Page 158 - Journal of Special Operations Medicine - Winter 2015

The Continuing Threat of Active Shooter
and Intentional Mass Casualty Events

Local Law Enforcement and Hemorrhage Control

Alexander L. Eastman, MD, MPH, FACS, Major Cities Police Chiefs Association

o matter the event type and scope, law enforcement to these events. A true paradigm shift has occurred, as
officers (LEOs) represent the first responders to each the response to the active shooter is no longer the re-
Nand every active shooter/intentional mass casualty sponsibility of the local SWAT team, but instead is one
event. Even with the most aggressively integrated opera- shared by every LEO nearby. In the response to con-
tions plan, the response to these events must begin with tinually evolving threats, some jurisdictions are now
LEO response, which places LEOs in the position of be- integrating the law enforcement/EMS response in ways
ing the first professional responders who have an impact never before thought possible.
on survival. Because of this unique role, hemorrhage con-
trol must be as much a core law enforcement skill as dees- Introduction to Law Enforcement Medicine
calation and firearm use. Couple this unique opportunity As the response to the active shooter has evolved, so has
with the fact that despite major strides in equipment, the interface between law enforcement and the medical
body armor, vehicle design, tactics, and the delivery of community. Recognizing that LEOs encounter many sit-
modern trauma and critical care, we have only barely im- uations on a daily basis that have some sort of medical
proved our ability to minimize LEO injuries and deaths. component, many have begun to train their officers with
To address both problems, it is imperative that we equip skills and equipment that were formerly reserved for
our officers with the knowledge and tools needed to miti- their EMS, fire, and rescue colleagues. The LEO may be
gate and minimize the consequences of injuries when they the first responder to arrive at a motor vehicle collision
occur. We must prepare to teach lifesaving skills to all our or cardiac arrest, to respond to calls about psychotic
officers. What has been limited historically to the tactical individuals acting bizarrely or depressed and suicidal
team medic or delegated to a civilian fire and rescue or persons threatening harm, or to treat a partner injured
emergency medical services (EMS) agency now must be in a shooting. SWAT officers, operating in environments
delivered to the hands of each officer who has the poten- inaccessible to standard EMS providers, must be able
tial for hostile contact. Therefore, our nation’s largest law to mitigate their own injuries and continue their criti-
enforcement agencies unanimously support the findings cal missions. Today, many U.S. police departments are
of the Hartford Consensus. forging relationships with local medical experts for as-
sistance in managing these issues and many others that
Responding to the Active Shooter they regularly face (not to mention a relatively low-fre-
Today’s law enforcement response to the active shooter quency but high-impact incident like an active shooter
looks nothing like it did even 15 years ago and, in fact, or intentional mass casualty event).
is again in evolution. Before the Columbine High School
shooting, law enforcement response to an active shooter
was the purview of specialized units such as Special More than 180,000 LEOs in our nation’s
Weapons and Tactics (SWAT) teams or emergency re- largest cities (or approximately one
sponse teams. However, after active murder continued of every five U.S. LEOs) . . . are now
for more than 49 minutes at Columbine High School, capable of saving an injured civilian or
law enforcement agencies worldwide transitioned from one of their fellow officers injured in an
a “surround and contain” posture to a much more ag-
gressive, dynamic response. More recently, using les- active shooter or other situation.
sons learned from other active shooter events, the law
enforcement response has become more dynamic, with Authors have described some of the components of a
groups such as the Texas-based Advanced Law Enforce- comprehensive law enforcement medical support pro-
ment Rapid Response Training (ALERRT) Center’s ad- gram. They have described the role of law enforce-
vocating rapid, dynamic, and overwhelming responses ment organizations in hospital disaster preparedness, 1

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