First responders are challenged to find better ways to handle active shooters

The increase in active shooter incidents is challenging our nation and communities to find better ways to keep guns away from troubled people and to reduce the carnage once an incident is underway.

There were 50 active shootings in the U.S. in 2017 and 2016, with 221 people killed and another 722 injured, more than double the casualties in the previous two years, according to the FBI.

No area is immune. Mass shootings happen most frequently in business offices and schools, but they’ve also occurred in churches, shopping malls and government facilities.

Several of the deadliest mass shootings in history took place in the past decade:

1. A lone gunman opened fire on a crowd of concert goers from a 32nd floor hotel window in Las Vegas, resulting in the deadliest mass shooting in U.S. history, with 59 killed and 851 injured.

2. A 29-year-old security guard who was disturbed by U.S. policy in the Mideast, killed 49 and wounded 53 at Pulse, a gay nightclub in Orlando, Florida.

3. In the deadliest shooting ever at a house of worship, a court-martialed Air Force veteran with a history of domestic violence, killed 26 people and wounded 20 others at a church service in Sutherland Texas.

4. A 20-year old who attended Sandy Hook Elementary School in Connecticut as a child returned to the school and killed 20 young children and six adults.

The political response to each incident tends to follows a predictable pattern. Progressives call for stricter gun control laws while conservatives argue that an armed citizenry is the best deterrent. Neither side seems interested in compromise.

With the number of incidents on the rise, many first responders and communities are reviewing and revising their response protocols and trauma care capabilities and procedures.

As an emergency room doctor who is involved in active shooting preparedness in Odessa, Texas, I feel confident in asserting that better planning on the ground among law enforcement and medical people can significantly reduce casualties.  

However, there are several challenges facing first responders:

No experience

In preparedness meetings, when I ask people when was the last time you dealt with an active shooter, the answer is almost always — never.

Who’s in charge?

While law enforcement is responsible for disarming the shooter and preventing more casualties, they lack expertise in dealing with the wounded. EMS (Emergency Medical Services) must be empowered too. But who makes the decision of when it’s safe to send in medical personnel? Who decides whether law enforcement should focus on the shooter or pull the victims to a safe place for treatment?

It’s critical that law enforcement and EMS prepare, plan and coordinate their responses to active shooter incidents. Lines of authority and communication procedures must be clear and accepted by all parties.

Lack of clear protocols

While intervening as quickly as possible to stop the shooter and treat the victims is critical, different situations require different tactics. Sometimes storming the shooter with a heavily armored SWAT team might be the best tactic. If the shooter is holding explosives, a sniper approach might work better. In every situation, the risk to civilians must be prioritized.

From a medical perspective, victims who are in danger of dying need to be identified and treated as quickly as possible. That may mean EMS moving in just behind a SWAT team and treating severely wounded people on the ground. Or, in different circumstances, police diverting the shooter momentarily and quickly pulling victims to a safe place.

Insufficient practice and drilling

Given that most police officers and EMS personnel have no experience with active shooters, it’s imperative that all parties conduct practice drills.  As elementary as that sounds, my experience is that the logistical challenges of getting everyone together and reserving a good venue (such as a school) discourages frequent drilling. Once or twice a year isn’t enough.

Who should we involve?

To what level should authorities include school administrators, teachers and businesses in active shooter preparedness? While it’s a controversial topic, the fact is civilians successfully ended 16 percent of active shooter incidents in 2017 and 2016.

As mass shootings have become bloodier and more frequent, the law enforcement response has evolved from establishing a perimeter and barricading the suspect to entering the scene quickly and disengaging the shooter.

While this approach undoubtedly saves civilian lives, it places first responders at greater risk. In what is likely a reflection of the more aggressive tactics, thirteen law enforcement people were killed by mass shooters in 2017 and 2016, compared with only four in the preceding two years.

Given the risks to all involved, it is imperative that communities and first responders make rational risk/reward decisions about when and how to disarm an active shooter and provide medical care to victims.

Sadly, there are no easy solutions, but careful planning and coordination will save lives.

Sudip Bose, M.D. specializes in emergency medicine, mass casualty, disaster care and PTSD He is a former major in the U.S. Army with 12 years of service. U.S. forces selected Bose to treat Saddam Hussein after his capture.  Follow him on Twitter @docbose.