Walking through the door I fight the adrenaline-induced tunnel vision. As team lead it’s my job to keep the big picture in sight and not focus on the minutia. I have four EMTs following my lead as we make it into the lobby. My boots make sucking noises with each step I take on the blood-soaked carpet; spent bullet casings litter the ground. With the smoke still clearing from the room I can smell residual cordite from the weapons fire mixed with explosive residue. I almost trip over the body in front of me because of the low visibility.
A quick check for a pulse and a reposition of the airway tells me he’s non-viable – blast injury to the torso and GSW to the neck. I pull a black ribbon from my triage waist pack and hand it to the EMT behind me. “Black tag – keep moving.” My EMT ties the black ribbon to the wrist of the dead body behind me as I continue in to the room.
With the smoke clearing more I can see the extent of the room. Vinny’s men are holding down the corners where they have a visual to every angle; two of his men have fallen into ranks with my team and two others are securing the egress route at the front doors. Vinny gives me a head nod – letting me know it’s secure and giving my team the floor to do our jobs.
In a loud voice I address the room. “If you can walk I need you to exit the building now. EXIT NOW!”
Nobody moves. Hell, nobody even says a word! I focus in on the six people sitting on sofas in the corner. I’m fighting with balancing the big picture and noticing the minute details – macro vs micro, the eternal battle of EMS. Micro wins out when I notice that everyone in front of me has their hands and feet duct taped – they’re incapable of walking out of here because they are bound hostages.
Six people with big round eyes are following my movements as I quickly scan them for injuries and I hear the muffled screams from under the duct tape. That tells me enough for now. Turning to the next EMT behind me; “Cut the tape on the feet, clear them, and get them out of here.” I want to quickly reduce the number of people in this room so that all I have left are wounded, and I want to keep the hands bound in case any of these hostages are tangos in disguise.
Moving on I see a man convulsing on the ground with a blood saturated shirt. While I reposition him to check his airway bright blood erupts from his mouth missing my leg by inches. Bright red blood – probably from a perforated lung – gives me an idea of where to look for the wounds. I rip his shirt off and see the entry wound to the right side of his chest. Feeling around his back I find an exit wound near the right scapula.
I turn to the next EMT behind me and hand him two occlusive dressings to seal the wounds, as well as a red ribbon from my triage pack. “Chest seal front and back; keep an eye on his airway. He’ll be one of the first out.” I move on in my clockwise lap of the room.
There’s a man laying supine on the ground, eyes open, not following me or reacting to me when I give him a knuckle rub to the sternum. There’s a mid-axillary GSW to the right flank with no exit wound. A quick listen at the neck with my stethoscope tells me he’s still moving air for now. Shrapnel is embedded in his torso with minor bleeding. I’m getting closer to the blast sight and this guy took more of the blast. Turning to the EMT behind me; “Compression dressing to the flank, he’s critical.” I hand him a red ribbon and move on.
Moving closer to the blast site I find a secretary wedged under her desk. Damn! She looks familiar! She’s screaming and tracking me with her eyes. Arterial spray is coming from her arm and her entire torso is covered with embedded shrapnel. I slide her out from under the desk and turn to the EMT behind me, “Tourniquet to the arm. She’s delayed,” and I hand him a yellow ribbon to tie around her wrist. She’s still screaming as I continue my clockwise lap.
Closer to the blast sight now I see the man laying on the floor screaming and clawing at the blood saturated carpet with his fingers. The source of his discomfort is fairly obvious as I almost trip over a leg that used to be attached to him. I pull a tourniquet to hand to the EMT behind me when I realize I’ve run out of help. Fuck! Micro wins out for a moment as I apply the tourniquet and tie a yellow ribbon to his wrist. Macro takes over again as I walk away from him. Sorry sir, some people are more critical than you are today.
Coming around to the front of the room I’m by myself as my team is caring for the people left in my wake with ribbons tied to their wrists. Two more bodies laying in front of me have further saturated the now ruined carpet. A quick check for vitals tells me there is nothing for me to do here. Judging by their military style clothing I’m thinking Vinny’s operators are very good at their job and left the tangos non-viable. With black ribbons tied to their wrists I walk off.
Finally, I’ve made a full circuit of the room and have a mental tally of the wounded and an extrication plan to get the most critical out first. Walking up to the man with the through and through GSW I see that my team has him ready to go. “Okay, he’s first out.” Looking to Vinny, “I need two SWAT for a cary out.” Vinny nods his head and points to two of his operators who rotate their M-4s to a back cary position and immediately jump in to help two of my EMTs roll the man on a combat cary tarp.
Just then I hear the call from across the room. “I need ALS over here.” It’s one of my EMT’s kneeling next to the unresponsive man with the mid-axillary GSW and blast injuries – he must have run into a problem that needs a paramedic. “I lost lung sounds on the right side,” he tells me as I kneel down and check his findings.
“Good pick-up. Grab a tarp, he’s next out.” I open my waist pack and pull out the enormous needle. Finding my landmarks I insert it to his chest, pull the needle while leaving the catheter in place, and re-check lung sounds. He’s breathing on both sides now that the collapsed lung has been vented with a pulp-fiction style stab in the chest.
As I stand up and look at Vinny, “Two more for a cary out.” Two camouflaged operators appear with two of my team and a tarp. As they’re working him I walk over to check on the man missing a leg.
One of my EMTs is with him and has check to make sure the tourniquet is doing its job. “Okay, this guy is next.” The first team of two EMTs and two SWAT head my way and roll the recent amputee onto the combat tarp. As they pick him up I check his shoe and see that it matches the one on the severed leg. I pick up the leg and put it on the tarp next to the patient. “Make sure the leg stays with him.”
As I make it over to the secretary under the desk I motion the second returning cary-out team to me and get her rolled onto the tarp. The two EMTs and two SWAT operators pick her up and I kneel down to look into her eyes. “I’m glad we got a chance to save you this year.”
We’re heading to the double doors guarded by Vinny’s men and she stops screaming and gives me a smile.
A man in a reflective vest steps out from a glass office. “END-EX, END-EX, secure all weapons!” End exercise.
Once again we have completed the yearly joint training exercise where SWAT teams from across the world and EMS teams work together. As always the realistic wounds and Hollywood quality makeup is unnerving to look at. The blood in the injuries flows and sprays just as it does on the streets and the actors are true to character. Despite knowing it’s an exercise the adrenaline flows very much as it does at a large unknown incident. The SWAT operators and tangos are using simunition shot from real service weapons and the explosions were controlled pyrotechnics with all kinds of bark yet very little bite. The man who got a needle stuck in his chest was a very elaborate mannequin with moving eyes, chest rise and fall, and accurate lung sound generation. If left alone for too long he eventually stops breathing. Once the computer recognizes the needle-decompression it restores bilateral lung sounds.
Exercises like this train us for the things we hope we will never see. I performed my duties better this year than I did last year and it helped me to recognize areas where I need improvement. The SWAT and EMS interaction is invaluable for the safety and efficiency of all participants. The sooner life saving measures can be taken on scene the more people we can save. Three recent mass shootings come to mind where this cooperation would have made a difference.
And yes, I did recognize the secretary from last year’s exercise – she was one of the first black tagged victims/actors. We never get a second chance to make a save on the streets, but it was nice to get a second chance here.