Ep 53: Don't Overcomplicate It

C3 Podcast: Active Shooter Incident Management

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Bill Godfrey:

Welcome to the Active Shooter Incident Management podcast. My name is Bill Godfrey, your podcast host, and I am joined today by two of our fantastic C3 Pathways instructors. Sitting next to me is Jill McElwee, like myself also on the Fire and EMS side. And across from us is Ron Otterbacher. Welcome, Ron, Jill. Thank you guys for coming in and being part of this today.

Ron Otterbacher:

Thank you.

Jill McElwee:

You're welcome. It's a pleasure.

Bill Godfrey:

Today's topic I wanted to talk about keeping it simple. Don't make this more complicated than it needs to be. As we travel the country and we're doing our training, it seems like we've frequently run into people that are just introducing unnecessary confusion and extra terminology. And I'll give you some specific examples. We talk about contact teams and rescue task force and using those as building blocks, but then you hear things like a rescue team as a unique entity from a rescue task force, extraction teams, evacuation teams, search teams, cordon teams. The list goes on and on and on and on. And I wanted to take some time to talk about that today and talk specifically about not over-complicating that. Ron, you want to start us off a little bit? I mean, what are some of the things that you've heard and seen and how does all that land for you?

Ron Otterbacher:

I think the big thing is simplicity supports efficiency. And if you are running, whether you're running the operation or we've seen it in the classes we teach as people are trying to learn the different responsibilities, the more areas you cover, then the more chance for a mistake to be made, or for them to lose track of what to call each different entity. And it's simple. Your contact teams take care of everything, security down range, your rescue task forces, take care of the medical side of things. Once they get inside, obviously, because we're fighting against the clock, we're also going to be providing treatment inside before the RTFs get there. So you're dealing with actually four different things. You've got the contact teams, you've got the rescue task force, you've got your perimeter, then you've got your ambulance exchange point, and that's pretty much how the operation runs. Anything else down range, falls under one of those different sections.

Bill Godfrey:

Yeah. Jill, what's your take? I mean, you've come to us with a tremendous amount of incident management experience being part of type one and type two teams and deploy on a regular basis. What's some of the creative stuff you've seen in the places where we're making this more complicated than it needs to be?

Jill McElwee:

Yeah, I think what happens is we take the responsibilities to Ron's point, we'll take the responsibility of a certain team and we want to name that something. So let's call that something, as opposed to just keeping the responsibilities under whatever that entity is. For instance, the contact teams or rescue task force. We don't need to have a different name for the components within that rescue task force, because we're not doing this when skies are bright and blue and things are wonderful and we can just take our time. There's an added stressor to these teams and to the responsibilities within those teams. I think we've learned from many lessons in the past, the simpler we keep this, knowing the area of responsibility for each of those teams, they don't need to be identified by, everyone doesn't need a moniker on their chest.

Bill Godfrey:

Sure. Yeah. It probably is going to be helpful for us to pause for a moment and really make sure we're clear with everybody about how we define the contact team and the rescue task force. And so in our world, contact teams deal with security problems. That's their job. Whether that's finding a bad guy, confronting the bad guy, securing an area, securing a room, securing a corridor, whatever, securing a casualty exchange point, whatever, they deal with security problems and generally staffed with armed law enforcement officers. I'm not aware that anybody is doing something different than that, but that doesn't mean they couldn't be, but so contact teams deal with security problems and nearly always staffed with law enforcement.

Rescue task force exists to deal with medical problems, but they travel with their own security. I think what's really, really critical for us to stress in our definition of rescue task force, is that how that task force gets staffed is a local decision and a local policy and resource issue. And when I say that, let me use this as an example. In most common configuration of a rescue task force would be two law enforcement and two fire and EMS personnel, but there are all kinds of reasons why that may not occur. Some jurisdictions legislate that, oh no, an RTF needs to be three cops and five fire EMS or some other combination like that, so how you staff it is a local decision.

But it also includes the situation that you're into. For example, if you feel like the situation's a little hotter than you would like and you don't want to put Fire and EMS down range, you might staff your rescue task force with all law enforcement and say, okay, this is going to be an all law enforcement RTF. Sometimes what some people feel like, to Jill's point, we need to call it a rescue team or something like that. It's still a rescue task force. You're going to have, even though it may all be law enforcement personnel, their reason for existing is medical. And you're going to have one or more people on that team that's going to be on their weapons platform, and you're going to have one or more people on that team that are going to be responsible for medical, that are carrying medical gear, medical kits, go bags, whatever the case may be, that are providing medical care.

