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IPSA's Public Safety Column
The IPSA's Public Safety Column is an opportunity for our members and corporate sponsors to provide thought leadership articles about all topics facing public safety.
The articles we publish are not necessarily the views of the IPSA, rather they are opinions shared by each contributor.
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By Robert Mitchell, Retired Chief and Member of the IPSA's Memorial Committee
“Rescue 22 respond to 2615 Kingfisher Dr. for a two-year old having seizures. Timeout 0345, Unit responding select Tac 6.”
It’s 0345 in the morning. You’re on duty having just laid down for the first time this shift about 30 minutes ago. You’ve decided not to eat anything to try and get some sleep. You’re on the back side of a 48-hour shift which wasn’t much slower. As you stagger to the truck, you try to remember where Kingfisher Drive is. When you do arrive at the address, a mom comes running out the front door carrying her two-year old daughter in her arms. As you take the toddler you notice she’s kind of stiff and her colors a bit greyish.
In the back of the truck you assess the little one and determine that she is indeed having a seizure and she is posturing. Mom tells you she has no known history, no allergies, doesn’t take any medicine and she’s been like this for at least 10 minutes. As you have done a thousand times, you continue her assessment, treatment and transport.
The hospital is 10 minutes away and your partner makes it in five. There’s been no significant change in your tiny patient’s status the entire time she’s been in your care. You turn her over to the Emergency Room staff and get your unit back in service and write your report. You’ve done everything possible for this little one and you’ve done it right. You return to the station. Your shift finally ends. You go home.
After the shift ends
As you stagger into the house, your greeted by your two-year old who wants to do nothing more than play with you. Tears well up in your eyes and you can hardly keep it together. This is an all too often sequence of events for most of us in EMS, and sometimes it’s hard to let go.
These are just a few questions you need to ask yourself to self-assess. Everyone knows the importance of diet, exercise, sleeping and staying hydrated. But is there more? The answer is yes.
Recognition of PTSD in public safety is at the forefront of the media and in many states, their legislatures. The International Public Safety Association has done several webinars on the topic and even created a series of posters for agencies and individuals to download and post in their departments. This is fantastic news, but how is this going to help the EMS responder in the field?
Collectively we have seen an increase in Critical Incident Stress Teams, Peer Support Teams, Chaplains and family training classes for spouses, significant others, and children that help to prepare them for what their responder maybe facing. Most responders don’t want to open to someone who has no operational experience in EMS or at the very least public safety. Having leaders who at least know how to recognize the signs of stress is a critical first step in getting help. As individuals we need to learn and understand that we may need help as well.
Do yourself and your loved ones a favor, if you’re stressed, look for healthy ways to de-stress. Don’t be afraid to reach out, you are not alone.
About the Author
Chief Mitchell retired after 38 years of public safety service in fire, EMS, law enforcement and Emergency Management. He currently holds his Chief Fire Officer, Chief Emergency Medical Service Officer and Professional Emergency Manager designations. He hold a degree in Professional Management from Nova Southeastern University and currently consults for a variety of different organizations. Chief Mitchell is a member of the IPSA Memorial Committee.
IPSA Posters: Depression, Suicide and PTS
The IPSA created this new K9 Officer Safety Infographic for free download, printing and sharing.
By Jerry Steckmeister, Police Lieutenant, Westchester County Department of Public Safety, IPSA Fitness and Wellness Committee Member
Anywhere that you find public safety professionals, you are sure to find hand sanitizer. It’s in their buildings, personal bags and vehicles. It’s always nearby as if it were a magical potion that can cure all ills. Sinks are often bypassed to get to the hand sanitizer dispenser.
The main benefit to hand sanitizer is speed. It is quicker than washing hands and it is portable. When used properly, hand sanitizer can be an effective tool in protecting public safety personnel. But is public safety’s reliance on hand sanitizer sound? According to science, the answer is no.
Most hand sanitizers contain alcohol, generally 60 percent or more. This is sufficient to kill most, but not all, germs. For instance, it is not effective at eliminating norovirus or Clostridium difficile spores. It is an essential tool in healthcare settings, where the primary threat comes from germs.
What the CDC says
Problems arise when individuals overestimate the power of hand sanitizer. As noted above, it is ineffective at killing certain germs. It also may not have an effect on chemicals, and does not remove dirt or grease. In fact, it may cause your skin to be more absorbent to certain chemicals, such as fentanyl.
