By Kerri Hatt, EMS1 Senior Editor
This week saw the worst mass shooting in modern U.S. history, with 59 killed and over 500 injured.
Even before an organized response could be mounted, off-duty firefighters, law enforcement officials, EMS providers and civilians helped concertgoers flee the scene, controlled bleeding and performed CPR, saving many of the wounded.
A statement from the International Public Safety Association about the MCI in Las Vegas read in part, “Mass casualty incidents like this attack … are rare and horrifying, but they do occur. We must unite to build resilient communities. As threats and tactics continue to evolve, the public safety community will continue to rely on the immediate responders – civilians – for their immediate aid and assistance to others, and their support to rebuild.”
Even in the early aftermath, some takeaways were clear:
- Train citizens in first care. “We must preach the efficacy of the tourniquet and the pressure dressing to ‘Stop the Bleed!’"— Chief Rob Wylie
- Prepare for the worst. “To be able to respond to such horrific events effectively requires planning and training on a regular basis. Interagency coordination doesn’t happen by circumstance.” — Art Hsieh, MA, NRP
- Run! or Escape! To concealment and cover. “The current active shooter survival mantras of Run! Hide! Fight! – or the variation Move! Escape! or Attack! – were conceived primarily for contained venues like schools, churches or office buildings. The Las Vegas shooter was 300-feet above, across Las Vegas Boulevard from the Route 91 Harvest Music Festival, and apparently shooting rapidly and indiscriminately into the crowd.” — Greg Friese
As a new type of mass casualty incident unfolded, it became clear that planning and staging must evolve for this new type of threat.
We reached out to leaders in the fire/EMS field for perspective. Here are some of their thoughts.
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“I believe medical planning for mass gatherings has forever changed. Normal medical planning includes looking at certain benchmarks, such as type of event, age of participants, number of people, whether inside or outside, and temperatures. Medical resources are usually dictated by these factors. You can now add the possibility of an active shooter from an elevated position if there are buildings or hills surrounding the event.
“Planning should include for an active shooter and a multi-casualty event. Unfortunately, the shooter in Las Vegas has created a new paradigm for other active shooters to consider. Planning should also now include sufficient egress points for quick exits and to prevent people from bottling up and possibly trampling each other during a quick exit.” — Gary Ludwig
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“A long-term security solution to public events is necessary. It is not realistic to think that we can prevent attacks against large gatherings of the public in various venues. We can reduce the risk by training the public on the signs of planning, acquisition of supplies or materials that might be used in a violent act.
“There are so many opportunities for the person who has a tendency to commit a violent act against another to get it right. Public safety persons only have to miss a sign one time and bad things might happen. The term is vigilance. We need our citizens to be ever vigilant to suspicious events and say something before it is too late to act. Public safety agencies including hospitals will need to think about what might be possible and plan and train for the possible.” — Chief John M. Buckman III
- “Medical planning for mass gatherings will largely still be part of greater system-wide multiple casualty incident response as opposed to dramatically increasing a presence at every event. Events like Las Vegas are incredibly tragic, yet at this point, very rare. EMS agencies don’t have the budget or resources to expect a Las Vegas-type incident at every local gathering. As part of a system-wide response, additional training in shooting, explosive and other threats is certainly prudent; as is reevaluating the equipment on our rigs for both emergency response and personal protection. The Boston Marathon bombing response was greatly impacted by the medical personnel on scene – yet at this point, it would be unrealistic to expect that level of clinical presence at every concert or large event.” — Dan Limmer
- “I think we’re going to see changes in venue selection for some outside events. I think we’re also going to see more events with mass casualty plans in place, either by choice or because it is added as a requirement by the city/county as part of getting a permit for the event. Tourniquets and/or hemostatic bandages will also become a standard item for all security and event staff to carry.” — Ann Marie Farina
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“In light of tragedies such as the shooting in Las Vegas, our first impulse is to analyze the incident and the response to see what we as an industry can do to improve the response. We should take this opportunity to review our plans and protocols for mass casualty incidents and natural disasters and gain thorough understanding of the events, venues, threats and resources within our communities to achieve focused vigilance.
“It will be important to digest the After-Action Report of the tragedy in Las Vegas. From the AAR, we can learn areas to implement or to alter within our own plans. Thorough analysis the response allows the industry to build lessons learned, best practices and collaborative findings from a tragic incident.
