Health and safety
Our job is dangerous, we intentionally put ourselves at risk in fires, but we are not trained to deal with snipers or gunfire. Since the Pulse shooting every apparatus has ballistic vests assigned to it, and our personnel at scenes of violence don their vests. If they need tactical helmets then the commanders have those.
GW: It always seems easy in the after action report (AAR), whether a hazmat or active shooter event, to define the warm zone, but during a dynamic situation it is difficult to say that this won’t become hot and will always remain warm… RW: That is why we rely on LE to differentiate between those things for us. The Pulse shooting went from active shooter to hostage to explosive ordnance disposal (EOD) response in minutes. It wasn’t a long drawn out active shooter, once he had hostages we had to back off for negotiation and figuring out how we could talk these people to safety. Then they told me he had some kind of explosive and our protocol is to back up, and this all happened in minutes.
GW: Have you developed a protocol that calls for certain criterion to be met before you can say ‘this is a warm zone,’ or will you always rely on PD saying ‘right, you need to withdraw as we got it wrong…’? RW: That is what communication is for. We have always had commanders who have that dialogue with LE on the scene. Police look at it from a different perspective. We see patients, but they notice if there is active gunfire or some type of explosive threat. It is imperative for commanders on both sides to have pertinent information to make that decision on a case by case basis. Good communication by the senior ranks determines what is hot and cold.
GW: I understand, but communications is always a problem in any real incident. It makes it difficult to say that PD will tell us, you hope the comms will work well enough for them to tell you… RW: They will tell us as long as they
have communication. Since Pulse, and even before it, we had table top exercises with LE so we can be on the same page. The first officer on the scene could be a patrol officer or a sergeant, they will set up a perimeter and other things as our units come on the scene. Our first commander will arrive and talk to their on-scene commander and that’s when the dialogue begins. Running onto the scene and not communicating with LE is not our practice. If we are on the scene and violence breaks out, well that is a different conversation, we get to a safe place and render care when we can. We rely heavily on LE to do their job as they rely on us to do ours.
GW: One of the legacies of the Pulse shooting was the ballistic vests. Have they had a negative impact on what you can do, making it harder to do fiddly things like intubation on the scene? Have you had to develop protocols to extract patients with injuries you can’t manage in a vest? RW: We have TECC trained all our personnel. This was adopted by surgeons supporting military personnel in a war zone, so our personnel can do any intubation, IV therapy and bleeding control, all those things are possible. We haven’t seen any limitations. Our goal is to ensure that we train with the vest so our personnel are comfortable when a situation arises and don’t need to worry about their necks, etc.
GW: When you did engage in extraction from the scene I read that you were mobbed and there was a report of seven people getting into the back of one ambulance for example. I wasn’t sure whether people bent the rules because of the unique situation and you were so close, or whether there was a failure of security and more of a cordon is needed? RW: It was human nature. When you have that many people and they see an apparatus that can move them, they become hard to control. It was more or less a riot, the people that got into the back of the ambulance were not trauma red patients, they could have been scratches, nervous, scared, and wanted
out of that scene, and we assisted. When they are scared and help is there they will run towards it. Controlling that is hard, and so is even quantifying when it is appropriate, we knew they needed help and we tried to provide it.
GW: If we look beyond Pulse towards CBRN, for example, there will always be a large mass of worried people, some sick but others with psychological symptoms. They will all be panicked and wanting egress, and there is a far greater mob hazard there. Has there been a need to work out a protocol with PD to go in and agree a way that worried people can be comforted and contained. There would be problems with gross contamination in ambulances if you had seven people… RW: Orange County protocol is rock solid. This was a unique situation. I keep stressing the uniqueness of it, but our LE and firefighter officers did exactly what the situation called for. You cannot write a protocol for every situation, and they did what they needed to do. Once they had transported individuals it was their job to clean that ambulance, but the majority of those cases where people were jumping in were not trauma red patients that require a team, it was mostly people wanting to get out of a situation, they saw help and took advantage of it.
GW: Has the current wave of terrorist events informed your exercises schedule? Previous exercises have seen EMTs dealing with nice wounds that they can tourniquet, for example, but those are not the injuries resulting from European terrorist attacks, so have you shifted training accordingly? RW: This is one of the best communities for support and galvanising units together, and we work closely with all hospital centres, level one and two trauma centres, LE and our transport companies. We do mass casualty exercises throughout the year and have set protocols so that we understand trauma red and green, and there is a set procedure how we move those individuals. We train to assess those individuals and what the situation dictates, and we train extensively on
CBRNe Convergence, Orlando, USA, 6-8 November 2018
www.cbrneworld.com/convergence2018 48 CBRNe WORLD February 2018
www.cbrneworld.com
CBRNeWORLD
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