But it doesn't change, to your point, Jill, it doesn't change the function of what they're doing. And so I wanted to make that really, really clear as a foundation for the rest of our conversation that the way that we prescribe those rescue task forces is simply this. It is a medical function that also travels with its own security and how you staff it, who you staff it with, the disciplines you staff it with, the numbers that you staff it with, are entirely a local decision.

Ron Otterbacher:

And understanding that security component never leaves that task force. When things kick off their responsibility is to the task force and anyone they've got under their control at that time.

Bill Godfrey:

And a really good example of this, so there was, oh, I'm probably going to get his rank wrong, I think it was a battalion chief, I'm not sure. He is a chief out on the West Coast that had done some live studies on some training iterations where he was kind of showing and demonstrating that cordons could be a faster way to get the medical done. And I mean it was a really, really good effort. There was a couple of things when I read the study I was like, hmm, I think might've missed a couple of things, but irrelevant. I applaud him for doing the study and taking a look at that.

And I think that that's great, but there's two things I would point out. Number one, it's great for them for their staffing, for their resources, for their response times. It may not translate to every other town in the US, but the other thing is that a cordon operation can still be accomplished with contact teams and rescue task force as a building block. I mean, Ron talked to me, if we set up a cordon, we send a couple of contact teams to set up what up a 100- foot long cordon and then we put our medical people in there, maybe, I don't know, 12, 15 medical people that are in this cordon. And then something happens, we have a threat that appears or challenges the cordon. What does that look like and how does that go down if we don't have security with those medical people?

Ron Otterbacher:

Again, as we look at everything, that was the wonderful thing about SIM, was you got security, immediate action plan and medical. Your immediate action plan, you're talking about what is going to happen if something kicks off. You've already discussed it, because when it kicks off is not the time to just have everyone rush to the threat, because that's when you lose your security component completely and everyone thinks, well, I thought you had it. I thought you had it. That's why it's so important to discuss what your responsibilities are and make sure you abide by that discussion.

If you identify four people that are going to head out if something kicks off, those are the only four people that do it. And you make sure everyone understands the rest of their responsibility stays there. You could take a 100-foot cordon and have 15 law enforcement officers and 15 EMS Fire folks and what you just have is in that point you've got a large rescue task force and you've just got to staff different ways, because you're providing that larger cordon instead of a small casualty collection point or whatever you need. But as long as everyone understands what their responsibilities are and you discuss it before things happen, because trying to figure out what we're going to do when it kicks off is going to guarantee you're not going to be successful.

Bill Godfrey:

I was thinking through as you were talking about that if you've got this cordon spread out, and like you said, I think 15 officers that are spread out and a threat appears, if three or four officers, if they didn't agree on an immediate action plan beforehand, it's going to be more than that, but if three or four officers peel off that cordon is that not going to create a problem, a potential gap in the security?

Ron Otterbacher:

It could, if they haven't discussed what their responsibilities are. They may say, okay, the four on the far end are going to kick off and leave. So the couple in the middle are going to have to go down to the far end to enhance that security component down there. Again, you're going to have to discuss these things. When it kicks off is not the time. And again, as some brilliant people say, hope is not a plan. You're hoping if it happens, someone does what they're supposed to do, but the chances are it's not going to be successful.

Bill Godfrey:

Yeah, that's interesting. I mean, Jill, from your perspective, you're the team leader that's taken a dozen Fire EMS personnel through this cordon. Does it affect you or what are your thoughts, I guess I should say, about not having one or more security people that are assigned just to protect the team as opposed to the cordon? What are your thoughts on that?

Jill McElwee:

That has to be established, because we have to remember that what we're doing here, we're fighting two things that kill people. There are two killers at hand here. We have the threat and if it becomes an active threat that has to be addressed, but we also have that clock we're fighting. So the people in the medical aspect is what's going to combat that clock. And if you've got medics that are at risk and aren't protected completely while they're in that cordon, while they're addressing, headed to those that are injured, then we are doing no good on that end. They have to be protected.

Clearly establishing you two or four or three, however many there are, are assigned to these medical aspects, these medical components, that means you're assigned to them and on both sides. Our Fire EMS folks, the medical component, has to know that this is your team that you're staying with this task force, this rescue task force is one unit. And that's why clearly defining that, and knowing that if we're going in when there is still an active threat and we're taking that rescue task force team into an area to provide care and to maybe extract those folks out, there's got to be a discussion on and a known that this is your area of responsibility, it's what we talked about earlier. As a rescue task force that's why to me, if I'm sending my folks in, I want to know exactly who's staying with those folks.

