Innovations in Active Shooting Emergency Medical Response and Triage

Abstract

The high impact and low frequency ‘black swan’ events such as terrorist attacks and active shooters are becoming the new normal. The terrorist events in Kenya (2013), Paris (2015, 2016), Belgium (2016), USA (2015 and 2016), UK (2017) highlight how ‘unexpected events often audit our resilience; everything that was left unprepared becomes a complex problem, and every weakness comes rushing to the forefront’ [20]. The recent mass casualty shooting events in the USA and around the world [6] have certainly highlighted national security issues globally and have had a profound effect on communities. The response to such an event crosses organizational and disciplinary boundaries such as law enforcement, fire/rescue, EMS and medical centers and as such contributes to potential erosion of efficiency and effectiveness in response stemming from matters pertaining to coordination, collaboration and cooperation. With the rise in prevalence of mass shootings, Emergency Medical providers may now find themselves responding to an active shooter event. Traditional triage and victim management techniques leveraged from military experiences are being re-examined. As noted by Smith et al. [14], ‘A recent analysis of mass shooting events noted a wounding pattern different from military experience with very few cases of life-threatening extremity hemorrhage; therefore, extrication and transfer to definitive care needs to be a priority in addition to any in-place care provided’. As noted in van Rein et al. [19] ‘prehospital trauma triage is essential in providing appropriate care for patients at risk from severe injury to improve their chance of survival’. This chapter will discuss the requirements for a more ‘tactically oriented’ medical response in an active shooter incident, and presents novel triage and scene management techniques to facilitate a more rapid and effective response to maximize victim survivability.