Explore " asim" with insightful episodes like "Ep 71: When Injured Flee A Shooting", "Ep 70: Sometimes Tradition Has To Change", "Ep 69: What About Hospitals?", "Ep 68: Known Bleeding vs Unknown Threats?" and "EP: 67 Hosting ASIM Advanced Course" from podcasts like ""C3 Podcast: Active Shooter Incident Management", "C3 Podcast: Active Shooter Incident Management", "C3 Podcast: Active Shooter Incident Management", "C3 Podcast: Active Shooter Incident Management" and "C3 Podcast: Active Shooter Incident Management"" and more!
Most Active Shooter Events are not Mass Casualty Incidents, but when they are you need to have a plan in place to deal with those who self-evacuate. Bill Godfrey, Mark Rhame, Kami Maertz, and Adam Pendley discuss the strategies and logistics needed to deal with patients who might not be in the hot or warm zones.
View this episode on YouTube at https://youtube.com/live/5RRrzRpUm6o
Hard is hard for a reason – it doesn’t mean it’s not worth doing. Getting held back by tradition, management and others are often the reasons we fail to implement change. Join Bill Godfrey, Adam Penley, Kami Maertz and Mark Rhame as they discuss these three common obstacles to changing policies and procedures and offer ideas and examples of how to overcome these challenges.
View this episode on YouTube at https://youtube.com/live/rdwFcKc-D38
Patient distribution, security concerns, reunification, media handling and even parking can easily overwhelm a hospital during a mass casualty event. Can we integrate our training and provide assistance? On this week’s podcast we’ll discuss how we, as Public Safety Officers, can assist our hospitals in the challenges they may encounter if faced with an active shooter incident.
View this episode on our YouTube channel at https://youtube.com/live/U19VnL3eFk4
90% of the time the active threat is over within 10 minutes. In today’s episode we tackle the question of when is it time to stop searching for an unknown threat and when is it time to start focusing on medical? When the bad actor has gone silent, it’s time to coordinate resources and stop the known bleeding.
Watch this episode on YouTube at https://youtube.com/live/_NVp91myDsk
Join us today as we delve into the ins and outs of hosting the ASIM Advanced course, covering facility needs and logistics. Discover the value of this training, its participants, and the rewards it brings. Ready to seize this opportunity? Visit c3pathways.com training section to request DHS funding and submit your request!
Watch this episode on YouTube at https://youtube.com/live/VKrSyAIP2jg
Jill McElwee joins Bill Godfrey, Pete Kelting and Don Tuten in part two of the discussion on how and why to adapt to change. We’ll address some of the common reasons given as to why we can’t change including:
Watch this episode on YouTube at https://youtube.com/live/TVAbDHcLPgM
Today we start a discussion on why it’s important to train both sides and establish communication. Bill Godfrey, Pete Kelting and Don Tuten talk about the importance of joint training and building relationships prior to an incident. While responder agencies tend to be somewhat isolated, being open to adjusting your training provides a skill set and confidence in the process that will allow you to move forward.
Watch this episode on YouTube at https://youtube.com/live/2NhKowiY03o
Active Shooter Events can be chaotic and overwhelming, and things can go wrong. In today’s episode, we’ll examine some of the common areas where problems occur and give you tips on how to recognize these, recover from them, and get back on track. Spending 60 seconds fixing a problem now, can save you time in the long run.
Watch this episode on YouTube at https://youtube.com/live/n-fUku7qC9o
Today we touch upon some common occurrences in Active Shooter Events where follow-on 911 calls report additional shooters in differently locations but in reality are not accurate. These calls -- though well intended -- often result in duplicate work, wasted resources, or over-response to a new location. Active Shooter Events have one shooter 97% of the time, but our training teaches the "plus one" theory that we should always expect another bad guy. If you don't manage it, you will spend valuable time and resources chasing ghosts.
Watch this episode on YouTube at https://youtube.com/live/NbApXhCQhVo
This episode gives us unique insight to the minds of high school students on the topic of Active Shooter Events, what they think about preparedness and procedures schools follow, and discussion of surprisingly insightful tactical thoughts.
Ryan also shares a very up close and personal experience with an incident that happened to him at his school. It was a surprising revelation in the discussion as he did not mention it during pre-interview. Importantly, he shares the raw emotional reaction he and some of his friends experienced.
Do NOT miss this episode!
P.S. This episode is safe for kids. Nothing gory. Just an unvarnished discussion with a 16 year-old high school sophomore about a difficult topic. If you're a parent, we encourage you to sit and watch it with your teenager.
Watch this episode on YouTube at https://youtube.com/live/_fGScoFWaCE
A law enforcement listener asks:
"Could you guys do a podcast about the naming of positions, particularly tactical? Our fire department has a big issue with the radio ID of tactical being used instead of the radio ID of command for that position until the cold zone command post is stood up and that title is transferred to the incident commander. I get why, but cannot seem to get the point across. They say it is not ICS compliant to use tactical radio ID. Please help."
Well, we can certainly help with that! (Psst... it is completely ICS compliant, we have proof)
Watch this episode on YouTube at https://youtube.com/live/RfKrGg_Y_48
There is no standard triage system in the United States. S.T.A.R.T. is most common triage system in use, but there are many. Join Jill McElwee, Ron Otterbacher, and Bill Godfrey as the discuss common triage gaps, mistakes, and how things are different in Active Shooter Events. Don't miss the Trappings of Triage!
Watch this episode on YouTube at https://youtube.com/live/q9Q8meRzYbI
In this episode we debunk five of the biggest misconceptions of Active Shooter Incident Management. Pete Kelting, Don Tuten, Jill McElwee, and Bill Godfrey set the record straight with detailed explanations, facts, and statistics. The number one may shock you -- don't miss this episode!
View this episode on our YouTube channel at https://www.youtube.com/watch?v=4jmWWDV6Qy8
Adam Pendley, Mark Rhame, Don Tuten, and Bill Godfrey discuss the Active Shooter Incident Management model policy (available for free download from the C3 Pathways website) along with common implementation challenges and trying to get multiple agencies on board. You do not want to miss this conversation.
Download the ASIM Model Policy as an MS Word document from https://c3.cm/policy
View this episode on YouTube at https://www.youtube.com/watch?v=maYTj8maOJM
NEW! Watch this show on YouTube at https://youtube.com/live/EV0xRrmByK8
Podcast Host Bill Godfrey is joined by Mark Rhame, Adam Pendley, and Don Tuten to discuss "The Key to Success" in an active shooter event. Their answer may surprise many, but it centers around making sure every responder arriving at the scene has a task and purpose. Whether you're resource rich or resource poor, it's crucial that responders are assigned to the task you need done, where you need it done, and when you need it done.
NEW! Watch this show on YouTube at https://youtube.com/live/t2Qhoz7WTg4
Bill Godfrey, Jill McElwee, and Ron Otterbacher discuss valuable medical insights from battlefield experiences which can be applied to active shooter scenarios. The trio takes a deep dive with easy to understand explanations about the value of using the military’s BATH assessment technique and the mechanics of tension pneumothorax, how it can kill, how you can fix it, and how to know the difference.
Whether you’re a responder with little medical training or a paramedic, you don’t want to miss this discussion! Knowing these things and the differences between them can help you save lives!
NEW! Watch this show on YouTube at https://www.youtube.com/watch?v=EaVr4fSJHLU
Bill Godfrey, Ron Otterbacher, and Jill McElwee discussed the challenges of terminology and the importance of simplifying it in a potentially chaotic active shooter incident. We must use straightforward terms that everyone understands and limit conversations between Command, Law Enforcement Branch, and Medical Branch to avoid confusion. Cultural differences between Law Enforcement and Fire and EMS are discussed, with an emphasis on simplifying terminology and having one Command for everyone involved.
NEW! Watch this show on YouTube at https://youtube.com/live/9DR97VXLPmI
Bill Godfrey:
Welcome to the Active Shooter Incident Management Podcast. My name is Bill Godfrey, your podcast host. Thank you for being with us today. I am being joined by Adam Pendley, here to my left, from the law enforcement side. Adam, thanks for coming in.
Adam Pendley:
Thank you.
Bill Godfrey:
And across the table of us, we got Mark Rhame from Fire and EMS. Mark, good to see you again.
Mark Rhame:
Yeah, thank you too.
Bill Godfrey:
We just spent a fun little weekend out in Vegas.
Mark Rhame:
We did.
Bill Godfrey:
That was...
Mark Rhame:
Not talking about what we did.
Bill Godfrey:
No, we cannot. No, we're not allowed to.
Mark Rhame:
No pictures.
Bill Godfrey:
And then next to Mark is Don Tuten, like Adam, also from the law enforcement side. Don, it's been a minute since we've had you in the studio. It's good to see you.
Don Tuten:
Yes, sir. It's good to be back.
Bill Godfrey:
All right. And for two of you, for Don and Adam, this is the first time you guys are getting a chance to see the new place and the new studio.
Don Tuten:
It's wonderful. I'll tell you, it's state-of-the-art. Great facility.
Bill Godfrey:
Yeah, it's nice to be able to drop in and just be able to do that. So today's topic, we are going to be talking about attackers that go mobile, or mobile attacks. So there can be multiple sites involved, multiple attack locations, and some of the challenges that can go with that. And Adam, as you reminded me right before we went on air, this is not a small number. It's not a small percentage. It's actually...
Adam Pendley:
About 21% of the time the attacker will start at one location and then continue the attack at more than one location.
Bill Godfrey:
Yeah, and I think we probably ought to talk a little bit about what gets included in from that from a data perspective, but then some of the real challenges of managing those incidents. So Adam, why don't you start us off a little bit and lead into that, and then we'll roll from there?
Adam Pendley:
Sure. So when you look back at active shooter events from about 2001 to currently, again, about 21% of the time the attacker will go mobile. Oftentimes these happen in rural areas where the attacker has some sort of direct attack on maybe a family member or someone maybe at home, and then they move on to other random locations that more traditionally meet the definition of an active assailant.The problem is, or one of the challenges of that, is early recognition that you potentially have an attacker that has attacked someone at one location and they're not trying to escape. Early indications are that they're moving to go attack somewhere else, and you get that second call within a short duration, and then maybe even a third call within a short duration. It's going to feel a lot like a complex, coordinated attack, but you may find that it's actually just one suspect moving from one location to the other.
Bill Godfrey:
Yeah, and I think we probably need to kind of be clear that the attackers that start by killing a family member or killing a few family members and then going and committing attack, that's one type. The bulk of the attack is happening one locations. But there have been a number of events, I can't remember the exact number, but there's been a number of these where the attacker has been truly attacking one site, moving to the next site, moving to the next site. There was one out in California where literally was driving down the road in the car and attacking multiple locations.