Ron Otterbacher:

Sure. And the cordon simply in my mind, expands the rescue task force. Those people assigned to the cordon with the medical people in, are the rescue task force. Again, understanding in the ideal world and the way it should be planned is, they're rescue task force, they're security component for that. Something kicks off, the other contact teams will address it, and you've got to have faith in everyone involved. As we look at it, the cordon is just an expanded RTF and expanded casualty collection point, and no one should be leaving that. But again, if we don't discuss it before we deploy, as soon as something kicks off, you're going to have people forgetting what their responsibilities are and heading out to try and confront the threat. And it's something that we need to discuss and train on before we deploy them in that fashion.

Jill McElwee:

Bill, I'm sorry, to what we're saying, the idea for me is we can't get this complicated. This can't be complicated. This has got to be keep it very simple that we know what we're fighting and we know the team that's going to address active threats and we know who is going to protect those that are taking care of those indirect threats and that clock. And if each of the areas of responsibilities are clearly identified and we don't get things lost in translation by having five or six or seven other names of, well, I was part of this team, some local naming conjunction that we've decided of our team. It's got to be simple, because we will revert to our area of training when we're stressed, when we're put in a position, we're going to revert to that, and it's the most simple aspect. We've learned time and time again from responses to mass casualty events and events such as that, that we all revert back to the training that we have, that simplest form of training.

Bill Godfrey:

And Ron, I think from my perspective, what you're saying, I mean, I agree with what you're saying, but I think I would probably rather see contact teams used to establish the cordon and then have, even if it's just two, the security with the RTF so that it's the same building blocks that they're using all the time in training. And if they didn't set an immediate action plan, which happens on a fairly regular basis, or their minds go blank, there's at least two people there with those medical people that know their job is to protect the team. And so if the entire cordon collapse because they all give chase over the threat, which I guess in some ways you could argue is protecting the team as well, if they're going to move the threat away and back them down or neutralize them.

I think, I like the simplicity of keeping those roles very clean to accomplish what they're trying to accomplish. Just let contact teams do cordon work, the security work, protection work, whether you're securing a room or some people call it a protected island, I've heard the term, which seems to be almost a duplication of the casualty collection point term. I'm not really understanding where that one came from, but just in terms of clearly delineating those roles, so that no matter what we do, when there's a medical team down range, whether it's one person or well, a hundred would be ridiculous, but whether it's one person or 20 people, that there's at least one person whose job it is just to protect that team and they're not confused about that.

Ron Otterbacher:

Absolutely. And the other thing to consider is why are we doing all this in a cordon as opposed to a casualty collection point if we can more effectively protect the casualty collection point? A cordon means we've got far more areas where threats could possibly come from. So with far more areas where threats could come from, we've got to have more security to prevent those threats from being able to come into our cordon, so I would look at saying, you might be better off to set one or two casualty collection points that we can protect easier, and then you're only protecting one or two entryways, and if something kicks off, you still got your contact teams out there to go address it.

Bill Godfrey:

Yeah, I think that that actually makes sense. From thinking these things through. I think I see the utility of the cordon being either when you're getting into the transport phase and if you've only got... The bulk of these incidents, the median number shot is three, and of those three, one is killed, those aren't mass casualty incidents. And if you're dealing with low numbers, then I don't think it makes sense to try to get a cordon, just grab the people and get them out of there and put them in an ambulance.

But if you're dealing with a dozen, 15 that are injured, especially if you have a high number of critical injuries, you got a high number of reds, then it's going to take more medical people to care for them and move them. Then I could see the cordon operation streamlining that so that you can jack up your numbers of medical folks that are able to operate and move those patients, provided that law enforcement feels the scene is an appropriate for that, that you're at the appropriate phase, that it's been 15 minutes since the last shot, we know where the bad guy is, he's down secured. Does that ring true for you?

Ron Otterbacher:

In my mind, a cordon is simply for a safe way to move resources back and forth, whether it be moving the victims out, whether it be moving RTFs in. I've got a cordon that says that this is a safe corridor I can move my people through and we've got security on that cordon. I wouldn't use it for other areas as an incident commander. That's just ensuring that even if we may get inside and determine we need more EMS and Fire resources inside, we got to have a safe way to get them in. That may be what it's used for. And same with when we move out, it's no different from when we set a cordon on the ambulance exchange point. We're simply providing security for when they take those patients out and load them in the ambulances. And I look at it, if you're doing it inside a building, then it's simply for movement.

Bill Godfrey:

Okay. All right. That makes sense to me. Does that make sense to you, Jill?

Ron Otterbacher:

It does, yes.

