SAN LUIS OBISPO COUNTY HEALTH AGENCY

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SAN LUIS OBISPO COUNTY HEALTH AGENCY Public Health Department Emergency Medical Services Division 2156 Sierra Way, San Luis Obispo, CA 93401 805-788-2511 FAX 805-788-2517 www.sloemsa.

1 SAN LUIS OBISPO COUNTY HEALTH AGENCY Public Health Department Emergency Medical Services Division 2156 Sierra Way, San Luis Obispo, CA FAX Operations MEETING DATE Operations October 3, 2013 STAFF CONTACT SUBJECT SUMMARY Stephen Lieberman, EMS Director Active Shooter EMS Rescue Task Force It is the understanding of EMSA staff that the Fire FTO s are drafting a policy surrounding the response to an active shooter scenario, specifically an EMS intervention in the warm zone of a tactical event. Chief Lewin (CAL FIRE) presented the concept developed in Ventura County at the 9/19/2013 EMCC meeting. EMSA staff has consulted with Ventura County EMSA and would like to present information related to minimum equipment standards. As the field/operational policy is refined, EMSA staff will present a draft policy defining minimum BLS and ALS equipment standards. REVIEWED BY RECOMMENDED ACTION(S) EMSA Staff Steve Lieberman, EMS Division Director Receive information ATTACHMENT(S) Ventura County Rescue Task Force Equipment List Ventura County Rescue Task Force PowerPoint presentation K:\PublicData\COMMITTEES\Operations Subcommittee\2013\ \EMS Rescue Task Force\Staff Report Summary Form - Rescue Task Force Summary Report docx

2 Individual Kit - BLS (50) ITEM FEMA Grant AEL Number QUANTITY Unit of Measure PRICE TOTAL PRICE PER KIT Ordered? Stat Packs "Competitor" Pack - Black 09ME-01-BAGM 1 Bag $75.00 $75.00 Yes CAT TOURNIQUET 09MS-04-TNQT 3 $25.15 $75.45 Yes HyFin Vent Chest Seal 09MS-04-BAND 2 $13.48 $26.96 Yes PETROLATUM GAUZE 5x9 STERILE 09MS-04-BAND 5 $1.03 $5.15 Yes 2" CLOTH ADHESIVE TAPE 09MS-04-TAPE 1 Roll $2.88 $2.88 Yes 4" Flat ETD 09MS-04-BAND 2 Rolls $5.49 $10.98 Yes 4x4 STERILE DRESSING 09MS-04-BAND 5 Pads $0.00 $0.00 Yes 5x9 Sterile Combine Dressing 09MS-04-BAND 2 Pads $2.50 $5.00 Yes 4" STRETCH GAUZE 09MS-04-BAND 2 Rolls $0.00 $0.00 Yes 3" STRETCH GAUZE 09MS-04-BAND 2 Rolls $0.49 $0.98 Yes NITRILE GLOVES (LARGE) 09MS-03-GLVN 6 Pair $0.50 $3.00 Yes NP AIRWAYS SIZE 28,30,32 Fr 09MS-02-AWMG 1 Each Size $3.67 $3.67 Yes STERILE LUBRICANT 09MS-02-AWMG 3 Packets $0.20 $0.60 Yes Flagging Tape White/Black Checkered 100yd x 13/8" 09MS-01-TTAG 1 Roll $2.65 $2.65 Yes Flagging Tape Red 100yd x 13/8" 09MS-01-TTAG 1 Roll $2.40 $2.40 Yes TRAUMA SHEARS 09MS-01-SHER 1 $4.49 $4.49 Yes SAFETY GOGGLES 09MS-03-ISOS 1 $3.59 $3.59 Yes ESTIMATED PRICE PER KIT $ $11, Individual Kit - ALS (30) ITEM FEMA Grant AEL Number QUANTITY Unit of Measure PRICE TOTAL PRICE PER KIT Ordered? Stat Packs "Competitor" Pack - Black with 'ALS' Screenprint 09ME-01-BAGM 1 Bag $75.00 $75.00 Yes Cook Emergency Pneumothorax Set 09MS-02-THOR 1 Kit $ $ Yes CAT TOURNIQUET 09MS-04-TNQT 3 $25.15 $75.45 Yes HyFin Vent Chest Seal 09MS-04-BAND 2 $13.48 $26.96 Yes PETROLATUM GAUZE 5x9 STERILE 09MS-04-BAND 5 $1.03 $5.15 Yes 2" CLOTH ADHESIVE TAPE 09MS-04-TAPE 1 Roll $2.88 $2.88 Yes 4" Flat ETD 09MS-04-BAND 2 Rolls $5.49 $10.98 Yes 4x4 STERILE DRESSING 09MS-04-BAND 5 Pads $0.00 $0.00 Yes 5x9 Sterile Combine Dressing 09MS-04-BAND 2 Pads $2.50 $5.00 Yes 4" STRETCH GAUZE 09MS-04-BAND 2 Rolls $0.00 $0.00 Yes 3" STRETCH GAUZE 09MS-04-BAND 2 Rolls $0.49 $0.98 Yes NITRILE GLOVES (LARGE) 09MS-03-GLVN 6 Pair $0.50 $3.00 Yes NP AIRWAYS SIZE 28,30,32 Fr 09MS-02-AWMG 1 Each Size $3.67 $3.67 Yes STERILE LUBRICANT 09MS-02-AWMG 3 Packets $0.20 $0.60 Yes Flagging Tape White/Black Checkered 100yd x 13/8" 09MS-01-TTAG 1 Roll $2.65 $2.65 Yes Flagging Tape Red 100yd x 13/8" 09MS-01-TTAG 1 Roll $2.40 $2.40 Yes TRAUMA SHEARS 09MS-01-SHER 1 $4.49 $4.49 Yes SAFETY GOGGLES 09MS-03-ISOS 1 $3.59 $3.59 Yes ESTIMATED PRICE PER KIT $ $9, Training Cache ITEM FEMA Grant AEL Number QUANTITY Unit of Measure PRICE TOTAL PRICE PER CACHE Ordered? HyFin Vent Chest Seal 09MS-04-BAND 40 $13.48 $ Yes CAT TOURNIQUET Trainer (Blue) 09MS-04-TNQT 50 $26.10 $1, Yes Flagging Tape White/Black Checkered 100yd c 13/8" 09MS-01-TTAG 10 Roll $2.65 $26.50 Yes Flagging Tape Red 100yd c 13/8" 09MS-01-TTAG 10 Roll $2.40 $24.00 Yes ESTIMATED PRICE PER CACHE $1, $1, Return Shipping Costs - FedEx $ Notes Cook Pneumo Set - BuyEMP.com - Rx Required C.A.T. Tourniquet - North American Rescue HyFin Vent Chest Seal North American Rescue STATPAK Competitor - Custom order Bag with 2 accessory zipper pouches and 'ALS' screenprint on 30 bags = $75 per unit + freight $23, Current Costs $25,000 Total Budget $1, Surplus BP Cuff and Stethoscope to be added to ALS Kits for eval/assessment of Tension Pneumo prior to chest decompression. This will be purchased and stocked by the Fire Departments. Costs not factored on to this

