Improving the Health & Safety of all Emergency Responders

And You Thought Fire Was Unpredictable…..The Role of the ISO at an Active Shooter/Hostile Event.

BY: Bob Delagi, MA, EMT-P, CHEP, ISO, HSO

Despite the changes in contemporary fire behavior and the increased attention to wind-driven fire, flow paths and hostile fire events, fire ground hazards remain fairly predictable, and the roles and responsibilities of the ISO, well established. However, contemporary firefighters and emergency medical service providers are now being trained to respond to yet another kind of hazard, far more unpredictable, and initiated by human action designed to injure or kill unsuspecting and innocent victims, including our nation’s first responders.

New threats have emerged that require robust fire service response. Our community-wide Comprehensive Emergency Management Plans and our classroom teaching and functional and full-scale exercises now must include training for response to Active Shooter, Hybrid Targeted Violence, Complex Coordinated Attacks, and fire as a luring tactic. It is essential that we embrace the need to prepare for these types of events, understand that these events require a “whole community response” and resolve that it’s not just a “police and EMS thing.” Rather, this is a multi-disciplinary response that includes law enforcement agencies, fire departments, ambulance services, hospitals, mental health professionals and other governmental, non-governmental, and not-for-profit agencies that can assist in initial response, short term and long-term recovery.

In April 2013, the Department of Homeland Security (DHS) and the Federal Bureau of Investigation (FBI), in cooperation with the International Association of Fire Chiefs (IAFC) and the International Chiefs of Police, convened to address, “Responding to Mass Casualty Shootings – Strengthening Fire/Law Enforcement/EMS Partnerships.” It became clear that there is a real and present threat and an obvious need for all organizations involved to work together when confronted with an armed individual who has either already killed and injured people or is threatening to do so.  The results include embracing a unified command structure, with changing response protocols across the fire service, in an effort to adopt a more assertive approach to rendering life-saving care and rescuing viable victims in areas considered to be “warm zones” (not fully secured) during such an event.

During response, the Incident Safety Officer (ISO) finds him or herself part of a command structure where the Incident Commander (IC) is not a fire department official, and where the competing objectives of neutralizing the threat and accessing injured victims are equally important and equally time dependant, however, securing the scene in the more traditional sense, facilitating the forward deployment of fire and emergency medical resources into a secure scene a difficult and time consuming task.

It is without question that fire and emergency medical service responders will not be entering a “hot zone” without proper training, equipment and competencies, and at the sole discretion of the law enforcement authority having jurisdiction. However, we must now relieve fire and emergency medical responders of the more traditional “stage and wait” ideologies, balance responder safety with life saving actions, and focus on point-of-injury care and rapid transport after extraction. How we accomplish this is dependant on local resources and capabilities. There is no “cookie-cutter” approach to this. Response assignments are subject to the resources available in the community. What may work in a big city – tactical paramedics embedded with law enforcement in a Rescue Task Force – may not work in smaller, more rural communities.

ISO’s consider the scenario – confirmed acts of violence, penetrating trauma, orthopedic injuries associated with stampede effect, psychological trauma, multiple agencies with simultaneous response, victims fleeing the scene, bystanders assisting with evacuation of patients, establishment of off site staging areas, unified forward command post, casualty collection point(s), challenges with communications interoperability, you get the idea – lot’s of moving parts, all fueled by human emotion on overdrive.

The alarm sounds for an active shooter call, and first arriving law enforcement confirm the incident with dispatch, and request fire, emergency medical response, with agency commanders to the forward command post and fire apparatus and ambulances to an offsite staging area. As they get closer to the scene, emergency responders observe the scene “going mobile,” meaning that aided cases are fleeing the scene under their own power, or with the help of bystanders, and injured patients confront responders with pleas for assistance. Upon arrival at the forward command post, agency commanders and ISOs are confronted with surveying the scene – type of occupancy, numbers of real and potential casualties, assisting in the establishment of a casualty collection point (CCP) with consideration of concealment and / or cover, and ground level and overhead force protection. Simultaneously, at the staging area, multiple pieces of fire apparatus and ambulances arrive en masse, from multiple directions, and their efforts to stage safely and effectively are fueled with high emotion. ISOs must be deployed to ensure safe and efficient movement in preparation for rapid deployment when called.

Once released to the CCP, the pace remains fast and furious….and dangerous.  Fire apparatus must be placed safely and effectively to drop off manpower and position themselves as cover and ambulances must get in – receive a patient – and depart to the designated hospital. Keep in mind the intense emotional impact, along with concurrent adrenaline rush on judgment and behavior exhibited by all involved. The ISOs work becomes vitally important to minimize this impact.

In 2013, the American College of Surgeons released The Hartford Consensus, as a result of a call to action after the Sandy Hook Elementary School disaster in December, 2012. This multi-disciplinary consensus committee work resulted in a strategic plan that will reduce death and disability from compressible hemorrhage, the number one cause of preventable death in active shooter events. In 2018, the NFPA released NFPA 3000 Standard for an Active Shooter/Hostile Event Response (ASHER), due to yet another fire service call to action after the Pulse Night Club massacre in June 2016. This multi-disciplinary technical committee’s work resulted in a planning, response and recovery guidance standard that includes responder safety considerations. Collectively, these consensus documents lay a solid foundation for future growth in preparing for, responding to, and recovering from response to ASHER incidents.

Across the country, fire, law enforcement and emergency medical services communities have been impacted by this growing threat. In order to meet their mandates, each is dependent on each other to provide much needed support. With this comes the need to adapt and expand and modify our well known and well established safety strategies, typically used by ISOs at fire scenes, technical rescues, motor vehicle crashes and hazardous materials incidents, to ASHER incidents.

Robert Delagi
Incident Safety Officer / Health and Safety Officer, Islip, NY Fire Department
Chief (Retired), Emergency Medical Services and Public Health Emergency Preparedness, Suffolk County Department of Health Services

Chief Delagi has 42 years of fire/rescue/EMS experience, and has developed domestic preparedness, hazardous materials, leadership & management, and safety related curricula for government and general industry. He is certified by the National Board on Fire Service Professionals as an Incident Safety Officer (ISO) and a Health & Safety Officer (HSO), and by the International Board for Certification of Safety Planners as a Certified Healthcare Emergency Planner (CHEP). Bob serves as the ISO/HSO for the Islip, NY Fire Department.

He is Paramedic who holds a Master’s Degree in Business and Policy Management, whose career included faculty appointments as an Assistant Professor at Suffolk County Community College and as an Adjunct Instructor at SUNY Empire State College. During his tenure with the Suffolk County Department of Health Services, he was the Emergency Management Liaison to the Suffolk County Department of Fire, Rescue and Emergency Services for Public Health Emergency Preparedness, the Medical Branch Director of the Suffolk County Urban Search & Rescue (USAR) Team, and on the senior management planning team for Suffolk County’s response to Active Shooter / Hostile Events in partnership with the Suffolk County Police Department, and the Suffolk County Fire, Rescue and Emergency Services.