Bill Godfrey:

Okay. So now let me ask you this question for both of you. In a number of these events and the suspect, the killing stops, and we don't know why. We don't always get the suspect in custody. We don't know where the suspect is. They fled the scene, left the scene, they've been subdued. Sometimes they kill themselves, though the number of suicides is declining. Does it change your mindset when the killing is done, the killing is stopped, I guess I should say the killing is stopped, there's no active killing, but you don't know the outcome of the suspect. You don't know where the suspect is. How does that change things in your mind, Ron, from a security posture and then Jill, what does that mean to you?

Ron Otterbacher:

The active threat is gone. At that time we don't know where, we don't know why, so we can't let our guard down. We've still got to perform in the area we do. But the other threat, going back to the clock, is still in place. So we've still got to get these people out and headed to a hospital and we've got to do as quickly and efficiently as we can. And then we would transition to move the RTFs out and go back to, let's find out where this guy is, if he's still here. If he's not guy, gal, doesn't matter, where has that threat gone to and why has it changed? We can't negate that it's just stopped and gone away. We've still got to go figure out where it's at. But while we're doing that, we still got to get the people that are injured out and transport to hospital and do it in a safe fashion.

Bill Godfrey:

And just to clarify, when you said bringing the RTFs out, you mean after the injured has been evacuated out, right?

Ron Otterbacher:

Yes, sir.

Bill Godfrey:

Pull them out so you can do a clearer.

Ron Otterbacher:

Right. And because we don't know where the bad guy is, we don't want them in there. Because now is it transitioning to, because we don't know where they are and until we go back and clear the areas we've been, is everything a hot zone. And because we have a rescue or we have security in place, when we move the RTFs in, that's fine, but there's no need to keep them in there while we're going back and trying to figure out where this guy went to. So it's just a safer fashion of doing it.

Bill Godfrey:

Jill, how about you? How does it change things for you when we're past the active killing, we've got no active threat, but we don't know why. We don't know where they are.

Jill McElwee:

I'll tell you, I want to say that I don't care about where the bad guy is at this point, because again, I keep going back in and it's my goal, and you'll hear me in class, to get us as focused on that clock as we are on the threat, that active threat, that suspect. I want us to, in our minds equate them equally. So I want that focus and drive to still stay on, okay, now, while our rescue task force teams are focused on that medical aspect, stopping the bleeding, correcting things we can correct in the field, so when they do arrive at the hospital, we've given this person a chance for survival, a higher chance for survival.

I want the focus to actually ramp up. Okay, now if that threat... Now all hands on deck, let's get these injured into ambulances. Let's get them to those casualty collection points, if they aren't already there. Let's move them, provide whatever care we can, not stopping, knowing that the clock is our enemy at this point. Get them moved to that ambulance exchange point, because the faster we get them into those operating rooms for these penetrating injuries in an active shooting event, the greater the chance for this person's survival. So for me, I would like to see that focus just raise and that our manner in which we respond once that threat is gone, okay, all hands on deck, let's get those ambulance exchange, our ambulances in place and let's get them transported, because the clock is just as big of a threat and a killer as that perpetrator.

Bill Godfrey:

Yeah, and I think the other thing that works out good is, as your ambulances are coming up to get loaded, they also are going to have visual contact with the contact team, the law enforcement officers that are securing that area. They're going to be able to wave them in, give them hand signals about where they want them to go, and kind of marshal them and get them in and out. It's not like we're setting up an outside casualty collection point. I mean, the idea is get them from the casualty collection point, put them in the bus and get the bus off the scene and go.

I think we've talked about some of the building blocks. What are some of the other terms or things that you've heard or seen, some of the discussions that you've had with folks in training and things like that that made you go, where did that term come from or some more examples of how we can use these things as building blocks? Anything come to mind?

Ron Otterbacher:

Again, it's just terminology that we know contact teams are responsible for security inside and out. But then they say, okay, you've got contact teams and now you've got, call it door security, you've got door security, or you've got... It makes no sense. You're a contact team. You've been given an assignment. I know that if I'm calling as the incident commander, I'm calling one of my contact teams providing security. We do have another term for another security components called perimeters. But you're either in the mix and you're part of the contact teams, or you're part of the RTF as a security component, or you're on the perimeter. Everything else falls under one of those areas. And I think by adding more terms, whatever you want to call them, makes no sense.

Bill Godfrey:

Yeah. Jill, how about you? Anything that jumps out at you?

