FDIC 2019 Quick Take: Deploy the fire/EMS RTF to active shooter/hostile events
NFPA 3000 encourages fire/EMS to enter the warm zone with police, treat at the point of wounding and save more lives during a mass casualty incident
By Kerri Hatt
INDIANAPOLIS — The rescue task force concept, which is within the framework of risk/benefit analyses and combat-proven, evidence-based medicine, allows for point-of-wounding care. Lifesaving care extends the life clock of the injured until further definitive care is available on scene or the patient reaches the hospital.
Mark Litwinko, an instructor for tactical emergency casualty care and the rescue task force for the Indiana Department of Homeland Security, presented on the rescue task force model at FDIC 2019. Lt. Litwinko is a 15-year veteran of the Fort Wayne (Ind.) Fire Department, assigned as an engine company officer, a medic and a hazmat technician. Additionally, he serves as a tactical-medic for the Fort Wayne (Ind.) Police Department Emergency Services Team.
Memorable quotes on implementing a rescue task force
Here are four memorable quotes from Litwinko’s presentation.
"Don’t let tragedy drive your policy changes."
"We can control chaos if we need to."
"Stop bleeding, keep them breathing, prevent freezing, get them leaving."
"A plan that is never practiced is simply just a theory."
Top takeaways on the rescue task force model
Litwinko explained the background and philosophy of providing patient care in the warm zone utilizing trauma care principles from the Tactical Emergency Casualty Care (TECC) guidelines. Here are the top takeaways from his presentation on the RTF model.
1. People are dying while we stage and wait
What is the traditional approach, Litwinko asked – stage and wait.
"We still stage and wait on certain runs," Litwinko said. "We wait for a totally secured scene by police."
Since every minute counts in bleeding control in survivability the rapid application of medical treatment at the place of wounding saves lives.
"Rather than asking, ‘is the scene totally safe?’ ask, ‘Is the scene safe enough?’"
"No one should die from preventable death injuries just because we’re waiting for an all clear that may never come."
2. Apply rapid intervention team tactics, terminology to RTF
While many department policies still dictate stage and wait, the rescue task force concept is not alien to fire departments, Litwinko pointed out. Just look at the RIT.
The rapid intervention team stages in an assigned area, waits for a specific assignment, before being tasked with going in, aiding and retrieving an injured firefighter from a high-risk environment. This is very similar to the rescue task force model.
"We have been doing this for years," Litwinko said. "But instead of entering a burning building to aid a firefighter, we’re going into an expo center to aid shooting victims."
Reframe the terminology your department is familiar with to extend to rescue task force deployment.
- Hot zone. A direct and immediate threat exists.
Apply the RTF model: a law enforcement only area, which has not been searched and should be considered to contain a direct threat. Avoid operating in the hot zone.
- Warm zone. A potential threat exists but is not direct or immediate.
Apply the RTF model: the area has been searched and no visual threat is apparent. Operating is permissible to save a life as directed by unified command with proper PPE and training.
- Cold zone. No significant danger or threat can be reasonably anticipated.
The area has been thoroughly searched and is now under direct law enforcement control. Continue patient care, re-triage patients and assign patients to transport units and receiving facilities.
3. The RTF moves until they reach a stopping point
Litwinko’s RTF operates under the fire service two-in, two-out premise, and pairs two firefighters with two law enforcement professionals to make up each team. Each responder is equipped with ballistic protection and medical supplies including a helmet, flashlight, medical gloves and an individual first aid kit (IFAK) – attached to each ballistic vest and intended for the sole purpose of treating the individual wearing that vest if they are injured.
The RTF goes until they meet a stopping point, Litwinko related, which could be one of the following:
- There are no more victims
- There are no more supplies
- A change in the scene (e.g. a new threat is introduced)
Once the RTF reaches a stopping point, they remove themselves and the victim they are working with. Another RTF will be assigned to the other victims.
Avoid leapfrogging, he cautioned. Everyone goes in the same door, so the only people ahead of the rescue task force is law enforcement.
When triaging and treating, you want to "do the most good, for the most amount of victims, as quickly as possible," Litwinko said.
Follow the TECC model: down and dirty BLS; tourniquets, chest seals, maybe basic airway maintenance, for the semi-conscious, unconscious, non-ambulatory gravely injured.
4. Apply NFPA 3000 to interagency rescue task force training
Litwinko referenced NFPA 3000: Standard for an Active Shooter/Hostile Event Response (ASHER) program, which calls for interagency training and preparedness to respond to and recover from an active shooter/active assailant event.
The goal is to narrow the timeline gap between when the perpetrator is located, contained or neutralized, and when the first medical care is provided to victims, Litwinko explained. This is achieved by coordinating resources from police, fire and EMS. An active assailant requires a public safety response from every agency.
"If we’re not training together, integrating common terminology, concepts and goals, we are failing these people."
Litwinko explained that integrating public safety response does not mean anyone needs to change their tactics. Let law enforcement do what they do well, let fire and EMS do what they do well; just integrate that response, he urged.
He used a game day analogy to make this important point; "If we don’t work out of the same playbook, when game day comes, we won’t be able to play together."
Learn more about the rescue task force model and NFPA 3000
- Why recent acts of mass violence should change the way fire, EMS and police train
- How to avoid the most common active shooter training mistakes
- Campaign aims to raise awareness of active shooter threat, rescue task force
- Code 3 Podcast: Interagency cooperation during rescue task force response
- NFPA 3000: A provisional standard commanding a call to action by first responders
- Active shooter standard advocates whole community approach
- Consider citizens while implementing new NFPA standard
- Ill. fire dept. changes active shooter response methods to save more victims
- Active shooter response command decisions are made by first arriving ambulance crews, fire companies and police officers
- Active shooter: How to get medics to victims faster
- Apply best-available data to active shooter incident planning, training