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Terrorism, Still A Threat

In light of the Paris, France terrorist shooting attacks on November 13 and the continued bold threats being made by ISIS against the United States it is of the utmost necessity that emergency responders stay alert to any responses that may indicate a terrorist attack and be prepared to protect themselves as well as the public. Terrorism can happen in any community, so stay trained and stay alert.

The following information is taken from the from the U. S. Fire Administration
“Fire/Emergency Medical Services Department Operational Considerations and Guide for Active Shooter and Mass Casualty Incidents”.

“More than 250 people have been killed in the United States during what has been classified as active shooter and mass casualty incidents (AS/MCIs) since the Columbine High School shootings in 1999. AS/MCIs involve one or more suspects who participate in an ongoing, random or systematic shooting spree, demonstrating the intent to harm others with the objective of mass murder. It has become evident that these events may take place in any community impacting fire and police departments, regardless of their size or capacity. Local jurisdictions must build sufficient public safety resources to handle AS/MCI scenarios. Local fire/Emergency Medical Services (EMS) and law enforcement (LE) must have common tactics, communications capabilities and terminology to have seamless, effective operations. They should also establish standard operating procedures (SOPs) for these very volatile and dangerous situations. The goal is to plan, prepare and respond in a manner that will save the maximum number of lives possible. Maximizing Survival Extraordinary efforts on the part of local fire/EMS agencies and direct pre-planned coordination with LE is required during response to these events in order to rapidly affect rescue, save lives, and enable operations with mitigated risk to personnel. It is essential that local policies be put in place before AS/MCIs happen to ensure coordinated and integrated planning, preparation, response, treatment and care. The recognition of AS/MCIs as a reality in modern American life has led to the assembly of a number of public safety organizations representing various disciplines to share and develop strategies for combating the problem. One group, convened by the American College of Surgeons and the Federal Bureau of Investigation in Hartford, Connecticut, developed a concept document for the purpose of increasing survivability in mass casualty shootings. The paper, The Hartford Consensus, describes methods to minimize loss of life in these incidents. The Hartford Consensus identifies the importance of initial actions to control hemorrhage as a core requirement in response to AS/MCIs. Experience has shown that the number one cause of preventable death in victims of penetrating trauma is hemorrhage. Well-documented clinical evidence supports the assertion. The Hartford Consensus focuses on early hemorrhage control to improve survival. These very practical recommendations include the critical actions contained in the acronym THREAT: T - Threat suppression H - Hemorrhage control RE - Rapid Extrication to safety A - Assessment by medical providers T - Transport to definitive care

The THREAT concepts are simple, basic and proven. The Hartford paper points out that life-threatening bleeding from extremity wounds are best controlled by use of tourniquets. Internal bleeding resulting from penetrating wounds to the chest and trunk are best addressed through expedited transportation to a hospital setting. Coordinated/Integrated Planning and Response To increase survivability of victims, fire and EMS agencies must incorporate THREAT principles as SOPs. At a minimum, SOPs should include:
• Jointly developing local protocols for responding to AS/MCIs. Fire/EMS and LE should plan and train together.
• Planning for and practicing rapid treatment and evacuation, including who, what, when, where and how it will be carried out.
• Using the National Incident Management System (NIMS) and the Incident Command System (ICS). Accordingly, fire/EMS and LE should establish a single Incident Command Post (ICP) and establish Unified Command (UC).
• Fire/EMS, LE and all public safety partners planning and training together.
• Including AS/MCIs in tabletop and field exercises to improve familiarity with joint protocols. Regularly exercise the plan.
• Using common communications terminology. In addition to NIMS and ICS terminology, fire department personnel must learn common LE terms and vice versa. Share definition of terms to be used in AS/MCIs and establish a common language.
• Incorporating tactical emergency casualty care (TECC) into planning and training. Training must include hemorrhage control techniques, including use of tourniquets, pressure dressings, and hemostatic agents. Training must also include assessment, triage and transport of victims with lethal internal hemorrhage and torso trauma to definitive trauma care.
• Providing appropriate protective gear to personnel exposed to risks.
• Considering fire hazards secondary to the initial blast if improvised explosive devices (IEDs) are used.
• Considering secondary devices at main and secondary scenes.
• Determining how transportation to and communications with area hospitals/trauma centers will be accomplished.”

This is only the first few pages, there is much more valuable reading on this subject at

Another source of Responding to Terrorism information is from the CDC, Center for Disease Control EMERGENCY RESPONSE RESOURCES or

Till next time, Stay Safe and God Bless!

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HENRY CAMPBELLSenior Correspondent

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