Ofer Lichtman of Rancho Cucamonga Fire Department (Calif.) is an expert on numerous subjects impacting the fire service, including Tactical Emergency Casualty Care (TECC) and terrorism awareness. The terror attack in San Bernardino (Calif.) in December of 2015 has heightened domestic concerns over violence and against civilian populations. Lichtman recently provided TargetSolutions with an in-depth interview of his thoughts regarding effective strategies for first responders during an active shooter incident. This article is Part 1 in a two-part series. Please click here for Part 2.
Here is the Q-and-A:
TargetSolutions: What are the current protocols that are commonly taken during an active shooter incident?
Lichtman: As a country, about 85 percent of fire departments have an archaic type of response that is traditional in the sense of waiting for law enforcement to declare a scene safe. Then firefighters would proceed to enter a cold zone environment and begin treating patients in a traditional EMS fashion. The other 15 percent of fire departments have some type of active shooter response model. These proactive fire departments have identified the best way to increase survivability in these situations is to treat preventable death injuries as close to the time and location in which they took place. Fire departments around the country are identifying this as a standard model that needs to be developed and practiced. Entering a warm zone environment and treating patients is one of the best things we can do as an industry for our community.
TargetSolutions: What are the characteristics of preventable death injuries during active shooter incidents in civilian environments?
We traditionally fall back on the military model of what’s killing our soldiers overseas. Our theory was that the injuries killing our soldiers overseas are the same injuries that are killing our civilians here at home. There was this notion that “a bullet in the Middle East does the same damage as a bullet in San Bernardino.” Massive extremity hemorrhage is known to be the No. 1 cause of preventable death injury in our soldiers, so it’s probably the No. 1 cause of preventable death injuries for civilians here at home during active shooters, but the reality is that it’s just not true! A recent study done in cooperation with the Committee for Tactical Emergency Casualty Care(C-TECC) shows that civilians do not have a way to defend themselves in active shooter situations and the proximity to shooters is much closer than it would be if they were in a gunfight as soldiers engaged in combat.
The issue of body armor in the civilian population is non-existent, whereas in the military it’s very advanced. When you consider that most soldiers have a ballistic plate on their torso and a helmet, you realize why there is a very high injury pattern to the extremities. That is the reality in the military. In the civilian tactical environment, we must be data driven and recognize the differences from true combat. For example, applying a tourniquet isn’t the No. 1 treatment we should be focusing on anymore when we are treating civilians with no body armor. Applying a tourniquet is still a very high priority but the data shows that torso injuries result in the highest amount of preventable death injuries in the civilian environment. If we don’t train our people on how to identify and treat that, then we’re negligent as first responders. We have to ask difficult questions like are we really doing everything we can to give these people the best chance for survival?
TargetSolutions: How can the community help first responders during an active shooter scenario?
Lichtman: We know there are plenty of civilians who are trained or can be trained to provide care, information, and even eliminate a threat if they can. The reality is that the response time for a bystander is truly zero minutes. We can never come close to that as first responders. So why not empower the community and correctly train them to not only survive an active shooter incident but what they can do to save themselves, family and friends. Second, teach them treatment options for preventable death injuries that are more specific in the civilian environment and not the military. Trained community members give us the time we need from injury to when advanced care can enter the warm zone. We need to treat this with a whole community-wide approach and decrease the time it take patients to get treated. We can achieve this with bystanders who are actively participating in treatment and not afraid to take action during these disasters.
TargetSolutions: What can first responders do to help train the community should such an event occur?
Lichtman: One of the most effective and inspiring programs around is called the First Care Provider program (FCP). It’s a non-profit organization that identifies the concepts and approach needed to be done by civilians during these environments we have been talking about. It draws from the TECC guidelines that we as firefighters use and adapts them to civilians. In essence, it empowers civilians how to ACT (Actions, Communicate, Treatment) in an active shooter situation, what actions and options are appropriate in different situations, including treatment of preventable death injuries in the civilian populations.
As firefighters, we’re missing a golden opportunity to impact and prepare our community if we do not engage with them on this topic. As firefighters, we are becoming more comfortable and proficient with TECC and must use what we have learned to prepare our community for what they can do to increase all around survivability. Just as we have done in the past with respect to fire prevention and community AED programs, this should be no different.
You might have already heard of some communities attempting to implement this in reaction to the San Bernardino incident. In Rancho Cucamonga, we have trained all city employees and more than 2,200 civilians in that same model. We put on a three-hour course that consists of first care provider training and surviving an active shooter event which focuses on TECC and what they need to do in that type of environment. We have to give the community the tools they need to do a good job so that we can do ours. Further, in Rancho Cucamonga and cities across the country, we’ve employed community trauma kits. We have placed these kits in every city-owned AED compartment throughout the community, these kits include the equipment necessary to manage injuries in a mass type of civilian shooting.
To read Part 2 of this two-part series, please click here.
About the Author:
Ofer Lichtman started out as a first responder in Israel and is currently the Terrorism Liaison Officer Coordinator for Rancho Cucamonga Fire Department (Calif.). Lichtman was instrumental in developing its Terrorism and Tactical Response Program. Lichtman is a member of the Joint Terrorism Task Force and is on the advisory board of the C-TECC.