6/17/2021 1 VNATA 2021 ANNUAL CONFERENCE Edward Strapp, FP-C, TP-C, NRP, LAT ATC What To Do Before Shots are Fired: Designing an Emergency Action Plan for an Active Shooter Incident at Your Institution Edward Strapp, TP-C/FP-C, NRP, LATC, ATC • Trooper / Flight Paramedic • Maryland State Police Aviation Command • Ski Patrol- Liberty Mountain (PA) • Rotational AT- US Ski & Snowboard • Certified Athletic Trainer (1997) • EMT-B (97), I(06) Paramedic (10) • Alpine Ski Patroller (1999) • Certified Flight Paramedic (2013) • Certified Tactical Paramedic (2017) Disclosures ▪ No financial or other commercial interests to disclose. ▪ The views expressed in this presentation are those of the faculty & may not be the same as the views of employers, clients, and/or colleagues. ▪ Participants should always use discretion & clinical reasoning when integrating the information contained in this presentation into clinical practice. ▪ Participants should ALWAYS abide by their State license & local protocols & treatments or interventions approved by their medical director or employer at all times. Warning! Some of the images and/or videos shown during the presentation are graphic and may be disturbing to some people. Learning Objectives ▪ At the conclusion of the program, participants will be able to: 1. Identify active assailant profiles & pre-event indications. 2. Create techniques for reacting to an active assailant event. 3. Understand the Critical concepts of the Emergency Action Plan in regard to Active Assailant events. 4. Demonstrate the proper sequence and implementation of critical decision-making skills and the current evidence. 5. Identify the rationale for the application of different advanced wound care interventions 6. Identify & discuss how a pre-hospital interdisciplinary healthcare team works collaboratively to improve patient outcomes.
Transcript
6/17/2021
1
VNATA 2021 ANNUAL CONFERENCE
Edward Strapp,
FP-C, TP-C, NRP, LAT ATC
What To Do Before Shots are Fired:
Designing an Emergency Action Plan for an Active Shooter Incident at Your Institution
Edward Strapp,
TP-C/FP-C, NRP, LATC, ATC
• Trooper / Flight Paramedic• Maryland State Police Aviation
Command
• Ski Patrol- Liberty Mountain (PA)• Rotational AT- US Ski & Snowboard
▪ No financial or other commercial interests to disclose.
▪ The views expressed in this presentation are those of the faculty & may not be the same as the views of employers, clients, and/or colleagues.
▪ Participants should always use discretion & clinical reasoning when integrating the information contained in this presentation into clinical practice.
▪ Participants should ALWAYS abide by their State license & local protocols & treatments or interventions approved by their medical director or employer at all times.
Warning!
Some of the images and/or videos shown
during the presentation are graphic and may be
disturbing to some people.
Learning Objectives
▪ At the conclusion of the program, participants will be able to:1. Identify active assailant profiles & pre-event indications.
2. Create techniques for reacting to an active assailant event.
3. Understand the Critical concepts of the Emergency Action Plan in regard to Active Assailant events.
4. Demonstrate the proper sequence and implementation of critical decision-making skills and the current evidence.
5. Identify the rationale for the application of different advanced wound care interventions
6. Identify & discuss how a pre-hospital interdisciplinary healthcare team works collaboratively to improve patient outcomes.
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Why are we here?
How well prepared are you for this event?
Active Assailant Events
▪ Active Shooter
▪ Stabbing/Edged Weapons
▪ Vehicles or other torpedoes
▪ Terroristic attacks
New York City 2017
Why are we here? What are others reporting
Informal THE DEN poll
What is happening today:
Month Mass Shootings Total Number Killed (including the shooters)
▪ What personnel are involved in your management of emergency situations at all different times?– Before Police arrives? Injured
patient? After Police arrives?
– What are the qualifications / training of those executing the plan?
▪ Visiting Team considerations?
▪ Casualty Collection Points– Where is the most equipment
▪ What determines the need for a Lock Down
– Community Reported (Hear or see something)
– Neighborhood events (Local Police response)
– High-risk events?
– High-profile activity?
– Potential Broadcast from an assailant
▪ Who are we responsible for?– Athletes
– Staff
– Officials
– Spectators and families
▪ Evacuation Location / Identification?
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Campus Buy in
▪ See Something Say Something– Campus activities
– Social Media
– Changes in Behaviors
– Triggers
▪ Cut from a team
▪ Angry at coaches or Administrators
▪ Parents making threats
▪ Parents becoming aggressive
– Amongst Spectators
▪ Arguments
▪ Fights
▪ Previous Conflicts
▪ Big Rivalries
“It’s possible, but not probable”
If you prepare for all of the possibilities … you will be prepared
for all of the probabilities!
Considerations: Time of event
▪ During the Day– Lock Down– Accountability
▪ Afternoon Sports– Lock Down
▪ Who is outside?▪ Who is inside?
▪ Weekend Events– What is locked and unlocked– Who has access– Accountability– Additional or limited
Resources
Considerations: Location of event
▪ During the Day– Classes– School Activities– Free time/Between Classes
▪ Afternoon Sports– Inside Facility– Outside Facility– Around Community
▪ Weekend Events– Open Air– Confided Outside Facility– Indoor Facility
EAP- Train / Practice / Rehearse
▪ Who gets trained?▪ Who do you train with?▪ What training do you do?▪ How often do you train?
▪ Do you train your coaches / administration / SAs in CPR / FA, Stop the Bleed?
▪ Do you do hands-on, practical, & scenario-based training that is venue, setting, & personnel specific & stressful in nature?
▪ Do you train outside in all weather conditions?
▪ Do you document your training?
