Joint Action Guide for High Treat Environments Manual, October 2016

Question 1

___ was the pivotal event which prompted a nationwide change in tactics used by law enforcement to respond to an event such as an active shooter.

pg 5

Answer 1

Columbine High School

Question 2

There is an agreed upon phrase that tells the basic approach to meeting the stated goal “Get us out!” That phrase is ___.

pg 5

Answer 2

Stop the killing and stop the dying

Question 3

The typical active shooting event in the United States lasts on average between ___ and ___.

pg 5

Answer 3

12 and 13 minutes.

Question 4

One critical action that must take place very early in the initial phase of response is the establishment of ___.

pg 5

Answer 4

Unified Command

Question 5

The ___ key elements are:

• Rapid integration of representatives from public safety agencies.
• Effective sharing of information.
• Joint critical decision making.

pg 6

Answer 5

Incident management system

Question 6

These several key items to be remembered pertain to ___, ___ and ___ of the injured.

• Unified Command must be established quickly.
• All personnel should be trained and equipped to provide Tactical Emergency Casualty Care (TECC) interventions.
• Access routes for EMS transport units must be an ongoing consideration for all responders.
• Staging Areas must be established and communicated to responding agencies early.
• A joint law enforcement and fire/EMS staging location (where teams will be assigned) shall be established and communicated to avoid unnecessary self-deployment and scene congestion
• Request additional resources early (for example, EMS Task Force or Mass Casualty Incident Alarm).

pg 6

Answer 6

Rapid access, treatment, and transport

Question 7

There are four primary methods to provide high threat patient care:

pg 7

Answer 7

1. Escorted Warm Zone (commonly referred to as Rescue Task Force)
2. Protected Corridor
3. Protected Island
4. Law Enforcement Rescue

Question 8

• A ___ is a team(s) of fire/EMS and law enforcement personnel who assemble for the purpose of rapid patient treatment within a warm zone.
  
  • These teams are identified by numbers, for example, RTF 1, RTF 2, and their primary purpose is the rapid treatment of patients. These teams may transition to extract patients from an area once treatment is believed complete.
  • RTF teams are developed from the Unified Forward Deployment Area.
• This is the most rapid method for entering area(s) and reaching victims.
  
  • It requires the least amount of law enforcement officers.
• An RTF is a minimum of two law enforcement officers, but four officers is the preferred composition.
  
  • Fire department personnel will be assigned for warm zone care of patients.
  • Law enforcement will be assigned for protection.
• An RTF team can extract patients as the situation dictates.
• May require ballistic protection for all responders.
• Highest risk to responders since threat may still be active in other parts of the building or area of operations.
• Highest level of coordination because it requires a multi-discipline team of fire/EMS and law enforcement personnel.

pg 7

Answer 8

Rescue Task Force (RTF)

Question 9

• A ___ is a pathway secured by law enforcement.
• Law enforcement secures area(s) and remains posted.
• Fire/EMS does not require an escort in protected area(s).
• May not require ballistic protection for fire/EMS personnel.
• Requires more officers because each officer can only cover what is in his/her sight and within weapon capabilities.
• Potentially a longer time interval to patient care than RTF method, because more law enforcement personnel are needed to secure area(s).

pg 7

Answer 9

Protected Corridor

Question 10

• Law enforcement establishes a protected casualty collection point (CCP) within the structure or area of operations.
• Law enforcement conducts rescue operations to move patients from unprotected area(s).
• Fire/EMS operates within CCP. Patients are then moved out of CCP through a protected corridor or law enforcement escorted extraction.
• May not require ballistic protection for fire/EMS providers.
• Potential delay in care since law enforcement has to secure area(s) and establish CCP.
• Patient care may be delayed if interventions are not performed prior to moving patient to CCP.

pg 8

Answer 10

Protected Island/ Casualty Collection Point (CCP)

Question 11

• __ primary mission is to eliminate the threat.
• ___ may remove patients when resources/circumstances are not available to support the other methods.
• ___ may initiate TECC care when appropriate.
• Additional law enforcement personnel needed for operation.
• Potentially removes officers away from primary mission.
• Potential delay in patient care.

