Like many of you, I've been through active-shooter response training where the focus is on law enforcement's aggressive approach to solving the lethal problem. That's what we want. It's a basic task that the first-arriving officers locate and stop the threat. Whether accomplished by independent officers or a contact team, it's a primary goal—but not the only one.
As trainers, we should also recognize the need for officers to help the innocents, especially the injured. Such acts of mercy can come at any moment during the response. Unfortunately, this important aspect doesn't always get its fair share of training time. In fact, it's sometimes ignored, with training exclusively concentrated on the contact team. Our goal in this month's article and the next is to fix this by discussing rescue concepts and tasks.
An Officer's Dilemma
Often the dogma is that contact teams hunting the active-shooter suspect should totally disregard the condition of the dead and the dying in their path. I get that. But although it's a relatively easy concept in theory, in practice it can be quite different.
Imagine that you just arrived at the scene of an elementary school shooting and it matches the devastating horror of Sandy Hook. With other contact team members, you begin searching for the suspect. It takes a constant mental effort to focus on your duties. It's extremely quiet—no shots fired—and your senses are in hyper-vigilant mode. You push down a hallway. Turning a corner, you see wounded children on the floor. One of them looks like your daughter. She is bleeding profusely. It is the worst situation not just of your career, but of your life. The blood is bright red and pooling quickly. She is going to die unless something is done now. She's looking into your eyes for help. What is the right thing to do?
Crisis Decisions
That's an extremely tough moment. If you press on and find the suspect, it can definitely be the correct course of action. (But I guarantee you will remember her face to your final days.) However, if you stop to save that child's life, wouldn't you be deserving of respect and thanks as well? What we want to do here is talk about and train for the decision to save a life and the concepts related to that decision.
To get started, we should backtrack with two definitions:
1. The contact team engages as soon as possible with the mission of stopping the threat. (There has also been good discussion about individual officers doing so rather than waiting for the arrival of more help. Courageous and confident cops willing to take this immediate risk rather than wait are, I believe, worthy of our praise.)
2. The rescue team has the responsibility for finding and evaluating the wounded and then moving them.
These two missions can switch with moment-to-moment changes in the situation. A rescue team can suddenly shift into contact team mode or vice versa.
Team Leader Up
The basic premise is that the rescue should come either after the suspect's actions have been stopped or sufficient personnel have arrived. In theory, rescue teams follow the contact team to help victims who have been bypassed in the hunt for the suspect. Whether the rescue team is only two officers or an entire squad, there should be a team leader—someone who makes the decisions and keeps the members alert and focused. Just because the team is in rescue mode doesn't mean that the environment is devoid of danger. The rescue team leader must direct and delegate, even to the point of deciding what the officers do with the wounded they encounter.
Assessing each victim's condition, then, falls on the rescue officer's shoulders. Saving Private Ryan provides a vivid example. On Omaha Beach, the wounded lay side by side. A doctor and a medic moved from one to another, quickly classifying them into three groups: immediate care, delayed care and deceased. This is down-and-dirty triage.
Along with checking for visible wounds, one method to help this process is the acronym RPM: respiration, perfusion (whether or not there is plenty of blood in the system) and mental condition. RPM is one method to evaluate the condition of the wounded—whether they are a civilian, a police officer or yes, even a suspect. (I was taught the RPM concept by fire department paramedics who recently attended our active-shooter
response instructor course.)
Casualty Care
Along with the initial evaluation, the rescue team mission should, as circumstances allow, also include at least preliminary first aid. Such a concept may be outside the norm for street cops. We have been told to wait for the paramedics to do the medical stuff. But they probably won't be there due to various delays or protocol that keeps them in a stand-by mode. Further, it takes time to get the injured to them and staying put is not the right option.
If it was a wounded cop bleeding on the ground, most of us would stop and help the officer. The same should be true with civilians. Delaying or avoiding combat care until the paramedics are available is questionable and could result in a bad outcome for the wounded.
Go back to our opening scenario with the wounded girl. Wouldn't it be best if this approach is changed? Instead, officers should have with them individual first-aid kits that include easy-to-use tourniquets, blood stoppers, gloves and surgical shears or a rescue cutter to remove clothing and stop the bleeding. They should also have the mindset and training to save lives in this setting.
