PPT - FireEngineering.com

Firefighters Support
Rapid Response and Treatment
Model (R2TM) for
Active Shooter Incidents
-------Operational Detail
About FSF
The Firefighters Support Foundation is a 501c3
non-profit organization whose primary
mission is to develop, produce and distribute
training programs to firefighters and first
responders. All of our programs are
distributed free of charge.
R2TM - Operational Detail
Permission is granted to reproduce or
distribute this material so long as the
Firefighters Support Foundation is
credited as the source
R2TM - Operational Detail
Accompanying Video
This PowerPoint presentation accompanies the video
presentation of the same title.
This program is a follow-on program to our introductory program
on the R2TM (Rapid Response & Treatment Model) active
shooter response model, titled: Active Shooter: the Rapid
Treatment Model (note the name change of the model). We
encourage you to view the earlier program first because
familiarity with the basic elements of the R2TM is assumed in
this program.
R2TM - Operational Detail
• Jeff Gurske is an Engineer and Acting
Lieutenant in the Portland metro area. Jeff is a
training contractor/consultant, contributing
author and adjunct college instructor.
• Craig Allen is serves as Training Sergeant in the
Portland metro area. Craig holds numerous
instructor certifications in firearms, defensive
tactics, less lethal weapons and other tactical
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Integration of Public Safety
Lots of good work being done nationally
Still a long way to go
How do we integrate?
What impacts does this integration have
on training, protocol and sustainability?
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What We Know
Time & Intensity
• 2007 – 2013 Highest numbers of incidents
• 2014 – On track for a record setting year
• Historically these events have taken > 12 min
• 2010 - 2014 90% under 5 minutes
• Rumors of a 2nd shooter usually high
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Incident Friction
• Public safety response not integrated
• Condition of our SOPs or SOGs
• Tradition and culture
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Zone Response
The Principles
•Hot Zone: Exclusion
•Warm Zone: Reduction
•Cold Zone: Support
The Problem:
•#1 most common A.A. item
•Causes a progress friction point
– Fire/EMS is waiting for the “all clear”
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Trauma Study
Orange County, CA
• Level I Trauma Hospital
– 14 years: 1996-2009
• 19,167 cases
• Blunt and penetrating trauma
• Results found:
– Increased mortality rate
with scene times ≥ 20 min
McCoy CE, Menchine M, Sampson S, Anderson C, Kahn C. et al. Emergency medical
services out-of-hospital scene and transport times and their association with mortality in
trauma patients to urban Level 1 trauma center. Ann Emerg Med. 2013 Feb;61(2):167-74
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Law Enforcement Goal
Data driven answers:
Mitigate the threat / saving life on the front end
The life-saving timeline continues
Mitigate time loss / saving life on the back end
Meaningful integration has the best chance to
impact life-saving across the spectrum
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EMS Goal
Data driven answers:
1. Access patient as quickly as possible
2. Address critical-fixable injuries
3. Get patient to definitive medical care ASAP
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Engineer the Response
• You may be able to use your current resources
to operate efficiently
• Do not be distracted by tactics
– Tactics require a functional system to be effective
• Engineer your response to work
– Embed a “Warm Zone”
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Nature of Conflict
• Friction
• Psychological
• Physiological
• Environmentally
• Uncertainty
• Remedy
• Experience
• Training
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Systemic Problem-Solving
• A combined effort putting the caregiver
at the patient’s side within minutes of
wounding to maximize life saving
– Agency expertise
– Clearly defined roles
– Familiarity
– Simplicity
– Unification of Command
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R2TM Response
“Everything in war is simple,
but the simplest thing is difficult.
The difficulties accumulate and end
by producing a kind of
friction that is inconceivable unless
one has experienced war.”
Carl Von Clausewitz
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R2TM Foundation
• 3 Tenets:
1. Rapid LE response
2. EMS securely introduced into a warm zone
3. Rapid treatment and transport of the victims
• Keep closest to normal SOPs
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R2TM LE Overview
• Rapid Response Tactics
• Threat mitigation
• Initiate Sergeant / Battalion Chief link-up
• Establish foothold (FOB)
• Identify Casualty Collection Point (CCP)
• Internal / External security
• Police bring wounded to CCP
• Introduction of Fire EMS
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R2TM Fire/EMS Overview
• Out of line of sight
• Prepare for response entry
• Establish Unified Command
• Security escort
Enter Warm Zone
• Begin MCI protocols
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LE Response
• Immediate introduction of LE assets
• Move quickly to last known area of
suspect / verification?
