How AMR Is Preparing for ASHE

Posted on Thu, Dec 15, 2016
How AMR Is Preparing for ASHE

Paramedics and EMTs face countless potential dangers on a daily basis – car crashes, severe weather, hostile patients and much more. Now, more than ever, they are also having to deal with active shooters, terrorist attacks and other mass causality incidents. The ever-growing threat of an Active Shooter/Hostile Event (ASHE) has American Medical Response (AMR) continually evaluating how it prepares for and responds to such high-threat encounters.

With dangerous incidents on the rise, AMR has implemented an ASHE initiative. It is an evidence-based approach that teaches responders how to prepare for an event, how to respond during an event and what to do after an event to minimize harm to responders and increase the survivability of victims.

“This is the beginning of another new problem,” said Edward Racht, M.D., Chief Medical Officer of AMR, comparing it to other health epidemics like Ebola. “We have to be diligent in our studies and vigilant in our approaches.”

The InterAgency Board for Equipment Standardization and Interoperability (IAB), founded by the Department of Defense and the Department of Justice, describes ASHEs as the intent to cause physical harm or death by a variety of means including the use of weapons.

Some of the more recent domestic events include the San Bernardino terror attack, the Dallas sniper attack on police, the Colorado Springs hostage situation and the Orlando nightclub shooting.

According to Dr. Racht, ASHEs are comparable to an evolving and highly contagious disease that everyone needs to address with urgency.

And, it starts with those who are not in uniform.

Oftentimes, the initial first responders are bystanders, not police or paramedics. ASHE victims can suffer from a variety of injuries that range in severity, but the most common and also preventable cause of death is hemorrhaging. Dr. Racht expressed that anyone can help save a life just by preventing blood loss.

A significant component of AMR’s ASHE initiative is teaching the public tourniquet application and hemorrhage control through the “Stop the Bleed” campaign.

“It is one of the most valuable interventions in the public today,” Dr. Racht explained. “It is life-saving and simple to do.”

Most incidents also require the assistance of multiple first responder disciplines, yet the nature of ASHE presents several operational challenges for all. As a result, research and best practices show that EMS, fire departments, law enforcement, hospitals and other agencies have to enact a unified and coordinated approach that goes beyond each discipline’s traditional responsibilities.

“We have to make the event as predictable as it can be. We don’t want to create confusion and potential harm because we aren’t coordinated.”

Dr. Racht compared the approach to understanding the emergence of these new challenges to other circumstances EMS and healthcare personnel face such as the initial identification of HIV/AIDS. During that era, “the ‘new’ and emerging threat forced everyone to better understand the disease, our response and how to best take care of our patients and ourselves.”

Development of the concept and practice of universal precautions was a milestone in the healthcare industry’s approach to all patients. Similarly, the Sept. 11 attacks led to the development of the National Incident Management System that now enables everyone to communicate and integrate much more effectively.

He also believes that studying past events will help responders prepare as much as possible for future ones. As part of its ASHE strategy, AMR is analyzing previous incidents, performing training exercises and evaluating equipment needs so responders can assess a situation quickly and respond appropriately.

Responders’ first priority, no matter the situation, is to ensure their safety.

EMS personnel have traditionally stayed and provided treatment in the cold zone – an area that theoretically does not pose a significant danger. Dr. Racht explained that this is still the safest and most effective place for paramedics and EMTs. EMS evaluation and management in the warm zone is an evolving area of discussion and one that requires careful thought, analysis and a focused approach to providing care that may not necessarily be delivered in the same way as it has been in secure environments.

Once the responders are safe, they identify the injured and assess the scope and magnitude of the event. They can then focus on providing immediate life-saving intervention which typically includes hemorrhage control and airway management.

“It’s part of what communities expect EMS responders to do – produce order out of chaos.”

Dr. Racht stressed that this is an international learning process and, while AMR is dedicated to ensuring it is fully equipped to handle such events, it is important enough and critical enough that it requires everyone’s attention and participation.


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