Overview

This report asks the following question: Why are tactical emergency casualty care (TECC) rescue task force (RTF) and Israeli hospital trauma programs the best approaches to addressing the current gaps and weaknesses in trauma management in the United States in the context of terrorist attacks and/or active shooter incidents? The purpose of this thesis is to ascertain why existing tactical emergency medical service protocols in most public safety jurisdictions are deficient and to analyze which types of resources jurisdictions need in order to ensure that they have optimal programs in place for mass casualty incident response. Active shooter and terrorist attacks have been on the rise since the 1990s. This thesis found that most public safety organizations in the United States are unprepared to provide emergency medical services during these incidents. Provision of tactical emergency medical services in hostile environments require that emergency medical services personnel train and deploy using TECC RTF guidelines and the Israeli hospital paradigm. This thesis recommends the implementation of a national standard to ensure that these programs are instituted in jurisdictions across the United States. CHAPTER I * INTRODUCTION * A. PROBLEM STATEMENT * B. RESEARCH QUESTION * C. HYPOTHESIS * D. RESEARCH DESIGN * E. CASE STUDIES * 1. The Israeli Hospital Trauma Model * 2. Aurora, Colorado - Century Theater Mass Shooting, July 2012 * 3. Boston Marathon Bombings, April 2013 * 4. Los Angeles International Airport Shooting, November 2013 * F. DATA ANALYSIS * G. METHODS SUMMARY * CHAPTER II * LITERATURE REVIEW * A. INTRODUCTION * B. CAUSES OF DEATH ON THE BATTLEFIELD AND SYSTEMIC IMPROVEMENTS IN COMBAT CASUALTY MEDICINE * C. DEVELOPMENT OF THE MODERN TOURNIQUET * D. PASSING OF TCCC TO CIVILIAN PUBLIC SAFETY JURISDICTIONS IN THE UNITED STATES * E. ISRAELI EMERGENCY MEDICAL RESPONSES TO MASS CASUALTY EVENTS * F. CONCLUSION * CHAPTER III * INCREASES IN ACTIVE SHOOTER AND MASS CASUALTY EVENTS IN THE UNITED STATES AND PUBLIC SAFETY AGENCIES RESPONSES * A. THE INCREASE IN ACTIVE SHOOTER AND MASS CASUALTY INCIDENTS IN THE UNITED STATES * B. POLICE AND EMERGENCY MEDICAL RESPONSES TO ACTIVE SHOOTER AND MASS CASUALTY INCIDENTS IN THE UNITED STATES * C. INTERNATIONAL ASSOCIATION OF FIREFIGHTERS, U.S. FIRE ADMINISTRATION, AND JOINT COMMITTEE TO CREATE A NATIONAL POLICY TO ENHANCE SURVIVABILITY FROM MASS CASUALTY SHOOTING EVENTS' RECOMMENDATIONS ON TACTICAL EMERGENCY * D. CONCLUSION . * CHAPTER IV * THE ISRAELI EMERGENCY MEDICAL RESPONSE MODEL FOR MASS CASUALTY EVENTS * A. STANDARD OPERATING PROCEDURES, TRAINING, AND DRILLS * B. ESTABLISHMENT OF TRIAGE ON SCENE AND AT EMERGENCY DEPARTMENTS * C. ISRAELI HOSPITALS * D. THE ACCORDION APPROACH * E. ISRAEL NATIONAL TRAUMA REGISTRY * F. ANALYSIS * CHAPTER V * CASE STUDY, AURORA CENTURY THEATRE MASS SHOOTING, JULY 20, 2012 * A. DESCRIPTION OF EVENT * B. POLICE, FIRE, AND EMS RESPONSE * C. HOSPITAL RESPONSE * D. PREVIOUS TRAINING AND EXERCISES * E. ANALYSIS * CHAPTER VI * CASE STUDY, BOSTON MARATHON BOMBINGS, APRIL 15, 2013 * A. DESCRIPTION OF THE EVENT * B. POLICE, FIRE, AND EMS RESPONSE * C. HOSPITAL RESPONSE * D. AFTER ACTION REVIEWS * E. PREVIOUS TRAINING AND EXERCISES * F. ANALYSIS OF EMERGENCY MEDICAL RESPONSE * CHAPTER VII * CASE STUDY, LAX MASS SHOOTING, NOVEMBER 1, 2013 * A. DESCRIPTION OF EVENT * B. POLICE, FIRE, AND EMS RESPONSE * C. HOSPITAL RESPONSE * D. AFTER ACTION REVIEWS * E. PREVIOUS TRAINING AND EXERCISES * F. ANALYSIS OF EMERGENCY MEDICAL RESPONSE * CHAPTER VIII * ANALYSIS * A. INTRODUCTION * B. BOSTON MARATHON BOMBINGS-SUMMARY AND ANALYSIS

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