For this reason, the Center for Disease Control recommends hand washing over hand sanitizer in a non-healthcare setting. When soap and water isn’t immediately available, hand sanitizer is generally a good substitute, but the CDC still recommends that you wash your hands as soon as you are able.
None of this means that you should throw out all of your hand sanitizer. Used correctly, it can be a valuable tool for hand hygiene. In a health care setting, when your hands aren’t excessively dirty, hand sanitizer can provide a quick reduction in bacteria. Outside of a health care setting, if you have access to soap and water, you should wash your hands instead of using hand sanitizer. If you might be exposed to germs, but do not have access to a sink, hand sanitizer might help reduce bacteria, but you should still wash your hands as soon as possible.
Do not use hand sanitizer if you have been exposed to chemicals such as pesticides or fentanyl. Wipe excess chemicals off with a clean cloth and wash your hands. If you have a large exposure or do not have access to a sink, follow your agency’s protocol for decontamination.
Public safety professionals have a wide range of tools at our disposal. Each tool is effective when used properly, but can be dangerous when used improperly. Hand sanitizer is no exception. When it is used appropriately, it can help us to stay healthy and prevent us from bringing unwanted germs back to our family. However, it is important to understand its strengths and limitations.
Jerry Steckmeister is a Police Lieutenant with 19 years of law enforcement experience. He is also a Major in the NY Army National Guard. In addition, he is a Director on the board of the Westchester B.L.U.E. Foundation and serves as member of the IPSA Fitness and Wellness Committee.
Become a Member of the IPSA's Fitness/Wellness Committee
By Anne Camaro, IPSA 911 Telecommunications Committee Member, Assistant Director of Administration and Training Cambridge Emergency Communications
As we gear up to celebrate another National Public Safety Telecommunicators Week, it is important to pave the way for new telecommunicators as they make their way from the classroom to the communications center. Whether working eight or 12-hour shifts, dispatchers know that no shift is ever like the last one. The uncertainty of the next call, the excitement of the next chase and the relief of the resolution are the only constants. The situations, the names and the people are ever changing in a web of stories that become the reason we choose to stay.
Ability to adapt
Having grown up in the boom of technology of the 1990s, I still remember the first time I sat down in front of a DOS based CAD. Having to adapt from mouse clicks to keyboard tabs was no easy task, however, that was the first of many different things I had to adapt to throughout the years. However, not everyone can adapt in the 911 telecommunications profession.
As communications supervisors recruit new talent and promote from within, one of the most desired qualities in a candidate is adaptability. Most supervisors will not hire or promote someone who demonstrates a resistance or fear to change. Individuals who are hired to work in this profession and then become unwilling or unable to adapt to the ever-changing environment in the communications center, rarely stay. No dispatcher, at least no successful dispatcher, can stay rigid and resist change.
So how can we become more adaptable? Jennifer Garvey Berger, author of “Simple Habits for Complex Times: Powerful Practices for Leaders” describes four steps we can take to become more adaptable. To face change successfully, she states that we must shift our mindset and highlights four tips on how to get started: (1) ask different questions; (2) accept multiple perspectives; (3) consider the bigger picture and (4) experiment and learn.
Further, Jeff Boss, an adaptability coach, describes an adaptable person as someone who is open to change, who has the will to face uncertainty, and who sees opportunity where others see failure. According to Boss, adaptable people are resourceful and think ahead; they don’t whine, or place blame; and they also don’t claim fame. Adaptable people stay current, are open minded and know what they stand for. A dispatcher who possesses these traits is desirable and will become invaluable to the agency they work for because they are willing and able to go the extra mile.
Change is scary and complex. It involves coming out of our comfort zone, but if we want to succeed as 911 telecommunicators we must understand that change is part of the job description. It is inevitable. From change, the best 911 telecommunicators learn and thrive. In a field that gets more complex by the minute, a famous quote attributed to Leon C. Megginson’s work regarding Darwin’s “Origin of Species” is valid, “It is not the strongest of the species that survives, nor the most intelligent that survives. It is the one that is most adaptable to change.”
By Ken Wallentine
In a recent survey, I asked for reader thoughts on meeting the challenge of the active shooter in schools. Thanks to the officers who sent thoughtful responses. Not surprisingly, several respondents suggested placing more officers in schools.