And so I kind of want to talk about how those can come in and how they sound and how they can affect us. Don, from your perspective, because I know a lot of years you were in charge of overseeing patrol operations, that kind of thing, SWAT, what happens when you start to get, in short order, multiple reports of shooting in different locations, but they're close to each other? How does that become a challenge for you, and what does that sound like on the radio?
Don Tuten:
Yeah, so the biggest thing is your assailant already has a plan. Police do not know that that person has a plan and where they're going to go. So when that initial call comes in, potentially you don't know about the other one or two locations that's getting ready to occur. So when that call does go out, officers, obviously they want to get there as quick as they can. They want to do God's work and get there and then make this go away. The challenge is when we get that little bit of over-convergence on one location where a lot of resources are going, then that second call comes in. Well, now the intelligence piece of that is really critical. It starts at dispatch, it trickles down to the supervisor, and how quick that intelligence processing takes place is how long it takes the reaction of the officer.
So I think from your initial response to the first event, depending on, once again, the size of the agency, how many resources are available to you, that initial convergence onto that initial scene for the first incident, it's one of those things that we have to be cognizant of, of, yes, you do have one incident there, and yes, you are doing other calls for service around your county, around your city, but you have to be available and cognizant that this may be only one, specifically if you get there and that person's not there.
Bill Godfrey:
So I think that's an important one that we need to parse out a little bit, is the idea of over-converging on the single scene. But before we do that, Mark, talk a little bit about from the Fire/EMS perspective. What happens in terms of the Fire/EMS response when you start to get multiple serious medical calls, serious shooting calls that are in close proximity? They're in the same station's first due.
Mark Rhame:
So I have to go back to what you were initially talking about, is multiple sites. For Fire/EMS, one of the things we talk about when we do our classes is how critical it is for us to get the good information from law enforcement. I know for law enforcement, a lot of times they're not thinking about getting that patient count and the criticality of those patients initially. That's not their thought. They're going, "We got to go after this threat." But from us Fire/EMS perspective is that we're trying to manage our asset response.
We're trying to figure out how much stuff do we need to be here and be successful. And when you talk about multiple sites, now you're talking about some security issues and other things. Is our staging location going to be in that cold zone, always be in the cold zone? Is the person moving from this location to another? Are you getting multiple 9-1-1 calls that's saying that they're moving toward this direction, and are we sitting up our command post in that cold zone in the correct location?
So asset management, where we're sitting up our assets initially, staging, and the command post is going to be critical based upon the information we're getting. And that's why law enforcement, where we really lean heavily on you in those initial couple minutes for Fire/EMS, saying, "Give us that best information you have right now so we can actually prepare for what we need to do to save lives."
Bill Godfrey:
And on the Fire/EMS side, assuming that the bulk of these attacks happen in one station's first due, what kind of implications does that have for a resource strain when you get, within 10 minutes, five medical calls in that station's first due that are all priority calls, shootings?
Mark Rhame:
Exactly. So not only does a shift commander, and I'll use that for an example, the shift commander, have to be worrying about this big event going on right now, but also the other calls are going on in their normal response. Do they need to go into a reduced response for other type of calls so they can keep the assets that are available for the critical side? That one station obviously is going to get overwhelmed, but obviously we're going to move units closer and closer to that location. And that's why, again, why we want to stand at that staging location so we're prepared for the big event going on and anything might be right around that corner.
Bill Godfrey:
Yeah, and I think the only thing that I would add to that is that your first incident is very likely to get a very quick Fire and EMS response, but your fourth incident who's now coming from two zones away or three zones away, the first units arriving at that might be 12, 15 minutes trying to get there because they're that far out of their position.
Mark Rhame:
And by then you may be going into mutual aid or first response, other agencies coming in. And then you got that issue of, do they know this area? And that's again why it's so important to create a staging location very, very quickly so that when we bring those assets in, we can marry them with other people and our first two and say, "Go with these people right here." You're going to be an RTF team or rescue task force team, these people here are used to this area, they understand this area. So we can make sure we have good response no matter who it's coming in, whether it's mutual aid or first response or the first responders in that area.
Bill Godfrey:
Yeah. And Adam, coming back to you, so you kind of alluded to this and Don mentioned specifically the over-convergence that we see routinely, I think, would be a fair way to say it. Everybody goes and everybody dumps in. When that happens, and then there's a second site incident that's reported four minutes later, five minutes later, how difficult is it, what are some of the challenges that result from that over-convergence? I'd like the two of you guys to, from the law enforcement side, kind of hammer that back and forth and walk through what some of the problems are, what some of the challenges are, and what some of the ways to address that and avoid it from happening.
Adam Pendley:
Sure. So we know from law enforcement scenes between parking and people getting into the scene and wanting to do good work, it's very difficult to extract officers away from that and get them onto the second attack. So it's important to manage that early. And one of the examples I use a lot is a first-year sergeant is very used to resource management. If they go on scene to a traffic crash and there's five officers there, but you only need one to write the crash and one to maybe tow the car, you put the other three back in service.
So one of the ways to do that on one of these fast-moving incidents is understand that obviously we need that first contact team to secure what you have, to quickly realize that the suspect has maybe left the scene, establish that tactical or that fifth man position to manage those resources that are incoming, and then use the concept of staging, understanding that if I have enough officers that are dealing with the immediate, stop the killing, there is no active stimulus, to begin a rescue of those that are down and to begin to secure that scene, everyone else either can wait in staging or can prepare for what might be a next attack as opposed to inserting every officer you have into this first scene.
Don Tuten:
Yeah, let me build on what Adam's saying, and just as important as what he's saying is the communication piece with the fire department and your other first responders. Without that initial communication, once you determine that, hey, this may not be the only one, you have to establish that communication so everybody's on the same page immediately. And whether that be with the chief, whether it be with the lieutenant, whoever on the fire department side saying, "Hey, listen, this may be multiple attacks coming on, where are you staging? This is our recommendation. We need to really start getting our people in." One thing on law enforcement, we don't use staging nearly as much as obviously the fire department does. So I think training is a big piece of that, and we could talk about that for a long time of exactly what-
Bill Godfrey:
And we probably should.
Don Tuten:
And you're right, as how law enforcement could do a better job training. But I think putting that piece, getting that communication set up immediately, being on the same page, sending those staging managers from the law enforcement side as liaisons with the fire department, it determines the one response mechanism for both sides.
Mark Rhame:
Well, also... I'm sorry.
Adam Pendley:
Go ahead, Mark.
Mark Rhame:
Bill, also, when you look at after action reports and you look at the problems of significant big calls, a lot of them is that they don't integrate their response. And without an integration policy or procedure or system in place, you're basically siloing your system. Your fire/EMS will have their own little separate area. Law enforcement has their own area. Mutual aid may even have their own little area, not standing up a command post in an integrated response, staging an integrated response.
You can pretty much go down the list and look at pretty much every after action report, white paper, whatever you want to call it. That's one of the downfalls, one of the problems. They don't get organized. They don't integrate. The information isn't flowing all the way through every single agency that's responding to that call, and you need to. You need to get that information to them for numerous reasons. But again, that's one of the things you see. We have to have integrated response and we have to integrate our staging, our command posts. All of these locations have to be integrated.
Adam Pendley:
And we on law enforcement, to what Don was saying, we need to learn from what fire and rescue has done for many, many years, and that is they'll bring as many resources they need to the scene, but they only engage what they need at that time. Everyone else is at the ready to come into the fight if necessary, and it's up to command and the staging manager to manage those resources that you may need on the actual fire ground, and everyone else is in staging. Same thing with law enforcement. We have learned how to better respond to active shooters incrementally over the years. Of course, all the way back to Columbine, we know we can't wait. We know we need to get rescue in sooner. And now, every law enforcement agency and many fire departments across the country are eager to get inside. They want to get in there and stop the threat and save lives.
But the problem is that everyone thinks that that's the only job that needs to be done. So everyone is rushing inside the scene as opposed to realizing that there may be other jobs that need to be done. That's why staging is important. That integrated response is critically important. So if you have the fire rescue resources on scene but there's no law enforcement with them, that's going to slow down the RTF response. So what we find is that even on these first attacks, especially where the assailant has fled, is that law enforcement will spend an inordinate amount of time searching for that threat. And I've said this many times, and I'll say it again now. Known bleeding will not stop while you search for unknown threats. And on top of that, if you have every resource in there searching for a suspect that is fled, you are caught off guard when he attacks a second location.
Mark Rhame:
Well, Adam, on that, can't we secure that initial location and start our treatment at that location, get those people off, while you're still searching for that unknown?
Adam Pendley:
Absolutely, and that's one of the priorities that we focus on, is we have to deal with the active threat. Then you begin rescue, and then you continue clearing. And if you do that with a strategy in mind, using staging as one of those strategies, not only are you managing that first scene better but you're at a good footing for if that next call comes in.
Don Tuten:
You're more disciplined.
Adam Pendley:
Right.
Don Tuten:
It puts you in a position to be a lot more disciplined at that location.
Adam Pendley:
Absolutely.
Bill Godfrey:
I think the other piece, Adam, going back to something you said at the beginning of that, was there's more jobs to be done than just going in and getting the bad guy. And I think if that's the A side of that issue, then the B side of that issue is there's also some jobs that have to happen at the same time.
Adam Pendley:
Absolutely.
Bill Godfrey:
There's more than one job to be done, and there's jobs that need to be done at the same time that other jobs are happening. Otherwise, you get penalized by the clock. It's not that you won't get it done. It's not that it won't get done or it won't happen. It's that it's not going to happen quickly. And for people that have been shot and are bleeding to death, speed is what's going to save lives.
So I want to get into some of the specific challenges of managing the multi-site stuff, but before we do that, I want to talk a little bit about communications. So you've got your first site comes in. We believe it's an active shooter event. That's how it's dispatched, or at least that's how it sounds as it goes out over the radio. You've got your influx of people, the typical everybody's coming and over-convergence is going on. Most everyone is using some sort of trunked radio system these days. There's very few people that are using some of the old-school dedicated channels. What happens from the comm ability when the second site information does come in and gets dispatched? How bad are communications compromised, and how much does that affect trying to shift your resources to the other site?
Adam Pendley:
Well, first and foremost, you start with dispatch, and it's important for dispatchers to be part of your active shooter training so they recognize that this second location is not some sort of artificial call or duplicate call or a call with the wrong address. They need to understand that this is potentially the same suspect that has now gone to a second site. And being able to discern that and being able to dispatch it in a way where those on the street understand that, A, this attacker has now gone to a second location. So you start with dispatch.
