Tag Archives: SWAT

Strike Out 2/2

We’re driving in the middle of the city after having just stopped at Starbucks to grab some caffeinated motivation for the day ahead of us. It was a long night yesterday as I was on the SWAT standby for an hour past my regular off-duty time. After the anti-climactic end to the situation I was able to go home and almost got enough sleep to make it through the next day. The hot coffee in my hand is helping to fortify my resolve as the morning commuters are exiting the freeway and the busy urban downtown area starts to come to life.

My coffee-inspired day dreams are interrupted by the computer on the console as it gets toned out and a call location drops almost on top of the icon representing our ambulance. The dispatcher comes up and tells us we have a patient with a laceration at the city police department on the second floor in the interrogation rooms. I’m actually looking right at the city police department building as the disembodied voice of the dispatcher is giving me the call information.

We pull up to the front doors as I load the gurney with all of my equipment and bid farewell to my warm coffee. I know we’ll be up on the second floor and the interrogation rooms are quite a ways on the other side of the building. Coming back to the rig for a Band-Aid could take a long time so it’s best to just take everything with us on the first trip.

A detective is waiting for us and proves to be a decent escort through the maze of the police intake and booking area as we make our way back to the interrogation rooms. The detectives aren’t really saying much but I can read their body language enough to know that something bad happened.

The detective opens the door to the little room and I’m faced with a complete blood bath. The tiny room looks like a set piece for the TV show Dexter with blood spatter covering the walls, desk, and floor. There’s a man sitting at the table with his hands cuffed to a metal ring on the desktop. Under his hands there is a fresh pool of blood.

I turn to the detective. “What the hell happened?” This is obviously the kind of high profile situation where Internal Affairs will get involved because someone messed up really badly. That explains why the officers were being so quiet and not telling me anything. The less I know about the facts the better it is for everyone when the investigation finally gets going.

The detective has a quiet voice as he fills me in. “So, did you hear about the hostage situation last night? Well, this is the perp from that scene. We had him in the room all night waiting for the morning shift detectives to come on duty. He asked for a soda. Someone gave him a can of Coke. He drank it, tore it in half, and cut his wrists with the sharp edges. We found him like this an hour later.”

“Wow!” That’s all I can say. I mean really, this is such a jacked up situation on so many levels I just don’t know where to start. The officers know how bad this is and they really don’t need the Paramedic to point out the sequence of stupidity that led to this bloody outcome. Whatever, I’m not here to judge, I’m just here to clean up the mess, as usual. But seriously, paper cups might be a good idea.

The man at the table hasn’t moved since I entered the bloody room but I can tell it’s the same man I talked to last night through the bars of the police cruiser. “Hey, are you okay?” Fine, it’s a stupid question but I have to start somewhere.

“Fuck you!” Seriously, are we going to play this game again?

Last night I could walk away from this guy based on the fact that he wasn’t visibly injured and refused all assessment. Today I can’t do it. I’ve got to check his wounds, bandage up what I find, and get him over to the hospital for medical clearance. He will eventually return here and be put on suicide watch.

I’m in the interrogation room and my partner, Anna, is handing me supplies to clean him up a little so I can see how bad the cuts are. As it turns out he missed the artery and all of the blood is just slow trickle stuff from the veins. He’s going to need some sutures and he’ll have some very impressive scars in a month or so when it all heals. Regardless of his medical outcome he just accomplished his third strike last night. He’ll be seeing the inside of a prison for the rest of his life, whether or not he manages to end his life a little early.

Three Strikes Laws are statutes enacted by state governments in the United States which mandates state courts to impose life sentences on persons convicted of three or more serious criminal offenses. In most jurisdictions, only crimes at the felony level qualify as serious offenses and typically the defendant is given the possibility of parole with their life sentence. These statutes became very popular in the 1990s. Twenty-four states have some form of habitual offender laws.

The name comes from baseball, where a batter is permitted two strikes before striking out on the third.

The three strikes law significantly increases the prison sentences of persons convicted of a felony who have been previously convicted of two or more violent crimes or serious felonies, and limits the ability of these offenders to receive a punishment other than a life sentence. Violent and serious felonies are specifically listed in state laws. Violent offenses include murder, robbery of a residence in which a deadly or dangerous weapon is used, rape and other sex offenses; serious offenses include the same offenses defined as violent offenses, but also include other crimes such as burglary of a residence and assault with intent to commit a robbery or murder.