pg 8

Answer 11

Law Enforcement Rescue

Question 12

___ are groups of individuals assigned to remove patients.

pg 9

Answer 12

Extraction teams

Question 13

Extraction teams are identified by numbers for example, ____

pg 8

Answer 13

Extraction 1, Extraction 2

Question 14

Extraction Teams are deployed from the ___.

pg 9

Answer 14

Unified Forward Deployment Area

Question 15

Extraction Teams are comprised of a minimum of ___ and one of the individuals must be a law enforcement officer.

pg 9

Answer 15

Three individuals

Law enforcement officer(s) on the extraction teams shall provide protection during transfer of care.

Question 16

Extraction Teams are tasked with rapidly moving patients from a ___, ideally to ___ for immediate transport.

pg 9

Answer 16

threat area & ambulances

Question 17

Considerations for ___ are the following:

• Command should deploy extraction teams as quickly as possible, following RTF, to ensure the most expeditious transfer of care.
• Teams should consider bringing TECC bags and/or patient carrying equipment with them.
• Individuals in the extraction team may need ballistic protection.
• Fire/EMS personnel should be easily identified, such as by wearing a traffic vest.

pg 9

Answer 17

Extraction

Question 18

A ___ is an area that may be established in order to provide treatment, triage, and other coordinated medical actions while awaiting an evacuation platform to definitive medical care.

pg 10

Answer 18

Casualty Collection Point (CCP)

Question 19

The initial CCP (Casualty Collection Point) may be established in a ___ while awaiting patient extraction.

pg 10

Answer 19

warm zone

Question 20

The primary goal of the CCP (Casualty Collection Point) is to ___ wounded.

pg 10

Answer 20

Rapidly treat and transport

Question 21

Do NOT delay patient transport to definitive care by moving a patient to the CCP (Casualty Collection Point) if a ___ is available.

pg 10

Answer 21

transportation platform

Question 22

Considerations for ___ location are the following:

• Proximity to evacuation assets.
• Patient and provider flow.
• Ability to search patients for weapons and other threats (such as IEDs) upon entry/exit.
• Ensure proper and adequate personnel are available.
• Ensure adequate medical and evacuation supplies are readily available.

pg 10

Answer 22

Casualty Collection Point (CCP)

Question 23

A ___ is the systematic removal of non-injured under law enforcement direction.

pg 10

Answer 23

evacuation

Question 24

The decision to remove the non-injured will be made by ___.

pg 10

Answer 24

Command

Question 25

___ may be used to support removal of injured.

pg 10

Answer 25

Non-injured

Question 26

___ will designate an area to relocate non-injured.

pg 11

Answer 26

Command

Question 27

To reduce redundant treatment of patients by later arriving RTF (Rescue Task Force) teams and to promote the timely extraction of patients, the RTF teams will identify the deceased or critically injured within the warm zone with the following markings:

pg 11

Answer 27

Deceased: Black and white striped ribbon.

Critically injured / priority for extraction: Orange and white striped ribbon.

Question 28

Patients will be triaged at the ___, unless the extraction task force removes them directly to awaiting transport units.

pg 11

Answer 28

Casualty Collection Point (CCP)

Question 29

___ is a set of best practice treatment guidelines for trauma care in the high-threat prehospital environment.

pg 11

Answer 29

Tactical Emergency Casualty Care (TECC)​

These guidelines are built upon critical medical lessons learned by United States and allied military forces over the past fifteen years of conflict

Question 30

The goals of the ___ include the following:

• To establish a medical care framework that balances the threat, civilian scope of practice, differences in civilian population, medical equipment limits, and variable resources for ALL atypical emergencies and mass casualty.
• To provide for aggressive forward deployment and principles for point of wounding management of trauma in high-threat and mass casualty environments.
• To provide care guidelines that account for ongoing threat and operations to minimize provider risk while maximizing patient benefit.
• To identify and treat those casualties with preventable causes of death and keep them alive long enough to reach the hospital; if they don’t arrive alive, there is nothing that the trauma surgeons can do for them.

pg 11

Answer 30

Tactical Emergency Casualty Care (TECC)