And then the second thing, to your point, Bill, is that we have to manage communications and we may end up with site one having to stay on a particular channel while maybe site two starts to be managed from a second channel. But then that extra layer of management, whoever's going to be in charge of both of these scenes, needs to have the capability to communicate, listen to, monitor both incidents, and hopefully doing that shoulder-to-shoulder-
Don Tuten:
And it's intelligence gathering.
Adam Pendley:
Yeah, yeah.
Don Tuten:
Because if they're not listening to both incidents going on at the same time, they're missing out on that intelligence. And, on top of that, if they're not hand in hand with their fire partner giving that same information out, we're missing the boat, quite honestly, because we have to do that. Specifically, they may get another call that we don't even know about yet. That guy could have done something maybe en route to another call or shot somebody in-
Bill Godfrey:
Car accident.
Don Tuten:
... a car accident.
Bill Godfrey:
Which actually happened in the California one. He banged up a bunch of cars and they had a-
Don Tuten:
Absolutely.
Bill Godfrey:
... an MVA that got dispatched that turned out to be part of the incident.
Don Tuten:
Which is so critical on getting that suspect information out, the vehicle, the mode of travel, the type of weapon. All of that information is so critical, because you're going to get little pieces from that first incident as witnesses come forward if not after or while that second incident has taken place. So where's the third, or where's the fourth? And it's so critical to get that information out, not only on the radio to everybody else that's working, but also to our other responding emergency responders, whether it be fire department, rescue, whoever that may be.
Mark Rhame:
And Bill, to piggyback on Don and Adam's point is that we talk about this in the class, how important it is to embed an intelligence officer in dispatch as quick as possible. And when we first bring that up in a class, you look at a lot of people in the room's faces and they're going, "What?"
Bill Godfrey:
What?
Mark Rhame:
That's not a priority. And we're sitting there going, "Well, actually it is." When you're chasing ghosts and you're chasing that bad information and you're spending resources to do that, one of the ways you can clean that up quickly, hopefully, is an embedded law enforcement officer, intelligence officer, in dispatch as quick as possible. Dispatch is already overwhelmed. And if you go to a lot of these places, they only have a couple dispatches on duty at any given time. You get an active shooter event, they way are over-consumed with what's going on. So to get someone from law enforcement there as quick as possible to start looking at that intel that's coming in, those 9-1-1 calls, you can probably save yourself a lot of time and resources.
Adam Pendley:
And the only thing I would add to over-convergence and some of the things we're talking about is, oftentimes, your command staff can over converge as well. And what I mean by that is we teach layers quite a bit. And if you start having multiple sites, that tactical group supervisor, the triage group supervisor, and the transport group supervisor, the triage, transport and tactical that are working together right at the edge of the warm zone, they may be in charge of that first site for almost the entire duration, while a second site, same thing, you get a first or second contact team in, a tactical triage and transport at that location, and now command is an extra layer up and they're at a command post that's hopefully in a relatively protected cold zone, and they're now managing more than one tactical site at a time. And if these... the other challenge, to not open Pandora's box too much, but in some communities, the distance may actually cover two or three, four different political jurisdictions, or four-
Don Tuten:
Yeah, counties or cities, or... yeah.
Adam Pendley:
Yeah, jurisdictional authorities. And you can get into the concept of maybe the senior leadership from those multiple jurisdictions get together and create a very quick tactical area command to manage critical resources going to more than one side at a time.
Don Tuten:
Well, and you said it, and somebody has to be in charge specifically pretty quick, because everybody's going to want to do something. We've all seen the news. We've all seen the challenges that different agencies have had in the past during these responses. So everybody wants to do something. But without somebody recognizing that, hey, this is one of potentially several events has taken place, that communication, that intelligence gathering, that corroboration, basically, on getting this together, if that doesn't occur, then we have... and I'll bring up political. That's one of them as well as different agencies. You have different agency heads or political figures making decisions, but nobody's working together.
Adam Pendley:
And one of our other instructors tells a funny, not funny story of, as the chief of the zone arriving to a critical scene and trying to find who was in charge, which should have been a lieutenant, only to see his feet going in the window of the crisis site. And she had to pull him aside later and say, "You can't do that. You're the lieutenant. You have to stay here. You have to be in command and direct your officers to do those tasks." Now, obviously if the lieutenant was the first one on the scene and had to save a life, that's one thing, but that wasn't the case. So getting command to understand that they have to stay put and be that extra level of incident command, to make sure that they manage the onslaught of resources that are coming, not only for the first site but a potential second or third site.
Bill Godfrey:
And I think where I want to take this next, because we're coming up on time, but I want to spend at least five minutes talking about this, you mentioned area command. The question that I get asked with some frequency is, when do you just have multiple sites that are under the direction of one commander, and when do you need to do area command, and when do you consolidate them and all that stuff? And what I would say to you is just think about it in terms of geography. How close are you together if all of your sites... Let's say we've got three attack sites, if they're all within a few blocks of each other and you're pulling from the same staging area, that's just one incident with three different geographical divisions, is what they would be called in incident command nomenclature. But that's one incident with one staging, and you're sharing those resources.
Now to your point, Adam, and this happened in California, just like you said, this guy drove a fairly short distance but through two, I think three different jurisdictions. And in some cases, they were on different radio systems. And so when their first dispatch went out, which might've been the third incident, they didn't know about the other incidents that were already ongoing. And so they stood up their own command, had their own resource requests coming in, and to some degree these incidents were operating independently without knowledge of what was going on in the other incident. That's the case where area command comes in, because instead of, whether it's geographic distance or it's a jurisdictional boundary on who is in authority, when you've got multiple commands that have already been stood up, that's where the opportunity for an area command to step in, because then the incident command team that's on the ground in jurisdiction A and the incident command team that's running the incident site in jurisdiction B, they continue to function with full authority, but the area command is over the top of them coordinating the larger resources and information needs and the intelligence and then later what will become the investigation as well.
Are there any other subtleties that you guys think we ought to talk a little bit about some of those challenges? Because it's going to be really... unless all of these incidents occur in your jurisdiction, you're hearing the dispatch on the radio, or if you're on attack channel, the dispatcher's calling you and saying, "By the way, three blocks away from you, we've got another shooting in progress," something like this, you may very well not know about the other incident going on. So let's talk a minute about some of those challenges and some of the ways once you recognize that it's happened, what are some of the things that we need to do?
Mark Rhame:
Bill, one small issue on that is that... I can give you a personal example. We were working some significant storms on one side of the county at one time. We were working our own event, no idea that anything else was going on. Came back to the primary dispatch channel when they advised us that a tornado touched down and had significant damage. We would've been a little bit more aggressive, at least in my thought, and to release units from my site, we didn't know it was going on. We had no clue. Basically I was still hogging resources because we didn't see the urgency. We were sitting there just working our site. As the incident commander at that site, I would've said, "No, we got to get these people back in service. There's another event that is more significant that needs those assets. We got to release them." But I had no knowledge of it.
Don Tuten:
You know, I think we always talk about communication between different agencies and different jurisdictions. The one thing we typically leave out is how critical it is for the comm centers to really meet and communicate. Because honestly, that's where it first hits the fan is those different comm centers. And if one comm center has an active event and they send out an alert to multiple jurisdictions, well, now we've started connecting those multiple jurisdictions. Even if it's not from the officers on the ground, it's still from the communication side of it, and we're starting to build that intel piece.
Adam Pendley:
And that's one of the things we talk about a lot too, to Mark's point and to what Don's saying as well, is that one of the first things you do when you set up an area command is tell everyone there is an area command so they know where they can get critical resources from, so they know that when they're done with resources, they get them back in service as quickly as possible. So setting up that comm aid or that communications between an area command and the individual sites is so critically important, which then leads to the second thing, and that is, we've talked about this a couple of times already, how important that early intelligence is. And if you can establish a pattern or you have some early information on who the attackers may be... Maybe think San Bernardino, where that was going to be a multi-site attack, but it was interrupted because of good early intelligence that was managed at the right level, that was able to intercept the additional attacks that were planned by those suspects.
Bill Godfrey:
What are some of the practical things for the sergeant on the ground, the lieutenant on the ground who hears the dispatch for the other event, is maybe not certain but pretty sure that their suspect is no longer on the scene? What are some of the practical things that we can give them in terms of tips on how to adjust? To Mark's point, make sure you're not hogging resources. You got the resources you need, but you're cutting other resources away or cutting them loose. What are some of those practical tips on how they might want to alternate or deviate from the standard response approach?
Don Tuten:
I think depending on the size of the agency, area discipline is a big issue. You don't want officers coming from a far distance or far area away to your site just to have to turn back and go back around. So I think there's recognition of that area discipline for those officers, knowing the resources that you have. If you're a smaller agency, maybe you start calling mutual aid pretty quick. That's one thing to get that additional resources in. If you're a larger agency, it's contacting those other zone lieutenants or commanders or whoever's in charge of that area, going, "Hey, listen, we're working this, just giving you a heads-up. I don't need any additional resources right now, but you never know what's coming up."
Mark Rhame:
Also, I think you want to make sure that your responders understand that freelancing is not allowed. That's something that we've really hit hard and put in our policies and practices. But if you have people freelancing, you're losing accountability. You're not managing your assets correctly. You need to make sure that people understand that they go to where their assignments are. When they're done with that assignment, they need to let their incident commander know they're available and ready to go to another event. Maybe they need to be released and sent to another location. But don't allow them people just to freelance and continue to do things outside of the command.
Adam Pendley:
Yeah, and then I would also say in a practical way, again, once all patients have been transported from your site, I say in these critical incidents, people might be in charge of more for longer than they expected when you have multiple sites, meaning you may have to tell that sergeant who's on the scene, "Hold what you got. Call me if anything changes. We're working multiple sites." And that sergeant may be doing more than he or she-
Don Tuten:
Because it's still a crime scene.
Adam Pendley:
Right. Absolutely.
Don Tuten:
Yeah. Yeah.
Bill Godfrey:
It's got to be a perimeter. Yeah. A perimeter.
Adam Pendley:
And then for those agency or those zones or agencies that might be out on the periphery that haven't been called in yet and they know a multi-attack's going on, if I were a sergeant of a squad on a midnight shift, I may call them all to a Walmart and say, "Hey, let's gear up and be ready. We haven't been called yet, but hey, the next call may come out in our zone and we're going to be ready, we're going to be together, and we're going to go."
