Columbine. Aurora. Mumbai. Mass casualty incidents are quickly associated with where they occurred, and the event details live on in the public consciousness every time they hear that place name. Across the country law enforcement agencies strive to learn from these types of events, planning scenarios and training responses, no doubt hoping never to have their city's name added to the list. In Philadelphia, the police department has also been hard at work making sure that if such an event ever were to occur in that city that first responders will be prepared and equipped to maximize the numbers who survive.
Some of the key ways they have done this are through the deployment of tourniquets, the development of active shooter training for fire department paramedics, and the creation of a police reserve medic program. Each on its own is a significant step to improve survivability, but taken together they represent a more comprehensive and collaborative approach to improving public safety and building on the city's existing planning and training efforts.
Not long after the Boston Marathon bombing in 2013, Chief Inspector Joe Sullivan of the Philadelphia Police Department (PPD)—the commander for homeland security and counter-terrorism—had the opportunity to attend a meeting on active shooter situations. In the meeting, a trauma surgeon spoke about how first responders can increase the survival of shooting victims by controlling the bleeding, ensuring their airway is open, and getting them to a hospital, where—if the first two conditions were met—a trauma surgeon would be highly likely to ensure their survival. One of the ways the surgeon said police officers could accomplish this would be through the use of tourniquets. Sullivan was intrigued by this statement, especially since he works in a city with multiple level 1 trauma centers, but was concerned about how much time would need to be invested to train the thousands of officers in his department on using a tourniquet. Then the surgeon said he could train a police officer to use one in an hour and Sullivan's major concern disappeared.
Sullivan also had the chance to hear the former commissioner of the Boston Police Department, Ed Davis, give a compelling presentation on the successful use of makeshift tourniquets at the Marathon bombing and how it highlighted the need for him to equip all of his officers with medical tourniquets. Small and easy to carry, quick to train on, and proven effective; it was now clear to Sullivan that the PPD should deploy tourniquets. Commissioner Ramsey agreed and the PPD went to work in partnership with the city's Director of Emergency Management Samantha Phillips to secure the needed funding and expedite the procurement process. A policy was developed, a four hour training was conducted, and by the end of 2013 more than 5,500 officers in the PPD were carrying tourniquets. They have already been used successfully in the field, and those successes were covered by the local media.
In 2013 PPD was already at work putting all its officers through an active shooter training developed and led by the SWAT unit, as well as participating in joint exercises with the Philadelphia Fire Department (PFD). According to Sullivan, the benefits of joint exercises are not just that both agencies' personnel train together, but that “the command staff can sit down afterwards and work through issues that would create risks if handled ad hoc at a real scene.” In these post-exercise debriefings, both agencies agreed to work to address some of the weaknesses in response coordination that the exercises brought to light. One outcome of this was the creation of a program, led by the PPD SWAT, to train the PFD paramedics to deploy into active scenes with the police department personnel rather than waiting for the entire scene to be secured.
A position statement issued by the International Association of Firefighters on active shooter events states that, “it is imperative that local fire and law enforcement departments have common tactics, common communications capabilities, and a common lexicon for seamless, effective operation,” and that one of the minimum objectives of a jointly developed standard operating procedure should be the use of Rescue Task Forces: “A RTF is a set of teams deployed to provide point of wound care to victims where there is an on-going ballistic or explosive threat.1 These teams treat, stabilize, and remove the injured in a rapid manner while wearing Ballistic Protective Equipment and under the protection of a Law Enforcement Department.”
In addition to the training, which Sullivan notes was enthusiastically received by the PFD medics, the PPD also worked with the PFD to design and select the ballistic protection that would be procured for the medics, ensuring that it met their needs for freedom of movement as well as gave them confidence in their safety at scenes. The medics for both departments were also issued new medical equipment to carry at scenes, ensuring that all medics could be confident in the quality of what they were carrying as well as the consistency across medic teams.
The third piece of this collaboration was the creation of a police reserve medic program within the PPD. In addition to the SWAT unit medics, it was known that about 70 personnel in the PPD had prior certification and experience ranging from an EMT to a RN. Although their primary police jobs would not change, they were invited to become reserve medics. Sullivan explained that the reserve medics allow for “utilizing the combined resources” of both PPD and PFD. Mass casualty scenes are fluid and fast changing, command responsibility can shift as the scene evolves, and some scenes may limit where fire department medics can be safely integrated. The reserve medic program “allows for greater flexibility depending on the situation.” Each of the reserve medics was provided with the training necessary to ensure their existing certifications were current and that they were versed in PFD medic protocols and equipment. Then they were licensed to operate under the same doctor who licenses all the PFD medics.
Obviously, the PPD hopes that they will never have to put all of this to the test in a real incident, but no community can secure that kind of guarantee. However, Sullivan is confident that survivability can be enhanced by training and integrating paramedics to work with the police department, as well as by equipping police officers with tourniquets and making use of the skills and training police officers might already have. The city has managed to implement these initiatives in a relatively short period of time, which Sullivan credited to the support of Police Commissioner Ramsey and the commitment of both the PFD and Samantha Phillips, the director of the city's Office of Emergency Management. The collaboration of these three agencies was key to these efforts and, he noted, “The police department could not have done this all by ourselves.”
Deborah L. Spence
Supervisory Social Science Analyst
The COPS Office
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