................................................................................. page 8 Literature Review.................................................................................................................. page 13 Procedures ............................................................................................................................. page 25 Results ................................................................................................................................... page 28 Discussion ............................................................................................................................. page 31 Recommendations ................................................................................................................. page 35 References ............................................................................................................................. page 43 Appendices Appendix A: Survey ............................................................................................................ page 46 Appendix B: Standard Operating Guideline ........................................................................ page 47 Tactical Emergency Medical Service 6 INTRODUCTION No two incidents involving a mass shooting/active shooter are the same. It appears that the "bad guys" (criminals and terrorists) are more determined, more violent, and more heavily armed than ever before. Many of these types of events cannot be peacefully resolved or negotiated and crisis situations such as "mass killings" appear to be occurring with alarming frequency (Vernon, 2010a). Public safety organizations today have to be prepared for virtually any type of emergency. The "all-hazard" approach now applies to police, as well as fire departments throughout the country. The fire industry has evolved to become a primary resource for emergency medical service in many urban locations in the United States. As such, they must be integrated into some of the tactical operations conducted by police departments in times of immediate need. One such type of immediate need is "active shooting incidents". In these instances, police personnel are focused on mitigating a threat that will continue to utilize deadly force on innocent civilians until such threat is terminated either by police intervention or suicidal action. History has shown that an active shooter will wound, kill, or otherwise incapacitate any civilian in his/her path in a premeditated effort to cause maximum impact on society's norms while leaving a tremendous toll on human life. Often there may be medical need inside the perimeter long before the scene is safe. It is the TEMS provider who may provide this care (Carmona, 2003) This is where fire/emergency medical service (EMS) personnel become invaluable. In those first few minutes that an individual sustains such a wound, their chance for survival is exponentially increased with immediate emergency medical intervention. This is what many Fire Departments across the country provide to their respective police/SWAT teams; an ability to Tactical Emergency Medical Service 7 address civilian casualties and operational injuries on-scene during an active shooting incident. This service is a necessary by-product of our current culture; where individuals maximize shock- value by demonstrating little or no regard for human life. That being said, the challenge for most fire departments is the integration of their resources with those of the Police department. Our missions are quite different, and given the diverse training that each entity provides, it is not surprising to encounter obstacles in the development of multi- departmental logistics, resources, program design, costs, standards, and policy. Salt Lake City Police Department currently has no established program to provide tactically trained emergency medical personnel (EMS) to SWAT members, patrol officers, or members of the public in SWAT or active shooting incidents. In the interest of public safety, Salt Lake City Fire Department needs to provide trained tactical medical personnel as an integral element to any Salt Lake City Police Department tactical operation. The purpose of the following research is to identify and provide both Salt Lake City Police and Salt Lake City Fire with a practical means to provide tactical EMS service to police department operations during these types of responses. Action research will be used to answer the following questions: A. How do other agencies effectively integrate tactical EMS (TEMS) into their operations? B. What are the parameters of the training? C. What are the common obstacles to such programs? D. What type of TEMS program would be most beneficial to Salt Lake City? Tactical Emergency Medical Service 8 BACKGROUND AND SIGNIFICANCE March 21, 2005: Red Lake, Minnesota Indian Reservation; 16 year old active shooter kills 5 students, 1 teacher, and a guard before killing himself October 2, 2006: Lancaster, Pennsylvania community college; active shooter kills 5 students then himself. April 16, 2006: Virginia Tech University; active shooter kills 31 people while moving from dormitory to classroom. This is the most lethal active shooter in U.S. history. May 26, 2007: Moscow, Idaho courthouse; sniper kills one police officer, wounds another before killing himself. December 5, 2007: Omaha, Nebraska; active shooter kills eight people and wounds 5 others in a shopping center. February 8, 2008: Baton Rouge, Louisiana: A nursing student kills two and then herself at Louisiana Technical College. February 14, 2008: DeKalb, Illinois: Active shooter kills seven students and wounds 15 others in a classroom at Northern Illinois University before killing himself (Vayer, 2003). These are just some of the incidents that have led to a collaboration of fire and police resources to meet the service need for emergency medical service on-scene of such events. Tactical Emergency Medical Service 9 These incidents are not, however, exclusive to "other cities". In Salt Lake City alone, we have seen active killing incidents first-hand: April 15, 1999: Family History Library; 71-year active shooter kills a security officer, patron, and wounds five others (including a police officer) before being shot by police (Gunman