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.