Bill Godfrey:
And I think to Mark's point about the freelancing and the tasks and the assignment, and we were talking about this earlier, and I think it is a good idea to kind of do a whole topic on this, but if you don't have a specific task assignment, what the hell are you doing down range in the first place? It just becomes another person to get in the way, to cause a problem, end up with a blue-on-blue, crisscrossing and doing... We're searching the same room three times.
Don Tuten:
You're there to help but you don't know what your job is.
Bill Godfrey:
Right. And certainly in the first few minutes of the incident, you're not going to have a bountiful number of guns. You want those guns exactly where you need them and exactly when you need them. And if you don't have a way to push those assignments out quickly as the need arises, how the heck are you supposed to get this done? And just overwhelming in numbers. Well, Karla's giving me the 30-minute sign where I think we're at a good breaking point on this one. Any last thoughts on this before we leave it?
Adam Pendley:
Because I always have to have the last word. Again, I just think the mindset should be that this is the first attack. And 99% of the time, it may only be the one attack, but be somewhat prepared in the back of your mind-
Don Tuten:
What if?
Adam Pendley:
... for that 1% of the time, that over-convergence is not a good idea.
Bill Godfrey:
Yeah. Final thoughts?
Mark Rhame:
Yeah, and I don't mean to beat a dead horse, but frankly, that's why, again, the importance of staging, building out those teams... Staging is not about slowing down, by the way. We say that over and over again. It's about being prepared to respond to an event, because let's face it. If you're not ready, that is a time killer. That will harm you more than anything else. Staging allows you to respond immediately when those teams are built and they're ready to go and they get their assignment. They know what their task and purpose is.
Bill Godfrey:
All right. Very good. Don, any last thoughts?
Don Tuten:
No, just, you can never overcommunicate unless you have a microphone in your hand. But talking to each other, you can never overcommunicate. And I think that's a big piece of it.
Bill Godfrey:
All right. Well, gentlemen, thank you very much. This is a fascinating topic to talk about and I think we've got several more for our next few podcasts to go through for the group. Ladies and gentlemen, thank you for joining us. I want to thank our producer Carla Torres for doing a great job in making us look and sound better. There's only so much you can do with filters about making us look better.
Don Tuten:
Sound, sound...
Bill Godfrey:
Yeah, the-
Don Tuten:
... is the key word.
Bill Godfrey:
Certainly on the sound side. If you have not subscribed to the podcast, please do so. If you have other people that you're working with that are not familiar with it, please share it. Share the information. Share the link. This doesn't really work unless we start to get everybody on the same page. So please do subscribe and share the podcast. And with that, we'll see you next time. Stay safe.
NEW! Watch this show on YouTube at https://youtube.com/live/N2B8yMdlueo
Bill Godfrey:
Welcome to the Active Shooter Incident Management podcast. My name is Bill Godfrey, your podcast host, and I am joined today by two of our fantastic C3 Pathways instructors. Sitting next to me is Jill McElwee, like myself also on the Fire and EMS side. And across from us is Ron Otterbacher. Welcome, Ron, Jill. Thank you guys for coming in and being part of this today.
Ron Otterbacher:
Thank you.
Jill McElwee:
You're welcome. It's a pleasure.
Bill Godfrey:
Today's topic I wanted to talk about keeping it simple. Don't make this more complicated than it needs to be. As we travel the country and we're doing our training, it seems like we've frequently run into people that are just introducing unnecessary confusion and extra terminology. And I'll give you some specific examples. We talk about contact teams and rescue task force and using those as building blocks, but then you hear things like a rescue team as a unique entity from a rescue task force, extraction teams, evacuation teams, search teams, cordon teams. The list goes on and on and on and on. And I wanted to take some time to talk about that today and talk specifically about not over-complicating that. Ron, you want to start us off a little bit? I mean, what are some of the things that you've heard and seen and how does all that land for you?
Ron Otterbacher:
I think the big thing is simplicity supports efficiency. And if you are running, whether you're running the operation or we've seen it in the classes we teach as people are trying to learn the different responsibilities, the more areas you cover, then the more chance for a mistake to be made, or for them to lose track of what to call each different entity. And it's simple. Your contact teams take care of everything, security down range, your rescue task forces, take care of the medical side of things. Once they get inside, obviously, because we're fighting against the clock, we're also going to be providing treatment inside before the RTFs get there. So you're dealing with actually four different things. You've got the contact teams, you've got the rescue task force, you've got your perimeter, then you've got your ambulance exchange point, and that's pretty much how the operation runs. Anything else down range, falls under one of those different sections.
Bill Godfrey:
Yeah. Jill, what's your take? I mean, you've come to us with a tremendous amount of incident management experience being part of type one and type two teams and deploy on a regular basis. What's some of the creative stuff you've seen in the places where we're making this more complicated than it needs to be?
Jill McElwee:
Yeah, I think what happens is we take the responsibilities to Ron's point, we'll take the responsibility of a certain team and we want to name that something. So let's call that something, as opposed to just keeping the responsibilities under whatever that entity is. For instance, the contact teams or rescue task force. We don't need to have a different name for the components within that rescue task force, because we're not doing this when skies are bright and blue and things are wonderful and we can just take our time. There's an added stressor to these teams and to the responsibilities within those teams. I think we've learned from many lessons in the past, the simpler we keep this, knowing the area of responsibility for each of those teams, they don't need to be identified by, everyone doesn't need a moniker on their chest.
Bill Godfrey:
Sure. Yeah. It probably is going to be helpful for us to pause for a moment and really make sure we're clear with everybody about how we define the contact team and the rescue task force. And so in our world, contact teams deal with security problems. That's their job. Whether that's finding a bad guy, confronting the bad guy, securing an area, securing a room, securing a corridor, whatever, securing a casualty exchange point, whatever, they deal with security problems and generally staffed with armed law enforcement officers. I'm not aware that anybody is doing something different than that, but that doesn't mean they couldn't be, but so contact teams deal with security problems and nearly always staffed with law enforcement.
Rescue task force exists to deal with medical problems, but they travel with their own security. I think what's really, really critical for us to stress in our definition of rescue task force, is that how that task force gets staffed is a local decision and a local policy and resource issue. And when I say that, let me use this as an example. In most common configuration of a rescue task force would be two law enforcement and two fire and EMS personnel, but there are all kinds of reasons why that may not occur. Some jurisdictions legislate that, oh no, an RTF needs to be three cops and five fire EMS or some other combination like that, so how you staff it is a local decision.
But it also includes the situation that you're into. For example, if you feel like the situation's a little hotter than you would like and you don't want to put Fire and EMS down range, you might staff your rescue task force with all law enforcement and say, okay, this is going to be an all law enforcement RTF. Sometimes what some people feel like, to Jill's point, we need to call it a rescue team or something like that. It's still a rescue task force. You're going to have, even though it may all be law enforcement personnel, their reason for existing is medical. And you're going to have one or more people on that team that's going to be on their weapons platform, and you're going to have one or more people on that team that are going to be responsible for medical, that are carrying medical gear, medical kits, go bags, whatever the case may be, that are providing medical care.
But it doesn't change, to your point, Jill, it doesn't change the function of what they're doing. And so I wanted to make that really, really clear as a foundation for the rest of our conversation that the way that we prescribe those rescue task forces is simply this. It is a medical function that also travels with its own security and how you staff it, who you staff it with, the disciplines you staff it with, the numbers that you staff it with, are entirely a local decision.
Ron Otterbacher:
And understanding that security component never leaves that task force. When things kick off their responsibility is to the task force and anyone they've got under their control at that time.
Bill Godfrey:
And a really good example of this, so there was, oh, I'm probably going to get his rank wrong, I think it was a battalion chief, I'm not sure. He is a chief out on the West Coast that had done some live studies on some training iterations where he was kind of showing and demonstrating that cordons could be a faster way to get the medical done. And I mean it was a really, really good effort. There was a couple of things when I read the study I was like, hmm, I think might've missed a couple of things, but irrelevant. I applaud him for doing the study and taking a look at that.
And I think that that's great, but there's two things I would point out. Number one, it's great for them for their staffing, for their resources, for their response times. It may not translate to every other town in the US, but the other thing is that a cordon operation can still be accomplished with contact teams and rescue task force as a building block. I mean, Ron talked to me, if we set up a cordon, we send a couple of contact teams to set up what up a 100- foot long cordon and then we put our medical people in there, maybe, I don't know, 12, 15 medical people that are in this cordon. And then something happens, we have a threat that appears or challenges the cordon. What does that look like and how does that go down if we don't have security with those medical people?
Ron Otterbacher:
Again, as we look at everything, that was the wonderful thing about SIM, was you got security, immediate action plan and medical. Your immediate action plan, you're talking about what is going to happen if something kicks off. You've already discussed it, because when it kicks off is not the time to just have everyone rush to the threat, because that's when you lose your security component completely and everyone thinks, well, I thought you had it. I thought you had it. That's why it's so important to discuss what your responsibilities are and make sure you abide by that discussion.
If you identify four people that are going to head out if something kicks off, those are the only four people that do it. And you make sure everyone understands the rest of their responsibility stays there. You could take a 100-foot cordon and have 15 law enforcement officers and 15 EMS Fire folks and what you just have is in that point you've got a large rescue task force and you've just got to staff different ways, because you're providing that larger cordon instead of a small casualty collection point or whatever you need. But as long as everyone understands what their responsibilities are and you discuss it before things happen, because trying to figure out what we're going to do when it kicks off is going to guarantee you're not going to be successful.
Bill Godfrey:
I was thinking through as you were talking about that if you've got this cordon spread out, and like you said, I think 15 officers that are spread out and a threat appears, if three or four officers, if they didn't agree on an immediate action plan beforehand, it's going to be more than that, but if three or four officers peel off that cordon is that not going to create a problem, a potential gap in the security?
Ron Otterbacher:
It could, if they haven't discussed what their responsibilities are. They may say, okay, the four on the far end are going to kick off and leave. So the couple in the middle are going to have to go down to the far end to enhance that security component down there. Again, you're going to have to discuss these things. When it kicks off is not the time. And again, as some brilliant people say, hope is not a plan. You're hoping if it happens, someone does what they're supposed to do, but the chances are it's not going to be successful.
Bill Godfrey:
Yeah, that's interesting. I mean, Jill, from your perspective, you're the team leader that's taken a dozen Fire EMS personnel through this cordon. Does it affect you or what are your thoughts, I guess I should say, about not having one or more security people that are assigned just to protect the team as opposed to the cordon? What are your thoughts on that?
