Editorial: A Call to Educate

Another EMS World Expo is in the books. Las Vegas gave us a warm welcome and a gracious hosting. With the tragic events of October 1 on everyone’s minds, we remain dedicated to advancing the profession of EMS by educating providers to be their very best.

It is no secret that EMS providers excel at preparing and training for the “high-acuity, low-frequency” event, also known as “The Big One.” Despite this dedication, we can likely never predict the elements of an active shooter event and its aftermath. Each unique incident brings a unique set of lessons.

As a responder to the scene of the June 2017 Simpson Field shooting in Alexandria, Va., I learned my own set of lessons. Arriving as the last patient was being transported, I found myself in a unique position: as a witness to the immediate aftermath and more specifically, to the needs of the witnesses, bystanders and first responders.

After checking in with the incident commander, I was tasked with verifying patient information: where they went, how they got there and whom they were. In true form, the rapidly evolving nature of these incidents often precludes the establishment of a true triage system. 

Shortly after, with a few bottles of cold water, I approached a group of police officers who were staffing the perimeter of the scene and asked them if they needed anything. One officer replied, “Sunscreen. We’re going to be out here for a while and I forgot my hat.”

Who knew? And what else don’t we know? 

Have you been able to account for bystanders and witnesses who were not transported? In the Fort Lauderdale airport shooting, some hid in closets and small spaces for hours, not knowing that the scene had been made safe shortly after the incident started.

Are you ready for every potential weather scenario? If it is cold, can you set up a warming tent? If it is hot, as it was in June in Alexandria, do you have a place for people to cool down? These may be standard preparations for a structure fire, but consider the length of time an investigation may take; there may be long-term needs for which we haven’t planned.

Investigators in Alexandria asked witnesses to remain on the scene near the baseball field so they could be interviewed. We now had multiple older adults, recovering from witnessing a horrific trauma, crashing down from their adrenaline rushes, overheating in their long-sleeved polyester baseball uniforms in 90-degree heat. They needed water, shade, chairs, a kind ear, something to eat, reassurance and a medical assessment for the knee injuries and ankle sprains that began hurting once they had calmed down.

Who could anticipate that there would be not one additional agency, but up to five working the Simpson Field incident? U.S. Capitol Police, Alexandria Police, the FBI and the Secret Service all had a stake in assessing the threats and the nature of the response. The Pulse nightclub shooting in Orlando proved once again that our issues with communication have not been fully resolved: The police command post was on the opposite side of the nightclub from the fire/EMS incident command post, forcing the use of the radio instead of the much easier face-to-face method. 

After the incident, responders will not only need time to perform routine duties such as unit restocking, cleaning and writing patient care reports (which may be subpoenaed), but also to compose witness statements, debrief, eat, hydrate, rest and check in with their loved ones. 

Have you thought about the logistics of gathering extra inventory? Is it easily accessible? In Alexandria, we were temporarily without multiple EMS bags, EKG monitors, oxygen bottles, stretchers and even a department SUV as they were being processed within the taped-off crime scene of the baseball field. In a small agency with just six front-line ambulances, missing this equipment from two of our units meant a delay in getting back into service until we rounded up the extra inventory. 

Have we prepared enough for the post-traumatic stress our providers will experience? Your agency may need to marshal the resources of multiple mental health experts. More than 100 EMS providers responded to the scene of the Route 91 incident; how long will it take to assess, evaluate and then treat these providers, perhaps for the long term?

While the Las Vegas shooter was located quickly, many inaccurate reports of multiple shooters complicated law enforcement efforts. Not only do we have our own internal communication hurdles, but we also may not have a perfect way to communicate with the public.

After police officers were shot in Dallas in July 2016, the police department’s medical director expressed frustration at the inability to clearly communicate with the public that the incident was over and the scene was safe. In addition, the Las Vegas shooting produced familiar stories of family members having difficulty tracking down their loved ones. With hospitals focusing on treating life threats, resources might not be immediately designated to identify patients or contact family members. 

EMS has an enormous task on its shoulders in trying to mitigate all of these dangers. But we do have a wealth of resources and knowledge to bring to bear for these events. We know what works and what doesn’t. 

The Las Vegas incident and others like it prove the value of the bystander: the untrained who controlled bleeding, the drivers who transported numerous patients in their own vehicles, the concert-goers who carried the injured away from the scene. The science doesn’t lie: Just as research proves the importance of bystander CPR, we know EMS cannot treat 500 instantaneous victims, and we must focus on time to definitive treatment. 

This is a call to educate. EMS is the helping profession; we must help the public know they will make a difference in these terrifying events. Read Tracey Loscar’s column on the back page of this issue for her eloquent take on the power of the individual. Let’s teach them how to Stop the Bleed. Let’s teach every citizen hands-only CPR. We can’t just sit by and wait for “The Big One.” After all, we are a community who works together before, during and after a tragedy. We are in this together.