By Christopher L. Wistrom, DO; James MacNeal, DO, MPH; Mike Blaser; Kevin Olin; and Ben Biddick
Jackie Joyner Kersee said, “It’s better to look ahead and prepare than to look back and regret.”
Responding to an active shooter incident at a school is one of the most trying and tremendous challenges for any public safety organization. Even in the best of circumstances, well-trained professionals will have difficulty assessing the situation, defusing the incident, treating the wounded, and moving through and beyond the terror.
As EMS and police prepare for these types of incidents, it is easy to overlook those that we are trying to protect. It is even easier to view them as a liability or in the way. After extensive planning and education, we propose that teachers are an often-overlooked and invaluable asset. After all, who is better positioned to be an immediate responder than those already within the situation?
By training those within the immediate emergency how to appropriately render medical aid, we greatly increase the potential survivability of the wounded. This makes the same classrooms, hallways and cafeterias where tragedy just transpired the ground zero for the healing process.
School employees are able to stop the dying if they are empowered to preplan a response, know the preventable causes of death in penetrating trauma, know how to treat the wounded, render emergency aid that stops life-threatening bleeding and how to direct the efforts of others.
These teachers then become vital partners who preserve life. An educated public turns a first response into an immediate response. The empowerment of the education is undeniable and, even if unused, serves to better the mental health of the teachers, students and parents alike. It prevents them from being helpless in their hallways.
A multidisciplinary cadre to address MCI response
This all looks great on paper, but how does reality play out? How does any community respond to the unthinkable?
In searching for that answer, our community engaged in a tabletop exercise. Grasping the full scope of the problem is no easy concept. However, it is clear that in traditional response models, it takes too long to get medical care to those who are injured.
We formed a multidisciplinary cadre to address this gap in care. Ideally, we hoped to find a plug and play education model that could be instituted. After much research, discussion and brainstorming, we found no such plug and play program, and thus developed our own.
The intent from the onset was to empower these untrained immediate responders with the tools necessary to save a life. We hoped this would encourage teachers and staff in the school district to render immediate and immensely valuable casualty care to school staff or students who may have sustained injuries in a large-scale act of violence.
We also desired to make the training universal, so that another community that was struggling with this issue could build on the work we had done and use our program as a cornerstone.
Casualty Care in the Classroom™ was born. This program places pressure dressings and tourniquets in the hands of teachers. It is based on the principles of trauma combat casualty care.
CCC was intentionally designed in a train-the-trainer format. This allows the model to be taught by local law enforcement and EMS with local health professionals to local schools. By using local resources, there is a greater personal interest in the training, as these are the schools our own children attend.
Training teachers to stop the bleed
The training was met with resounding success. Teachers no longer have to wait for public safety personnel to reach them in order to receive aid. They are empowered to render the aid themselves and stop severe bleeding until police, fire and EMS personnel could reach them.
It was shocking just how aware and concerned our teachers were when it came to the daily headlines and reports of large-scale acts of violence. Of 160 active-shooter incidents since 2000, 24.4 percent were at educational facilities, with 117 killed and 1,230 wounded [1].
Providing the teachers with training on how to open an airway, pack a wound, apply a pressure dressing and apply a tourniquet empowered them to take action and participate in the response instead of waiting helplessly for rescue. The teachers were hungry for the education, and since have become an essential element in our response.
We learned in these 45-minute educational sessions that the teachers had questions about what law enforcement officers may look like as they respond, when to call 911, how to avoid overwhelming dispatch, liability, self-aid and improvised aid. All these questions have been adopted as part of the training.
Participants are also educated about the objectives of all the agencies during the response. They are taught that law enforcement is there to stop the killing in order to create an environment where CCC-trained staff and paramedics can stop the dying. When victims understand the necessary role of law enforcement, then they can have realistic expectations. Instructors explain that law enforcement may bypass injured victims during an active threat, but not because they are callous or do not care about the injured.
Empowering teachers to act as active shooter first responders
Although all involved hope this training will never have to be used in a real-world incident, it is essential for a rapid and empowerment-based response to very real dangers should they occur. This positive action seeks to rob the perpetrators of violence of the larger body counts and horrific headlines they seek.
To have teachers who possess an understanding of the public safety response processes, knowledge to provide medical care and empowerment to make practical application of that knowledge creates an environment where our children receive the most rapid and effective care possible in the event of a mass casualty incident. It is the display of a strong, united community and promises to save lives, speed healing and restore safety as rapidly as possible.
The return on this investment is a conscious mind satisfied that every resource available has been prepared and primed to respond to any large-scale act of violence and an unconscious mind ready to resort to its training, rising to the occasion.
This article, originally published October 4, 2017, has been updated
References
1. U.S. Department of Justice, Federal Bureau of Investigation. Study on Active Shooter Incidents between 2000-2013. Sept. 16, 2013
About the authors
Dr. Christopher Wistrom is a board-certified emergency medicine physician and practicing EMS field physician. He also serves as associate EMS medical director for Mercy Health in Janesville, Wis.; Lake Geneva, Wis. and Rockford, Ill.
Mike Blaser is a sergeant; and Kevin Olin and Ben Biddick are officers of the Janesville Wisc. Police Department.