Jill McElwee:
That has to be established, because we have to remember that what we're doing here, we're fighting two things that kill people. There are two killers at hand here. We have the threat and if it becomes an active threat that has to be addressed, but we also have that clock we're fighting. So the people in the medical aspect is what's going to combat that clock. And if you've got medics that are at risk and aren't protected completely while they're in that cordon, while they're addressing, headed to those that are injured, then we are doing no good on that end. They have to be protected.
Clearly establishing you two or four or three, however many there are, are assigned to these medical aspects, these medical components, that means you're assigned to them and on both sides. Our Fire EMS folks, the medical component, has to know that this is your team that you're staying with this task force, this rescue task force is one unit. And that's why clearly defining that, and knowing that if we're going in when there is still an active threat and we're taking that rescue task force team into an area to provide care and to maybe extract those folks out, there's got to be a discussion on and a known that this is your area of responsibility, it's what we talked about earlier. As a rescue task force that's why to me, if I'm sending my folks in, I want to know exactly who's staying with those folks.
Ron Otterbacher:
Sure. And the cordon simply in my mind, expands the rescue task force. Those people assigned to the cordon with the medical people in, are the rescue task force. Again, understanding in the ideal world and the way it should be planned is, they're rescue task force, they're security component for that. Something kicks off, the other contact teams will address it, and you've got to have faith in everyone involved. As we look at it, the cordon is just an expanded RTF and expanded casualty collection point, and no one should be leaving that. But again, if we don't discuss it before we deploy, as soon as something kicks off, you're going to have people forgetting what their responsibilities are and heading out to try and confront the threat. And it's something that we need to discuss and train on before we deploy them in that fashion.
Jill McElwee:
Bill, I'm sorry, to what we're saying, the idea for me is we can't get this complicated. This can't be complicated. This has got to be keep it very simple that we know what we're fighting and we know the team that's going to address active threats and we know who is going to protect those that are taking care of those indirect threats and that clock. And if each of the areas of responsibilities are clearly identified and we don't get things lost in translation by having five or six or seven other names of, well, I was part of this team, some local naming conjunction that we've decided of our team. It's got to be simple, because we will revert to our area of training when we're stressed, when we're put in a position, we're going to revert to that, and it's the most simple aspect. We've learned time and time again from responses to mass casualty events and events such as that, that we all revert back to the training that we have, that simplest form of training.
Bill Godfrey:
And Ron, I think from my perspective, what you're saying, I mean, I agree with what you're saying, but I think I would probably rather see contact teams used to establish the cordon and then have, even if it's just two, the security with the RTF so that it's the same building blocks that they're using all the time in training. And if they didn't set an immediate action plan, which happens on a fairly regular basis, or their minds go blank, there's at least two people there with those medical people that know their job is to protect the team. And so if the entire cordon collapse because they all give chase over the threat, which I guess in some ways you could argue is protecting the team as well, if they're going to move the threat away and back them down or neutralize them.
I think, I like the simplicity of keeping those roles very clean to accomplish what they're trying to accomplish. Just let contact teams do cordon work, the security work, protection work, whether you're securing a room or some people call it a protected island, I've heard the term, which seems to be almost a duplication of the casualty collection point term. I'm not really understanding where that one came from, but just in terms of clearly delineating those roles, so that no matter what we do, when there's a medical team down range, whether it's one person or well, a hundred would be ridiculous, but whether it's one person or 20 people, that there's at least one person whose job it is just to protect that team and they're not confused about that.
Ron Otterbacher:
Absolutely. And the other thing to consider is why are we doing all this in a cordon as opposed to a casualty collection point if we can more effectively protect the casualty collection point? A cordon means we've got far more areas where threats could possibly come from. So with far more areas where threats could come from, we've got to have more security to prevent those threats from being able to come into our cordon, so I would look at saying, you might be better off to set one or two casualty collection points that we can protect easier, and then you're only protecting one or two entryways, and if something kicks off, you still got your contact teams out there to go address it.
Bill Godfrey:
Yeah, I think that that actually makes sense. From thinking these things through. I think I see the utility of the cordon being either when you're getting into the transport phase and if you've only got... The bulk of these incidents, the median number shot is three, and of those three, one is killed, those aren't mass casualty incidents. And if you're dealing with low numbers, then I don't think it makes sense to try to get a cordon, just grab the people and get them out of there and put them in an ambulance.
But if you're dealing with a dozen, 15 that are injured, especially if you have a high number of critical injuries, you got a high number of reds, then it's going to take more medical people to care for them and move them. Then I could see the cordon operation streamlining that so that you can jack up your numbers of medical folks that are able to operate and move those patients, provided that law enforcement feels the scene is an appropriate for that, that you're at the appropriate phase, that it's been 15 minutes since the last shot, we know where the bad guy is, he's down secured. Does that ring true for you?
Ron Otterbacher:
In my mind, a cordon is simply for a safe way to move resources back and forth, whether it be moving the victims out, whether it be moving RTFs in. I've got a cordon that says that this is a safe corridor I can move my people through and we've got security on that cordon. I wouldn't use it for other areas as an incident commander. That's just ensuring that even if we may get inside and determine we need more EMS and Fire resources inside, we got to have a safe way to get them in. That may be what it's used for. And same with when we move out, it's no different from when we set a cordon on the ambulance exchange point. We're simply providing security for when they take those patients out and load them in the ambulances. And I look at it, if you're doing it inside a building, then it's simply for movement.
Bill Godfrey:
Okay. All right. That makes sense to me. Does that make sense to you, Jill?
Ron Otterbacher:
It does, yes.
Bill Godfrey:
Okay. So now let me ask you this question for both of you. In a number of these events and the suspect, the killing stops, and we don't know why. We don't always get the suspect in custody. We don't know where the suspect is. They fled the scene, left the scene, they've been subdued. Sometimes they kill themselves, though the number of suicides is declining. Does it change your mindset when the killing is done, the killing is stopped, I guess I should say the killing is stopped, there's no active killing, but you don't know the outcome of the suspect. You don't know where the suspect is. How does that change things in your mind, Ron, from a security posture and then Jill, what does that mean to you?
Ron Otterbacher:
The active threat is gone. At that time we don't know where, we don't know why, so we can't let our guard down. We've still got to perform in the area we do. But the other threat, going back to the clock, is still in place. So we've still got to get these people out and headed to a hospital and we've got to do as quickly and efficiently as we can. And then we would transition to move the RTFs out and go back to, let's find out where this guy is, if he's still here. If he's not guy, gal, doesn't matter, where has that threat gone to and why has it changed? We can't negate that it's just stopped and gone away. We've still got to go figure out where it's at. But while we're doing that, we still got to get the people that are injured out and transport to hospital and do it in a safe fashion.
Bill Godfrey:
And just to clarify, when you said bringing the RTFs out, you mean after the injured has been evacuated out, right?
Ron Otterbacher:
Yes, sir.
Bill Godfrey:
Pull them out so you can do a clearer.
Ron Otterbacher:
Right. And because we don't know where the bad guy is, we don't want them in there. Because now is it transitioning to, because we don't know where they are and until we go back and clear the areas we've been, is everything a hot zone. And because we have a rescue or we have security in place, when we move the RTFs in, that's fine, but there's no need to keep them in there while we're going back and trying to figure out where this guy went to. So it's just a safer fashion of doing it.
Bill Godfrey:
Jill, how about you? How does it change things for you when we're past the active killing, we've got no active threat, but we don't know why. We don't know where they are.
Jill McElwee:
I'll tell you, I want to say that I don't care about where the bad guy is at this point, because again, I keep going back in and it's my goal, and you'll hear me in class, to get us as focused on that clock as we are on the threat, that active threat, that suspect. I want us to, in our minds equate them equally. So I want that focus and drive to still stay on, okay, now, while our rescue task force teams are focused on that medical aspect, stopping the bleeding, correcting things we can correct in the field, so when they do arrive at the hospital, we've given this person a chance for survival, a higher chance for survival.
I want the focus to actually ramp up. Okay, now if that threat... Now all hands on deck, let's get these injured into ambulances. Let's get them to those casualty collection points, if they aren't already there. Let's move them, provide whatever care we can, not stopping, knowing that the clock is our enemy at this point. Get them moved to that ambulance exchange point, because the faster we get them into those operating rooms for these penetrating injuries in an active shooting event, the greater the chance for this person's survival. So for me, I would like to see that focus just raise and that our manner in which we respond once that threat is gone, okay, all hands on deck, let's get those ambulance exchange, our ambulances in place and let's get them transported, because the clock is just as big of a threat and a killer as that perpetrator.
Bill Godfrey:
Yeah, and I think the other thing that works out good is, as your ambulances are coming up to get loaded, they also are going to have visual contact with the contact team, the law enforcement officers that are securing that area. They're going to be able to wave them in, give them hand signals about where they want them to go, and kind of marshal them and get them in and out. It's not like we're setting up an outside casualty collection point. I mean, the idea is get them from the casualty collection point, put them in the bus and get the bus off the scene and go.
I think we've talked about some of the building blocks. What are some of the other terms or things that you've heard or seen, some of the discussions that you've had with folks in training and things like that that made you go, where did that term come from or some more examples of how we can use these things as building blocks? Anything come to mind?
Ron Otterbacher:
Again, it's just terminology that we know contact teams are responsible for security inside and out. But then they say, okay, you've got contact teams and now you've got, call it door security, you've got door security, or you've got... It makes no sense. You're a contact team. You've been given an assignment. I know that if I'm calling as the incident commander, I'm calling one of my contact teams providing security. We do have another term for another security components called perimeters. But you're either in the mix and you're part of the contact teams, or you're part of the RTF as a security component, or you're on the perimeter. Everything else falls under one of those areas. And I think by adding more terms, whatever you want to call them, makes no sense.
Bill Godfrey:
Yeah. Jill, how about you? Anything that jumps out at you?
Jill McElwee:
On the medical side, not so much jumps out. I think for us, we're pretty good at knowing that we need to put this person in an ambulance and get them to a hospital for that definitive care, that carry on care. What I think sometimes I'll hear groups want to establish is, we need a treatment area. So we got to do now while we're providing treatment, very fast, quick treatment to help mitigate what's going to kill the person the fastest, stopping that bleeding. And we will go through some of those, I'm sure later. But I hear people focused on terms that I love. And I'm not going to let anybody say anything bad about ICS. I know the value in ICS and I know all the components and on mass casualties. Just because there is a component for certain areas, we have to set up triage, treatment and transport often and when the clock is your enemy in situations like this, and do you have the resources available? That's the key. Do not spend resources establishing a component that is not needed for this.