Here is a snapshot of some other responses:
Virtual reality, active shooter scenario
I recently participated with dozens of school district executives, school resource officers, principals, vice-principals and counselors in a series of school shooting scenarios. The virtual reality system allowed us to experience an active school shooter scenario in penetrating virtual reality, using actual weapons and feeling the impact of gunfire. At the end of each virtual reality session, we gathered cops and educators to debrief. Ideas and questions flowed freely. Conversations that began in virtual reality will continue as partnerships strengthen.
I learned about programs that help students report concerns and/or reach out for help. The best of these is a smartphone app called SafeUT. It is a resource for students, parents and educators. Students and parents can submit tips, chat with a qualified mental health professional, make an immediate one-button call for help and monitor existing tips and helpful hints for safety and well-being. Other states are creating similar apps.
Just last week, a middle school student in my community threatened to shoot up his school. Classmates who heard the threat said something and used the SafeUT app. A cop went to the home and spoke with parents and the student. He and his partner searched the kid’s bedroom and found an AR-15 and a handgun. The app, powered by students willing to say something, worked. Mass shooting prevented? Probably.
Broadening the discussion
The conversations about safer schools and safer kids are happening across the country. These discussions need to include local public safety officers, teachers and parents. Those conversations need to be far broader than just hardening the targets. Let’s join the community in talking about prevention. Let’s be sure that our departments and schools are social media smart. Are we watching out for and reaching the kids who signal trouble? Are our schools fostering an emotionally healthy environment? Are there safe places and trusted people for kids who are bullied, abused or emotionally struggling?
As public safety servants, we prepare tirelessly for many events that will never happen in our community. With the violence at Parkland and Great Mills, the focus right now is on school shootings.
We must prepare the best we can. In our sheriffs’ offices and police departments, let’s talk about something that we know about: threat assessment. When we get a tip, do we have a system in place to quickly bring a school official, mental health professional, school resource officer, and—as appropriate—parent or guardian together for a risk analysis and intervention plan?
Our preparations will necessarily lead to deeper connections with educators, parents, kids and our entire community. Our preventive efforts will pay off, too. As we stretch our reach to kids on the fringe, we may or may not prevent a school killer, but we may just make life better for a lonely kid.
There is a genuine compassion and commitment among public safety officials to keeping our communities safe. Your communities need your critical conversation contributions.
Chief Ken Wallentine is a Special Agent who directs the Utah Attorney General Training Center, overseeing use of force training and investigation and cold case homicide investigations. He is also a consultant and Senior Legal Advisor for Lexipol. Ken formerly served as Chief of Law Enforcement for the Utah Attorney General, serving over three decades in public safety before a brief retirement. He also serves as the Chairman of the Peace Officer Merit Commission of Greater Salt Lake County.
By James Dundas, IPSA Memorial Committee Chair
Duty. Honor. Courage. Noble words to live and serve by. The epitome of those words was sadly reinforced recently as the public safety community of practice lost seven brave souls in the line of duty. In the one week from March 21 to March 28, 2018, the United States has averaged the loss one first responder per day.
Wednesday, March 21, 2018: Police Officer Andres Laza-Caraballo (age 31) of the Juncos Municipal Police Department in Puerto Rico was shot while off duty when attempting to intercede in a violent incident. Officer Laza-Caraballo confronted armed men when they entered a barber shop and began firing. Officer Laza-Caraballo was fatally wounded. He was a 10-year veteran of the department. He leaves behind two children.
Thursday, March 22, 2018: FDNY Firefighter Michael Davidson (age 37), a 15-year veteran, husband and father of four girls, died in a fire on a movie set in the Hamilton Heights neighborhood of Harlem. Part of an interior attack crew, FF Davidson became separated from the others when an evacuation was called. Search teams were quickly assembled and re-entered the building in a desperate attempt to locate FF Davidson. When found, FF Davidson was unconscious. He was transported to Harlem Hospital where he died.