resources to locate and neutralize an active shooter while

4 Goal For all first responders to have the knowledge, tactics and confidence necessary to work quickly with available resources to locate and neutralize an active shooter while simultaneously providing rapid medical care and a mass casualty response.

5 Response Option A Enter unsecured scene, grab medical gear and start treating patients

6 Response Option B Stage well away from scene. Establish Treatment Area. Do not enter and provide care until confirmation that scene is absolutely clear, even if this takes hours.

7 Response Option C Use Law Enforcement to escort into Warm Zone and provide life saving medical care (Rescue Task Force)

9 Evidence based Medicine Penetrating Injuries (%) from ground combat

10 Statistics: Based on Medicine

11 15% of these Deaths are Preventable.

12 Wound Data and Munitions Effectiveness Team (WDMET) Study ~20% of fatal penetrating injuries die within 30 minutes The greatest benefit will be achieved through a configuration that puts the caregiver at the patient s side within a few seconds to minutes of wounding.

13 TREATMENT AIRWAY IS NOT FIRST PRIORITY STOP BLEEDING -Tourniquets -Bandaging Airway control; simple adjustments/oral Airway Treat sucking chest wounds MOVE ON TO NEXT VICTIM Out of supplies=start DRAGGING VICTIMS OUT

14 Patients will die without rapid medical care. Death from bleeding 2-4 minutes Death from Airway compromise 4 6 minutes Death via Tension Pneumothorax; 20 minutes Golden Hour for Shock 60 minutes

15 Staffing Law Enforcement Officers Firefighters (BLS or ALS)

16 Three Zones 1. Hot Zone: Direct threat care. PD Contact Team or SWAT Medic only 2. Warm Zone: Indirect Threat Care (Rescue Task Force) 3. Cold Zone: Evacuation Care Standard EMS practices Zones are determined by Law Enforcement IF THIS IS AN ACTIVE SHOOTER EVENT; COLD ZONE CAN BECOME A HOT ZONE QUICKLY

17 Review: RTF Operations Active shooter scenario occurs Initial responding patrol officers form contact teams and enter building Clear primary corridor or Warm zone as they move to sound of shooting Notify Command of injured locations and need for Rescue Task Force

18 Movement Stay with Law at all times RTF under control of Law Each have own radios for constant comms to both Law & Fire Maintain a low profile during care

19 PPE

20 Equipment NO YES

21 Medical Care

Increasing the Ability to Survive in Critical Trauma Incidents. Richard M. Smith President, Con10gency Consulting, LLC

Increasing the Ability to Survive in Critical Trauma Incidents Richard M. Smith President, Con10gency Consulting, LLC In 2017-346 Reported Mass Shooting Source: Gun Violence Archive gunviolencearchive.org