Get Out Now
Rescue team members may direct those in the "delayed" care category—and possibly worse—to self-evacuate; able-bodied civilians should be told to help them. The tactical logic behind this is clear: If a wounded person can get out under their own power—or with the help of others—then it frees up the officers to move on to those in greater need.
It's amazing what a human being can do when the will to survive kicks in. The Columbine survivor Patrick Ireland is a great example. Severely injured, including suffering from a bad head wound, Patrick crawled to a broken second-floor window and pulled himself up into it. Positioned on top of an armored rescue vehicle, SWAT officers in rescue team mode were able to pull him out and ease him down to the ground. There, he recognized that he was by a vehicle. But because of his wounds, he couldn't process what type it was. He did know it was a four-wheeled means of escape. The cops had to stop Patrick from crawling into the driver's seat to drive himself out of the carnage.
Whether carried by officers or civilians, the transport of those who can't exit the chaos on their own is a difficult task. "Dead weight" is an applicable term. The closest most cops have come to this is the body drag portion of a police academy's physical fitness testing. In an active-shooter environment it will be even more difficult, but there are ways to make it easier.
One is to use the tools and implements around you. If an office chair with casters (especially with arms) is available¸ grab it. It's a "field-expedient wheel chair." Place a wounded person on it and get them out of there. Note: It often works best to pull the chair rather than pushing it forward. Another option: a shopping cart. Sure, it's not the best solution but whether it's a victim riding in one, or the walking wounded just using it for support like an old man's walker, the cart can get people moving toward medical help.
If the above options aren't handy, then it may be up to the rescue team to carry out the wounded. (The body drag is a less-desirable method but still an option as well.) There's no doubt that adrenaline will be flowing and rational thought will be difficult. Training should kick in if your department is proactive and has provided such instruction.
It's often important to pause before trying to physically move the injured. Assess the best course of action to take, such as applying blood stoppers/tourniquets before moving the victim, and how best to move the person to minimize further injury. Unless they're fully capable, individual cops should probably avoid picking up an unconscious adult. Officers should recognize that they could harm themselves during the lifting. Such awareness can prevent "blowing out" the back or damaging a knee while getting someone off the ground. Standing with that weight, and then trying to carry the person, can be more challenging. It's nothing like we see in the movies.
Also consider: If the individual is blood-soaked, what's the best way to pick them up without losing control and injuring them more? And don't forget that the floor could be slick with fresh blood, other body fluids and water from fire sprinklers further complicating the rescue. Think about it before you rush in.
Your local fire department is the best source for rescue carry training. Whether you're working with one, two or more officers, firefighters can demonstrate proven techniques that are more effective than a grab-and-go approach. Their rescue playbook has been around a long time. The "Hawes carry" or the "fireman carry" are applicable for one rescuer and the options increase with the presence of more able-bodied personnel.
Sometime back I went through a combat casualty care course put on by the Santa Ana (Calif.) police and fire departments. Medical personnel and firefighters taught this class. It was an excellent learning process on how good training from professionals could make treatment and rescues more efficient. From one trainer to another, I would recommend you find similar opportunities for your troops.
Cover Me
No matter how many officers are moving the wounded, a tactical balance must be maintained. Not everyone should focus on treatment and transport. Until we know otherwise, it's still a hot zone and some team members should be in bodyguard mode. When stationary, the team needs protection for its members and any civilians. Once moving, this is even more important as the danger level increases due to the expanded threat environment.
Shots Fired, Rescue Now!
An example of a worst-case scenario came a few years back in my home town, Orange, Calif. An active-shooter incident erupted in a mobile home park: two killed and five wounded. Officers quickly responded. They found a bleeding, obese woman collapsed outside a mobile home. It was immediately evident that a rescue was needed. Exceptionally brave officers moved up to her. While some formed a protective shield with weapons ready, it took three cops to get her partially off the ground and effect the rescue. Their original plan was to place her in a nearby patrol car's back seat. They quickly realized that that was not going to happen. Adjusting to the problem, officers provided protection while now four cops heaved her up onto the trunk. The patrol car backed out and got her to medical attention.
What's the level of your officer's preparedness for something similar? Give it some thought and then join me next month for more info on this topic.
Train safe. God Bless America.