Page 156 - Journal of Special Operations Medicine - Winter 2015

The TSU study also observed that most active shooter cooperative effort as it is a matter of police tactics and
incidents (40 percent) occurred in offices, stores, and clinical acumen. It is also a test of community leadership
industrial locations. Schools and colleges were the next and of common determination that knowing and dealing
most common locations for these events, at 29 percent. with a threat is far superior to dismissing it as unlikely
The assailant moved between multiple locations in al- to occur in one’s presence. These events, fortunately, are
most one-fifth of incidents and had no apparent con- rare. However, although the individual risk to citizens is
nection to the shooting location almost half of the time. small, the demonstrable increase in active shooter inci-
Shooting was still in progress on arrival of the first re- dents in recent years and the disproportionate potential
sponding officers half of the time. This initial response effect of IEDs represent a continuing collective threat. It
was often by one or two officers. Officers responding to is within our power to address the threat appropriately. 15
shooting in progress engaged the shooter in 43 percent
of cases. If the officer engaged the shooter, that officer
was shot 15 percent of the time. All 110 incidents in References
the TSU study involved one attacker. In a study of 160 1. McDowell K. Remembering the UT tower shooting 46 years
incidents, 98 percent involved a single shooter. In both later. Available at: http://alcalde.texasexes.org/2012/08/
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studies the median number of victims was five. remembering-the-ut-tower-shooting-46-years-later. Accessed
June 22, 2015.
Similarly, the effect of improvised explosive device (IED) 2. Shepard C. The injured at Columbine High School. Available
attacks in the U.S. is not fully appreciated. The Boston at: www.acolumbinesite.com/victim/injured.html. Accessed
June 22, 2015.
Marathon bombing of 2013 is rightly remembered as 3. The Office of the President. Training first responders and
a signal tragedy, but the number of injuries received by school officials on active shooter situations. Available at:
victims of IEDs from criminal behavior is not widely www.whitehouse.gov/sites/default/files/docs/fact_sheet
recognized. In the period from 1983 to 2002 there were _training_first_responders_and_schools_on_active_shooter
_situations.pdf. Accessed June 22, 2015.
more than 36,000 explosive incidents, causing almost 4. Bureau of Justice Assistance, Department of Justice. Active
6,000 injuries and 699 deaths. Relatively unsophisti- shooter response training. Available at: www.bja.gov/Program
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cated IEDs can have serious effects, as was the case in Details.aspx?Program_ID=106. Accessed June 22, 2015.
Boston, where 264 victims included 70 hospitalizations, 5. Schweit KW. Addressing the problem of the active shooter.
16 amputations, and three deaths. One estimate of the FBI Law Enforcement Bulletin. May 2013. Available at:
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damage resulting from the Boston attack placed the eco- https://leb.fbi.gov/2013/may/addressing-the-problem-of-the
-active shooter. Accessed June 22, 2015.
nomic impact at $400 million. 14 6. Federal Bureau of Investigation Office of Partner Engage-
ment. ALERRT/other training initiatives. Available at: www
Unlike the threat of terrorist attacks envisioned after .fbi.gov/about-us/office-of-partner-engagement/active
9/11, which were thought more likely to occur at high- shooter-incidents/alerrt-other-training-initiatives. Accessed
June 22, 2015.
profile events in major urban areas or at instal-lations 7. Eastman A. Trauma kits help police control severe bleed-
of national infrastructure, these data indicate that any ing. Washington Post. January 26, 2015. Available at: www.
community of any size is at risk. No single preventive washingtonpost.com/local/crime/trauma-kits-help-police-
measure, such as hardening school build-ings or train- control-severe-bleeding-saving-lives/2015/01/26/a6d0dcde-
ing teachers in emergency response, will substitute as a 8ade-11e4–8ff4-fb93129c9c8b_story.html. Accessed June 12,
2015.
comprehensive response plan. Active shooter incidents 8. U.S. Fire Administration, FEMA. Fire/Emergency Medical
do not occur solely, or even pre-dominately, in schools Services Department Operational Considerations and Guide
and institutions of higher education. for Active Shooter and Mass Casualty Incidents. September
2013. Available at: https://www.usfa.fema.gov/downloads/
pdf/publications/active_shooter_guide.pdf. Accessed June 30,
Within the FBI itself, first aid training 2015.
emphasizing hemorrhage control has 9. DHS Office of Health Affairs. Event summary: stakeholder
engagement on improving survivability in IED and active
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%20and%20Active%20Shooter%20Incidents.pdf. Accessed
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10. Attorney General Eric Holder delivers remarks at the Interna-
Community leaders, including law enforcement officials, tional Association of Chiefs of Police annual conference. Jus-
emergency medical and rescue service chiefs, and hospi- tice News. October 21, 2013. Available at: www.justice.gov/
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that the basic elements of an effective response are al- 11. Blair JP, Martaindale MH, Nichols T. Active shooter events
from 2000 to 2012. FBI Law Enforcement Bulletin. January
ready present in much of the country, but the reaction to 2014. Available at: http://leb.fbi.gov/2014/january. Accessed
these events is as much a problem of organization and June 22, 2015.

144 Journal of Special Operations Medicine Volume 15, Edition 4/Winter 2015