2020 Trauma/Critical Care Presentations

Alexandria Barton, OMSII1, David Langley, OMSII1, Joshua Calvano, OMSIII1, Rebecca Ryznar, PhD1, Ryan Henschell, OMSIII1, William Suddarth, OMSII1, Alex Knippenberg, OMSII1, Andrew Glen, PhD1, Anthony LaPorta, MD1, Ryan Shelton, NREMTP2, Renato Rapada, DO1; 1Rocky Vista University College of Osteopathic Medicine, 2South Metro Fire Rescue

Objectives: Active shooter incidents have increased in frequency and complexity with emergency personnel struggling to manage these events from a law enforcement (LE) and medical standpoint. A significant contribution to failure in these events is a lack of realistic training. Put simply, training does not take place in an environment resembling conditions where providers must perform critical skills under heightened stress.

Methods: In November 2018, South Metro Fire Rescue (SMFR) performed 18 simulated mass casualty events with the goal of the first critically injured patients being transported within nine minutes of gunfire. Simple bleeding control was the first critical factor and shared objective of LE and EMS. For LE there was a limited amount of contact teams deployed to stop killing by the perpetrator(s). Newly arriving, untasked officers were allocated to apply tourniquets, pack junctional injuries, apply chest seals and report victim locations as the second critical factor. Other skills that were evaluated for trigger time and success of intervention were cricothyrotomy and needle decompression. These procedures were performed on “Cut Suits”, a human worn task trainer. On May 7th, 2019 these same LE and EMS from SMFR responded to the STEM School shooting.

Results: The impact of stabilization at the STEM shooting was immediate with the first Douglas County Sheriff entering the building to confront and stop the killing. LE immediately followed into the warm zone to apply tourniquets and a chest seal on multiple patients. Unified Command was established allowing for the transportation of the first critically injured patients in 15 minutes and 33 seconds. It was clear at this point, that viable patients are, and have been, dying in mass shootings due to the lack of simple bleeding control and rapid access of first responders into the building.

Conclusion: It is vital to have SWAT Paramedics integrated with LE in the hot zone while having fire/EMS and LE quickly behind for rescue of known victims reported by interior teams. The shorter the time from trigger to patient access and intervention, the greater the survivability for patients. The repetition and attention to detail through multiple dry runs are key to success. The task trainers allowed EMS to avoid hesitation when applying tourniquets during the STEM event by desensitizing providers to interfacing with live patients. To keep these skills current and save lives, it is of the utmost importance to continue multi-disciplinary active threat training throughout the year.