Fire EMS, Firefighting, Fireground Safety

Tactical Emergency Casualty Care for High-Threat Environments

Issue 10 and Volume 171.

By MARK LITWINKO For many of us, the phrase “Scene safe, BSI” was engrained in our memory during our initial emergency medical services (EMS) training. But what does “scene safe” really mean? No scene is totally safe, but for some of us, our role in EMS requires us to operate in austere environments. We do so with a safety net of training, tactics, and equipment. (1) Police officers as security detail for Rescue Task Force Team 1. (Photos by author.) Traditional EMS protocols and guidelines often limit us from providing adequate patient care during perceived “high-threat” incidents. Active shooter events, improvised explosive device detonations, rioting, acts of violence against public safety—all of these incidents are becoming all too common for emergency service responders. During the Columbine High School shootings in 1999, it took more than two hours until medical care was rendered to victims inside the building. For some victims,…

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