Also on Thursday, March 22, 2018, in York City, Pennsylvania, FF Ivan Flanscha (age 50) and FF Zachary Anthony (age 29) perished in a huge multiple alarm fire in the former Weaver Organ and Piano Warehouse. FF’s Flanscha and Anthony were part of an interior crew dousing hot spots when a part of the structure collapsed, entrapping them and other members. The York City Technical Rescue team was brought in to lead the search, but unfortunately, both Flanscha and Anthony did not survive. Two others, Assistant Chief Greg Altland and FF Erik Swanson received serious, but not expected to be life threatening injuries.
In what is becoming a more frequent and tragic consequence of exposure to hazardous substances, Special Agent Melissa Morrow (age 48) of the FBI succumbed to brain cancer on March 22, 2018, because of her search and recovery work at the Pentagon on September 11, 2001. She worked 10 weeks on site, and like many first responders, fell from continuous, long-term exposure to toxins. She is survived by her parents and one sister.
Friday, March 23, 2018: The Caldwell County Office of Emergency Management reported that FF Larry Marusik of the Ellinger Volunteer Fire Department succumbed to critical burn injuries sustained on March 10 while fighting a large wildland fire. He had been under treatment at the Brook Army Medical Center.
Saturday, March 24, 2018: We saw the deaths of two Pratt, West Virginia, volunteer firefighters who died in a crash of their apparatus when responding to a severe multi-fatality traffic accident. Preliminary reports show that their rig left the roadway and crashed into a rock wall. Three other firefighters were injured, one critically.
While it is premature to speculate on causal factors of these tragedies this past week, there are some practices that the public safety community may acknowledge that may help prevent a future tragedy from occurring. These recommendations were pulled from the IPSA’s 2017 LODD Report:
IPSA's Report about 2017 Line of Duty Deaths
Join the IPSA’s Memorial Committee
First responders experience extreme physical demands, often in hazardous environments. Many tragedies occur suddenly and without warning. Gunshot wounds, building collapses, vehicular accidents, assaults and other causal factors contribute to untimely deaths in our emergency response community. Further, first responders face several threats to occupational related diseases such as cancer and cardiorespiratory related maladies. Law enforcement, firefighting and rescue activities are inherently dangerous occupations. Since the year 2000, the data reviewed accounts for the loss of 2,841 law enforcement officers, 1,937 fire and EMS personnel and 233 K9s.
Download the IPSA's Report about 2017 Line of Duty Deaths
The International Public Safety Association Memorial Committee was established to monitor line of duty deaths to honor the supreme sacrifice of our brave and heroic first responders and to review LODD data for trends, patterns and anomalies so the IPSA can develop recommended policies and changes that improve safety. If you are interested in getting involved with the IPSA's Memorial Committee, then apply to serve today.
By Dan Fish, Lexipol is an Official IPSA Supporter
How do law enforcement officers end up chronically stressed, burned out and suffering from compassion fatigue? Why do so many officers fail to take care of themselves mentally and physically? And how can we help them achieve better health and balance?
Questions like these are dominating public safety lately. Look at any law enforcement publication, website or conference line-up, and you’ll see topics related to physical and mental wellbeing, post-traumatic stress, peer support and other behavioral health issues. (Full disclosure: The inspiration for this article was a presentation called “Keeping the Super Heroes Super,” presented by licensed psychologist and organizational consultant Kimberly A. Miller, Ph.D., at the FBINAA California Re-Trainer in August 2017.)
In part, this shift is driven by sheer economics—recruiting is getting more and more difficult for law enforcement agencies, so we need to find ways to retain good officers. But scientific developments are also driving the change. We’re learning more about the essential connection between mental and emotional health and performance. And that changes job-related stress from something we should just “deal with” to something that presents significant risks for law enforcement agencies.
What’s stressing out officers?
There’s no shortage of stressors in law enforcement. Depending on where you live and work, you may face media scrutiny or community distrust. Then there’s the grind of responding to call after call where people are exhibiting their worst behavior or are victims of someone else’s bad behavior. But let’s focus for a minute on two even bigger factors that underlie these specific stressors.
First, law enforcement officers are hard-wired to focus on the negative. We are always in threat assessment mode. All the way back in the academy, we were taught to focus on the bad things that can happen—because doing so could save our lives one day. This hard-wired approach to focus on the negative can take its toll and make it difficult to differentiate situations where we should be looking for the positive.
