“As a rule … we wait for police to arrive on scene, and they let us know when it's safe to enter,” Acting EMS Chief Robert Farrow said.
He said sending paramedics into potentially unsafe scenes would require careful calculation.
“The benefit is you save more lives,” Farrow said. “The downside for public safety… is you put yourself at a higher level of high risk.”
Pittsburgh has made an exception to its rule, and other departments in Western Pennsylvania are beginning training to meet the federal recommendations.
Pittsburgh EMS has 13 medics embedded with the SWAT unit. Because SWAT is often deployed after first responders determine a situation has become volatile, standard paramedics are generally first to the scene.
Questions about how quickly EMS should respond arose after the June 12 shooting at the Orlando nightclub Pulse, where a gunman opened fire about 2 a.m. Injured patrons trickled out for nearly three hours until authorities sent in SWAT officers about 5 a.m. to rescue the remaining wounded. Victims died in the interim.
Paramedics have contended with such scenarios since the 1999 Columbine High School massacre in Colorado, when 24 people were wounded and 13 killed — including a teacher who bled to death in a classroom while police, firefighters and paramedics maintained a perimeter outside the suburban school for nearly four hours.
An FBI analysis of active shooting incidents found 160 shootings from 2000 to 2013. From 2000 to 2006, there was an average of 6.4 incidents per year. From 2007 to 2013, there was an average of 16.4 incidents per year.
Paramedics traditionally have waited for an “all-clear” that it's safe to go into an active-shooter situation, though federal guidelines suggest that victims' chances of survival improve when paramedics go into the “warm zone.”
In the Orlando nightclub shooting, most ambulance units set up at a staging area several blocks from the scene, outside of that warm zone – in part because the shooter, Omar Mateen, indicated he had explosives. That claim turned out to be false.
Studies performed in the aftermath of mass shootings have shown “the value of having medical and rescue personnel who are properly trained and equipped to enter the warm zone to maximize victim survival,” according to a 2014 policy statement from the Federal Emergency Management Agency.
According to the statement, “FEMA therefore encourages first responder agencies to develop this capability.”
That capability is something more EMS officials are considering.
In April, two paramedics with the Medical Rescue Team South Authority in the South Hills trained in Washington, D.C., for some of the most intense situations first responders could face. The training focused on “care under fire” — how to provide medical care and attention to victims during active situations, such as an active shooting and chemical attack.
MRTSA paramedic Matt Coleman said that while the medical skills remain the same, the reactions in an evolving and dangerous environment require special training.
“If somebody is shot in an apartment building, and there's still a threat around, that person still needs to receive medical attention and be evacuated,” Coleman said. He said the training honed skills such as providing medical treatment under duress as well as a broader understanding of safety, such as being aware of one's surroundings.
Similar training is in the works for Pittsburgh, Farrow said. Officials from the EMS, police and fire bureaus met last month to discuss training that would allow medics to enter right behind police — before the scene is declared safe.
“It's something we can't really do unless we train our people, because that's asking a lot of them,” Farrow said. “We're now asking them to put themselves at further risk than previously. You've got to get the buy-in of employees and make sure they receive the proper training and have the proper equipment.”
That equipment includes about 50 pounds of tactical gear, and the training involves not just quick, critical medical care, but how to be aware of one's surroundings in volatile situations.
Coleman said it's a matter of the evolving job of first responders.
“EMS no longer sits in a truck two blocks away and waits for someone to give the all-clear,” Coleman said. “When kids are in the hallway bleeding to death, people have come to realize, you can't just let people lay there.”
The Associated Press contributed. Megan Guza is a Tribune-Review staff writer. Reach her at 412-380-8519 or mguza@tribweb.com.
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