have a lot of information about these events, although, unfortunately,
statistics cannot predict future events. Problematically, officers historically
arrive in time to interrupt the shooting in less than one of every thirteen
events. From 2008 to 2011, the average spree killing—the rapid mass murder of
innocents without hostages—took place in less than three minutes.
have recently become even quicker with their murders since 2011, typically
concluding within 2 minutes. The 2012 Aurora movie theater shooting took less
than a minute with 70 persons shot). There are
inevitable delays between the initial 9-1-1 call and the first officer to
arrive. It is extremely rare for police
to interrupt the wounding cycle.
Officers tend to arrive singly at first, often arriving many
seconds or even minutes apart. Within
ten to fifteen minutes, police resources begin to pour in as available officers
from surrounding agencies respond.
Within 30 minutes, officers from surrounding counties begin to
arrive. SWAT teams become available
within one-hour. Literally hundreds of
patrol cars clog the arteries leading to the location, freezing traffic for
blocks. Separate police and fire Command Posts (CP) are set up. Fire stages some distance away from the
scene, awaiting permission to begin its Mass Casualty Incident protocols
Inside, the police begin to realize the wounded are untended and
bleeding out. As search operations are conducted to ensure the entire structure
is clear of threat, some officers now focus on the wounded. Frustrated calls
for ambulances are radioed. Officers eventually begin dragging the wounded out
of the structure, sometimes as far as one-quarter mile to anxiously awaiting
firefighter medics. Others will self-dispatch with wounded in patrol cars.
Fire begins making multiple requests to enter. Radio
interoperability problems prevent police and fire from communicating with each
other. Firefighters tend to hold back for approximately a half-hour before they
attempt to self-deploy, causing confusion at the CP. At some point, fire is eventually cleared to
enter the structure. The wounded and the dead are transported.
Crowds begin to form early.
If this is a school, frantic and highly emotional parents arrive. Some attempt to enter the school. Many
angrily demand information from the officers attempting to hold the perimeter.
The media is gathering and may not acquiesce to requests to congregate at the
CP. SWAT formally clears and the
building is evacuated, sometimes taking hours to complete. The investigation
The Police Focus
The police focus to date has generally been to mass a number of
officers—generally four or five—with the intent of moving in formation to interrupt
the suspect’s killing. Once the suspect is confirmed to be down, law
enforcement then conducts a sweep for possible additional suspects. When the SWAT team deploys, a more thorough
search is then conducted. Missing from this law enforcement centered approach
is what to do with the wounded.
Fire personnel currently play little part in law enforcement’s
view of Active Shooter response. The overall
event is a wider problem, something that a police-centric solution cannot
solve. By viewing it as a public safety event, the dramatic benefits of an
integrated response with police and fire working synergistically can be
There are two simultaneous and time competitive processes at work,
1) the suspect continues to inflict wounds as long as he perceives he is free
to do so and 2) the wounded are in the process of dying. Once the shooting
stops, the emergency is not yet resolved.
The wounded are in a time critical race for survival.
The triage protocol lists four categories. Expectant: The victim
is dead or is unlikely to survive.
Typically, one-quarter to one-third of those who are shot eventually
perish. Immediate: The victim requires immediate medical attention, and is
likely to survive if treated within 60 minutes, or the so-called “Golden Hour.”
Delayed: The victim’s injuries are severe and may be life-threatening, but are
not expected to deteriorate significantly over several hours. Minor: The victim’s
injuries are not expected to deteriorate over several days given basic first
Patients in the “Immediate” category are critical and can tolerate
very little delay. They must have advanced trauma care within one-hour of
suffering their wound—not within one-hour of the police arriving, the so-called
Platinum 15 minutes. For example, US Representative Gabrielle Giffords was on
the operating table within 53 minutes of being shot, something her neurosurgeon
credited with saving her life. Stabilizing and rapidly transporting the
“Immediate” patients is where the life-saving continues.
Stopping both processes—the wounding and the subsequent dying of
those who can be saved—must be nearly simultaneous priorities, i.e., the police
rapidly interdicting the suspect is Priority 1 and the police facilitating fire
personnel instituting their MCI protocol is Priority 1A.
Changing the Response
We must collectively enlarging the focus and change the response. Firefighter-paramedics
must be granted early entry and access to the wounded. Only law enforcement can
facilitate the rapid entry of fire personnel into the structure and the
collection of the wounded. This is a criminal mass-casualty event, and fire’s
Mass Casualty Incident protocols are proven in rapidly transferring the wounded
to advanced life support facilities. Far from being difficult to achieve, the
results become a natural cooperative effort once both disciplines understand
the advantages of this approach.