And so I think for me on the medical side, Bill, that's what I hear more of. Well, we need a treatment officer. Often in our specific scenario when our goal is to take that person, that injured person, from the scene immediately to an ambulance, we're loading them directly into an ambulance when possible. And understanding that that may not be possible in every situation when a community may just have three or four ambulances at their disposal. Knowing that we've got to get this person transported to a hospital if you have the resources available, it's just mind blowing to see some of the things that are set up that are not needed.
Ron Otterbacher:
I looked at it-
Jill McElwee:
They look cool. It does look cool, but...
Ron Otterbacher:
Does your treatment area have, okay, this is the tourniquet area, this is the wound packing area, this is the bandaging area. It makes no sense. One person working on it, you're going through it. You're doing all the stuff you do, then you're getting the heck out of there. And that's a critical part of this.
Bill Godfrey:
Yeah. Jill, when I think back to our original paramedic training, whenever we talked about mass casualty incidents, you just triaged treatment and transport that flowed together. You didn't even really kind of think to ask the idea of whether it was really necessary. And when we started looking at these things originally back over a decade ago and realizing that some of the traditional approaches were actually introducing delays. And I remember when we first introduced the idea of, Hey, do you really need to set up treatment? Can't we do what we need to do in the casualty collection point, and then put them right on a bus and get them out of dodge? And yeah, that was like anachronism. It was-
Jill McElwee:
But what do we do with the red tarp we have, Bill? We've got this nice never used red tarp. Yeah, I get it. You're right. We've introduced delays. You hit it on the head. And when we step back and think at the totality of care that this person needs, if this individual has a penetrating wound, then blood is not where it's supposed to be. Potentially, air is not where it's supposed to be in the body. And those are things we can provide quick fixes for, not cures for, but we can provide fixes that takes that clock and it just slows it down just a tad, and it provides this person a much higher chance for survival. And so those fixes that we are doing in the field, those treatments that we're doing in the field, don't have to have a specialized area. They can be done at first contact with this person, with the injured.
Bill Godfrey:
Yeah. I think the name of this podcast is obviously going to be, don't make this complicated, but it could also be, we don't need all the terminology. I think we could do a whole separate podcast about just the terminology of things that get thrown in. It makes it complicated when it doesn't need to be.
Ron Otterbacher:
Well, think about it, ICS has already addressed a lot of that by going away from codes and everything else. They want plain talk. They want me to tell you what I need. You tell me what you need, and it's just straight talk. I don't have to know what your codes are. I don't have to know what your unit number is. I just know that I've got an incident commander, I've got an operations chief, I've got the different things that are there. I've got tactical. I've got the law enforcement supervisor. If I'm from another jurisdiction, which is oftentimes I am, I'm coming into your area. If I don't know anything, I know someone's going to be in charge of this bad boy. So, audit the command, where do you want me? It's that simple.
Bill Godfrey:
Yeah. Yeah. It is important to keep it that way. So our primary message with this one is, gang, don't over-complicate this. You can build anything and everything you need with the two building blocks of contact teams and rescue task force. And all of the other stuff, all of the other tactics, all of the other medical stuff that we might need to do, medical operations, you can do those with contact teams and RTFs, so let's keep it simple. All right. Well, Otter, Jill, thank you so much for coming in today.
Ron Otterbacher:
Of course.
Bill Godfrey:
I appreciate it.
Ron Otterbacher:
It was a pleasure.
Bill Godfrey:
Yeah. Fun too. And this is you guys' first time in the new studio, right?
Ron Otterbacher:
Yes, sir.
Bill Godfrey:
Yeah.
Jill McElwee:
It's impressive.
Ron Otterbacher:
Pretty fancy.
Bill Godfrey:
Yeah, of course. When you stand up, you got to be really careful not to trip over the cords. We've got a little bit of room for improvement there, but well, thank you both for coming in. Ladies and gentlemen, thank you for tuning in. We appreciate it.
If you have not subscribed to the podcast, please do click subscribe, and don't be shy about sharing it with your friends. Obviously, there's a lot of work to be done across the country. And then the more we share this information with others, the more lives we can save. With that, until next time. Stay safe.
NEW! Watch this show on YouTube at https://youtube.com/live/iXHgu7zomfo
Bill Godfrey:
Welcome to the Active Shooter Incident Management Podcast. My name is Bill Godfrey, your podcast host. I am joined today by three of our wonderful C3 Pathways instructors. On my right here is Tom Billington, one of our Fire/EMS instructors. Welcome, Tom.
Tom Billington:
Good to be back.
Bill Godfrey:
It is good to have you back. Been a minute, that's for sure. We're also joined across the table from us. Russ Woody, one of our law enforcement instructors. Russ, welcome from North Carolina.
Russ Woody:
Yeah, glad to be down, Bill.
Bill Godfrey:
Good to have you here. And then we've got Travis Cox, also one of our law enforcement instructors and our training director. Travis, it's good to have you here in the studio.
Travis Cox:
Hey, it's good to be here. Good to see you guys again.
Bill Godfrey:
It's exciting. It has been a minute. It feels good to be back doing podcasts again. And of course, we've upped the game a little bit. I looked, it was September of last year that we did our last podcast, so we're just shy of a year being off the air. Can you believe that?
Travis Cox:
Yeah. It didn't seem that long, but time flies as they say.
Russ Woody:
It really does.
Bill Godfrey:
It sure does. It sure does. And everybody's due an explanation about why that is. And the truth of the matter is, there has been a lot of changes, all good stuff, but a lot of changes over the last year and it just became difficult to keep up with. You may or may not notice if you have heard the podcast before, we are also videotaping our podcasts now, as well. They're going to be up on our YouTube channel and we're here in our brand new studio.
Travis Cox:
And it's amazing.
Russ Woody:
Yeah, it looks great. Really does.
Bill Godfrey:
It is so exciting to be here. But we've also moved, we are no longer in the building we were in before. We've moved to a new location. We've got new offices set up, new space. We've got a dedicated studio set up and we're getting ready to open a dedicated training center. Granted it fell a little bit behind schedule, some construction delays. It just seems like you can't keep construction on schedule no matter what you do. But that's going to get cleared up and we're going to have this beautiful training center opened up here I think pretty soon.
Russ Woody:
As you know, Bill, when I got here, I started taking pictures. I've been sending pictures to all my friends about how this facility looks, how professional it is, and a lot of people were saying, wow, that's quite an improvement. So it's come a long way.
Travis Cox:
Definitely. Definitely. When I first saw it, it wasn't what I expected, but when I saw it I said, "Oh man, this is the first class all the way." So excited to be here and looking forward to what we're going to be doing in the future.
Russ Woody:
Very much same. It really didn't surprise me. It seems like everything that Bill does, really puts forward every effort and it is a great facility.
Bill Godfrey:
Well, those are gracious words, Russ, but this is a team effort and there's a lot of people involved in doing this from picking out all the stuff. Our producer, Karla, who's behind the scenes, she and a couple of the other people picked out a lot of the carpet and the finishings and the colors and it's just really nice to have a place that we can call our own and do some dedicated training in. And with any luck, we'll get the construction back on schedule and we'll get caught up here pretty soon. So anyways, it's exciting to be back. Let's get into the meat of it. We decided to talk today about rescue task forces and some of the common challenges that we see with RTFs, being a little bit confused about what the expectations are, what they're supposed to be doing, that kind of stuff. So Tom, this was one that you kind of threw out as a suggestion and we were all like, yes, that's a great topic. So why don't you talk a little bit about what was on your mind and what you're thinking.
Tom Billington:
Well, Bill, when we teach a class, we usually don't have enough time to go into all the exact details, but the RTF is such an important part. The Rescue Task Force, and first of all, just talking about what it is the Rescue Task Force is, it's usually a group of four people. So usually two Fire/EMS and two law enforcement working together as a team to go into the casualty collection point and start doing the treatment and get things sorted out. But we've never really talked about how do you do that? Why do you need more than one RTF? What is your goal when you get there? How do you organize things? And I think that's just a good place I wanted to start. But definitely, I think the important part is how are we formed and why are we formed this way, I think is the important part. I may be in a situation where I'm working with law enforcement officers I may have never met if I'm in a large organization. So I want to make sure that I know what's expected of me as the medical person and what I expect of the law enforcement person as far as the medical roles go. So I think that's just some of the things I wanted to cover.
Bill Godfrey:
Yeah, I think that's exciting.
Travis Cox:
It is really important for law enforcement to know what their mission is and what the responsibilities are on RTF because sometimes that can get confusing and sometimes law enforcement thinks they're there for other purposes besides what the RTF purpose is.
Tom Billington:
That's right.
Russ Woody:
Yeah. Seen it so many times where the law enforcement personnel that are attached to that RTF don't understand that they have made a promise to those individuals that, I'm with you. They are there with them throughout the event.
Travis Cox:
Yeah, exactly. Exactly. When I teach that section, I like to use my Top Gun rule. Never leave your wingman.
Russ Woody:
That's right.
Travis Cox:
Never leave your wingman. And the fire counterparts are your wingmen on that mission.
Bill Godfrey:
And before we dive into the meat of where Tom's going with this, which I think is really important and we have not talked about before on the podcast series, even though we've talked about RTFs, we haven't talked about where Tom's want to go with this, but I do want to just remind everybody who's listening, when Tom talked about the typical two and two, that's just a typical. There's no magic to those numbers, but here's what's important. There are people on the team that are responsible for security and they're up on their weapons platform. There's people on the team that are responsible for medical and they are carrying whatever medical gear that you're going to take in and you work together. And I think, Tom, where you were going that starts in staging before you deploy is the conversation to introduce yourselves and talk about what the expectations are and the rules. Because at the end of the day, so if Tom and I are the medical element of the RTF, our job is to take medical care of the patients, but you guys are responsible for moving us safely to where those patients are.
Tom Billington:
It's a hundred percent team effort. It's a hundred percent team effort. And law enforcement has to know the safest route to get to where you need to get to. And then once we get there, it's up to the medical side to start doing their triage and treatment.
Bill Godfrey:
Yeah, absolutely. And at the end of the day, your situation, your staffing, your community, your resources, the threat that you're facing is going to dictate the size of that team and who's on that team. And there may be some communities where the rescue task force is made up of all law enforcement personnel and that's fine, but you still have to divvy up the duties. Some of them have to be on security and some of them have to be on medical. And I just wanted to set that foundation before we go into talking about the CCP.
Tom Billington:
Absolutely. I've seen it where you just mentioned all law enforcement personnel. Sometimes some agencies have what we call TAC medics. So you have EMS-trained folks that are capable of filling that medical function when they go down range as the RTF.
