Page 155 - Journal of Special Operations Medicine - Winter 2015

next 18 months. Since March 2013, the FBI has hosted every shift. Another challenge is how hospital emer-
response workshops for more than 64,000 police com- gency and surgical services will receive victims of active
manders from more than 4,000 agencies. The FBI’s 56 shooter incidents in areas of the country where trauma
6
field offices hosted active shooter workshops for more systems are resource or geographically challenged.
than 1,800 police agencies. More than 1,000 leaders
of public safety agencies at all levels of government at- Changes of this magnitude require considerable support
tended tabletop exercises in active shooter response. from public safety and health system authorities and
Within the FBI itself, first aid training emphasizing hem- other community leaders. As the sentinel events at Col-
orrhage control has been extended to all 13,000 special umbine, Fort Hood, Tucson, Sandy Hook, and Aurora
agents. Similar programs by police organizations, such each recede from the memory of the public and of gov-
as the Major Cities Chiefs Police Association and oth- ernment officials, there is a tendency to assign decreased
ers, have reached many tens of thousands more officers. 7 priority to these low probability-high consequence in-
cidents. This attitude is understandable, as the daily
challenges of routine operations demand continued at-
These violent acts occur in communities tention. However, it is important to remain mindful of
of all sizes throughout the country and the continued presence of the threat of intentional mass
appear to be increasing in frequency. casualty attacks in the U.S.

Since Columbine in 1999, active shooter incidents have
The initiatives taken by the law enforcement community become more frequent. In the eight-year period after
have encouraged similar work in the emergency medical Columbine, an average of five active shooter events oc-
and fire rescue services. In September 2013, following curred per year. Since 2009, that figure has increased
collaboration with leaders of public safety agencies and threefold. A recent study by the Texas State University
10
professional organizations, the U.S. Fire Administration (TSU), San Marcos, conducted in concert with the De-
released detailed operational guidance for local develop- partment of Justice, was based on police reports, public
ment of fire service and emergency medical and rescue records, and media reports for 2000–2012. The in-
11
services active shooter response plans. Following the creased frequency of incidents seen in this study is not
8
Boston Marathon bombing in April 2013, this project explained by changes in case definition or solely on the
expanded its scope to include similar contingencies. basis of increased case reporting. Characteristics of ac-
tive shooter incidents from 2000 to 2012 are presented
In addition, the Department of Homeland Security spon- in the table on this page.
sored collaboration by authorities in medicine, law en-
forcement, fire/rescue, and emergency medical services Characteristics of Active Shooter Incidents, 2000–2012
at all levels of government with specialists in the private 40% occurred in offices, stores, and
and public sectors to develop consensus guidance for Locations industrial sites
communities developing active shooter and mass casu- 29% occurred in schools and colleges
alty event plans. The Department of Homeland Secu-
rity’s Office of Health Affairs assembled more than 250 Shooter All involved a single shooter
representatives working collaboratively on specifics of Shooting 51% were still in progress on arrival
hemorrhage control, protective equipment, interoper- of police
ability of responding authorities, and exploration of the Engagement 43% of attackers continuing fire on
role of citizen first responders in mass casualty events. 9 of shooter officer arrival were fired upon by
officers
The training provided to thousands of law enforcement Wounding of 15% of officers engaging a shooter in
officers and the planning principles defined by public police exchange of fire were shot
safety and medical authorities demonstrate that im- Source: Blair JP, Martaindale MH, Nichols T. Active shooter
provements are achievable in many communities; how- events from 2000 to 2012. FBI Law Enforcement Bulletin. Janu-
ary 2014. Available at: http://leb.fbi.gov/2014/january. Accessed
ever, applying these changes locally requires changing June 22, 2015.
current operating procedures, interagency planning, and Note: N = 110. In a 2000–2013 study (N = 160), less than 2 per-
conducting periodic exercises to ensure success. The ca- cent of incidents involved more than one shooter.
pability to respond cannot wait for the mobilization of Blair JP, Schweit KW. A Study of Active Shooter Incidents, 2000–
special teams. As the police response to an active shooter 2013. Texas State University and Federal Bureau of Investigation.
U.S. Department of Justice, Washington, DC. 2014.
has shifted from special weapons and tactics teams to Available at: www.fbi.gov/news/stories/2014/september/fbi-releases
patrol officers, emergency medical and rescue services -study-on-active-shooter-incidents/pdfs/a-study-of-active-shooter
are challenged with ensuring a rapid, coordinated re- -incidents-in-the-u.s.-between-2000-and-2013. Accessed June 22,
sponse with the police that is available at all times on 2015.

The Hartford Consensus 143