Rapid reaction: Responders need to level-up to match lethal capability of mass shooters

What happened: A single gunman with an assault rifle killed 50 people and injured dozens more at Pulse, a gay nightclub, in Orlando early Sunday morning. Surgeons expect the death toll, already the worst mass shooting in U.S. history, to climb because of the severity of patient injuries. The shooter's father told NBC news that his son, Omar Mateen, recently became very angry after seeing two men kissing.

Why it's significant: Paramedics, alongside firefighters and police officers, once again, find themselves on the frontlines of terror and chaos in an American city. The targeted victims — more than 300 people in a gay night club — represent an identifiable, non-random category congregated at a relatively soft target. Previous mass shooters have targeted churchgoers, college students, and elementary school teachers and children.

Top takeaways: Each time a mass shooter strikes EMS leaders and field personnel need to reassess their individual and agency preparedness for a similar incident in their community. In the days ahead we will learn more about the incident, the response of Orlando police and fire departments, and the heroic actions of bystanders and responders to save lives. Meanwhile, here are three immediate considerations for active shooter incident response.

1. Level-up training and response capabilities.
The moniker of 'worst mass shooting in U.S. history' is likely to be short-lived. EMS agencies need to level-up their active shooter, rescue task force and bleeding control training to match the lethal capabilities of a single shooter. An incident with 53 wounded puts a much greater strain on a regional trauma system's prehospital and hospital providers than an incident involving five or 15 patients. Immediately review active shooter response plans, triage and bleeding control supply caches, and systems for distributing trauma patients among hospitals.

2. Everyone needs to learn and practice active shooter response.
Generations of children have practiced fire drills in school and carry those skills with them into adulthood. A large percentage of working adults receive basic training in fire extinguisher use. Some adults learn to specialize in suppression of structure fires.

We need a similar national and ongoing effort to teach all Americans to recognize an active shooter and act swiftly and decisively to run, hide, or fight. Some citizens will also learn to use and carry a firearm. The Orlando shooter engaged in gunfire with an officer working at the club.

This incident, like many previous mass shooters, was not concluded until a massive law enforcement response engaged, contained and killed the shooter. There is no single solution for mass shooter response. Instead it take a collaborative approach from the targets of the shooter, other bystanders, initial public safety responders and later-arriving tactical specialists.

A casualty is carrier out of the Pulse nightclub early Sunday morning. (AP Photo/Steven Fernandez)

3. Expect multiple and dynamic scenes.
One of the surprises of this incident is its containment to a single, densely occupied building. The shooter does not appear to have targeted multiple locations, attempted escape, or committed crimes before reaching the Pulse nightclub. Part of the real-time response across a jurisdiction needs to be gathering intelligence from other 911 calls and public safety reports to determine the scope and boundaries of the incident.

Finally, an Orlando-based paramedic, listening to Orlando fire department radio communications, on public radio channel, posted information about the incident as it developed as a comment on the Pulse Facebook page. The immediate availability of scene information for public consumption and wide-spread distribution adds a significant additional challenge for incident commanders.

Learn more about active shooter response and training:

• Hybrid Targeted Violence vs. Active Shooter Incidents
• Paris massacre rapid response: EMS leaders must prepare for Hybrid Targeted Violence in the U.S.
• Rapid Response: Active shooter or active stabber" The EMS response is the same
• Rapid Response: Mass murder at Ore. college shows challenge, importance of good PIO work
• Why police need to train to use and carry an IFAK
• Rapid Response: Clear and concise radio communication is key to MCI management
• Self-care tips to recover from a traumatic EMS incident
• Active shooter incident: Overcome adrenaline to focus on one patient at a time

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