I followed news of the Orlando Pulse nightclub shooting with one thing on my mind: Where was EMS? As Omar Mateen’s three-hour assault played out, we now know, the 80 medics on the scene were kept more than 100 yards from the club, outside what’s known as the “hot zone.” Many of the injured were transported to hospitals in pickup trucks.
The same was true during the Columbine school shooting in Littleton, Colo., in 1999, when crews waited outside nearly an hour for a SWAT team as a teacher lay dying. Medics were also kept from entering the Aurora, Colo., movie theater where 12 people were killed in 2012 during a showing of “The Dark Knight Rises.” Cops took many of the victims to hospitals in their squad cars.
After these tragedies, grieving friends and family have pressed officials for answers — why were the lifesavers kept from the victims?
I understand that frustration. I was a paramedic for nearly 10 years. In that time, my job certainly put me in danger’s way; like many of my co-workers, I believed that saving a patient’s life was worth losing my own. But because EMS departments (rightly) prioritize the safety of their crews, we were encouraged to stay on the periphery of crime scenes.
This approach is outdated. Paramedics must be trained to respond in dangerous environments, and they should be given the tools they need to stay safe. With the uptick in mass shootings across the country, we can’t afford to keep them on the sidelines.
Early in my training, my instructor presented my class with a seemingly simple scenario: man down in the street. But after my partner and I rushed to his side and began rendering care, our teacher yelled that we were both dead. By not confirming that the scene was safe, we’d stepped on the same downed power line that had electrocuted our patient. Now there were three people dying in the street.
The point of that exercise was to drill into our heads that if we don’t protect ourselves, we can’t save anyone else. Our instructors told us that we’re sent into very dangerous situations not to impose order but to save lives.
Yet once I got into the field, I realized how tough it is to follow this advice. Often, a scene considered safe at the time of dispatch quickly and unexpectedly spirals into chaos; just because nobody had pulled a weapon when 911 was called doesn’t mean that won’t happen when we show up. One time, I responded to a call in a massive housing project. A woman had been beaten nearly to death by her boyfriend. When we emerged from the apartment with her limp body, we were confronted by a large, upset crowd. The victim was a friend; the assailant had disappeared. There was no outlet for all that raw emotion, so the crowd turned on us. They surrounded us, 100 people pressing in, screaming, pushing. Then, as grief turned to violence, there were sirens. Two county marshals had heard our distress call and rushed in. The crowd calmed just enough for us to leave.
Another night, a man was shot in the neck in front of our parked ambulance. It was late, on a dark street in a rough part of town. No help for blocks around. We quickly made the decision to treat the patient, fully aware that the shooter was close by, gun in hand. We were jumpy as we worked — I remember hoping against hope that if the gunman fired another round, I’d hear the shot before the bullet arrived. That act went against both my training and department policy. But a man was dying, and we were his only hope. It’s a perfect illustration of EMS’s wild nature — training and policy manuals carry you only so far when you’re practicing medicine in the street.
Which is why it’s time for emergency responders to adopt a new model, one that acknowledges the reality of our jobs.
Some places are already heeding this call. Departments such as Dallas Fire-Rescue and Pennsylvania’s West End Ambulance Service have ordered bulletproof vests and helmets for paramedics. In states including Michigan, Virginia and New York, EMS departments are teaching paramedics how to enter violent scenes long before they’re deemed “safe” in order to speed up treatment and save more lives. In this “rescue task force” training, endorsed by FEMA, paramedics learn the language and choreography of armed entry.
They learn how to team up with armor-clad cops to enter buildings where active shooters are on the loose. They learn how to identify “warm zones” — relatively safe areas at a shooting scene where patients can be collected, treated and readied for transport. Rather than diagnosing and treating patients where they’re found, the rescue task force model focuses on rapid triage, stabilizing life-threatening injuries and getting patients off the scene as quickly as possible. “We have to get in there to stop the dying,” E. Reed Smith, medical director of the Arlington County Fire Department in Virginia, told the Los Angeles Times. “As long as we’re standing outside, we have not stopped the dying.”
The rise in active-shooter situations makes this training all the more important for cops and paramedics. Between 2000 and 2006, there were an average of 6.4 active-shooter incidents a year; that jumped to 16.4 between 2007 and 2013.
In many cases, people died while waiting for help that was just outside the door. Patients treated within 60 minutes of an injury — the “golden hour,” in emergency-medicine parlance — have the best chance of survival. The majority of gunshot victims who receive care within five minutes survive. After the 2013 Boston Marathon bombing, an article in the Journal of the American Medical Association attributed the miraculous survival rate — 261 of the 264 casualties — to the fact that EMS units were already on the scene when the bombs detonated and went to work immediately.
It’s good that EMS is shifting to meet the demands of a new, more dangerous world. But as we make this transition, we need to stay focused on our core goal — patient care. Paramedics cannot be cops, and they shouldn’t try to be. Even as we enter crime scenes faster, our goal cannot be helping only the good guys, or working with police to catch criminals. And we need to focus on recruiting people who care about health, not adventure-seekers looking to be in the thick of the action.
In an ambulance, you can practice medicine in bad neighborhoods, at crime scenes, in squatter camps, in jails and in housing projects. Over the course of a shift, I might have found a dead body, delivered a baby, treated an asthma attack, knelt over a dying man while police searched the house for his killer. This is the province of the paramedic alone.
Imagine if paramedics had entered the Pulse nightclub and started treating patients immediately. Imagine medics in flak jackets and helmets, surrounded by police assault rifles, setting about the critical work of saving lives right there on the dance floor. Would more people have survived if EMS had been able to treat patients sooner? The answer is almost certainly yes.
Unfortunately we won’t have to imagine for long. Another active-shooter incident is all but certain. Maybe next time, the paramedics will be right there, in harm’s way, saving lives. That’s as it should be.