EMS: 3 Key Things to Know When an Active Shooter Survives

When an active shooter survives, the shooter becomes another patient for EMS to triage, treat and transport.

Eleven people were killed October 27 at a Pittsburgh synagogue by a gunman armed with an assault rifle and several handguns. Six others, including four police officers, were injured before Robert Bowers, the shooter, was apprehended.

The mass murderer is alleged to have made violent threats on social media sites and has been charged with a federal hate crime for “obstructing the free exercise of religious beliefs resulting in death.” It’s also a tragic reminder that some of the most deadly mass murders in the United States have taken place at churches and synagogues.

The 20-minute attack at Tree of Life Congregation killed eight men and three women, ages 54 to 97. The victims included a husband and wife and two brothers. Two victims, including one of the police officers, were hospitalized in critical condition.

In many active shooter incidents, the shooter either dies by suicide or is killed exchanging gunfire with law enforcement. The CharlestonSutherland Springs (Texas) and the Parkland high school shooters left the scene uninjured. Two of the shooters were apprehended uninjured.

Bowers was shot by police and arrested. It’s possible his intent was to die by suicide or through a suicidal confrontation with police. Don’t assume the shooter has a death wish. If the shooter survives, EMS transport is likely:

  1. Suicidal intent might continue through assessment, care and transport with a willingness to cause further injury to self and others.
  2. Document statements made to EMS providers by the perpetrator. If personnel resources allow, assign one EMS provider to write, in real time, the perpetrator’s responses to assessment questions and treatment actions.
  3. EMS assessment and care will be on video. There are sure to be one or more body-camera equipped police officers with the suspect in the patient care compartment. EMS providers’ words and actions will become part of the investigation and scrutinized by investigators and attorneys.
Media Logistics Advice

Before arriving at the hospital, EMS leaders should anticipate and prepare EMS personnel for extraordinary media scrutiny.

The transporting crew will be found, contacted by phone and email and through social network profiles. They will be confronted on- and off-duty by mainstream journalists and less-than-mainstream opportunists.

Prepare all personnel with a succinct and standardized message on how to respond to media inquiries and to whom those inquiries should be directed to.

Treating Public Safety Victims

Treating a single injured police officer is stressful for any EMS agency and its providers. Caring for four injured officers is an MCI within an MCI.

At least annually, EMS personnel should receive training on policies and procedures applicable to treating one of our own – a fellow EMS provider, police officer or firefighter. The approach is the same – treat what you find with the tools and training within your scope, whether the patient is a murderous racist or the most kind-hearted cop on the force. But anyone who has treated a public safety colleague will likely tell you, “it’s just different.”

About the Author

Greg Friese, MS, NRP, is Editor-in-Chief of EMS1.com. He is an educator, author, paramedic and marathon runner. Greg is a two-time Jesse H. Neal award winner and 2018 Eddie Award winner for best Column/Blog.

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