Page 54 - Journal of Special Operations Medicine - Fall 2016

Medical Provider Ballistic Protection
at Active Shooter Events

Jason P. Stopyra, MD; William P. Bozeman, MD; David W. Callaway, MD;
James E. Winslow III, MD, MPH; Henderson D. McGinnis, MD;
Justin Sempsrott, MD; Lisa Evans-Taylor, MD; Roy L. Alson, MD, PhD

ABSTRACT
There is some controversy about whether ballistic pro- enforcement) within 12–15 minutes. Based on these data,
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tective equipment (body armor) is required for medi- law enforcement (LE) agencies have nearly universally in-
cal responders who may be called to respond to active stituted immediate entry tactics to find the active threat,
shooter mass casualty incidents. In this article, we de- engage immediately, and stop the killing. Experience
scribe the ongoing evolution of recommendations to shows that waiting for specialized tactical teams to arrive
optimize medical care to injured victims at such an in- causes undue delays that cost innocent lives. 2
cident. We propose that body armor is not mandatory
for medical responders participating in a rapid-response A similar change is now taking place in the medical
capacity, in keeping with the Hartford Consensus and community. As active shooter events continue to occur,
Arlington Rescue Task Force models. However, we ac- the response community has learned through tragic ex-
knowledge that the development and implementation perience that potentially salvageable patients have died
of these programs may benefit from the availability of because of delays in providing medical care. This, in
such equipment as one component of risk mitigation. turn, has been due to the traditional approach of hav-
Many police agencies regularly retire body armor on a ing medical providers stage and wait at a distance until
defined time schedule before the end of its effective ser- LE officers can ensure the safety of the scene. As this
vice life. Coordination with law enforcement may allow often requires lengthy and intensive searches of the site,
such retired body armor to be available to other public these well-intentioned efforts to mitigate potential risks
safety agencies, such as fire and emergency medical ser- to medical providers have led to delays in care and loss
vices, providing some degree of ballistic protection to of life in patients with potentially survivable injuries. 3
medical responders at little or no cost during the rare
mass casualty incident. To provide visual demonstration The Committee for Tactical Emergency Casualty Care
of this concept, we tested three “retired” ballistic vests was the first group to articulate the need to balance
with ages ranging from 6 to 27 years. The vests were the requirements of ensuring the safety of responders
shot at close range using police-issue 9mm, .40 caliber, and providing lifesaving trauma care to patients in the
.45 caliber, and 12-gauge shotgun rounds. Photographs civilian setting. Building on the TECC principles and
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demonstrate that the vests maintained their ballistic pro- cutting-edge concepts such as the Arlington County, Vir-
tection and defeated all of these rounds. ginia, Rescue Task Force model, recent multidisciplinary
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consensus recommendations such as the Hartford Con-
Keywords: body armor, ballistics, active shooter, active as- sensus have called for widespread preplanning and
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sailant, mass casualty incident coordination efforts between LE, emergency medical
services (EMS), and fire agencies to ensure rapid access,
treatment, and extrication of critically injured victims
while simultaneously providing for rescuer safety.
Introduction
Active shooter events such as school, workplace, and These recommendations envision a first wave of LE of-
public venue shootings continue to occur and result in ficers who rapidly progress toward and stop the threat
tragic loss of life. These incidents dominate news head- posed by an active shooter (i.e., stop the killing). These
lines and, although rare in any given community, they are followed by a second wave of small teams composed
are a major concern to public safety providers in all of armed LE officers escorting medical personnel to pro-
communities. Historically, the overwhelming majority vide limited lifesaving treatment and extrication of criti-
of these events involve a single assailant (98%) and end cally injured victims (i.e., stop the dying). These small
violently (e.g., by suicide or initiation of force by law teams proceed only into areas that have already been

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