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Rescue efforts questioned after Aurora

EMS NOW - a weekly highlight of emergency medical services

Paramedics cited as unprepared but system preparedness should be in question.
By Rick Russotti, RN, EMTP
This article made possible with the support of KMS Medical

"When a shooter sprayed a movie audience...paramedics were not prepared for the extent of the carnage and arrived with too few ambulances..."  - Ben Brumfield and Cristy Lenz, CNN
The above quote occupies the opening lines of a recent CNN article outlining the Aurora Fire Department Preliminary Incident Analysis of the July, 2012, theater shootings (link provided by Denver Post).  The incident took place on July 20, 2012 at 0040 hours, according to the report. A chaotic scene was described by initial responders who were met by nearly 1400 movie goers. Also, according to the report, responders were swarmed response vehicles and access/egress points.
"The number of critically injured patients encountered prior to reaching the theater slowed the process of apparatus reaching specific locations. Responding units were stopped by frantic moviegoers covered in blood and carrying critically injured patients." - AFD report
The report also notes that communications between traditional response agencies was lacking, resulting in delay in notification and deployment of EMS resources. Communications improvement and responder interoperability were major areas of improvement described by the McKinsey report after 9/11. The National Incident Management System (NIMS) also held interagency coordination at major events as a bedrock goal.

A gunman opening fire in a crowed multiplex theater is one of the most terrible situations conceivable perhaps trumped only by the release of a chemical agent. Preplanning and training for civilian soft target locations cannot be overstated. As I've said in past postings "skip the airport disaster drill and train for todays emerging threats."

While the AFD incident analysis reads with striking similarity to the after action report from Columbine High School in1999; we have to wonder how well have we remembered the lessons from Columbine?  How ready are we for an active shooter situation in a civilian soft target?

The threat of attacks on soft targets (movie theaters) continues. Why was EMS taking the headline fault for issues during this event? Faulting EMS for large-scale, multi jurisdictional failures seems to be a trend. It would be rare for an EMS agency, including one attached to a fire or police department, to take the incident command role in an active shooter event and more likely be operating as a division within the NIMS/ICS framework. So, why then do we continue to see headlines describing EMS as the weak link in a system-wide response? Natural events in Pittsburgh, Washington D.C., and NYC have all cited EMS as the poor performer and contributor to deaths.

The traditional response groups to fire, EMS and law enforcement must work together in training for scenarios such as a movie complex shooting. An understanding of each services response objectives and standard operating procedure must be reviewed and drilled on. Tabletop exercises and functional exercises can make this a reality.

EMS NOW sponsored by KMS Medical

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