edward strapp, fp-c, tp-c, nrp, lat atc shooter incident
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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.
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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)
Total Number Wounded (including the shooters)
Occurred at a School or University
January 35 23 145 0
February 43 49 152 0
March 48 70 188 0
April 52 64 208 0
2020s School Shootings
Date Location Deaths Injuries
Date Location Deaths Injuries
8-Jan-20 Belle Glade, Florida 0 1
11-Jan-20 Dallas, Texas 1 1
14-Jan-20 Bellaire, Texas 1 0
14-Jan-20 Fort Worth, Texas 0 2
23-Jan-20 Oxnard, California 0 1
3-Feb-20 Commerce, Texas 2 1
16-Sep-20 Sonora, California 1 0
16-Sep-20 Macomb, Illinois 0 1
26-Feb-21New Orleans,
Louisiana1 0
1-Mar-21 Pine Bluff, Arkansas 1 0
12-Apr-21 Knoxville, Tennessee 1[n 1] 1
26-Apr-21 Plymouth, Minnesota 0 0
6-May-21 Rigby, Idaho 0 3
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Some of the Deadliest Shootings
Date Location Deaths Injuries
16-Apr-07 Blacksburg, Virginia 33* 17
14-Dec-12Newtown,
Connecticut28* 2
1-Aug-66 Austin, Texas 18* 31
14-Feb-18 Parkland, Florida 17 17
20-Apr-99 Columbine, Colorado 15* 21
18-May-18 Santa Fe, Texas 10 14*
1-Oct-15 Roseburg, Oregon 10* 9
21-Mar-05 Red Lake, Minnesota 10* 7
July 26, 1764Greencastle, Pennsylvania
10 2
* = Shooter
CIVILIAN RESPONSE TO ACTIVE SHOOTER EVENTS
Active Shooter Events Active Shooter incidents in the US in 2019
Definition
Active Shooter Event=
Attempted Mass Murder
Current Trends
▪ 277 Active Shooter incidents in the United States Between 2000-2018
Link
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The Shooter
▪No “Profile”
▪Avenger Mindset
▪Some Broadcast
Current Trends
▪ 277 Active Shooter incidents in the United States Between 2000-2018
Link
Risk Factors
▪ History of violence
▪ Exposure to violence
▪ Substance abuse / Dependence
▪ Mental Illness
▪ History of suicidality
▪ Stalking, Harassing or Threatening behavior
▪ Negative family dynamics & support system
▪ Isolation or instability
▪ Others are concerned
Current Trends
▪ 277 Active Shooter incidents in the United States Between 2000-2018
Link
Current Trends- Educational Environments
▪ 277 Active Shooter incidents in the United States Between 2000-2018
Link
Current Trends- Open Spaces
▪ 277 Active Shooter incidents in the United States Between 2000-2018
Link
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98% Solo Attacker
3 Minutes
Attack Resolution
50% of Attacks End Before Police
Arrive!
Victims
Stop
(15%)
Attacker
Stops
(35%) Attack
Begins
Suicide
(24%)
Leaves
(11%)
Subdue
(12%)
Shoot
(3%)
Attack Resolution
50% of Attacks End After Police
Arrive!
Police
Stop (35.5%)
Attacker
Stops
(14.5%) Police
Arrive
Suicide
(11.2%)
Surrender
(3.3%)
Subdue
(9.5%)
Shoot
(26%)
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Current Trends
▪ 277 Active Shooter incidents in the United States Between 2000-2018
Link
Three Stages of Disaster Response
▪Denial
▪Deliberation
▪Decisive Moment
Denial▪ Don’t deny
hearing gunshots
▪ Go to deliberation
Deliberation
Human Brain Lizard Brain
Stress Response Emergency Action Plans
▪Avoid / Run
▪Deny / Hide
▪Defend /
Fight
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Training Options
▪ CRASE–Avoid–Deny –Defend
▪ Alice
– Alert
– Lockdown
– Inform
– Counter
– Evacuate
▪ FBI-
– Run
– Hide
– Fight
Elements of an Emergency Action Plan (EAP)
▪ An effective EAP includes:– A preferred method for reporting active shooter events and other emergencies
– An evacuation policy and procedure
– Emergency escape procedures and route assignments (e.g., floor plans or safe areas)
– An emergency notification system to alert various parties of an emergency, including the following:
▪ Individuals at remote locations within premises
▪ Law enforcement, EMS
– Contact information for, and responsibilities of, individuals to be contacted under the EAP
– Information concerning local area hospitals (e.g., the name, telephone number and distance from your location)
Evacuation Policy and Procedure
Link
Hide & Hope
Avoid / Run
▪Leave ASAP
▪Know your exits
▪Call 911
Avoid
▪Consider secondary exits
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Avoid
▪Consider secondary exits
▪Know your Options
Deny / Hide
-Lock the door -Lights out-Out of sight
Deny
-Lock the door
-Lights out
-Out of sight
Deny
-Lock the door
-Lights out
-Out of sight
Know your Surroundings Las Vegas (2017)
▪
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Deny
•Barricade• Heavier =
Better• More =
Better• Doorstops =
Better?
Deny
▪Door Stops
Deny
▪Outward Opening-–Ropes–Tension Sleeve
Deny
▪ Numerous commercially available door locks on the market.
Defend / Fight
•Positioning
•Grab the gun
•Fight
Defend
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Defend
Don’t fight fair,
Fight for your life!
Know your Surroundings
▪ Avoid = Run– Where will you go?
▪ Deny = Hide– How will you deny?
▪ Defend = Fight– If need be, what can be used in the room to
defend?
Know your Surroundings
▪ Avoid = Run– Where will you go?
▪ Deny = Hide– How will you deny?