Bill Godfrey:
Yeah, very good. So Tom, we're the first RTF. Let's just assume for this conversation that the four of us are RTF-1. We're the first ones down range, other than the contact team who's hopefully organized the casualty collection point or at least established the location, has got some security, has got that done. But we're the first ones that are going to punch through, so let's just kind of talk from that context. You guys are going to move us up, get us where we need to be. Tom, when we punch through the door, what's the first things on your mind?
Tom Billington:
Literal, earlier I took my app out of my phone, the Active Shooter Incident Management checklist, the app, C3 app. It tells you right here, once I'm stood up and I know who the team is and we're going down, one of the things I need to do is make sure tactical knows that I am deploying. I work for tactical, we are on a medical mission, so I need to make sure tactical knows where we're going and they agree with where we're going. And then once we get in there and we find the safe route, we have to know what are we going to do when we're in the room. Remember, if our makeup is two medical and two law enforcement, if that's our case, and we have seven or eight critical patients, are two medical personnel going to be able to handle this? No.So the first thing I want to do when I enter that room as an RTF is I'm going to take the lead, maybe might call it the capture collection point lead, CCP lead. I'm going to take the medical lead right off the bat and say, "Hey, I need more RTFs. I need them now. Let's not mess around." I'm going to call a triage and ask for what I need specifically. I'm not going to say, send me some more. I'm going to say, "Hey, I have three yellows, four reds, I need five more RTFs at this CCP." I get a response from triage. Yes, we copy that, we'll send it. Now my next job is I'm going to start my triage. That's where the law enforcement has already done a great job, hopefully. You want to talk about law enforcement triage a little bit.
Russ Woody:
On the law enforcement side, when we get there-
Bill Godfrey:
Russ, I'm going to bump into you there for just a second because I want to clarify what Tom was saying. He was saying earlier we need to notify tactical and I want to clarify those comments. So Tom and I, as the medical element, are on the radio with triage and the RTF team actually works for triage. What Tom was talking about with the tactical is, our security is on the radio with tactical.
Tom Billington:
Exactly.
Bill Godfrey:
And you need to let them know where you're moving when we get there, that's what Tom was addressing.
Russ Woody:
Absolutely.
Tom Billington:
Yeah. We kind of refer to the tactical position that air traffic controller, that person working tactical is going to give us the direction, the route where we need to get there. And then once we get there, we're going to get our medical personnel in that room and that CCP and then let them go to work.
Bill Godfrey:
And when we hit into the CCP and the numbers that Tom was talking about giving, we're going to give those numbers to-
Tom Billington:
Triage.
Bill Godfrey:
To the triage group supervisor. So just wanted to make that clarification. Russ, with that, talk a little bit about what we're hoping for law enforcement who've set up that CCP to done some triage ahead of time.
Russ Woody:
So hopefully the contact teams that we'll talk about in another podcast, I'm sure, have met some of the goals that are going to help us. And that is setting up that casualty collection point. And in doing that, they should have provided security for that casualty collection point. So they should be there providing that and we should be able to come in with our RTF and arrive safely. We have been guiding through and once we're there have that ability to then function as the lead in that room needs us to possibly for some time. But law enforcement, hopefully, has done some triage. We're only going to go red or green given that casualty count of those particular injuries and then started possibly some of the treatments that would be appropriate for law enforcement.
Bill Godfrey:
And of course, you mentioned the key there is we're not expecting law enforcement to go through and do full assessments. It's a click, red or green. If they're hurt and they follow your commands to get up and move to a particular location, that's a green. And if they didn't, that's a red. Done.
Russ Woody:
That simple.
Bill Godfrey:
Yeah, it really is that simple. So when we get in there, you mentioned, Tom, the importance of taking lead. And I want to visit on that for a minute. So you and I came up in a time, and I don't know, thank God we don't touch patients anymore really.
Tom Billington:
Yeah, I agree.
Bill Godfrey:
But we came up in a time where it was common for us to be the only medic that was covering an area that was covered for four or five ambulances. And so we ran into incidents on a regular basis where you were the only medic and you had essentially four, five, six patients you had to take care of. Maybe not a mass casualty in today's sense of mass casualties, but you had to provide multi-patient care. And over the last, I don't know, 20, maybe 30 years, 20 years, certainly, we have seen the number of paramedics in the field that are deployed really, really go up, which is a great thing. But the result of that is the frequency with which they need to manage multiple patients has really plummeted. And I think it's been a little bit of a lost skill, Tom.
Tom Billington:
The triage part has been a lost skill. Again, like Bill said, I've done triage in the field where I had to decide somebody's not going to survive. Now when you start getting a lot of paramedics in the room, they start looking at each other. So somebody has to take the lead and that should be that first RTF, a medical officer take the lead right off the bat. And a few things when you're taking the lead is, when I come in to the casualty collection point, I'm looking around. How did I come in here? What route did I take? What would be a good area, thinking ahead, where I might be able to set up an ambulance exchange point? Is there a closer door to my right that I didn't come in? Could that be a good ambulance exchange point? I'm thinking about that also. So now I'm thinking about my triage, thinking about a possible ambulance exchange point. I'm calling for more resources. Now, I'm going to start triaging the folks and start doing some treatment.
Bill Godfrey:
So-
Tom Billington:
Go ahead. Go ahead, Bill.
Bill Godfrey:
I was just going to say, tell me a little bit about why you want to think about the ambulance exchange point when you're coming through the door.
Tom Billington:
The ambulance exchange point is one of the areas that we know in our research, a lot of time is wasted. The clock is ticking and that is one area where we can save precious minutes. And since I am the first RTF in, I'm getting situational awareness of where I'm located in the facility. I have a good idea from walking in here, oh, I know that this might be a faster route. So that way I can work with law enforcement to get security set up for AEP, ambulance exchange point, rapidly, so we're not going to be waiting on that. We don't want to wait, we're fighting that clock continually. So always thinking ahead a couple of steps.
Russ Woody:
And we, as law enforcement, hopefully, will realize and talk with you on that and then pass that information on to tactical or the contact teams that are there on the ground with us and they will go and push out and establish that security at that AEP and hopefully maybe a corridor in between.
Travis Cox:
Yeah, I was going to say that's where that teamwork starts to come in as that RTF gets in that room and the medical treatment starts to happening. That's something that law enforcement can start working on is as you come up with a suggestion for where the AEP should or could go, we can provide that intel. Is that the safest route? Is it possible that we can secure that area? All those other factors that come in from a law enforcement perspective to make sure that we're working together to get the best possible location for the AEP.
Bill Godfrey:
Yeah. So let's talk about that for a second, Travis. On the law enforcement side, talk a little bit, the two of you, about what's involved in actually securing an AEP. Okay, so Tom and I go, "Hey, there's an exit door right there, it backs up to a parking lot. We'd like to use that as our AEP." What's involved in you guys actually making that ready so that we can get an ambulance moved up?
Travis Cox:
Well, I think one of the first things we have to consider from the law enforce side is what's the status of the suspect or the shooter? Is the suspect contained? Is the suspect down or is the suspect at large? Obviously, if the suspect's still at large and we don't know exactly where he or she may be, that's going to provide a lot more security elements or security questions that we have to take into consideration when we look at a AEP site bringing those patients outside. So I know, Russ, you've done a lot of that before. And once we take those patients outside, there's a lot of risk factors we have to take into consideration.
Russ Woody:
Absolutely. And it does. It's a resource drain if it's an area, and terrain will dictate if you have to push out quite a ways or if you can get on the edges of buildings and provide the security that's needed there. But certainly, it has to be done early because it won't take that Rescue Task Force long to get in and that first patient that they contact that is in real dire need and us fighting against that clock to now decide to move them out. And that's going to take some time to get that ambulance into the space and make sure we have it secured for them.
Bill Godfrey:
And I think that I wanted to highlight that, Tom, because I think it is one of the most consistent things that we see is that we forget about getting the ambulance loading area, what we call the AEP, the ambulance exchange point, and we call it the AEP instead of the transport loading zone because it requires security. It takes time to get that secured, that area, I don't want to use the word cleared, but to check that area and feel like that you guys have it under cover. And if we've waited until we're ready to transport and now we're doing that, we just pissed away 10 minutes.
Tom Billington:
Absolutely.
Travis Cox:
So if the shooter does go active, again, law enforcement already has a pre-planned situation or pre-planned idea of what they want to do, who's providing cover, who's going to address the threat, and then we can move forward from there. So those are things that we have to take into consideration on the law enforcement side, and communication is key that we're communicating what the plan is to our medical counterparts. So as we're moving those patients, they know what to expect if we get a shooter going active again.
Russ Woody:
And for the law enforcement on that AEP or on that scene, that immediate action plan could be as simple as, if there is a threat that starts again, the two of you are going to stay here and continue to secure this because we've made a promise that this is secure and we've got to keep to that to that Fire and EMS side and the patients we have there on scene. And then, okay, the other two or four that are in that scene, you'll be the ones that will go and go after that active threat.
Bill Godfrey:
I like it. Okay, so we're RTF-1, we've punched through the door, we've done an initial triage call quickly. We've identified an area that we think is good for an ambulance exchange point. We have handed that off to you guys as our security element. You're talking to tactical and working on getting that secured. It's time for you and I to go to, we called for the additional help, now it's time for you and I to go to work, pick it up from there.
Tom Billington:
And that's where our old fashioned triage from way back kicks right in. We have to decide, there's two of us right now using the triage method that we're using in whatever system we're in at that time, who's going to get treated first? What actions can we take immediately to help somebody sustain better? What other quick things can we do? But then we get down to the meat and bones and say, "All right, this person needs intervention now." And that's when we start doing some more advanced procedures. We don't want to go to town on the advanced procedures, folks. We want to get them in an ambulance, get them to a trauma center, but we can do some things that can keep that clock at bay. Some airway management, maybe portal decompressions or things like that.
Bill Godfrey:
Basic bleeding control, tension-pneumos, that kind of stuff that we need to deal with. The other thing that I want to mention, granted, it's a little bit of a pet peeve of mine, the most common triage system used by Fire and EMS across the country is the START triage system. And I hear people tell us on a regular basis, "What's your-" "Oh, we use START." Okay. And then you ask them a few questions and you realize, they've just told you that they use START and they have no idea what the flow chart is or what the criteria is for how to classify people as red, yellow, or green. And it leaves me going, "Okay, you say that you use START, but you don't, because you don't know what the criteria are. So what methodology are you using?" And before I move on from that, I do want to remind everybody that's listening, START has no scientific basis to it whatsoever. It was originally developed out on the west coast in response to training civilians who were going to be expected to do interventions in mass earthquakes. And somewhere along the line, we adopted it in the EMS system. And yet even though we say across the country, more than 50% of the people use START, I think I've had less than 2% of the EMTs and paramedics that I've asked that have been able to tell me what the criteria are. And so it's a huge gap. The other reality is, especially in a shooting, great, I use START, I used it correctly and now I have four reds, which one's the priority?