Strike Out 1/2

strike

1 –  to try to hit or attack something

2 – Baseball; a pitched ball judged good but missed or not swung at, three of which cause a batter to be out

3 – Collective refusal by employees to work under the conditions set by the employer, a work stoppage

4 – to be unsuccessful in trying to do something

 

out

1 – to a finish or conclusion; the game played out

2 – a means of escape; The window was my only out

3 – used in two-way radio communication to indicate that a transmission is complete and no reply is expected

As the car passes the officer he recognizes the driver as a known felon. They’ve been briefed on this guy – armed and dangerous, two strikes down in a three strike state, gang affiliations with narcotic distribution. The plates on the car come back as stolen and the officer calls for backup before attempting a felony traffic stop. The man in the car knows that he’s been made so he speeds up, trying to outrun the officers. Every officer in this part of the city starts to converge on his location. When he finds himself boxed in he exits the car and starts shooting at the officers in their cars as he runs down the quiet neighborhood street. Seeing another officer blocking his escape route, he realizes that he’s trapped. He makes an abrupt turn and runs up to the nearest house. One kick to the front door and he makes entry into someone’s home. The officers hear screams as he takes a few hostages and yells threats through an open window. The officers surround the house but pull back as they initiate a SWAT call-out for a hostage situation.

The Bear Cat rolls past me and slowly drives up the street to park in front of the house where the suspect has barricaded himself. The six SWAT officers in the armored truck are positioned to report on any changes in the house and they will be used as a rapid reaction force if the suspect does something stupid like killing a hostage. Their job is to hold the scene at a forward position and react as needed to buy the rest of the team some time to formulate a plan.

From my vantage point in the incident command center I can see the SWAT commander setting up his game plan: floor plan of the house on a white board, arrows showing expected direction of attack, frequent radio communication and the occasional cell phone call. The SWAT snipers, dressed in woodland camouflage, begin the long and solitary walk to disappear into the neighborhood, with Remington-700 Police Sniper Rifles slung on their backs and a M4 duty weapons slung in the front. They quickly vanish from sight, undoubtedly taking up overwatch positions from rooftops a few streets away.

The SWAT Medic that is embedded with the team comes up to my rig and we make a game plan on various extrication scenarios and transport options. We’ll work under force protection protocols and enter the warm zone if necessary to initiate prompt treatment and extrication of wounded. If the suspect decides to force the officers into shooting him I’ll go in afterwards and make a field pronouncement. If he’s really stupid and starts shooting the hostages I’ll handle the initial triage and treatment while my partner calls for the appropriate number of units for transport. I’ll utilize the SWAT members to help extricate victims to the curb for the responding units to transport to the hospital.

The police helicopter finally shows up and starts doing lazy orbits of the house from 800 feet in the air. The pilot has the FLIR (forward looking infrared) turned on the house so he can see any movement. It’s sharp enough to pick up a hand on a window and discern our uniforms with the patches on the shoulders or the characteristic lack of heat signature where the ballistic vest insulates the torso. Unfortunately it’s not sharp enough to pinpoint heat signatures in the house. By now the snipers are in their overwatch position and I hear their quiet radio transmissions as they report on activities in the house as seen in their magnified scopes atop the rifles.

The rest of the SWAT officers start showing up to the command center that was hastily carved out of this quiet street in the middle of the hood. Their duffle bags of gear have been laid out like dominoes on the sidewalk. Officers who drove their personal vehicles into the hood stroll up to the duffle bags and begin their transformation from average citizen to door kicking SWAT officers. Black uniforms, heavy ballistic body armor, communication ear buds placed under headphones, and finally weapons loaded and made ready. The SWAT commander walks around to the troops showing a picture of the suspect as they prepare for the final showdown.

Whoomp! Whoomp! Whoomp! The continued noise of the forty-millimeter grenade launcher has been rhythmically pounding the house with tear gas for the last ten minutes. They systematically hit the house room by room – filling the interior with gas – until they have the suspect and hostages pushed to a back bedroom where there is no escape. I count 35 gas grenades before it finally goes silent.

The SWAT officers – who have collectively just heard a dispatch on the radio – turn in unison to walk down the street towards the house for the final assault. The K9 officer falls in with them and someone grabs a Halligan tool for door breaching. I’m going over scenarios in my head for possible outcomes in the next few minutes. I may end up with more patients than I can handle, with trauma that I can’t fix here on the streets. I could end up with wounded SWAT officers or a dead suspect or a random bystander shot in the mix. Maybe an officer twists his ankle on entry or gets a dog bite while going through back yards or a sniper falls off of a roof. Hell, anything could happen, I’ll just have to wait here and deal with the consequences as they come.