Second, law enforcement today is an all-encompassing, 24/7 career. There is a high level of responsibility that comes with being a protector of the public. Coupled with that, law enforcement culture expects officers to be stoic and strong in the face of adversity. We are taught to resist normal physiological responses to tragedies or critical incidents. This combination creates a perfect storm: The profession becomes all-encompassing, but at the same time we don’t provide officers with tools to deal with the effects of the profession.
How do officers know when they’re stressed?
The consequences of police officer stress pose a serious threat. Before we go further, let’s consider a few definitions:
How does police officer stress manifest itself?
For many officers, law enforcement is their identity. They don’t leave much energy for their family, their friends or themselves. In turn, they can quickly feel isolated when dealing with the normal challenges of law enforcement. Once isolated, it’s a short step to despair and depression. Consider these possible signs and symptoms:
Most of these signs and symptoms can be traced back to depleted energy.
How does self-care help?
The answer to the devastating consequences of police officer stress is self-care for mental health.
You may have heard this term tossed around, but what does it really mean? Self-care is not an exercise regimen or seeing a psychologist (although it could encompass those things). Rather, it’s a conscious process of considering our needs and seeking out activities and habits that replenish our energy—so that we can do our jobs better. This last part is often difficult to understand. Type A personalities often lead individuals to believe that they do their best when they commit all their resources to something, working harder and harder. But that’s simply not true.
We only have a finite amount of energy each day to expend. Just as taking a day off from the gym can help us train harder the next day, participating in activities outside law enforcement helps us refuel emotionally, which makes us more effective when we go back on duty. Combating the negative mindset also comes into play here. When you consider that negative emotion burns twice as much energy as positive emotion, the challenge and skill to remain positive makes its own case. We need to train officers to regularly assess their energy levels and focus on the positive.
One way to do this is by applying the “For vs. To” test to reframe an experience. Saying that something happened “to me” makes the experience negative and victimizing. Saying that something happened “for me” immediately turns the experience into a positive event and creates a challenge for officers to better themselves by developing their leadership and coping skills. Everything is a lesson and at minimum, in every tragedy/critical incident, there is a test of humanity. That test can develop good character if administered correctly, and should allow officers to feel relief instead of regret. The lesson is to not allow a temporary event to become a permanent state of mind.
Another important factor to understand about self-care: It’s a perishable skill, just like driving, shooting or arrest and control techniques. To be successful in maintaining good mental health, officers must practice. So let’s look at a few ways to do just that.
3 self-care tools
As mentioned above, Dr. Kimberly Miller presents frequently on the topic of self-care. She uses the analogy of “filling one’s bucket” with coping mechanisms that help officers stay positive, develop identity and self-worth outside of law enforcement, and be more in touch with their feelings and emotions. Here are three self-care tools she teaches.
Our society praises selflessness. That’s understandable; our natural inclination is to put ourselves first, and learning to push back against that impulse makes us better citizens and human beings. But like any habit, selflessness can become an addiction. What we often see in law enforcement officers is dedication to the job taken to an extreme. And like any addiction, over time, it begins to cause problems—physically, mentally, emotionally.
Law enforcement agencies have typically done a poor job of understanding police officer stress and helping officers cope. That needs to change. We need leadership role models who will demonstrate the important of actively choosing a balanced lifestyle. We need peer support and supervisors who show officers that it’s OK to feel pain and emotional distress—that doing so builds resilience over time.
We cannot give away what we don’t have; unfortunately, too many officers don’t understand this concept. Today’s officers require a new kind of bravery: The courage to change hard-wired habits and commit to self-care. This is not something we can put off to deal with in retirement—or we might never get there. When it comes to positive mental health, we simply can’t afford to trade the now for later.
Dan Fish is Professional Services Representative for Lexipol. He retired from law enforcement in May 2017 after a 30-year career where he served in all ranks of the Petaluma (CA) Police Department including Chief of Police. Fish earned his bachelor’s degree in criminal justice from Sacramento State University and he holds a graduate certificate in law enforcement leadership from the University of Virginia. He holds several California certificates including the POST Management Certificate and the Phi Theta Kappa International Honor Society Leadership Development Program. Fish is a graduate of the POST Executive Development Course and Command College, the LAPD West Point Leadership Program and the FBI National Academy session #263.