▪ Defend = Fight– If need be, what can be used in the room to
defend?
Police Response
▪ Direct To Threat if Active Shooting is Occurring
▪ Stepping over Causalities
▪ Hot Zone, Warm Zone, Cold Zone
▪ Follow their EVERY COMMAND– Don’t be holding the gun when they arrive
Critical 15%
▪ The first 15% of any emergency determines the effectiveness of the remaining 85%
–First 15% = planning
–85% = implementation
Emergency Action Plan
▪ Help to Organize and provide a unified approach in a large event
▪ Key Components to the plan include– Personnel Involved– Communication Standards– Adequate equipment– Training and evaluation
Emergency action plans provide guidelines and templates for documentation of emergency planning to help prepare individuals for a
catastrophic injury situation.
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Emergency Action Plans
▪ Components-– Scope of Coverage
▪ Athletes
▪ Staff
▪ Spectators
– Personnel
– Communication
– Locations
– Practice / Training / Rehearsal
– Documentation
Building your EAP
Overmanage-▪ Risk Management
▪ Policies & Procedures
▪ Emergency Action Planning
▪ Catastrophic Injury & Crisis Management Planning
▪ Personnel
▪ Equipment
▪ Communication
▪ Practice, Training, Rehearsal
▪ Documentation
▪ Relationships / Teamwork
Be Intentional-▪ How you think!
▪ How you prepare!
▪ How you communicate!
▪ What you say!
▪ How you train!
▪ What / How you document!
▪ What you do!
Active Assailant EAP / Crisis Plan
▪ What is your plan?
▪ Is it practiced as often as your other EAP?
▪ “EVENT CALL” system
▪ Who do you collaborate with on campus & in community
▪ Documentation
▪ Communication w/parents, coaches, ATs, administration, etc.
▪ Active Assailant– Active Shooter vs Hostage Situation– On Campus or in Community
▪ Environment▪ Recognize warning signs
▪ See Something, Say Something
▪ Activate-▪ Avoid, Deny, Defend
▪ Providers-▪ Staff and Students▪ Campus Police/Security
▪ Police / EMS
Communication
▪ Meet with your Police/ EMS-– Local, County, State Resources
– EMS
– Tactical EMS Groups
– Capabilities ALS vs BLS
– Usual response
▪ Introductions– Protocols
– Communication
– Casualty Collection Points
– Transports
▪ Educate-– Education level & capabilities– Protocols – Expectations– Joint training
▪ Equipment-– Who has what?– What is available?– What is necessary?
▪ Incident Command-– Who– Where
Communication
▪ How?
▪ What?
▪ When?
▪ Who?
▪ Verbal vs Non-Verbal
▪ 2-way Radios / Phones
▪ Public Address Systems– In Building and On the Grounds
▪ Addresses / Phone Numbers / Maps
▪ Intentional Communication-– Where is the assailant– Where should you go/avoid
▪ Parents / Families / Coaches / Administration / Media-– Crisis/Catastrophic Plan– Family Reunification
Personnel
▪ 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
6/17/2021
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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
Materials– Civil Disorder– Utility Failure– Pandemic– Bomb– Tornado
– 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
▪ Tourniquets
▪ Rolled Gauze
▪ Hemostatic Agents
▪ Chest Seals
▪ AED’s
▪ WHERE is this equipment– Classrooms?
– AED Cabinets
– Out on Campus not in buildings
– Athletic Training Kits
– Large MCI Kits
▪ Care under Fire– Get off the X
– Get people out of the line of fire
– Don’t risk Avoid/Deny/Defend
▪ Room Spaces– Can they be unlocked/accessed
– Can they be locked
▪ Cover vs Concealment
Are we ready?
Plans are worthless,
but planning is everything.
President Eisenhower
Sandy Hook Promise Critical Incident Stress Management (CISM)
▪ Student-Athletes
▪ Coaches, staff, administration
▪ Friends / Family
▪ Athletic Trainers – (“put your oxygen mask on
before helping others”)
▪ Campus resources
▪ Community resources
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Closing Thought
Nobody ever wrote down a plan to be unprepared, untrained, unqualified or just not ready.
Those things are what happens when you don’t have a plan
QUESTIONS?
THANK YOUstrappatc@gmail.com THANK YOU
Darryl Conway for your advice and guidance in putting this all together
Resources
▪ https://www.fbi.gov/file-repository/active-shooter-incidents-in-the-us-2019-042820.pdf
▪ https://www.fbi.gov/file-repository/rems-k-12-guide-508.pdf
▪ https://www.fbi.gov/about/partnerships/office-of-partner-engagement/active-shooter-resources
▪ https://www.fbi.gov/file-repository/active-shooter-guide-for-businesses-march-2018.pdf
▪ http://www.policefoundation.org/wp-content/uploads/2018/01/csp_aar.pdf
▪ https://www.fbi.gov/file-repository/active-shooter-one-page-summaries-2000-2018.pdf
Resources
▪ https://www.cisa.gov/sites/default/files/publications/active-shooter-emergency-action-plan-template-112017-508.pdf
▪ https://www.cisa.gov/sites/default/files/publications/active-shooter-emergency-action-plan-112017-508v2.pdf
▪ https://www.cisa.gov/first-responder
▪ https://www.dhs.gov/xlibrary/assets/active_shooter_booklet.pdf
▪ https://www.dhs.gov/xlibrary/assets/active_shooter_pocket_card.pdf
▪ https://www.cisa.gov/first-responder
▪ https://www.cdse.edu/documents/toolkits-physical/active-shooter-plan-template.docx
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Resources
▪ https://doi.apa.org/fulltext/2020-78672-001.pdf
▪ 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,
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