The tear gas grenades have been quiet for fifteen minutes now and the bulk of the SWAT officers turned the corner towards the house ten minutes ago – it’s been quiet since then. Out of the darkness from the direction of the house comes a lone patrol car backing slowly towards my rig. The officer steps out and walks up to my window. “Hey, we’ve got the suspect here, can you check him out real quick before we take him downtown?” Really, just like that and it’s over?

I walk around the back of the police cruiser to the back window which is rolled down. I can see a man in his mid-30s, hands cuffed behind his back, calmly siting in the back seat. I can talk to him through the bars on the back window. “Hey, are you hurt?”

“Fuck you!” Not exactly the response I was looking for but okay I guess it’s something.

“Did you get taken down hard or is the tear gas hurting your eyes?” It’s not the first medical assessment I’ve done through the bars of the back of a police cruiser.

“I said FUCK YOU!” Maybe I’m just asking the wrong questions.

“Are you saying that you don’t want any help from the Paramedics and you just want me to go away?” I think they call that a leading question.

“No, I don’t want anything from you. FUCK YOU!” Okay then. Somewhat of a limited vocabulary but he’s made his wishes quite clear.

I stand up from the window and address the officer who has been standing by waiting for me to complete my medical assessment. “He’s all yours.”

 

 

Scrum 1/2

scrum

1 – rugby – the method of beginning play in which the forwards of each team crouch side by side with locked arms; play starts when the ball is thrown in between them and the two sides compete for possession

2 – a confused crowd of people pressed close together and trying to get something or speak to someone

3 – a brief and disorderly struggle or fight

The limitation of riots, moral questions aside, is that they cannot win and their participants know it. Hence, rioting is not revolutionary but reactionary because it invites defeat. It involves an emotional catharsis, but it must be followed by a sense of futility.

Martin Luther King, Jr.

The high intensity LED strobes on the rig are lighting up the dark concrete canyons of empty streets in my urban workplace as I get closer to the call location. Sirens and the occasional air horn reverberate from the buildings as I creep through intersections and accelerate down the open streets. I pass City Hall and point out the tent city that was resurrected after a somewhat violent clash between the city police and members of the Occupy movement.

My EMT partner is helping to cover shifts in this county and is far from his normal surroundings of rural EMS calls. John is a part time EMT in one of the rural counties that surrounds my mostly urban county. He picked up this shift to get some overtime,  and being new in the EMS community, he wanted to come here to get some “action.” He’s about to get more than he bargained for as we get closer to the call location.

I round the corner just two blocks from my destination when I’m met with a SWAT skirmish line slowly backing towards my flashing rig. Thirty officers in full riot gear – extra padding in the uniform, full helmets with gas masks on, and plastic shields – are holding off a mob of four hundred angry people in dark clothing. The occasional bottle is lobbed from the crowd and breaks on the asphalt near their feet. The officer in charge whirls around to face me and a single motion from his baton-wielding arm is enough to convince me that I need to find another route to my destination. No arguments from me – this is the last place I want to be right now!

I pick up the mic as I point the rig up a one-way downtown street with headlights coming at me in all lanes. “Medic-40, we’re re-routing, we got blocked by protesters at Main street.” Driving the wrong way, up a one-way street, I’m giving an update to dispatch while pulling my ballistic vest from my bag and trying not to have an accident while I dodge oncoming traffic. I don’t remember this lesson being in my Emergency Vehicle Operation Course!

“You green-eyed mutha’ fucka’! I’m gon’ whoop yo ass like on Jerry Springer!” She’s screaming insults at me and balling up her fist as I escort her to the rig.

“Okay, you can whoop my ass later, let me check you out first.” Placating the psychotic patient has become something of an acquired skill in this county.

She called 911 saying that she needed an ambulance and then hung up. My dispatcher was unable to get her on repeated call backs so they sent us and a fire crew to see what’s going on. Seeing all of that in the call notes of the MDT I requested a PD back-up before we even got on scene. It’s just safer to have the guys with guns on scene when you don’t know what you’re getting into.