Why public safety professionals need to prevent, identify stress (and apply coping strategies)
By Dr. Michael Pittaro, IPSA Fitness/Wellness Committee Member
After nearly 30 years of serving in a variety of public safety positions, one common theme always emerged, the importance of mental and physical health/fitness. Even today, mental and physical health/fitness is still under-addressed in 911 telecommunications, law enforcement, corrections, fire/EMS, emergency management, public works, public health and all related public safety professions. In 2011, I transitioned from the field to the classroom as a criminal justice professor. I’m presently teaching the next generation of public safety professionals about strategies to prevent and reduce stress.
Consistently, medical research illustrates that stress contributes to a host of mental and physical ailments stemming from the public safety profession. This is not surprising given that the public safety profession represents some of the most dangerous, demanding and physically/mentally exhausting occupations. Here are some examples.
A profession that has been mostly neglected, as far as stress-related research, is that of correctional officers. Correctional officers have a suicide rate that is twice that of the general population and some studies suggest that the suicide rate is even higher than that of other law enforcement officers. Even more disturbing is that, on average, correctional officers will not live to see their 59th birthday.
There is a need to provide information, education and awareness to public safety professionals. There is also a need to develop prevention and intervention strategies designed to address the physical and emotional wellbeing of all public safety professionals.
Below are some methods for coping with stress. This is not a complete list, and it is not a simple solution to a complex problem, but it is a good place to start.
Minimize unnecessary stress in your life: Stress is a part of life. There is truly no way to escape it, but everyone can minimize unnecessary stress. Unnecessary stress is often the stress that is created in our minds, whether real or perceived. For example, I would become so frustrated when I came home from work and my kids left the kitchen a mess. While I still get angry and frustrated, I have learned that teenagers are simply lazy and rebellious at times, so I do not allow it to upset me as much as it did in the past.
Change the way you react, respond to stress: This is along the same line of thinking as the above. How we react and respond to stress can be controlled with some time, patience, effort and practice. Everyone needs to learn how to recognize the physical and emotional signs and triggers. Know and identify when you are becoming stressed and learn how to self-calm.
Accept the things that you cannot change and are beyond your control: As a former Executive Director of an outpatient substance abuse facility, this is a phrase that became part of our daily mantra. It is also a common saying in both Alcoholics Anonymous and Narcotics Anonymous. It holds true here as well.
Adopt a healthier, happier lifestyle: Public safety professionals work with the public. This includes toxic individuals in toxic environments, which often leads to cynical and jaded thoughts. Given the reality and scope of the work environment, surround yourself (at least outside of work) with positive, supportive individuals. Engage in a hobby or do something that makes you happy. Make the time to exercise. Exercise helps reduce stress, depression and anxiety. It will help push negative thoughts aside.
Learn to say “No”: Several strong type-A personalities struggle with this one. Think before you commit to a new task. Take a day or two before giving an answer. Saying no helps keep your life in balance.
Take away something positive from a negative situation or event
Many individuals look at the glass as being half-empty as opposed to being half-full. However, if you sit down and evaluate your life, you will determine that the positive things in your life outweigh the negative. Redirect your negative thoughts to the positive.
Accept that there is both good and bad in the world
Despair, hate, bias and crime are world-wide problems. That’s a reality that will likely not change in the near-term. However, given that this won’t change, it is incumbent on us to focus on the positive achievements we perform every single day. Public safety professionals help people, save people and we protect people. That is what we do, we need to be proud and we need to focus on that.
Laugh more, criticize less: Humor and laughter helps to ward off stress. Avoid getting together with friends just to commiserate about your day. That is not healthy. Instead, hang out with friends and family members who enjoy a good laugh. Distance yourself from toxic friends and family.
Compartmentalize: One of the most helpful strategies that has worked well for me is to compartmentalize. Compartmentalizing is a psychological concept that can be used as a coping, defense strategy when dealing with conflicting internal events simultaneously. In other words, leave work at work and home at home. When the two carry over from one aspect of your life to the other, problems become compounded.
Change must be embraced: To change our thinking, behaving and acting, we must embrace change. Thinking about changing is not sufficient. Everyone must take daily action steps toward change. These steps often take us outside of our comfort zones. As the late Jim Rohn, an entrepreneur, author and motivational speaker, previously stated, "Your life does not get better by chance, it gets better by change."
