Page 84 - JSOM Winter 2018

Willingness of Emergency Medical Services Professionals
to Respond to an Active Shooter Incident

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1
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Matthew J. Chovaz, MD ; Raj V. Patel, MD ; Juan A. March, MD *;
1
Stephen E. Taylor, MHS, CCEMTP ; K. L. Brewer 2

ABSTRACT
Background: Historically, staging of civilian emergency med- Introduction
ical services (EMS) during an active shooter incident was in
the cold zone while these professionals awaited the scene to The frequency of mass casualty incidents caused by an active
be completely secured by multiple waves of law enforcement. shooter has increased throughout the United States and abroad.
This delay in EMS response has led to the development of a In the United States, from 2000 through the end of 2015, there
more effective method: the Rescue Task Force (RTF). The RTF have been 200 active shooter incidents. Excluding the shoot-
concept has the second wave of law enforcement escorting ci- ers, these incidents have resulted in 696 wounded and 578
1,2
vilian EMS into the warm zone, thus decreasing EMS response deaths. The vast majority of these incidents end quickly, typi-
time. To our knowledge, there are no data regarding the will- cally within 15 minutes. The average EMS response time in the
ingness of EMS professionals to enter a warm zone as part United States is less than 8 minutes; thus, it is a realistic possibil-
3,4
of an RTF. In this study, we assessed the willingness of EMS ity for EMS to arrive on scene before the shooting has ended.
providers to respond to an active shooter incident as part of Historically, staging of civilian EMS providers during an active
an RTF. Methods: A survey was distributed at an annual, edu- shooter incident was in the cold zone while awaiting the scene
cational EMS conference in North Carolina. The surveys were to be completely secured by multiple waves of law enforcement,
distributed on the first day of the conference at the beginning since scene safety has, in the past, been given the highest prior-
of a general session that focused on EMS stress and wellness. ity. Thus, during an active shooter incident, EMS is typically
Total attendance was measured using identification badges staged in the cold zone, away from the warm or hot zones.
and scanners on exiting the session. Data were assessed us-
ing χ analysis, as were associations between demographics of Because EMS usually waits for law enforcement to completely
2
interest and willingness to respond under certain conditions. secure the scene, critical medical interventions are often not per-
A p value < .01 indicated statistical significance. Results: formed in a timely manner. This delayed EMS response during
The overall response rate was 76% (n = 391 of 515 session at- an active shooter incident could potentially result in an increase
tendees). Most surveys were completed by paramedics (74%; in the number of preventable deaths. One study of combat casu-
n = 288 of 391). Most EMS professionals (75%; n = 293 of alties noted that 24.3% of those killed possibly could have sur-
5–7
391) stated they would respond to the given active shooter vived. Critical medical interventions must be performed in a
scenario as part of an RTF (escorted by the second wave of prompt and timely manner if casualties are to survive potentially
law enforcement) if they were given only ballistic gear. How- life-threatening injuries. Some believe that staging of civilian
ever, most EMS professionals (61%; n = 239 of 391) stated EMS in the cold zone while awaiting the scene to be completely
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they would not respond if they were provided no ballistic gear secure has resulted in suboptimal victim outcomes. This has led
and no firearm. Those with tactical or military training were to development of the RTF concept, which has recently gained
more willing to respond with no ballistic gear and no firearm favor as the more effective method. The RTF is a relatively new
(49.6%; n = 68 of 137) versus those without such training concept for civilian response. It was originally developed in the
9–12
(31%; n = 79 of 250; odds ratio, 2.2; 95% confidence interval, military as part of Tactical Combat Casualty Care. In 2011,
1.4–3.3; p < .001). Conclusion: EMS professionals are will- the Committee on Tactical Emergency Casualty Care published
ing to put themselves in harm’s way by entering a warm zone the first guidelines for tactical medicine delivery by civilian EMS
13
if they are simply provided the proper training and ballistic professionals. The concept has expanded to include whole
equipment. community integration, with medical care provided at all lev-
els, from the first care provider, nonmedical professional first
responders, medical first responders, and physicians. 14
Keywords: emergency medical services; EMS; active shooter
incident; Rescue Task Force
The RTF concept has embedded EMS personnel arriving quickly
at a patient’s side to begin triage, perform critical interventions,

*Correspondence to Juan A. March, MD, Brody School of Medicine, East Carolina University, 600 Moye Blvd., Greenville, NC 27834; or
marchj@ecu.edu
1 Drs Chovaz and March and Mr Taylor are with the Department of Emergency Medicine, Division of EMS, East Carolina University, Brody
School of Medicine, Greenville, SC. Drs Patel and Brewer are with the Department of Emergency Medicine, East Carolina University, Brody
2
School of Medicine, Greenville, NC.
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