“Don’t you take me to no county hospital! I know my rights. You have to take me to EPS!” I’m taking a blood pressure as she yells at me. Just as I thought – way too hypertensive – she’ll need medical clearance before going to EPS (emergency psych services). She’s not going to like this because I’m now obligated to take her to the county hospital.

“Okay, here’s the thing. I need to put these restraints on you because you’re threatening me.” She struggles a little but lets me put the substantial leather wrist restraints on her – thereby greatly decreasing the chance that she can follow through with her threats to whoop my ass.

The city PD officers must be a little busy because they’re taking an eternity to get here. The fire crew simply escorted the screaming woman to the back of my rig and told me she wants to go to EPS. Before I even had her situated on the gurney the fire engine was driving away. Thanks a lot, guys!

“Why aren’t you taking your Seroquel?”

“I don’t like the way it make me feel! It make me all sleepy! Fuck you! Take me to EPS you green-eyed mutha’ fucka’!” Classic; the crazy person doesn’t like feeling normal so they stop taking their anti-psychotic medication. I’m about to make you feel VERY sleepy!

I’m drawing up a sedative in a syringe as the officers finally arrive and walk up to the back of my rig to face my not-so-pleasant patient. “I hear you want a green sheet, what’s going on?”

My patient seals the deal with her next outburst. “Fuck you! I’ll put you on a green sheet you bald-ass mutha’ fucka’. Let me up! I gon’ whoop his ass too!”

“Good enough for me. I’ll be back in a minute.” The officer walks back to his car to write up a 5150 form – a 72-hour hold for psychiatric evaluation – as his partner stands by in case we need any help.

As my patient is distracted by slinging insults at the officer I inject a sedative into her arm. With a green sheet in hand I have a pleasant drive to the county hospital and get a chance to do my paperwork while my patient snores like a chainsaw on the gurney.

 


Necromancy Revisited 2/2

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.  

Necromancy Revisited 1/2

nec·ro·man·cy

1 : the practice of communicating with and learning from the dead to predict the future

2 : see also – necromancer; one who practices divination by conjuring up the dead

re·vis·it·ed

1  :  to visit again

2  :  to re-examine (a topic or theme) after an interval, with the view to making a fresh appraisal

The phone is ringing in the bank manager’s office, which is odd. The last time the hostage negotiator called the phone rang at the teller’s window. Thinking that possibly there has been some progress on getting his demands met, he walks to the ringing phone and picks it up with his left hand as his right hand holds down the “dead man’s switch” – a button that needs to be pressed to keep the bomb from going off. If he takes his finger off the trigger, his vest will explode.

“What do you want?” With the anticipation of talking to the hostage negotiator on the other end he’s already setting the tone with an aggressive stance yet no one answers him. Looking up from the phone and out the window he sees a tiny puff of smoke on the adjacent building that is quickly followed by a round hole in the window and spider web crack lines extending to the frame.

That was the last thing he saw as the bullet from the police sniper travelled through his head. He releases the “dead man’s switch” as he falls back, but he never hits the floor – his vest explodes, sending shrapnel and body parts throughout the building.

From forty yards away, staging with my police escorts and the rest of my EMS team I see the fifty-foot ball of fire come out of the window. Crap! Now I have hostages with blast injuries. This is going to be a very bad day!

I walk into the command post to meet the SWAT team leader and get the briefing prior to the assault to attempt resolution of the hostage situation. Camouflaged SWAT members are checking gear and loading weapons as the commander calls for our attention.

“Okay gentlemen, this our latest intel.” The SWAT commander is pointing to a rough floor plan drawn on a white board. “We have three tangos holding approximately ten hostages. I’m getting real-time intel from sniper teams who are in place now. They report the leader has an explosive vest and the FBI SWAT team just raided their home base and found bomb-making material. The good news is that it’s just a black powder device so we’re not dealing with high-yield C-4. The bad news is that we don’t know what the triggering device is or how it’s connected.

“In approximately ten minutes your SWAT team will rappel down from the sixth floor to the mezzanine level. You will then stack along the west wall at which time we will call the phone in this office. It is our expectation that the tango with the explosive vest will answer the phone, at which time our sniper will take out the target. We are told that a single shot from a .308 will weaken the window and allow entry. You will take your team through that window and eliminate the additional tangos. Remember, you have a room with approximately ten civilians.

“Once you secure the room you will call for EMS. They will be staging down the block and enter through the front door. You will provide force protection while they address any life threatening injuries and extricate any wounded. EMS, remember you are entering a warm zone which was hot just a minute prior. I need the SWAT team leader and EMS team leader to come together on how to work together and extricate any wounded with all haste while staying safe. That is all gentlemen; you have ten minutes.”

