SHENANDOAH -- Getting emergency medical care to victims of active violence situations means the difference in life and death and substantially decreases the number of fatalities.
With this thought in mind, emergency responders, police, firefighters and others gathered at Shenandoah Valley High School on Wednesday night for a class titled "Life in the Warm Zone: Medical Response to Active Violence."
Mark Wiekrykas, a paramedic with Shenandoah EMS, criminal justice instructor at McCann School of Business & Technology and former Mahanoy City police chief, coordinated the class to stress the dramatic changes in the way of thinking for emergency services that came about following several incidents of active violence including mass shootings, bombings and acts of terrorism.
Wiekrykas said that prior to the Columbine High School shooting in 1999, it was standard practice for police to set up a perimeter outside incidents and wait for a SWAT team to assemble, make entry and deem the scene safe before the injured were treated and removed.
The incident at Columbine led to a new line of thinking and the development of the "active shooter response" concept where the first arriving police make immediate entry to try to locate the suspect, neutralize the threat and allow quicker access to the victims.
"The longer we wait, the more people are going to die," he said.
Wiekrykas said that by looking at the history of such events from the medical standpoint, it was determined that the shooting or whatever type of violence is usually over quickly, in many cases before police arrive. But many patients worsen or even die during the time medical personnel are held back because the scene has not been determined to be completely safe.
Wiekrykas said the shift in thinking is that a certain amount of risk must be assumed and that patients must be accessed and receive intervention quickly.
This thinking led to the development of the concept of "Rescue Task Force" that was initially developed by the Arlington County, California, fire department and has since become a national best-practices model.
Wiekrykas explained that in the Rescue Task Force concept, the police still make the initial entry through the scene toward the threat but then additional teams of police officers and EMS providers follow.
"The police provide the protection and the EMTs and paramedics access each victim and initiate immediately necessary care following lessons learned from the military in the Iraq and Afghanistan conflicts," he said.
Wiekrykas, along with tactical response medics Stephen Bobella, paramedic, and Jody Heckman, RN, west leader and assistant west leader respectively of the Region 2 Tactical Response Team, explained that tourniquets and wound packing are used to stem serious bleeding and simple airway management can allow a significant number of patients to remain stable or even improve until they can be removed to more definitive care.
"With these simple life-saving tools, we can substantially cut back on the number of fatalities," Bobella said.
Both Bobella and Heckman are part of the team that is frequently called to assist the Pennsylvania State Police Special Emergency Response Team and other tactical units in Schuylkill, Berks and Lehigh counties.
All three men stressed the importance of getting to the injured victims as soon as possible, but only those in areas that have been deemed, at that time, free of threats of the ongoing violence.
That area, Wiekrykas said, is termed the "warm zone." He said that only law enforcement officers will enter what is called the "hot zone" where the actual threat is.
"The 'hot zone' is only for law enforcement, our goal is to get to the 'warm zone' because the majority of dying happens between when the violence happens and the scene is secure," Wiekrykas said.
"If we have to wait for SWAT to get there, we're going to have a lot more people dying," he said.
Wednesday's session was the first step in getting people -- EMS, firefighters, police, educators and others -- familiar with the Rescue Task Force thinking and hopefully the formation of a local Rescue Task Force.
Wiekrykas said several Shenandoah Ambulance employees and volunteers have already participated in a more advanced tactical emergency casualty care course that expands on the Rescue Task Force concept and also plans to host the instructor of that program for a local course in the near future.
He said that all emergency responders need to change their thinking from totally securing a situation to getting emergency care to victims as quickly and safely as possible.
"A coordinated response, good communication and a good command structure is all needed," Heckman said. "Working together safely will not only neutralize a situation but substantially reduce the number of deaths."
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