By Christopher L. Wistrom, DO, James MacNeal, DO, MPH, Mike Blaser; Kevin Olin and Ben Biddick
Responding to an active shooter incident at a school is one of the most trying challenges for any public safety organization. Even in the best of circumstances, well-trained professionals will have difficulty assessing the situation, defusing the incident, treating the wounded, and moving through and beyond the terror.
As EMS and police prepare for these types of incidents, it is easy to overlook those who we are trying to protect. We may view them as a liability or in the way. After extensive planning and education, we propose that teachers are an often-overlooked and invaluable asset. After all, who is better positioned to be an immediate responder than those already within the situation?
By training those within the immediate emergency how to appropriately render medical aid, we greatly increase the potential survivability of the wounded. School employees are able to stop the dying if they are empowered to:
- Preplan a response;
- Know the preventable causes of death in penetrating trauma;
- Know how to treat the wounded;
- Render emergency aid that stops life-threatening bleeding;
- Direct the efforts of others.
An educated public turns a first response into an immediate response. The empowerment of the education is undeniable and, even if unused, serves to better the mental health of the teachers, students and parents alike. It prevents them from being helpless in their hallways.
A multidisciplinary cadre to address MCI response
It is clear that in traditional response models it takes too long to get medical care to those injured. We formed a multidisciplinary cadre to address this gap in care.
Our intent was to empower untrained immediate responders with the tools necessary to save a life. We hoped this would encourage teachers and staff in the school district to render immediate and immensely valuable casualty care to school staff or students who sustain injuries in a large-scale act of violence.
We also desired to make the training universal, so that any community struggling with this issue could build on the work we had done and use our program as a cornerstone.
Out of these goals, Casualty Care in the Classroom™ was born. This program is based on the principles of trauma combat casualty care and places pressure dressings and tourniquets in the hands of teachers. CCC is designed in a train-the-trainer format, which allows the model to be taught by law enforcement and EMS with local health professionals to local schools. By using local resources, there is a greater personal interest in the training, as these are the schools our own children attend.
Training teachers in trauma and airway management
The training was met with resounding success. Teachers no longer have to wait for public safety personnel to reach them in order to receive aid. They are empowered to render the aid themselves and stop severe bleeding until police, fire and EMS personnel could reach them.
It is shocking how aware and concerned our teachers are when it comes to daily headlines and reports of large-scale acts of violence. Of 160 active-shooter incidents since 2000, 24.4 percent were at educational facilities, with 117 killed and 1,230 wounded.
Training the teachers on how to open an airway, pack a wound, apply a pressure dressing and apply a tourniquet empowered them to take action and participate in the response instead of waiting helplessly for rescue. Hungry for the education, they have become an essential element in our response.
We learned in our 45-minute educational sessions that teachers have questions about what law enforcement officers may look like as they respond, when to call 911, how to avoid overwhelming dispatch, liability issues, and how to provide self-aid and improvised aid. All these questions have been adopted as part of the training.
Participants are also educated about the objectives of all the agencies during the response. They are taught that law enforcement is there to stop the killing in order to create an environment where CCC-trained staff and paramedics can stop the dying.
When victims understand the role of law enforcement, they can have realistic expectations. Instructors explain that law enforcement may bypass injured victims during an active threat, but not because they are callous or do not care about the injured.
Empowering teachers to act as first responders
To have teachers who possess an understanding of the public safety response processes, knowledge to provide medical care and empowerment to make practical application of that knowledge creates an environment where our children will receive the most rapid and effective care possible in the event of a mass casualty incident.
About the authors
Dr. Christopher Wistrom is a board-certified emergency medicine physician and practicing EMS field physician. He also serves as associate EMS medical director for Mercy Health in Janesville, Wis.; Lake Geneva, Wis. and Rockford, Ill.
Mike Blaser is a sergeant; and Kevin Olin and Ben Biddick are officers of the Janesville (Wisc.) Police Department.