Changing the Landscape for Active Shooter Response: Establishing an RTF Model

Background:

Columbine, Aurora, Boston, Orlando, Sandy Hook, Las Vegas. It’s happening and it’s becoming more frequent. Response protocols to an active shooter incident or a similar hostile event is something that can no longer be left to chance. 

Hudson County is one of 21 counties in the State of New Jersey. It has a population of nearly 700,000 and is the smallest and most densely populated county in the state. The county is made up of 12 municipalities and is made up of combined paid and volunteer EMS and Fire Services, with paid Law Enforcement.

Overview:

In 2015, the New Jersey UASI Executive Committee held a meeting with response entities within the seven UASI counties and 2 core cities with respect to funding earmarked for Active Shooter mitigation. As the Hudson County OEM EMS Deputy Coordinator, I attended the meeting and recognized the importance of the topic, but more importantly, I had tremendous concerns about the gap that existed within the response community to these types of incidents.

Initially, the funding allocated for Fiscal Year 2015 (FY15) was $200,000 per UASI county/city. Respectfully, I requested that the Hudson County OEM Coordinator allow me to establish a plan to spend the funding. Based upon new national strategies evolving, it was a perfect time to have funding to train individuals on how to respond “collectively” to active shooter incidents.  The Hartford Consensus, led by Dr. Lenworth Jacobs, had recently convened and established new recommendations on how to mitigate these events, not only through paid professional responders, but through a “whole of community” response. This idea takes civilians and makes them an integral part of a response, by teaching them how to stop life threatening bleeding.

One of the very intriguing recommendations which came out of the Hartford Consensus focused on shifting the paradigm of response. Quite simply stated, this recommendation outlined current methods of response, and based upon lessons learned from past active shooter incidents, highlighted the importance of collaborating a response between all disciplines, rather than functioning independently.

The Rescue Task Force concept takes all disciplines and combines them into a practical group whose focus is to access a structure where victims are down inside, bleeding to death. Exsanguination, or life-threatening bleeding, has the potential to kill someone within three to five minutes. A new model became imperative given the fact that “staging” medical resources at a secure location until the scene is “safe and clear,” in almost all situations, results in death to victims who may have had a chance at survival. 

Concept:

The funding from the grant was $200,000. Approximately $90,000 was approved for training. Changing the way ALL disciplines in Hudson County responded to an active shooter incident became the primary goal. I requested that all $200,000 be allocated to equipment for RTF establishment, offering my services free of charge to train those that would take part. Maximizing survivability to the victims of these incidents was going to require significant changes in response protocols.

Process:

Once commitment was granted to allocate funding toward the Rescue Task Force program, obtaining approval and endorsement from all disciplines was going to be the next challenge. Meeting with the key stakeholders and introducing the idea of modifying response protocols across the board was the priority. 

Engage EMS and/or Fire Services: The Rescue Task Force concept deviates from the standard “scene safety” mentality that has been driven into the brains of medical responders forever. Inherently, these responders recognize that scene safety and an “all clear” status does nothing for victims of active shooter/high impact incidents, who can bleed to death in three to ten minutes. Because of this reality, having EMS and Fire agree that changing the response protocol to these incidents was not a real challenge.   

Engage Law Enforcement Key Stakeholders (collectively): Recognizing the fact that Law Enforcement essentially drives the Rescue Task Force concept, it was imperative to clearly explain and justify the reasoning behind the need for change. Because Hudson County is a relatively manageable size with respect to the number of municipalities (12), it was decided that attending a monthly County Police Chiefs meeting would be the optimal way of capturing the attention of the “decision makers.” Carefully explaining the changes occurring nationally, through statistical data and citing best practice recommendations, was the approach taken. Allowing all chiefs in the county to hear the pitch “together” afforded them the opportunity to voice concerns, support, etc. as a group. This process also cut down on the time that it would have taken to meet with each Chief individually. The meeting was an overall success with great buy in from the LE community.

Support from the Prosecutor: Once acceptance and buy in was received from the EMS/Fire/LE community, meeting with the Hudson County Prosecutor was the next step. The point of this meeting was to be transparent about our initiative. Explaining how and why this was important for the county, as well as how this potentially could save the lives of many victims of an active shooter incident was the goal. Ultimately, if support was granted from the Prosecutor, or “Top Cop,” it would only assist in fortifying the support given by the municipal police chiefs. In fact, once our meeting concluded, I respectfully asked if the Prosecutor would officially endorse the program to her Police Chiefs. She graciously accepted my request.

Developing and Delivering a Program Concept:

With the essential personnel on board, the next item of business was to develop and deliver the concept. Initially, the NJ UASI Executive Committee developed a template for Best Practices for RTF. Utilizing this as well as components from other successful RTF programs throughout the country was the basis of our Hudson County RTF framework. 