Russ Woody:
The judgment of what you feel has to happen and hopefully by then these other RTFs are showing up. And so that's when you can start saying, all right, this is my judgment. I can do the best for this person for their longevity to survive. And so that's how we do it. The other RTFs come in, and again, you're not off the hook when the other RTFs come in. You start assigning them immediately to the next patients that need to be treated. But also, remember, you got to talk to triage. Triage is your boss. Triage wants to know what's going on. Triage is saying to the RTFs, "Hey, how many reds do you have? How many greens do you have? How many yellows do you have? What's going on in there? What time is it?" All those things. So again, if you're the lead RTF, you have to think about that. You need to get the color codes of what you have to triage because they need to tell transportation for the ambulance counts. So we have to get that job done also. However, do not get hung up on colors. The triage colors will change. Some will go down, some will go up. We just want to get the best count out there as possible and get these folks out of there and get them into an ambulance as soon as possible.
Bill Godfrey:
Travis, you and Russ have both been coaches at the tactical position countless times where you're coaching tactical triage to transport. How many times have you seen triage and tactical get wrapped around the axle over the colors not matching what they were 10 minutes ago?
Travis Cox:
Oh, all the time. All the time. And you got to be cognizant of the fact that they are going to change and you just have to deal with it as it changes. So again, it's about beating the clock and reducing the clock as much as you can. Not so worried about the colors of the patients, but how quickly can you get the ambulance exchange points set up. How quickly can you get those patients on the move and get them to a trauma center.
Russ Woody:
Not only the color code, but also just the casualty count itself is going to vary as it goes along. Just because the contact teams gave you a count of 15, don't get hung up that we've only got 13 or 14 there. Where's the other? Or we must be missing-
Travis Cox:
Just get the resources there.
Tom Billington:
That's right.
Travis Cox:
Just get the resources.
Russ Woody:
Get the resources. And don't forget-
Tom Billington:
Because this comes up so much, I'm going to even stress it even further. I've had instances where the RTF is saying, "Hey, we're ready for an ambulance." And triage says, "Wait, how many yellows do you have?" No, we need to get these people to the hospital. So don't get wrapped up in that. And that's another discussion for triage and transport.
Travis Cox:
I think it comes down to trusting the people that you've sent down range. If whoever's in that room and is telling you what they need, if you're on the outside, you're triage or transported tactical, you got to trust the judgment of those responders inside the room because they have the best vantage point of what's going on and what's needed.
Bill Godfrey:
I need one more rig. So sometimes just in how we communicate, I think, can probably help that up. And I do want to highlight your point and make it loud and clear that first RTF through the door has got to provide the assignments for the other ones that are coming through, whether that's one more RTF, three more RTFs. If law enforcement sets up a cordon and we dump 15 medical people in there to do ... whoever's coming in, we need to tell them what we need done. "Hey, we've got three reds over there I haven't been able to get to. We're down to the reds. I need to know which one needs to go first." And to talk about that, I've got this kind of injury. I've got these kind of vitals, and have those conversations. So if it's maybe the second RTF coming through the door begins to help us finish up that assessment and that initial care, and then the third RTF coming through the door, they say, "Tom, what do you need? It's time to start moving people." Go ahead. Go ahead, Russ.
Russ Woody:
That's one of the things, too, you have to be careful of. I know you've seen it, Travis, I have. Be careful, that lead in that room is vitally important to not blurring lines between the casualty collection point and turning the AEP into a casualty collection point. We want to only move them out when it's time appropriate.
Travis Cox:
Good point.
Russ Woody:
So there's not going to be any delay getting them loaded for transport and moving them out. We don't want to take all of our 15 out and have them out there exposed to possible threats or elements. So that's one thing, again, that lead is vitally important.
Travis Cox:
Yeah, I was going to say another thing about that lead that's so critical, and we see it in training all the time. If someone does not take a lead role in that room, you see in training all the time, at least I've seen it in training all the time, that a patient may get reassessed two and three times over when they're ready to transport, but because no one's taking lead and there's no coordination within that room on the medical side, you're wasting time there just reassessing the same patient over and over when they're ready to be transported.
Bill Godfrey:
We didn't tag them. We didn't put a ribbon on them. We didn't mark them. We didn't. Yeah, that's a huge issue. And I also want to reinforce that because as medical guys, we're not typically trained in tactics. And you guys have heard me tell the story about how I learned what the X was. I had a patient that was down in the middle of a hallway that had exposure to about four rooms on each hallway. It was an X intersection. And I leaned over to start trying to take care of the patient and the guy I was with, it was my security goes, "No, no, no, no. We're going to move him." I go, "No, I need to take care of him." And I lost that argument and I got moved along with my patient into a room. And they're like, "You don't treat on the X." And I go, "What the hell's an X?" "Well, that was where that guy was standing when he got shot, and that's a bad place to be."
And then afterwards, they took me out to the hallway and said, "Look at all these exposures." And I think what you're saying is critical. The AEP is a safe location. The CCP is a safe location, but if you take all of your patients out of the CCP and expose them to being laying on the sidewalk, you've taken them from a less secure place, which is an interior, believe it or not, everybody's always in a hurry to get out. You're safer on the inside with security posted than you are exposed to all those elements on the outside. And so on the medical side, we have to remember not to move them until we're ready. There's either an ambulance there or an ambulance that's immediately on the way. Move those out, which requires coordination for us among the RTFs to say, "This one's going next." We should be stacking them by the door. This red, this yellow, this green are going to go next. Whatever the numbers are going to be to try to balance our load. And so our natural tendency is to try to get everybody outside, but that goes against-
Travis Cox:
Yeah. We're more secure inside and we can secure the place better inside. So we want that rescue unit or that ambulance either en route or on station before we start to move. Obviously, depending on how far the room is from the AEP, that's going to dictate that. But we definitely don't want that ambulance just sitting there, nor do we want patients sitting outside waiting on the ambulance. So it's a timing thing.
Russ Woody:
Perfect world, the ambulance would stop rolling at the same time that the patient got to the back of the ambulance.
Tom Billington:
Classic touch and go.
Russ Woody:
Perfect.
Bill Godfrey:
I think, you know what, that's a really good way to kind of talk about and illustrate that. And I think as we are coming up on the end of our time here, I think as we wrap this up, the big thing to just kind of reinforce is underlying is that first RTF has a lot more responsibility than just medical care for the patients they encounter. They've got to take a leadership role. And if you happen to be a medic and a company officer, great. And if you're not, suck it up, buttercup. You're the first one through the door. And oh, by the way, it doesn't have to be a medic. EMTs, I've seen EMTs do magic.
Russ Woody:
Oh, yes.
Tom Billington:
And again, we have our handy dandy right here on my phone, Incident Management Checklist. It tells me, as the RTF, everything we just talked about. So if you start getting behind, pull that checklist out. What did I forget? What can I follow up on? It tells you all these points. Stick to them to get that clock from ticking too fast.
Travis Cox:
And then for my law enforcement friends, when we get in there, they're part of that contact team. There's a lot we can do before that RTF gets there. So as much as we can do, we've evolved as responders, we're carrying tourniquets. Some of us are carrying medical kits, so at least minimum we can triage the room from red to greens. And so we can give some information to the medics when they do get there, and that'll speed up the process to help speed up the clock.
Russ Woody:
Have that security in place, come up with your immediate action plan and start providing medical if you can.
Travis Cox:
Saving lives is everybody's job, not just medicals.
Russ Woody:
It is.
Bill Godfrey:
It is. And Russ, I think your point is well taken. Don't forget to post your security. If you've got a contact team of three or four, you can't all do medical. It's kind of like an RTF. You're splitting your function a little bit, but don't forget where you are. So well, let's talk about any closing thoughts. Anybody have, anything else they want to add?
Tom Billington:
Sometimes I just wish we could take a big stopwatch and put it around the neck of the person who's the first RTF, because you can save lives with time if you do things correctly. Follow that checklist, make sure the AEP is getting set up, make sure you're getting triage done and make sure you have resources coming in to help you. You can save lives just by that timing. So it's very important and it's an important issue to discuss.
Russ Woody:
Absolutely. To Tom's point, we can do certain medical treatments as law enforcement and the medical personnel on scene can do certain things too, but there's some things that can only be cured in an operating room. So moving them off that point and getting them there is key.
Travis Cox:
I'll say this because over half of my law enforcement career, I've been in a training role and you have to train this. You can't wait to disaster day to throw together RTF for the first time. So I would encourage all those agencies out there, whether it's on special events, on smaller incidents, but you got to put RTFs together, get law enforcement and Fire and EMS comfortable with working together, comfortable with trusting each other's judgment. And then when disaster day does hit, you'll be ready to go.
Bill Godfrey:
Yeah, Travis, I completely agree with you. We talk about how we work together all the time on calls and we do, but there's a difference between being on the same call and being integrated into each other's teams. And what we're talking about with a Rescue Task Force is the equivalent of you guys being with Tom and I when we roll up on a structure fire and we're like, "Okay, throw this pack on, grab the hose line and come right in behind us, it'll be fine. It'll be fine. Trust us." So if we don't practice that ahead of time and we don't work on that, it's going to lead to some challenges.
Tom Billington:
Yeah, training is key. Training is so vital to making that concept work, RTFs.
Bill Godfrey:
Gentlemen, thank you so much. It's exciting to be back at it again. I'm certainly glad that we're back doing podcasts again. Thank you for coming in and doing this. And to the audience, thank you for being patient with us as we've negotiated this last year of mass changing and we've tripled the number of deliveries we're doing across the country, which is super exciting. We're doing the Active Shooter Incident Management Advanced Class pretty much every week somewhere in this country, which is fantastic. But it brought with it's some growing pains, and so we fell off the wagon a little bit. But now that we've got our studios set up and we'll get some rotations done and get caught up on podcasts, I'm looking forward to being back on the regular.
Travis Cox:
Absolutely. We got big things on the horizon. We hope you guys are following us on social media and keeping your eye on us, and hopefully, we'll see you in a training class soon.
Bill Godfrey:
Ladies and gentlemen, thank you for joining us. And until next time, stay safe.
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