Last year, I attended a three-day course entitled “School Shootings: Prevention, Response and Mitigation,” as a member of the fire-service advisory committee at the local career-development institute. Taught by both a retired police chief and several retired federal agents, the course gave the history, motivation and analysis of multiple-victim shootings at schools throughout North America, with special emphasis on the Columbine High School and Virginia Tech attacks.

Of the 35 attendees, only four were from the fire service. At first we had to overcome the learning curve regarding current police tactics in dealing with these shootings. Equally difficult to comprehend was the Internet subculture that instructs, openly discusses and borderline promotes school shootings as a way for a student to get even while becoming infamous forever more.

As the course continued, it became obvious that the sooner first responders started medical triage and treatment, the greater the chance that victims would survive. The class discussion at times centered on how we first responders could better prepare and work comfortably in an ongoing environment that may be contained but not yet fully secured. For example, three volunteer EMTs at Virginia Tech (college students, not SWAT members) agreed to go into the stairwells with the SWAT team to triage and treat victims, who were brought to them in a controlled setting while SWAT teams continued to sweep the area. No other victims died after EMTs entered the building. After the course, we started a dialogue in our area on how to best respond to and mitigate such carnage.

I am not looking for every EMT or medic to be an armed SWAT member, but do some of you issue tactical vests and allow medics discretion to enter just after SWAT has swept an area? Is that somehow captured in your SOGs?

History has shown that these mass shootings can occur in several venues other than schools, including businesses, churches and nursing homes. On consecutive days last month, shootings occurred at Fort Hood in Texas and at the Gateway Center Building in downtown Orlando, Fla. For this reason, the course has been re-titled to “Active Shooter, Prevention, Response and Mitigation.”

All of these sites, including Fort Hood and the Gateway Center, followed patterns that were similar to those of the shootings at Columbine and Virginia Tech. The shooter was acquainted with the surroundings well enough to choose a location inside the building where people would congregate naturally. At Fort Hood, it was the processing center; at the Gateway Center, it was the work spaces on the floors familiar to the shooter. Using these congested areas and choke points, a single unchallenged shooter can acquire, target and shoot a new victim about every five seconds. Most of the shooters planned their actions by carrying or placing extra magazines at strategic locations in the venue and additional ammunition in a vest, fanny or backpack.

Former Forest Park (Ohio) Police Chief Ken Hughes is the lead instructor for the Active Shooter course. He has traveled to many of the sites of these mass shootings, and no doubt will travel to both Fort Hood and Orlando when possible to gain further insight into these shootings and the motivation of the alleged gunmen. Even in these early stages of the investigations, the course can begin to put things in perspective using the prevention, response and mitigation guidelines.

Prevention

Obviously, preventing a mass shooting would be the goal of any first responder potentially involved in the mitigation of such an incident. After the fact, it is easy to recognize some telltale clues that someone is about to go on such a rampage. The first is a critical change in behavior that takes on a more aggressive approach to any adversity. In the case of Army Maj. Nadal Malik Hasan, it is alleged that there were several red flags, including his unwillingness to be deployed and his giving away of his furniture and other possessions the day prior to the shootings.

Other clues, especially with younger individuals, can be found in blogs and personal Web pages, as well as on YouTube, Facebook and Twitter postings. Threats, especially against specific places or individuals, often are posted even weeks before a shooting. It's reported that Hasan posted several items indicating his belief that jihad martyrs are philosophically no different than soldiers falling on a grenade to save their comrades and that those of the Muslim faith in the armed forces should be allowed to leave the military as conscientious objectors if being deployed to a predominately Muslim nation.

It also was reported that Hasan had an e-mail exchange with a radical Muslim cleric in Yemen who is known to be connected to Al Qaeda and for encouraging young Muslims to kill U.S. troops in Iraq. The Pentagon also is concerned that those who oversaw Hasan's medical training at Walter Reed Hospital had discussed his zealous religious beliefs and strange behavior months before the attacks at Fort Hood.

Jason Rodriquez, the alleged shooter at the Gateway Center, exhibited the same aggressive tendencies, but these were mainly observed by close family and friends. The exception concerns a report that Rodriquez had been allegedly detained by the Orange County (Fla.) Sheriff's Office in June 2007 and evaluated at a nearby hospital as a “danger to self and others.” He later was released.

After the attack on the eighth-floor offices of his former employer, an engineering firm that had let him go for poor performance two years earlier, Rodriquez was captured at his mother's home and gave up peacefully. His comparatively brief shoot-out left one person dead and several others wounded. When asked why he shot these former co-workers, he is reported to have replied, “Because they left me to rot. … I'm just going through a tough time right now, I'm sorry,” referring to his employment at a fast-food restaurant, potential bankruptcy and having been recently divorced.

The challenge in the prevention of mass shootings is for professionals in the fire, EMS, police and medical sectors to recognize the signs of stress and conversation that could indicate someone is planning such an act of revenge. One other indicator is talk of suicide. The history of mass shooters shows many wish to die by what is termed “suicide by cop,” or to die in the ensuing gun battle with law enforcement — which some believe gives them fame and glory — rather than live through the criminal justice process.

Response

Response to these two shootings made a tremendous difference in the death toll. At Fort Hood, there were 13 dead and 30 wounded. The response, engagement and the neutralizing of the shooter by two civilian police officers within five minutes of the first shots being fired saved countless additional lives. If we remember the five-second rule — a shooter acquires targets and shoots another victim every five seconds — the 43 victims would total approximately four minutes elapsed time before the shooter was engaged by the police officers. For the police, the goal was to engage the shooter as quickly as possible and take him out of action.

