8.8. HIGH THREAT SITUATION/ ACTIVE SHOOT

Related titles

Absent.

Definition

1. Area of active fire/Zone of immediate threat: the area within the inner perimeter in which there are active threats.
2. Indirect Threat Zone: An area within the internal perimeter in which security controls are present. This zone may have potential threats, but there is no immediate danger.

Purpose of providing EMD

1. Assess the scene.
2. Minimize further harm to the injured and prevent injuries.
3. Achieving goals with minimal additional injuries.

Description of the patient

Inclusion criteria

A high-risk environment is a situation in which there are threats that can directly or potentially threaten EMD specialists or patients.

Exclusion criteria

A situation where there are no significant threats to the EMD specialist or the patient that would interfere with the routine provision of EMD.

Management of the patient

Assessment, treatment and intervention

1. Peculiarities of providing assistance in the area of active fire/immediate threat:

a) postpone medical interventions in the presence of a direct threat (for example, an active fire, possible destruction of an unstable building, the presence of an improvised explosive device, the presence of poisonous substances);
b) threat mitigation methods will minimize the risk to patients and EMD professionals;
c) triage should be delayed until a later stage of care;
d) evacuation priority should be based on available resources and the situation;
e ) it is necessary to minimize interventions;
e) encourage the patient to self-help or instruct an outsider how to provide help;
e) features of bleeding control:

• • • • the application of a tourniquet is an important medical intervention in the immediate danger zone;
      • advise the patient to apply direct pressure in the absence of a tourniquet (or its impossibility);
      • independently position or explain to the patient how to take a position that will allow maintaining the patency of the respiratory tract, if the patient is not immediately transported.

2. Features of providing assistance in the area of indirect threat:

a) support the assessment of the situation;
b) ensure the safety of EMD system specialists and the patient by checking the safety of equipment and the environment (weapons, car on fire);
c) conduct an initial examination (see the instruction “General trauma”), if necessary, carry out the following interventions (see the relevant instructions):

• • • • bleeding control: tourniquet, wound tamponade;
      • respiratory tract: maintain airway and ventilation (see guideline “Airway control”);

d) do not delay patient release and evacuation for non-life-threatening interventions;
g) consider setting up a casualty assembly point if multiple patients are encountered;
e ) at a fixed casualty collection point, triage of patients in this phase of care should not be limited to the following categories:

• • • • intact and/or capable of self-release;
      • deceased/waiting;
      • all others.

Patient safety

1. Predict specific threats based on the assessment of the situation.
2. During high-threat situations, the safety of EMD workers should be considered when weighing the risks and benefits of treating patients.

Useful information for training

1. In high-threat situations, a new risk assessment should be considered. It is necessary to simultaneously consider the safety of EMD specialists and patients.
2. During high-threat situations, a comprehensive response with other public safety organizations may be warranted.
3. Depending on the situation, a small risk can provide a significant benefit for patient safety and outcomes.
4. In such situations, maintaining a communication and incident management concept can be critical to improving efficiency and reducing risk.

Key elements of documentationii:

1. Traditional documentation may not be suitable for use when working in hazardous/active threat areas.
2. Major interventions must be documented:

a) the time of applying a hemostatic tourniquet;
b) the number of points according to the SHKG, etc.