How do we create an Emergency Action Plan Mindset?
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What goes into an EAP
▪ Guidelines are intended to reduce your personal risk– If you are inside a building when an event occurs, you should:
▪ Avoid: Evacuate the Premise only if there is an accessible escape Route
▪ Deny: Find a place to shelter which you can lock or barricade
▪ Defend: Don’t hide and hope, prepare any available means within your area
– Make Notification
– Information to Report
– What to do when Law Enforcement arrives
– If you are outside a building when an event occurs, you should:
TRAIN THE LIZARD BRAIN
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EAP Bottom Line
Regardless of the situation, relentless preparation & planning, consistent & stressful training, and an understanding of the benefits & drawbacks of each option is imperative.
Crisis Management
▪ Questions-– Where is the team going to evacuate to
(home, visitor, officials)?– Where will the triage area be set-up?
▪ Who staffs?▪ Role of ATs / Team MDs
– What is the responsibility of ICA personnel / first responders (ATs, MDs, students, etc.) during a crisis?
– What type of advanced notification / communication will take place? ▪ Pre-scripted announcements / social media /
website
– Training- Table Top / Full-Scale Exercises
▪ Threat Matrix-– Fire– Terrorism– Active shooter– Power Failure– Lightning– Smoke– Air quality– Heat– Hazardous
– Flooding– Wind– Snow– Hurricane– Icing– Earthquake– Air Crash– Public Assembly– Collapse– Disease– Mudslide– Nuclear
Catastrophic Incident Planning
▪ Definition of a Catastrophic incident-– Sudden death of a SA, coach, and/or ICA
staff member
– Disability / Quality of Life Altering injury / illness including, but not limited to:▪ Spinal cord injury resulting in partial or
complete paralysis
▪ Severe head injury
▪ Injuries / Illnesses resulting in severely diminished mental capacity or other neurological injury that results in an inability to perform daily functions;
▪ Irrecoverable loss of speech, hearing (both ears), sight (both eyes), or one or both arm(s) and/or leg(s); and
– Other incident as deemed appropriate.
▪ Catastrophic Incident Management Team (CIMT)-– President
– Superintendent / School Board
– AD / Senior Staff
– Coaches
– MDs / ATs
– Legal Counsel
– Media Relations
– Counseling Center
▪ Other Appropriate Personnel-– Academics
– Compliance
– Business Office
– Campus Personnel
– Community Personnel
Medical Time Out
▪ Ideal Shelter and Protection Locations
▪ Communications methods– Direct Communications
– Campus Announcements
– All clear call
▪ Is the bus an option?– Is it a good option?
Closing
▪ Emergency Action Plans-–Create a Road Map–Collaborate–Practice / Train / Rehearse–EAP Walk-Through with Staff,
Responders, and Students.–Provide EMS and LEO with copies
of the EAP
Train the Lizard Brain
Bottom Line
▪ When confronted with an emergency, catastrophic, and/or crisis situation, personnel have options with regards to the overall management of the athlete & the situation.
– “There is no such thing as ALWAYS & NEVER”
▪ Every emergency situation & every patient is different
▪ Individual circumstances must dictate appropriate actions
– “The TEAM … The TEAM … The TEAM”
– DO THE RIGHT THING!
▪ TEAM Approach– Leadership / Followship / Relationships– “Leave Your Ego At The Door”– Train Often & Train Together
▪ Mental Rehearsal– “Expect the Unexpected”– “If it is predictable … It is
Manageable”
▪ TEAM must carefully weigh all factors & make educated decisions on what best fits into their individual situations
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The O.O.D.A LoopBridging the Gap-
Healthcare Providers Response
▪ What do you need?– Something you have access to
– Something you are comfortable using
– Something you can use in a hurry
– Something you can get / create / replace
▪ “Go Bag” (IFAK)-– Tourniquets
– Pressure dressings
– Gauze / hemostatic agents
– Chest seals
– Gloves
– “MARCHE” supplies
▪ Your preparation is your success!– If it is predictable, it is
manageable!
Equipment and Resources
▪ Wound Care/Bleeding Control– Stop the Bleed Kits
▪ Silva, JR. The News Media’s Framing of Mass Shootings: Gun Access, Mental Illness, Violent Entertainment, and Terrorism Criminology, Criminal Justice, Law & Society.2020 21(2): 76-98
▪ Abel MN, et al. Pre-Attack Warning Behaviors of 20 Adolescent School Shooters: A Case Study Analysis. Crime and delinquency. 2021, 0(0): 1-28
▪ Mountjoy M, Moran J, Ahmed H, et al. Athlete health and safety at large sporting events: the development of consensus-driven guidelines Br J Sports Med. 2021;55:191–197.
▪ Sarani B, et al. Characteristics of survivors of civilian public mass shootings: An Eastern Association for the Surgery of Trauma multicenter study; Journal of Trauma and Acute Care Surgery.2021 90(4):652-658
▪ Kimberly Myers , Higher Education Institutions: Complex and Underprepared for Active-Shooter Situations; Campus Law Enforcement Journal. 2017 47(1) 34-38.
Resources
▪ Falk, Louis, et al. Cultivation and Reporting of Campus Threats. Quarterly Review of Business Disciplines. 2020; (7)2: 105-122.
▪ Duwe G, Sanders NE, Rocque M, Fox JA. Forcasting the Severity of Mass Public Shootings in the United States. Journal of Quantitative Criminology. 2021
▪ Silva JR, Greene-Colozzi EA. Mass Shootings and Routine Activities Theory: The Impact of Motivation, Target Suitability, and Capable Guardianship on Fatalities and Injuries.Victims & Offenders. 2021; 16(4): 565-586,