• Understand “sweeps” vs. “clears”
• What are immediate threat indicators?
• FOB’s can be useful
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Threat Mitigation
• Does not require 100% confirmation of
suspect location
• Fled, Dead, Captured
• Once Immediate threat indicators have
lapsed, transition to victim assessment
/ retrieval
• Can continue sweep operations and
CCP identification
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FOB Purpose
• Brings stabilization to operations
• Provides for dual operations
• Aids UC and 9-1-1 point of contact on
• Increases efficiency of interior sweeps
• Aids with decentralized tactics
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Corridor Lockdown
• When immediate threat indicators have
• LE lockdown hallways, architectural features,
large geographical areas
• Sets the stage for victim transfer
• Minimal resource allocation can have
significant impact
• Corridor lockdown builds on itself
• Aids in scene stabilization
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Unification of Commands
Needs to be physical is design
Sgt / BC ideal
Fire Understands / Police need to embrace and
• Only one location for UC
• Don’t view UC as a monolithic entity
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Casualty Collection Point
Efficient prioritization
Centralized location
Simple Concept
Low cost
Enhanced Security
“Quick Connect”
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Casualty Collection Point
Provides a bridge between police and fire
Allows for simultaneous operations
Proven military tactic for categorization
Minimal UC Command & Control
Can have multiple CCPs if necessary and aids
in incident control
– Use caution on adding unnecessary layers of ops
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CCP Location
Key Elements
Law Enforcement Identifies
Fire Establishes
Not necessarily victim dependent
Ease of vehicle access / transport priority
Ability to Secure
Adequate Space
Should be located on the interior
Can establish CCP with barricade / hostage
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Casualty Collection Point
• Make a clean workspace
– Identifiable treatment zones
• Reduce the desire to over complicate the MCI
– i.e. Internal triage zone to external treatment zone
• Only essential personnel
– “Greens” and other non-injured: elsewhere
• “Scoop and Run” vs. “Stay and Play”
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Hot Zone Medical Care
• Limited to rapid and easy intervention
– i.e. Tourniquets
– Follow TECC recommendations
• Victims transferred to CCP via LE
– Hasty field triage
• Get critical patients to EMS first
• Having LE transfer victims to the CCP is
resource driven and supported by the 9
principles of warfare
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Tourniquet Use
• Extremely effective to combat extremity
• Easy to train and inexpensive
• Studies indicate upwards of 90% associated
survival rate
Kragh JF, Walters TJ, Baer DG, et al. Survival with
emergency tourniquet use to stop bleeding in major limb
trauma. Annals of Surgery. 2009;249: 1-7.
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Prepare for Entry
• Stage resources out of line of sight
• Limit first responding fire/EMS resources
– Reconnaissance; Pave the path
• Take only needed equipment to get the job
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Command Link-Up
• Request link-up over interoperable channel
• Location to be out of hazard zone
• Capable members
– Fire: officer, BC, Chief; LE: Sgt, Lt., Commander
• Should be physical
– Cautious of non-physical link up
• Simplify the ICS structure
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Communications Plan
• Must have radio interoperability
– Ability to talk and listen
– Critical for intelligence, integration and safety
• LE and Fire/EMS should conduct entity specific
operations on separate channels/frequencies
– Do not impede critical operations
• Use short succinct communications
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Components of Fire Security
• Apparatus Security
– Escort
– On Engine
– NFPA Guidelines
• Overwatch
• CCP Security
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MCI Operations
• Will your triage method hamper time?
• Triaged patients may shift categories on you
• Fix major problems
– TECC guidelines
• Work trauma codes?
• Monitor available medical resources
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Interference with Transport
• Increase victim scene
• Increases total out-ofhospital time
• Requires more
• Creates damage
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Destination Etiquette
• Do not shift the MCI to another location
– Refrain from blind transport (last resort only)
• Assign someone to communicate with
receiving facilities
– Example: Medical Resource Hospital
• Document as much patient info as practical
– Use technology
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Environmental Concerns
• Stop further harm from occurring
• What is the weather?
– Keep in doors if appropriate
– No return: 32*C / 89.6*F
• Need for decontamination?
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Commit to the Response
• Create a response that your jurisdictions can
use on a daily basis
– i.e. Assault
• Make sure your neighbors can plug in
• Keep it simple and highly functional
• Train on a reoccurring basis
– All hands on deck
• This is a “three legged race”
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More info
• Craig Allen
– [email protected]
• Jeff Gurske
– [email protected]
R2TM - Operational Detail

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