Dr. Michael Pittaro is an Assistant Professor of Criminal Justice in the School of Security and Global Studies (SSGC) with American Military University and an Adjunct Criminal Justice Professor at East Stroudsburg University. Dr. Pittaro is a criminal justice veteran, highly experienced in working with criminal offenders in a variety of institutional and non-institutional settings. Before pursuing a career in higher education, Dr. Pittaro worked in corrections administration; has served as the Executive Director of an outpatient drug and alcohol facility and as Executive Director of a drug and alcohol prevention agency. Dr. Pittaro has been teaching at the university level (online and on-campus) for the past 15 years while also serving internationally as an author, editor, presenter, and subject matter expert. Dr. Pittaro holds a BS in Criminal Justice; an MPA in Public Administration; and a PhD in criminal justice.
How 911 communications center supervisors can prevent employee burnout and improve morale
How to build a strong team for crisis readiness
Shifting the officer safety paradigm beyond tactics to include health, wellness
By Julie Downey and Charles Kean, IPSA RTF Committee Members
By design, active shooter hostile events or mass casualty incidents are used to cause wounding and death on a large scale. As public safety agencies work toward appropriate responses to ASHE/MCIs, whether in the form of a shooters, bombers or any other hostile means, the MCI aspect of the response plan is often lacking. Law enforcement must continue working with their public safety partners to gain rapid access to an unstable and dynamic situation, and the medical community also needs to be included in the response model.
The rescue task force concept of providing immediate medical care to the injured during an ASHE/MCI is gaining traction. As the incidence of ASHE/MCIs rise in U.S., the evidence of RTFs saving lives is also growing. While many jurisdictions are implementing RTFs, as we saw in the 2017 Las Vegas shooting, several agencies have not adopted the concept.
This article examines two jurisdictions in the United States and highlight the common goals, problems and some unique situations present in various ASHE/MCI response models.
Springfield is the capital of Illinois and is in Sangamon County. In a city of 118,000 people and a county of 245,000, there are two different level-one trauma centers. With over 20 fire departments and EMS providers along with 25 law enforcement agencies, getting all of them on the same page is difficult. Complicating the ability to synchronize various agencies is the composition of the departments. Three private ALS EMS agencies provide the bulk of the transport in Sangamon County, and law enforcement agencies range from a two-member department to a 245-member agency.
In Springfield, as the planning and training for implementation of the RTF concept has evolved, casualty triage has taken a more prominent position in the overall concept of operations.
In the Springfield program, the contact team is tasked with neutralizing the threat. This is common in most RTF plans. The contact team is directed to notify incident command about the location of victims, and if possible, the number and condition of the injured.
The first RTF to enter the crisis site and begin the treatment and evacuation of the casualties has a rather simple triage method, dead or not dead. As the RTF moves through the area, patients are treated and marked for evacuation, or if capable of movement, directed to exit the site through the same path the RTF and contact team entered. While some may argue it is dismissive to triage with the categories being dead or not dead, the purpose for the initial RTF is to quickly assess patients with easily correctable life threats and then move on to the next patient.
After this is completed, then additional RTFs are tasked to evacuate casualties and re-evaluate patients using the more traditional START methodology. This includes reassessing patients marked as dead, unless there are obvious non-survivable injuries. In the revised MCI plans, the four-category START system is fully implemented at the warm-zone and cold-zone interface.
Working with hospitals
MCI plans need to include first responders (law enforcement, fire/EMS and 911 telecommunicators) and local hospitals. Many hospitals are unprepared, and if a MCI comes to their facility or if there is a potential for violence at the medical facility, they will simply call law enforcement to secure the facility.
Often the reality is that during an ASHE/MCI, law enforcement will be deployed to the crisis site. The agencies that are adjacent to the stricken jurisdiction will be involved in assisting their sister agency with response on site. In short, law enforcement resources will be scarce when it comes to the physical security of medical facilities.
Several recent ASHE/MCIs have occurred when key hospital administrators and management personnel were not on shift. Therefore, hospital administrators and managers need to have policies in place that allow the movement of less critical patients from critical care beds to waiting rooms or treatment by physician extenders such as nurse practitioners and physician’s assistants. Along with written and legally reviewed policies, charge nurses and unit managers need to be trained and empowered to make those treatment decisions, in consultation with the emergency department, attending physicians and where applicable, trauma surgeons.
