Friday, February 28, 2014

Active Shooter After Action Reports Analyzed in FEMA Lessons Learned 'Trend Analysis'


Active Shooter After Action Reports Analyzed in FEMA Lessons Learned ‘Trend Analysis’

By: Anthony Kimery

02/28/2014 ( 7:00am)


A new Federal Emergency Management Agency (FEMA) Lessons Learned Information Sharing ( analysis of 30 active shooter After Action Reports (AARs) highlighted “the importance of inter-agency coordination on the ability of emergency medical services (EMS) personnel to respond” to an active shooter incident.


“Trends also emerged with regard to the management of on-site logistics,” the FEMA LLIS “Trend Analysis” report stated.


To assist with both exercise and response planning for an active shooter incident, FEMA’s team included response recommendations and considerations that first responders can adopt. describes a trend analysis as “an analysis comparing similar events, activities, capacities, or capabilities over a predetermined time period to detect patterns or relationships between factors or variables.”


FEMA's LLIS analysis of the 30 AARs said “Proactive law enforcement response with the intent to use force to stop the attacker, such as the response to the Virginia Tech shooting, ensures that the gunman, if still alive when law enforcement arrives, is unable to continue inflicting harm on potential victims. While the main priority for active shooter response efforts is minimizing the number of casualties, an equally pressing priority is getting emergency medical care to victims of the shooting in a timely manner.”


FEMA’s LLIS analysis of the AARs also “found several trends related to the deployment of emergency medical services during an active shooter incident.”


The key findings are:

  • EMS active shooter incident protocols should consider a plan that takes into consideration the pressing medical needs of the wounded and the operational risk involved; and
  • Management of on-scene logistics, when responding to an active shooter incident, has a significant impact on the efficiency of response and on personnel safety.


With regard to on-scene logistics management, the LLIS analysis of the 30 after action reports determined that “On-scene activities during response to an active shooter incident will be fast-paced and, often times, hectic. In order to minimize the impact of this on operations, EMS should consider placing priority on logistics management -- which affects the speed at which EMS can conduct triage operations, provide pre-hospital treatment and expedite the transport of victims to healthcare facilities.”


“Good logistics management is dependent on proper incident command and an effective staging area for resources,” LLIS said, adding that “Interagency coordination is crucial once EMS is deployed on scene.”


FEMA’s LLIS team said “EMS assets will benefit from a unified command structure that communicates the location of the staging area, the security status of the scene, the approximate number of victims and the time when they can access the scene. In order to ensure this exchange of information occurs, agencies must have well-developed relationships with one another.”


When on scene logistics is managed through interagency coordination, FEMA's team said it “ensures that personnel remain safe throughout the response effort [and] prevents EMS from unknowingly deploying within the hot zone of an incident where they may be at risk and could become casualties themselves. In order to keep EMS personnel safe, unified command should keep EMS informed of the situation as it unfolds and establish an operations perimeter to manage response operations.”


The following recommendations were made in AARs on logistics management:

  • “It is critical to have fire/EMS assets staged away from the incident until force protection can be well coordinated through a unified command;” and
  • “Establish a perimeter to secure the area for fire/EMS victim triage. This will reduce the amount of officers needed for force protection.”


“Logistics is also important during triage operations,” FEMA’s LLIS analysis of the 30 active shooter AARs said. “Proper triage operations ensure that victims quickly move through the different phases of care, starting with patient stabilization through to hospital care. Efficient and effective triage entails the proper identification of a victim’s injuries and general condition by EMS personnel. This will ensure that victims receive the best possible care on the scene, during transport, and at the hospital once they arrive. To expedite the application of pre-hospital treatment, responding agencies should also consider different ways to move patients to a secure location for treatment while the scene is being cleared of all threats."


The following triage and pre-hospital treatment recommendations came from the AARs analyzed:

  • “[Law enforcement should] work with EMS personnel on smaller incidents to reinforce the learned behaviors of briefing, determining evacuation corridors, and evacuation of patients so that the behaviors become second nature and the response can be scaled to the event;”
  • “Continue to assess best practices for triage set-up and logistics;”
  • “Triage tarps should be set further apart from one another to decrease confusion and possible cross-over of patients;” and
  • “Triage tags, patient care reports, or standardized Incident Command System forms must be completed accurately and retained after a multi-casualty incident.”


The FEMA LLIS analysis further determined that “The management of assets, through the establishment of a staging area and a scene perimeter, meant logistics improved the efficiency and effectiveness of the response effort. The familiarity between agencies, primarily fire/EMS and university police as a result of previous exercise drills and working planned events, was stated as a main reason why they were able to easily carry out incident command protocols and procedures during this incident.”


With regard to personnel safety and security, the analysis of the 30 after action reports found that because victims of a shooting often suffer gunshot wounds that leave them in critical condition, EMS is charged with providing medical care to victims to stabilize them long enough to be transported to a definitive-care facility.


“However, in the immediate aftermath of an active shooter incident, threat levels can remain high due to the potential existence of secondary hazards (e.g. secondary shooter, placement of improvised explosive devices), resulting in operational and tactical delays of EMS delivering significant life-saving care to the wounded,” FEMA’s LLIS analysis said.


“Although personnel safety needs to be maintained throughout the response, this can inadvertently cause a delay in providing medical care to a victim, decreasing the chances of survival in some cases,” the analysis continued. “Consequently, EMS should take these two considerations -- medical needs of the wounded and personnel safety -- into account during the response to an active shooter incident.”


To ensure that both medical attention and operational risks are managed properly, FEMA’s LLIS team said that “responding EMS personnel need to collaborate closely with law enforcement on scene [and that] the analysis of the AARs demonstrated several ways in which EMS personnel coordinate with law enforcement during response.”


The following recommendations from the AARs include:

  • “EMS units must take their direction from the on-scene [Incident Command] IC or[Unified Command] UC. [Regional Communication Centers] do not have … a visual understanding of the incident to the point where they can give tactical direction to emergency assets at the scene of an emergency or disaster;”
  • “Outside entities are not familiar with buildings; law enforcement should guide EMSto the scene or area to respond;” and
  • “Conduct joint [law enforcement] LE/Fire/EMS tabletop and functional exercises towork through active shooter tactical incidents.”


FEMA's LLIS analysis also noted that “Several real-world and exercise AARs discussed the use of force protection, where law enforcement escorts EMS through the incident site, to facilitate a more aggressive and rapid medical response. This model allows EMS to deploy to the ‘warm zone’ of an incident to start saving lives before the all clear is given, which could range from minutes or hours before being announced.”


In order to carry out this tactical, interagency operation, the FEMA LLIS analysis said “law enforcement works with EMS personnel to provide a protective escort through the incident site so that EMS can provide trauma care to the wounded,” and that “a major emphasis is placed on treating patients who are likely to perish from sustaining one of the three most common fatal injuries from ballistics.”


Agencies that wish to explore the feasibility of establishing plans and procedures to incorporate force protection in their active shooter response protocols should consider the following AAR recommendations:

  • “Establish a unified command rapidly with representatives from all disciplines to apply better communications and coordination of law enforcement and fire/EMS assets;”
  • “Provide force protection training to all first responders, unified command staff, and private ambulance companies to save lives;”
  • “Develop a ‘regional force protection policy’ and establish a [on-scene] perimeter to secure the area for fire/EMS victim triage;”
  • “[Exercises should] evaluate the ability to safely and efficiently remove and treat large numbers of injured and uninjured, from a hot zone to a secured location, effectively providing for their safety and wellbeing;” and
  • “Further explore the feasibility of patient/victim extraction by providing joint training and exercise opportunities to law and fire first responders.”


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