Jill McElwee:

On the medical side, not so much jumps out. I think for us, we're pretty good at knowing that we need to put this person in an ambulance and get them to a hospital for that definitive care, that carry on care. What I think sometimes I'll hear groups want to establish is, we need a treatment area. So we got to do now while we're providing treatment, very fast, quick treatment to help mitigate what's going to kill the person the fastest, stopping that bleeding. And we will go through some of those, I'm sure later. But I hear people focused on terms that I love. And I'm not going to let anybody say anything bad about ICS. I know the value in ICS and I know all the components and on mass casualties. Just because there is a component for certain areas, we have to set up triage, treatment and transport often and when the clock is your enemy in situations like this, and do you have the resources available? That's the key. Do not spend resources establishing a component that is not needed for this.

And so I think for me on the medical side, Bill, that's what I hear more of. Well, we need a treatment officer. Often in our specific scenario when our goal is to take that person, that injured person, from the scene immediately to an ambulance, we're loading them directly into an ambulance when possible. And understanding that that may not be possible in every situation when a community may just have three or four ambulances at their disposal. Knowing that we've got to get this person transported to a hospital if you have the resources available, it's just mind blowing to see some of the things that are set up that are not needed.

Ron Otterbacher:

I looked at it-

Jill McElwee:

They look cool. It does look cool, but...

Ron Otterbacher:

Does your treatment area have, okay, this is the tourniquet area, this is the wound packing area, this is the bandaging area. It makes no sense. One person working on it, you're going through it. You're doing all the stuff you do, then you're getting the heck out of there. And that's a critical part of this.

Bill Godfrey:

Yeah. Jill, when I think back to our original paramedic training, whenever we talked about mass casualty incidents, you just triaged treatment and transport that flowed together. You didn't even really kind of think to ask the idea of whether it was really necessary. And when we started looking at these things originally back over a decade ago and realizing that some of the traditional approaches were actually introducing delays. And I remember when we first introduced the idea of, Hey, do you really need to set up treatment? Can't we do what we need to do in the casualty collection point, and then put them right on a bus and get them out of dodge? And yeah, that was like anachronism. It was-

Jill McElwee:

But what do we do with the red tarp we have, Bill? We've got this nice never used red tarp. Yeah, I get it. You're right. We've introduced delays. You hit it on the head. And when we step back and think at the totality of care that this person needs, if this individual has a penetrating wound, then blood is not where it's supposed to be. Potentially, air is not where it's supposed to be in the body. And those are things we can provide quick fixes for, not cures for, but we can provide fixes that takes that clock and it just slows it down just a tad, and it provides this person a much higher chance for survival. And so those fixes that we are doing in the field, those treatments that we're doing in the field, don't have to have a specialized area. They can be done at first contact with this person, with the injured.

Bill Godfrey:

Yeah. I think the name of this podcast is obviously going to be, don't make this complicated, but it could also be, we don't need all the terminology. I think we could do a whole separate podcast about just the terminology of things that get thrown in. It makes it complicated when it doesn't need to be.

Ron Otterbacher:

Well, think about it, ICS has already addressed a lot of that by going away from codes and everything else. They want plain talk. They want me to tell you what I need. You tell me what you need, and it's just straight talk. I don't have to know what your codes are. I don't have to know what your unit number is. I just know that I've got an incident commander, I've got an operations chief, I've got the different things that are there. I've got tactical. I've got the law enforcement supervisor. If I'm from another jurisdiction, which is oftentimes I am, I'm coming into your area. If I don't know anything, I know someone's going to be in charge of this bad boy. So, audit the command, where do you want me? It's that simple.

Bill Godfrey:

Yeah. Yeah. It is important to keep it that way. So our primary message with this one is, gang, don't over-complicate this. You can build anything and everything you need with the two building blocks of contact teams and rescue task force. And all of the other stuff, all of the other tactics, all of the other medical stuff that we might need to do, medical operations, you can do those with contact teams and RTFs, so let's keep it simple. All right. Well, Otter, Jill, thank you so much for coming in today.

Ron Otterbacher:

Of course.

Bill Godfrey:

I appreciate it.

Ron Otterbacher:

It was a pleasure.

Bill Godfrey:

Yeah. Fun too. And this is you guys' first time in the new studio, right?

Ron Otterbacher:

Yes, sir.

Bill Godfrey:

Yeah.

Jill McElwee:

It's impressive.

Ron Otterbacher:

Pretty fancy.

Bill Godfrey:

Yeah, of course. When you stand up, you got to be really careful not to trip over the cords. We've got a little bit of room for improvement there, but well, thank you both for coming in. Ladies and gentlemen, thank you for tuning in. We appreciate it.

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