For the dead and wounded, the medical response was an extension of the very place the shootings occurred, a military installation full of combat-trained, disciplined personnel. The same training used to save fellow soldiers in combat was pressed into service with make-shift dressings that included everything from disposable diapers to torn strips of uniforms. Fort Hood Fire Chief Billy Rhoads believes the response of his department also was integral to the effective coordination of incoming mutual aid for immediate triage, treatment and transportation of the wounded to various medical facilities on or near the military complex.

In Orlando, the scenario was a bit different, but the response once again saved lives. Unlike Fort Hood, the shootings occurred very quickly and then abruptly stopped; consequently, police were uncertain whether there was still an active shooter on the premises. They ordered a lock down of the remaining floors and then had the necessary police personnel available to not only search the premises for the shooter, but provide cover to contain any threat on the eighth floor and allow members of the Orlando Fire Department to immediately confirm the death of one victim and attend to the wounded to prevent them from bleeding out. The decision by the Orlando Fire incident commander to go into a contained threat rather than a fully secured building potentially saved several of these lives.

According to District Fire Chief Russell Nail, the incident commander in Orlando, the incident started with the report of a shooting, which elicited the response of Engine 3 and Rescue 1. The call was almost immediately upgraded to multiple victims, prompting a first-alarm medical assignment which added Engines 1 and 101, Tower 1, Heavy Rescue 1 and District 1. Responding on Interstate 4, Nail indicated that since it was the day after the Fort Hood shootings, he was concerned that this might be the continuation of a series of coordinated terrorist strikes across the country. On his arrival, Nail established an initial staging area on the north end of the Gateway Center, and units were advised to have their medical equipment ready for victims.

Engine 1, responding from the south, was diverted by Orlando Police Department personnel into the courtyard area on that side of the building, where two of the shooting victims had made it down from the eighth floor and were being assisted by the police department. Engine 1 contacted Nail and requested that they be allowed into the first floor to triage and remove the victims for further treatment. Having the experience of operating with the police department on previous shootings, Nail verified that units had contacted the police department on their tactical frequency and were assured that while the building had not been completely secured, the area was contained by police personnel and it was safe for Engine 1 to enter and remove these two victims.

As information began to be exchanged on the police tactical channel, it was learned that there were three more victims on the eighth floor, which was being swept for the shooter. Orlando Fire was requested to send personnel to that floor. Meanwhile, the police had secured the elevators, the eighth-floor elevator landing, and had a SWAT team ready to be assigned to the fire department's entry and exit. The crews of Engine 101 and Heavy Rescue 1 were given that assignment. On their arrival to the eighth floor, they triaged and confirmed one victim dead and two other trauma-critical patients. These victims were treated and then brought to the street level for transport to the hospital.

Nearly simultaneously, a report from the police department indicated additional victims on the 12th floor, and the Engine 3 and Tower 1 crews were ready to meet with an additional SWAT team to enter the building when it was discovered that this information was erroneous.

During these events, Engine 2 and Rescue 2 were dispatched to a separate location where another victim of the shooting attempted unsuccessfully to drive himself to the hospital. Once the engine and rescue cleared that run, they were directed to the staging area at the Gateway Center. Separately one of the building occupants who had been removed by the police to a safe area began to experience chest pains, but later refused treatment by private ambulance.

Nail credits his personnel for the quick action that saved additional lives from potentially bleeding out on the eighth floor. He also credits having enough units and personnel available on any mass-casualty incident to quickly deploy them to any victim with life-threatening injuries.

While a critique of the incident is ongoing, the coordinated response of fire and police personnel also added two new tools to more quickly secure the building. These were the use of fire department plans that gave the police department a schematic of the floor layout of the building, and the use of the Knox Box system to unlock any door or closet to be assured the building was free of any additional shooters or victims.

Mitigation

The mitigation of any such mass shooting begins with the capture or neutralization of the shooter or shooters. For years, it has been argued that the entire premises is a crime scene that must not be disturbed — and at times this thought has been detrimental to the speedy treatment of the victims. More recently, law enforcement has begun using similar tactics to the military in setting up a safe perimeter in which fire-rescue personnel can operate to treat, triage and then move those victims who can be saved. The coordination and trust between Orlando fire and police personnel appears to be a classic case of the success of such tactics.

Mitigation, of course, goes beyond these tactics and into the tedious task of collecting and processing the evidence needed to bring the shooters to justice and the debriefing and support of all the personnel involved.

The bottom line is that an active-shooter scenario can happen anywhere from the smallest villages to the largest cities. The discussion for the fire service is whether it is time to change our response from one where a scene must be totally secure to one where the threat can be reasonably contained before treatment of the victims begins.

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Chief Robert R. Rielage, CFO, EFO, MIFireE, is the chief of Wyoming (Ohio) Fire-EMS, a 78-member combination fire department bordering Cincinnati. He previously served as the fire marshal of the state of Ohio. A graduate of the Kennedy School's Program for Senior Executives in State and Local Government at Harvard University, Rielage holds a master's degree in public administration from Norwich University and is the immediate past-president of the Institution of Fire Engineers-USA Branch. He is a member of the FIRE CHIEF Editorial Advisory Board.

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