“Learning from this incident is incredibly important; however, we must be careful that we do not overcorrect in our response to the incident. We have historically seen that in reacting to significant events, there is a danger that we create a hyper-vigilance effect in the period immediately following a tragedy that results in responder fatigue. A period of intense disaster and mass casualty planning can ultimately lead to fatigue and complacency by personnel if it does not translate into a culture of preparedness and a consistent, comprehensive planning program that lasts well beyond the coming weeks and months.
“As we move forward from this tragedy, agencies across the country will review and update their emergency response plans with their community partners. It will also be important for every EMS agency to ensure it is providing the training needed to its employees and first responder partners to protect our communities from any incident. Some excellent resources include: The Independent Study lesson: FEMA: IS-15. B: Special Events Contingency Planning for Public Safety Agencies; The National Association of EMTs (NAEMT) Hazards Disaster Response (ADHR) course; and Bleeding Control Course.
“At Priority Ambulance, we offer our prayers and best wishes for our colleagues in Las Vegas. We hope to never respond events like the tragedy in Las Vegas; however, having this type of dialogue helps us all better prepare for that day when it comes.” — Dennis Rowe
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“For agencies that are up to date on current tactics and operations, this scenario adds yet another layer of complexity to mass event planning. Agencies in major metropolitan areas had already anticipated this situation, and will continue to build capacity to their response.
“For agencies that continue to stick their heads in the sand and refuse to actively engage in planning and training for major violent events, I hope it will serve as a huge wake up call. The events of 9/11 were so large in scope, many of us couldn’t understand how we would build a response to it. Focused events such as these are increasingly common and well within the possibility of reality for most EMS agencies across the country.” — Art Hsieh, MA, NREMT-P
About the panel
Gary Ludwig is a 39-year fire service veteran, having served in the St. Louis and Memphis fire departments for 35 years. He has written over 500 articles for professional publications and has been invited to speak at over 250 professional EMS or fire conferences or seminars. He is the co-author of several books and author of “Blood, Sweat, Tears, and Prayers – Firefighting and EMS in Some of the Toughest Cities in America.” He was the 2014 James O. Page EMS Leadership Award winner. He also served on the FireRescue1 Editorial Advisory Board.
Chief John M. Buckman III, also one of our columnists, is Fire Chief’s editorial advisor. He served 35 years as fire chief for the German Township Volunteer Fire Department in Evansville, Ind. He has served nine years as director of firefighter training for the Indiana State Fire Marshal Office. He was president of the International Association of Fire Chiefs in 2001-2002 and is a co-founder of the IAFC Volunteer and Combination Officers Section.
Dan Limmer is a paramedic, educator and police officer who has been involved in public safety for more than 35 years. He has authored more than a dozen EMS textbooks, including the Emergency Care textbook and is a frequent international conference speaker. He is the Chief Pass-ologist at Limmer Creative, a company he co-founded to publish high quality study and test prep programs. Dan is on the EMS1 Editorial Advisory Board.
Ann Marie Farina is a paramedic in Washington state. She has been in EMS since 2003 and has worked in a variety of positions in Alaska and Washington since then. Over the years, her jobs have included working as a wildland fire medic, a dual-role firefighter/paramedic, a 911 transport medic, and as an educator. In March of 2014, Ann founded The Code Green Campaign, a mental health awareness campaign that raises awareness about mental health conditions and suicide in first responders. Through Code Green Ann has worked as an educator, researcher and consultant in order to assist agencies in improving their mental health programs. Ann Marie also serves on the EMS1 Editorial Advisory Board.
Dennis Rowe is director of new business integration at Priority Ambulance, a national ambulance company serving nine states based in Tennessee. Rowe is currently serving as president of the National Association of EMTs and serves as the organization’s liaison on the National Trauma Institute’s Board of Directors.
Art Hsieh currently teaches at the Public Safety Training Center, Santa Rosa Junior College in the Emergency Care Program. Since 1982, Art has worked as a line medic and chief officer in the private, third service and fire-based EMS. He has directed both primary and EMS continuing education programs. Art is a textbook author, has presented at conferences nationwide, and continues to provide patient care at an EMS service in Northern California. He serves on the EMS1 Editorial Advisory Board.