The Hillsboro, Ore. Police and Fire Departments recognized that
changes were needed and rewrote the model of public safety’s response to the Criminal
Mass Casualty Incident. The Hillsboro Police had already evolved beyond the
multiple-officers formation concept several years earlier in favor of rapid
intervention by officers entering from multiple ingress points. This initial
collaboration resulted in both agencies merging their talents in support of the
comprehensive mission. They sought to jointly answer the question of how to
stop innocents from being shot while giving those already wounded a better
chance at surviving.
Hillsboro Active Shooter Model
The following list is an overview of the integrated Hillsboro Active
Shooter Model. Officers respond to dispatched reports of an Active Shooter. As
they arrive, they each park on the same side of the street and purposely leave
space for the ingress-egress of fire equipment and ambulances.
The first officers arriving make either solo or two-officer
entries at their discretion. Multiple ingress points are employed, converging
quickly on the suspect. If there are indicators of the suspect wounding people,
the officers rapidly move to interrupt the killing. If there are no indicators,
the officers rapidly begin to dominate key architectural features such as
hallways, and stairwell exits and elevator banks in multi-story buildings. Fire
units stage just around the corner.
As the number of officers inside the structure grows and within
minutes of the first officer’s entry, a supervisor (or officer) selects and
broadcasts a location for a Casualty Collection Point, detailing two to four
officers, as needed, to secure it. A Joint Command Post for both fire and
police is established. Officers arriving at this point act as fire escorts or
external ingress/egress security. Officers may ride in the fire units or lead
with a patrol car.
As some officers continue to locate the suspect(s), others begin
transporting the wounded to the CCP.
Officers apply a tourniquet to anyone with uncontrolled extremity bleeding
prior to moving them. The obviously dead are transported last. Once the CCP is
declared to be sufficiently secure, fire personnel make entry and set up their
MCI protocol. A fire officer and police officer (Hall Bosses) link up inside.
This is an interior branch communicating each others’ needs, e.g., body counts,
Officers secure the perimeter. As the number of officers from outlying
allied agencies increases, the security of the perimeter improves. Ambulances
begin to receive multiple wounded, generally transporting two immediate and one
delayed. Minor patients are held until the severely wounded have been
Implementing the Integrated Response
The City of Hillsboro has conducted ten large scale scenarios over
a year long period, including six scenarios run in a multi-story Middle School
and four scenarios in an unoccupied new five-story hospital. These realistic exercises tested and
validated the potential success of the integrated Active Shooter Model. Here are the exercise results.
Officers located the suspect in under six minutes of the first
shooting, with 25 victims requiring varying levels of immediate medical
aid. The CCP was established within 10
minutes of the shooting. Fire entered the CCP four minutes later, beginning
their MCI protocol. The 16 wounded (including six immediate, six delayed, and
four minor patients) were transported within 40 minutes of the shooting. By
comparison, it is not unusual for fire to make formal entry into a structure
more than one-hour following initial dispatch.
Some flexibility is required by both disciplines to integrate the
response. The challenge for police—especially supervisors and mid-level command
officers—is to facilitate the early introduction of fire’s lifesaving MCI
protocols through training. This instruction emphasizes medical reality: the sooner the wounded are delivered to fire
personnel, the greater the chance of saving the injured.
The challenge for fire command, especially at the executive level,
is to accept the concept of introducing their personnel into a reasonably
secure but not pristinely safe environment (although police officers would
argue most police activities are safer than entering a burning structure).
Audio recordings of events where police officers, in frustration
and anger, are repeatedly pleading over the radio for ambulances to somehow
appear through the sea of police units choking the streets can be a thing of
Instead, it is possible for the worst of the wounded to already be
on their way to the trauma centers, medically stabilized by paramedics, well
within 30 minutes of the initial police entry.
This is accomplished through an integrated public safety response
meeting the mutual goals of interrupting the wounding process and gaining rapid
treatment for the wounded.
In Part Two, we will cover the priorities in the response and
whether TEMS or TCCC are the right answer.
George T. Williams is the Director of Training for Cutting Edge
Training in Bellingham, Wash. He has been a Police Training Specialist for more
than three decades, as well as an expert witness in federal and state courts
nationwide and a widely published author for more than two decades. Mr.
Williams develops and presents revolutionary concepts within integrated force
training solutions through a problem-solving format, functionalizing police
skills and tactical training. He may be contacted at firstname.lastname@example.org.