Each of the level-one trauma centers in Springfield operates its own EMS system. To the benefit of the community, the EMS protocols are nearly identical which aids in reducing confusion in providing pre-hospital care. The MCI protocols for both systems are the same. They use the START triage system. However, there are some limitations with solely relying on the START system. For example, while it is designed for MCI situations, it does not address active threat environments. In the high stress and dynamic environment of an active threat, MCI is often the most overlooked aspect is the triaging and evaluating casualties.
Hospitals and patient transport
MCI planning must consider patient transport. During crisis, patients are arriving at medical treatment facilities by conventional EMS transport, law enforcement transport and/or self-evacuation. This model, while difficult to control during chaos, may create an unintended reverse triage. Patients that are capable of self-evacuation often are not severely injured, and they will likely arrive ahead of the patients who are in dire need of medical interventions, especially resuscitation and surgical intervention.
During an MCI and patients are being transported, there is a misconception that law enforcement will be available to secure medical facilities. There may also be a perception that the hospital’s internal security will be able and capable of controlling access to the hospitals, especially the emergency department. This is not typically the reality.
Training immediate responders
Another area for improvement is community resilience. In central Illinois, the HSHS St. John’s Hospital Trauma Team is using outreach education to teach Stop the Bleed to local fire and law enforcement agencies. The next goal is to implement a program like Davie, Florida and get bleeding control kits in the community with AEDs.
Davie is a highly populated town located in Broward County, Florida. Most agencies agree the public needs to get involved in rendering immediate care for someone that is severely bleeding. In October 2015, the Davie Fire Rescue was recognized at the White House/Department of Homeland Security for their innovation in developing Severe Bleeding Kits and distributing the kits to all their AEDs. In addition, they incorporated the severe bleeding training into all their CPR/AED classes. They have renamed the program to coincide with the DHS program – Stop the Bleed.
Early MCI management issues
Since the early 2000’s, several issues were identified regarding MCI management in Broward County. The biggest issue was that each of the 20 fire-rescue agencies in Broward County had adopted their own MCI plan. When mutual aid was provided from neighboring departments, as is frequently seen during MCIs, this led to multiple levels of confusion. The region identified the need to correct this problem with all agencies in Broward County agreeing to a single MCI protocol that consisted of common terminology, triage and tagging methods. This has greatly improved MCI management, which expanded state-wide.
In early 2004, Florida’s EMS Advisory Council approved and recommended a MCI procedure and a state-wide MCI triage tag. Funding was secured through DHS grants for the state to supply all ALS agencies with MCI equipment. This included a common field operation guide, field unit bags with personal triage fanny packs, MCI tags, colored tarps, identification vests and MCI trailers.
MCI management achieved, but RTF issues surface
To ensure all first responders were using the same guidelines for MCI management, the procedure was placed in the Florida Fire Field Operations Guidebook. This FFOG, funded by the State Fire Marshall’s Office, was provided to every first responder vehicle (law enforcement, fire and EMS) within the state.
State-wide strides were made to prepare all first responders for MCI management, but equipment and procedures are not enough. There remains an on-going need to continually train, utilize and refine the procedures to ensure a constant position of readiness. Unfortunately, what was encountered 20 years ago with MCI management in Florida, is now occurring with the fire-rescue response to an ASHE/MCI. Law enforcement and fire-rescue agencies across the county and state are now developing their own sets of procedures and terminology.
The RTF concept is gaining in acceptance, but it is still not widely adopted. Some agencies fear that their personnel may get injured. Other agencies debate whether RTF personnel need to have full ballistic protection. Davie Fire Rescue has trained all personnel in RTF with classroom training followed by walk-through exercises and several full-scale exercises. The biggest obstacle we face is creating a true unified command. As we train more with law enforcement, we will see improvements.
Most fire-rescue agencies see the need to change our response to an ASHE/MCI. They see the need to get-in quicker to stop the dying, but there is no consensus on what this model looks like. Fortunately, there are several excellent resources now available through the International Public Safety Association, and even the National Fire Protection Association has a committee working on Active Shooter response (NFPA 3000).
As active threats continue to evolve, first responders, medical treatment facilities, community leaders and civilians must evolve their training and response.
International Public Safety Association’s Rescue Task Force Best Practices Guide
International Public Safety Association’s InfoBrief: Stop the Bleed
International Public Safety Association’s Position Statement supporting Stop the Bleed
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