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Friday, January 3, 2014

FEMA Recommends Paramedics Enter Active Situations

Police tape secures the scene after a shooting at Sparks Middle School October 21, 2013 in Sparks, Nevada. (David Calvert/Getty Images)

Police tape secures the scene after a shooting at Sparks Middle School October 21, 2013 in Sparks, Nevada. (David Calvert/Getty Images)

FEMA recently released new guidelines for medics in “warm zones”: situations like a mass shooting in which the shooter hasn’t yet been subdued.

FEMA’s advice to medics? Go in.

The long-held thinking has been to keep emergency personnel in the ambulance until the coast is clear.

But after the Columbine High School shooting in 1999 — when both police and medics waited for SWAT teams to clear the area — law enforcement officials decided police should act immediately to restrain the shooter.

And now, FEMA advises send the medics in as well, with helmets and flak jackets if possible.

But the Emergency Medical Services in Reno, Nevada, have been sending their medics into warm zones even before FEMA’s new guidelines.

Kevin Romero, the EMS director for Regional Emergency Medical Services Authority in Reno, told Here & Now’Robin Young that his department was motivated by Columbine to be more active.

However, Romero says not all EMS personnel are trained — nor should they be required to be — for these types of incidents.

At the Sparks Middle School shooting, Romero said one of his responders was a tactical paramedic who was trained to enter such a situation, but another wasn’t. The paramedic who wasn’t trained for such a situation stayed behind and created a staging area.

“All EMS providers acknowledge that it doesn’t matter if you’re responding to a laceration or a domestic disturbance, all incidents are dangerous,” Romero said. “We need the properly trained paramedic – whether that’s a paramedic that’s trained in the active shooter, whether that’s a paramedic who works with a bomb squad.”

When asked whether EMS who respond to such situations should carry firearms, Romero said he does not want EMS responders to also take up law enforcement roles.

“We want our EMS providers to concentrate on EMS,” Romero said. “We don’t want them to be put in the position where they become law enforcement.”


  • Kevin Romero, the EMS director for Regional Emergency Medical Services Authority in Reno, Nevada.



It's HERE AND NOW. FEMA recently released new guidelines for medics in so-called warm situations: mass shootings in which the gunman has not yet been subdued. The advice: go in. The long-held thinking has been to keep emergency personnel in the ambulance until the coast is clear, but after the Columbine shootings in 1999, when both police and medics waited for SWAT teams to clear the area, and victims bled to death, law enforcement officials decided police should act immediately to restrain the shooter, and now FEMA is saying send the medics in as well to stop the bleeding with helmets and flak jackets if possible.

Well, Reno, Nevada, has been doing this for a while. Kevin Romero is EMS director for REMSA, that's the Regional Emergency Medical Services Authority in Reno. We remember the October shooting at the middle school in Sparks, Nevada, a teacher killed, two children shot. And Kevin, do we understand within seven minutes of the first call, one of your paramedics arrived at the school with a bulletproof vest and helmet?

KEVIN ROMERO: Yeah, we've actually been training with the law enforcement agencies in Reno for about the past 15 years. And we have eight specially trained tactical paramedics that trained with the SWAT teams. And we had a lot of paramedics on duty that day, but it just so happened that one of the closest was one of those specially trained paramedics.

But our policy is to get the most properly trained paramedic to the right type of call with the right type of equipment. An active-shooter-type incident, we do get a paramedic inside of that incident who does have bulletproof vests and helmets and all the proper equipment to treat with inside of a warm or a hot zone.

YOUNG: This is the new recommendation. What was your EMS responder able to achieve that day?

ROMERO: Well, he was able to get on-scene within about four minutes and link up with some law enforcement people who he trains with and immediately gain access into the school and was able to go treat the wounded very quickly and then able to coordinate the ambulances that were staged out of the area by bringing them in one by one to transport those people out safely.

YOUNG: I mean, do you get the sense that in this case, as is being sad, your EMS responder saved lives?

ROMERO: Absolutely. There's no doubt. And, you know, the Columbine incident is one of the incidents that prompted us to start this type of program back in 1997.

YOUNG: Yeah, to stop bleeding. It would appear that the new proposal - and in fact a headline in the New York Times was new advice, let medics rush in. How do you feel about that broad stroke on it?

ROMERO: Rather than saying we need to just have the medics rush in, we need the properly trained paramedic. Whether that's a paramedic that's trained in the active shooter, whether that's a paramedic who works with the bomb squad and doing what our U.S. military does every day. You know, we really need to reach out and start looking at the fact that these types of incidents aren't going away, and how can we mitigate them better.

YOUNG: But you say so they should be properly trained. But should they be armed? I've been looking around on different blogs where firemen and EMS are talking about the new policy. Here's a post on one. They say it doesn't say hero on my paycheck, and when it does, it better come with a hefty raise. I understand the concept, but to send an unarmed EMS worker into an uncleared area to find out that maybe there could be dirty bombs or whatever behind door number one, that EMS person is going to become a target.

ROMERO: And we agree with that 100 percent. In the Sparks middle school shooting, there was a tactical paramedic trained on that ambulance, and there was another EMT provider on that ambulance who wasn't trained. The tactically trained paramedic jumped out, and the other provider drove off to a staging area.

So to say on a broad spectrum that all paramedics need to rush into these different types of incident just doesn't make any sense. But to properly train them and send the right ones in with the right equipment, that makes sense.

YOUNG: But is part of that equipment a gun? Do you think EMS workers should be armed?

ROMERO: You know, it's our philosophy here in Reno, Nevada, that we want our EMS providers to concentrate on EMS. We don't want them put in a position where they become law enforcement, where they have to be posted up at the corner of a school. So we surround them with people that they train with, and they run multiple calls with these people, special weapons and tactics calls.