The SWAT commander walks out on his way to the forward command post as the SWAT team leader, Vinny, and I look over the rough floor plan together. Vinny’s a serious man dressed in his camouflage uniform with an imposing M-4 rifle slung over his shoulder.

Vinny is pointing to the floor plan on the wall and walking me through their method of clearing the room. “Once we have the tangos down I’ll set an internal perimeter and secure egress through the front doors. I’ll alert you via radio that it’s clear to enter. We’ll give you two operators, with your team, on force protection. How are you going to work the room?” He’s a no-nonsense, straightforward kind of guy who seems to know his business.

“That sounds good. I’ll start on a clockwise lap of the room to get a patient count and identify the first out critical patients. As I tag the wounded I’ll spin my guys off on treatment and facilitating egress. I’ll want to stage the wounded for pick-up and transport to the left of the entrance. We have rigs staging, ready to do a drive by and transport to the hospital. It would help if I can use some of your guys to help cary people out. If any of the wounded are heavy it may take four people to get them out.”

“Easy enough, I’ll send you two operators at a time when you need them. Otherwise we’ll stay out of your way and let you work on the wounded. You good?”

“Yeah, I’m good, stay safe.” A blue nitrile fist hits a tactical glove fist and we return to our respective teams for final preparation.

From my vantage point, a half block away, I see ten ropes fall to the ground on the west wall of the building. In a silent rappel, ten SWAT operators slide down the ropes and fall into a stack formation at the corner of the building.

The radio on the officer next to me crackles to life. “Sam one in position.” It’s Vinny on his throat-mic, telling the commander that he’s ready in a whisper.

“Tac-com copies, Sam one. Sniper two, do you have visual?” The tactical commander is getting ready to put things in motion.

“Sniper two, clean line of sight, we are go.”

“Tac-com copies. All teams we are go in ten seconds. Out.”

After waiting for what seems like an eternity, everything happens at once. The sniper fires and the sound of breaking glass is quickly followed by a huge explosion; a fireball comes out of the broken window. As soon as the flames recede, Vinny’s team moves around the corner in lethal stack formation and enters the building. A few seconds later the rapid fire of the M-4 can be heard from the inside of the building. Short bursts of six shots followed by another short burst of eight shots. Some sporadic returning fire and then the final burst of six shots echo out of the building.

The radio crackles to life again. “Three tangos down. Initiating final sweep now.”

The officer next to me leads us up to the forward staging area just twenty feet from the front doors. I can see movement through the windows as the SWAT operators are clearing the room and securing weapons. Smoke is still pouring out of the office window where the explosion came from. Two SWAT operators force open the front doors and secure the egress while the radio crackles again; “Code-4, EMS is clear to enter.”

“Copy. EMS coming in now.” I lead my team towards the front doors.

 

 

Necromancy

nec·ro·man·cy

1 : the practice of communicating with and learning from the dead to predict the future

2 : see also necromancer; one who practices divination by conjuring up the dead

The elevator is cramped with all of equipment and people squeezing close together. My partner, Scottie, stands next to me with all of our equipment stacked on the gurney and the strange addition of two SWAT officers with body armor, helmets, and assault weapons. I can smell the cordite from the recently fired weapons. We passed the shooter on the way to the elevator still warm with spent shell casings laying in the hallway; at least a dozen hits to center mass – no need for medical attention. We’re not here for him; we’re here for the unknown amount of victims that he shot before SWAT took him out.

The silence is broken when one of the SWAT officers keys his mic to alert the rest of his team that he’s coming up in the elevator with paramedics. Adrenaline is pushing through everyone’s veins and has been for the last twenty minutes. Sympathetic nervous systems are stimulated; pupils dilate, pulse and respirations increase, we have to fight not to tunnel vision on what we are about to see.

The doors slide open to reveal two more SWAT officers securing elevator access to this floor of the building. I hear the cries for help as we exit the elevator and see the blood splatter on the wall. Following the blood streaks to the ground I see a wounded officer and tunnel vision gets the best of me. I put a hand over the arterial spray coming out of his thigh as I’m applying the tourniquet with the other hand. Scott pulls the quick release on the officers body armor to check for additional wounds. As the bleeding has stopped I stand up and see the elevator doors open again; it’s my second EMS team with their SWAT escorts.

