Page 85 - JSOM Winter 2018

and remove casualties from the warm zone for transport. The Methods
RTF concept uses a primary contact team of law enforcement
officers to clear an area and downgrade that area from a hot After review and approval by the institutional review board at
zone to a warm zone. A secondary combined team comprising East Carolina University Brody School of Medicine, an anon-
law enforcement and EMS (the RTF) then enters the warm ymous voluntary survey was distributed to participants at EM
zone. The law enforcement component of the team provides Today, a statewide, educational EMS conference held annu-
cover and protection for the EMS portion of the team to ally in North Carolina. To attract EMS professionals from the
quickly assess, treat, and remove patients from the warm zone. entire state, the conference is located in Greensboro, North
Carolina, which is centrally located. Attendees are primarily
To clarify, the RTF does not use tactical paramedics embed- EMS field providers at all levels, but training officers and ad-
ded with the initial law enforcement or Special Operations and ministrators are not excluded.
Tactical Team (SWAT) that enters a hot zone. The RTF con-
sists of EMS personnel, not tactical paramedics, and thus does After a review of the literature, the survey tool was developed
not regularly train together with law enforcement or SWAT. by the authors of the current study, who are experts in the field
Instead, the RTF enters the warm zone only after the first wave of emergency medicine and EMS, and have a combined expe-
of law enforcement has somewhat secured the scene. By de- rience of over 70 years. The closed-ended paper survey con-
ploying EMS early in an active shooter incident, critical medi- sisted of an introductory active shooter scenario, six simple
cal interventions can be provided in a more timely manner and closed-ended (i.e., yes or no) questions regarding their willing-
thus prevent unnecessary loss of life. ness to respond, and a short demographics section (Table 1).
We purposefully decided not to specify the type or level of
In 2013, an expert panel convened in Hartford, Connecticut, ballistic gear in the survey, because of the many different types
to help address the medical care provided during an active and levels of ballistic gear available.
shooter incident, broaden the message, and engage the Amer-
ican College of Surgeons in public policy. They recommended TABLE 1 Survey Scenario, Questions, and Responses
that to improve survival during active shooter incidents, coor- Scenario: You are the first EMS unit to arrive at an unsecure scene of
dination between law enforcement and the medical and evac- an active shooter in a high school. The first group of police officers has
entered the school. The second wave of police officers asks you to join
uation teams is required. In 2014, the Hartford consensus them as they enter the school to provide care to any victims. The first
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updated its recommendations stating that EMS/Fire/Rescue wave of law enforcement has not neutralized the threat.
“response must be more fully integrated and traditional role Yes No Unanswered
limitations revised . . . It is no longer acceptable to stage and (No.) (No.) (No.) Question
wait for casualties to be brought out to the perimeter.” Un- 138 249 2 Q1. Do you have any tactical/
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fortunately, one recent study noted that even after training, military medical training?
50% of EMS providers (without prior military or tactical ex- 221 168 2 Q2. Do you have any tactical
perience) agreed they should never enter a building with an EMS training available to you?
active shooter until the scene was declared safe. 17 37 354 0 Q3. Are you currently a member
of tactical medical response unit?
During the fourth update of the Hartford consensus, one of 360 31 0 Q4. In the event of an active
the three key themes that emerged was use of protective equip- shooter situation such as
described above, would
ment (e.g., ballistic vests, helmets, and eyewear). Yet there you be willing to enter the
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are few published data regarding the use of ballistic equipment hostile environment with law
by EMS and Fire personnel. In addition, some EMS agencies enforcement to provide care to
acknowledge that the development and implementation of the injured if you had ballistic
the RTF concept may benefit from the availability of ballistic gear and a firearm?
equipment as one component of risk mitigation. 19 293 94 1 Q5. Same scenario: Would you
enter with ballistic gear but no
firearm?
Some may argue that use of ballistic equipment such as a bal- 148 239 4 Q6. Same scenario: Would you
listic vests, helmets, and eyewear for EMS professionals during enter without ballistic gear and
an active shooter only makes common sense. Some believe that without a firearm?
ballistic equipment is just another form of personal protective 73 284 34 Q7. Current or former military
equipment, like gloves or an N95 mask. Yet, there is some member?
controversy about whether ballistic protective equipment
(i.e., body armor) should be required for medical personnel The surveys were distributed at the beginning of a general ses-
who may be called to respond to active shooter incidents. sion on the first day of the conference. The session was enti-
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Some believe ballistic equipment is too costly and potentially tled “If Life Is Worth Saving, It Must Be Worth Living” and
increases the liability of the EMS agency. Others believe that focused on stress and provider wellness. Surveys were distrib-
ballistic equipment will only make EMS appear to be law en- uted by two of the authors by placing them on every seat in
forcement and thus be more of a target. Because of increased the session before its start. The surveys were then collected by
violence against EMS personnel, a small minority suggests the same two authors as attendees left the session; surveys left
EMS professionals should also be armed. 20 on seats in the room after completion of the session also were
collected. Total attendance was measured using identification
To our knowledge, there are no data regarding the willingness badges and scanners as attendees exited the session.
of EMS professionals to enter a warm zone as part of an RTF.
The goal of this study was to assess the willingness of EMS The survey data were entered in an Excel spreadsheet (Micro-
providers to respond in an active shooter incident. soft, www.microsoft.com). Statistical analyses were completed

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