Equipment: PPE and medical equipment was purchased with the full grant funding. PPE is obviously costly and maximizing the amount of PPE that we could procure that would fit appropriately, was a challenge.  Deciding to purchase ballistic protection that “fits most” alleviated sizing issues and would allow multiple people to don the equipment. It was decided that designing a finite number of RTF kits and distributing that number to each participating agency would be most effective. Dividing the total funding by the number of participating agencies allowed us to determine how many kits we could distribute. It was determined that each municipality would be allocated ten (10) RTF bags. 

By utilizing this framework, we would focus on training en mass and having the RTF equipment cache delivered to an incident where it could be distributed to anyone who successfully completed the training and was signed off as an acceptable RTF operator. Proof of this is provided through an agency RTF photo ID card, which must be produced at an incident.

Identifying the equipment for purchase was done as a committee amongst all agencies who wished to participate. The main consensus was to ensure that all equipment and kits were set up the exact same way for every municipality. The purpose of this was to create a familiarity with the equipment regardless of the agency, should teams be called into another municipality to assist. RTF kits, although labeled specifically for each municipality, are completely interchangeable.

Train the Trainer (TTT) course: The RTF course (5 hours) is a combination didactic, skills and movements course, which incorporate the recommendations and ideals of the C- TECC (Committee on Tactical Emergency Casualty Care), TCCC (Tactical Combat Casualty Care), as well as the recommendations born from the Hartford Consensus. 

Committed Fire/EMS agencies designated trainers from their respective operation and sent them to our TTT course. The course focused not only on the content to be delivered, but a concept slide deck that outlined the process for equipment purchase, as well as the requirements for each RTF agency. These individuals would then be tasked with delivering the training to members within their own agency.

Formalizing an Agreement: A Rescue Task Force is not functional in Hudson County without a fully executed Memorandum of Understanding (MOU) between the medical providing agency/agencies and the Municipal Law Enforcement agency. This MOU provides a firm outline of the expectations and requirements of the RTF. One of the most crucial requirements outlined in the MOU is the mandatory training that must exist between LE and medical providing agency. Failure to comply with any portion of the MOU may lead to repossession of RTF equipment by the Hudson County OEM.           

Current Hudson County Operational RTFs

The following municipalities have operational RTFs with signed MOUs:

Bayonne: McCabe Ambulance Service-Bayonne Fire Department-Bayonne Police Department

Hoboken: Hoboken Volunteer Ambulance Corps. – Hoboken Police Department

            Weehawken: Weehawken First Aid Squad – Weehawken Police Department

Secaucus: Hudson Regional Medical Center EMS – Secaucus Police Department

            Union City: Union City EMS – Union City Police Department

            West New York: West New York EMS – West New York Police Department

*Jersey City (Core City): Jersey City Fire Department – Jersey City Police Department (signed MOU, awaiting equipment, SOP and cross training)
 

The following agency has agreed to training and dates have been established for TTT courses:

North Hudson Regional Fire Department (NHRFD) is the FD with jurisdiction within Union City, North Bergen, West New York and, Weehawken. Once training is complete and equipment is obtained, HRFD will be added to the existing MOUs in Union City, West New York and Weehawken. This will bolster the number of responders who are RTF trained within these communities.

The following municipality/agency has expressed interest and is looking at implementing the RTF model:

Township of North Bergen

Hoboken Fire Department
 

Community Resilience:

In addition to training the professional response sector, training our civilian population in bleeding control techniques is just as important, if not more important. Empowering civilians to act by providing them with proper training and access to appropriate equipment maximizes the potential for survival. Civilians are ultimately the first link in the trauma chain of survival. They are the First Care Providers, or the ones who can fill the gap between the incident occurring and the arrival of trained personnel.  Delivering training that matches the bleeding control techniques we teach to professional responders is vital to creating an environment that is committed to fully mitigating an active shooter incident. 

In Bayonne, over 100 personnel from the Bayonne Board of Education have been trained in Bleeding Control techniques.  Those trained range from Principal to Custodial staff. Additionally, 20 Bleeding Control Trauma Boxes were donated by the local hospital, Carepoint Health-Bayonne. These boxes have been strategically mounted next to AED boxes throughout the schools. Presently, Bayonne High School has 9 boxes throughout the school, with one box located in each of the remaining 11 public grammar schools in the city. 

Thinking Ahead:

The civilian training within the schools was so successful that we are now in the process of rolling a bleeding control course into the high school Health curriculum. All high school Health teachers will attend a training on the curriculum and how to deliver the program to the students. It is hopeful that this will be implemented by the start of the school year, Fall 2018.

Conclusion:

It has become blatantly obvious that times have changed. Terroristic style attacks are occurring at an unfathomable rate and the days of turning a blind eye and relying on hope and percentages are no longer a prudent or viable option. The frequency of active shooter incidents throughout this country is so rapid, that we, as a nation, are becoming desensitized. Desensitized civilians, responders and elected officials ultimately results in complacency. Complacency WILL result in sloppy execution and planning. Fighting complacency and ensuring that we are well-prepared not only as professionals, but as bystanders and civilians, will ultimately give us the best chance of mitigating a threat that is not going away anytime soon.