“Okay, he’s got a GSW to the thigh, arterial spray, tourniquet in place; he’s first out. I’m going to walk the floor and get the criticals ready for extraction.”

Turning from the injured officer to the rest of the room I take in the sites and sounds. It’s a typical legal office with cubicles in the center surrounded by offices. Cries for help are coming from all over the office space. SWAT officers are holding perimeter positions where they can secure the whole room so we can extricate the victims. It’s called force protection; once they eliminate the threat they then secure the scene so we can treat and transport the victims while under protection.

I had a plan before the elevator doors opened but I’ve already deviated from it by front loading the wounded officer for extraction. It’s a natural reaction to take care of the uniforms first; they are here to protect me and I want to protect them first in my treatment; it builds trust between agencies. But the reality is that there are probably other victims that are hurt worse. I need to get a handle on this before the scene gets away from me. I need to get back to my plan.

Standing by the reception desk at the front of the office I yell across the room as loud as I can. “If you can hear my voice and can walk I need you to start walking towards the stairs. Start walking now if you can!” Bloody office workers start to emerge from the cubicles; some limping, starring at blood on hands in disbelief as the SWAT officers herd them to the stairs.

Looking down at the receptionist I see what looks like a shotgun wound to the head. Checking a pulse and finding nothing I move on. A hysterical mother is cradling her twelve year old son who had a GSW to the neck; he can talk but can’t move any appendages, traumatic paralysis.

“Scottie, c-spine this kid, he’s next out.” I see Scottie headed in my direction and the third EMS crew is coming out of the elevator with their SWAT escorts. I need to pick up the pace and sort this chaos out quickly.

I’m making my way around the office with my SWAT shadow. A man in the office clutching his chest, no injuries, probable heart attack; he can wait, I move on. A woman with bilateral GSWs to the knees, arterial spray; two tourniquets and I move on. Another woman with a through and through GSW to the chest; two occlusive dressings to stop the sucking chest wound and I move on. A DOA; I move on. A woman with venus bleeding from a GSW to the leg; pack the wound with gauze imbedded with clotting agents, tell her to hold pressure on it and I move on. An old lady hiding under the desk who was too afraid to move when I called out but has no injuries; I pull her out and have a SWAT officer walk her towards the stairs as I move on. Finally I’ve made it around the room of offices and cubicles and back to the DOA receptionist.

I send another EMS team towards the sucking chest wound lady as the kid with the neck wound is getting pushed towards the elevator on a gurney. Then the two women with leg injuries are pushed out on gurneys. And finally the man with a probable heart attack is wheeled past me while sitting in his office chair. The SWAT officers protected the EMS crews throughout the whole process; they held the perimeter and escorted us too and from the scene.

I’m making a final lap around the office space to make sure I didn’t miss anyone when a man in a reflective yellow jacket steps out from a cubicle wall. “END EX, END EX!”

The SWAT officers repeat the order to End Exercise over their radios. The DOA receptionist gives me a big smile as she stands up and stretches; sore from not moving for the last ten minutes. Her hollywood quality head wound is still glistening with fake blood.

The basic premise of this scenario is that there is an active shooter situation with multiple victims who have been shot and are in various states of severity. The on scene Unified Command-ers propose using a SWAT team to eliminate the threat and once that is accomplished, to escort the EMS team into the scene and be given close quarter force protection while providing the needed medical care (triage, emergent treatment) and then egress the area under cover and protection.

This was obviously a very elaborate exercise in which 29 SWAT teams from various local and international agencies participated. Currently we do not go into the “warm zone” so fast on the heals of SWAT and under force protection protocols. Yet that concept is being challenged on many levels as the necessity of early medical intervention has growing acceptance.

After the exercise I had an interesting conversation with the head of the Israeli EMS training division. He related a situation where a suicide bomber created an MCI with 150 injured people in which EVERYONE was treated and transported within 29 minutes. We are no where near that proficient yet. But with the new reality of global terrorism and increasing frequency of natural disasters we must continue to train for the worst case scenario.

After running the scenario as the EMS team lead I ran it again as EMS support with a different SWAT team and then observed from the sidelines as another group ran through. It was an extremely enlightening experience. Not only in my own shortcomings  but in the tactics and priorities of other agencies. We can’t predict the future or know what we will face but we can train and push our skills in the hopes that we are prepared. EMS does not conjure the dead yet we do quarry the dead; we learn form them so that we can help others in the future.