And they feel very comfortable that they're protected by those people.

YOUNG: Well in fact here's another response from somebody saying that they're an EMS worker. They say I'll do it. You know, my job is to care for people. And they make the point that you're going to be safer surrounded by these armed policemen wearing ballistic gear in a live shooting situation than you might be on that abdominal pain call with no fire department, no police department backing you up. We wouldn't be the target; the person with the guns would be.

However, this person also says I'd never ask my partner to do it. You know, I don't think it should be required that we do it, but I would want to do it.

ROMERO: Well, I think first and foremost all EMS providers acknowledge that it doesn't matter if you're responding to a laceration or a domestic disturbance. All incidents are dangerous, very similar to what you saw there in Boston. Medical providers rushed in to stop hemorrhage and provide quick care. But what that doesn't mean, it doesn't mean that all EMS providers need to be trained on what they can do to help in this type of incident.

YOUNG: You mentioned the bombings, and so I'm going to raise something that is touchy, from what I'm gathering reading on these blogs for EMS workers, because the fear is raised that an active shooter is one thing, but it's a terrible thing to say but that if it's known that EMS workers are going to rush into let's say bomb situations rather than hang back and wait for law enforcement to sweep an area and make sure that it's safe that we'll start seeing what we're seeing in other countries, that bombers will set something off, wait for the emergency personnel to arrive and then set something else off to target them.

ROMERO: And I think we've got the first step there, and that's the awareness and recognition that we know that can take place. And that's when heightened awareness of everybody, the general lay public, we need to be aware of that type of incident.

We had something very similar, not in nature, but it brought back a lot of memories for us, and that was the Reno air race crash. As our EMS providers watched the Boston bombings, we saw something very similar to the Reno air race crash, and that was the hemorrhaging and the loss of limbs. But the heightened awareness of knowing, as I watched that, knowing that everybody there was thinking the same thing, let's get these people out of here as quick as possible, control the hemorrhage, but let's be aware of our surroundings.

And I think that was done great in Boston. And we're going to continue training our law enforcement on how to do a little bit of EMS side of things, as well, until we can get people in there.

YOUNG: How about pay? Is there going to be more pay for the EMS worker willing to take the greater risk?

ROMERO: We do have differential pay that we pay for people that are tactically trained or search and rescue trained. I will tell you that our tactically trained paramedics stopped doing that about three years ago and asked that that go into a fund rather than affect their pay, a fund for better equipment, things that they can utilize on those scenes. And they are very well-equipped now.

The one thing that's very hard to do is bridge the gap between EMS and law enforcement when it comes to funding. You can't go out in a federal grant, an EMS agency, and get things like flak jackets and helmets. So that's one of the struggles that we've had, but we've been able to overcome and get some funding for those people.

YOUNG: Well, that's quite something that they would give up their own pay for that, but it sounds as if the federal government is changing its policy and recommendation, it needs to come up with the funding for that equipment that medics will now need.

ROMERO: Absolutely, absolutely, and flak jackets for the regular paramedics. Any shooting or stabbing, or if they're asked to go into that type of incident, having that available equipment is really important.

YOUNG: Kevin, thanks so much.

ROMERO: All right, take care.

YOUNG: Bye-bye.


YOUNG: OK, so I'm still stuck on that, using their extra pay to pay for equipment. Medics, EMS workers, police, your thoughts on this new policy. Leave a comment with this story at hereandnow.org. Transcript provided by NPR, Copyright NPR.

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  • Adam

    Robin Young, the word you were looking for was “double tap” a common tactic used in America Drone strikes that kills rescuers. http://www.salon.com/2013/08/01/investigation_finds_evidence_of_cia_drone_strikes_on_rescuers/

    • USArmyRecon

      Adam, the term “double tap” has an entirely different meaning in the military community I can assure you. As for your referenced article, if you were even vaguely familiar with US military operations, or the the area referenced, you would likely be drawing different conclusions. What do you suppose the EMS system in North Waziristan consists of? These people do not have running water or vehicles. The “responders” mentioned in the article are very likely combatants coming to the aid of fellow wounded combatants. I am not saying that it is appropriate to target them, or making a statement as to whether or not it constitutes a war crime, I am only pointing out that targeting a large civilian gathering with an explosive, and then utilizing a secondary device to deliberately target dedicated emergency responders is not even remotely comparable. Your comparison is in very poor taste.

  • USArmyRecon

    Another perfect example of how the unique back ground of the military medic has priceless transition value to the civilian sector. Sadly, medics leave the army with nothing but an EMT-Basic certification for the civilian side, despite multiple classroom and didactic hours focusing on scope of practice well beyond the EMT-B level. No recognition of being CMAST/TC3 competent (Combat Medic Advanced Skills/Tactical Combat Casualty Care). Add to that the fact that senior medics, and those who have completed BCT3 (Brigade Combat Trauma Team Training) prior to a deployment, potentially have a much higher level of trauma management knowledge than a civilian EMT-P; specifically regarding firearm and blast trauma. But the schools, boards, and NREMT stand to lose too much money from allowing a medic the simple courtesy of challenging their exam, and demonstrating a level of proficiency adequate to perform the job of EMT-P/LPN(LVN).

  • exBronxite

    “However, Romero says not all EMS personnel are trained — nor should they be required to be — for these types of incidents.”

    The small-town old ladies in the neighborhood “first aid squads” said the same thing about CPR at one time, too.

    Times have changed.

    That’s why they call them “Dangerous occupations,” volunteer or paid.

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