ABSTRACT
Introduction: To evaluate emergency medical services (EMS) professional response to escalating threats of violence during simulated patient encounters and describe differences in behaviors by characteristics. Methods: EMS professionals of a large county-based system participated in 1 of 4 standardized patient care scenarios. Each 8-minute scenario included escalated threats of violence such that EMS personnel should escape the scene for safety. Trained evaluators recorded EMS professionals' performance using standardized data elements. Outcomes included EMS personnel escape and verbal de-escalation attempts. Descriptive statistics and univariable odds ratios (OR) with 95% confidence intervals (95% CI) are reported. Results: There were 270 EMS professionals evaluated as individual members of 2-person crews. Overall, 54% escaped the unsafe scene and 54% made an adequate de-escalation attempt; 20% did not make an adequate de-escalation attempt nor escape the unsafe scene. Paramedics demonstrated lower odds of escaping compared to emergency medical technicians (OR: 0.40; 95% CI: 0.17-0.94), yet greater odds of adequate de-escalation (OR: 3.17, 95% CI: 1.38-7.31). EMS professionals with more than 20 years of experience (OR: 0.32, 95% CI: 0.13-0.79, ref:2 years or less) and those with military experience (OR: 0.37; 95% CI: 0.17-0.81) demonstrated reduced odds of escaping. Crisis intervention team (CIT) training was associated with reduced odds of escape (OR: 0.38; 95% CI: 0.21-0.69), but increased odds of adequate de-escalation (OR: 2.19; 95% CI: 1.19-4.04). Conclusions: Nearly half of EMS professionals did not remove themselves from a simulated patient care scenario with an escalating threat of physical violence. EMS-specific training for de-escalation as a first-line technique, recognizing imminent violence, and leaving a dangerous environment is needed.
ABSTRACT
OBJECTIVE: An integrated response to active threat events is essential to saving lives. Coordination of law enforcement officer (LEO) and emergency medical services (EMS) roles requires joint training, as maximizing survival is a shared responsibility. We sought to evaluate the performance of an integrated LEO-EMS Rescue Task Force (RTF) response to a simulated active shooter incident utilizing objective performance measures. METHODS: Following prior didactic training, we conducted a series of evaluation scenarios for EMS providers and patrol officers in our urban/suburban advanced life support EMS system (pop. 1,000,000). The scenario-tested command staff, LEOs tasked with neutralizing an active shooter threat, and two RTFs of LEOs and EMS providers each tasked with triage and treatment of 11 simulated casualties scattered over 2 office building floors totaling 13,000 square feet. Trained evaluators recorded performance on 30 objective data elements related to LEO-EMS operations/communication, time intervals, and trauma care. Data were analyzed using descriptive statistics and t-tests for between group comparisons. RESULTS: Over 18 days, 69 scenario events evaluated 388 EMS providers and 468 LEOs. Overall median (90th percentile) times in minutes from dispatch were: unified command established 4.1 (5.5), RTF assembled 9.4 (13.5), first victim contact 11.9 (16.5), first victim to internal casualty collection point (CCP) 16.6 (20.8), all victims ready for evacuation 21.6 (26.0). Life-saving interventions included tourniquet placed: 96% (95% CI 92-99) and LEO placed tourniquet: 88% (79-94). Clinical delays included inappropriate chest decompression: 4% (2-9) and unnecessary initial treatment: 17% (12-25). Correct operational actions included communication with LEO to ensure EMS was safe to treat: 70% (61-77) and appropriate CCP selection: 84% (74-91). Incorrect operational actions included failure to maintain protective LEO-EMS formation: 49% (45-62) and inappropriate single patient evacuation: 20% (14-28). Limitations included the lack of a pre-training control group for this novel program. CONCLUSIONS: We described the performance of an integrated LEO-EMS Rescue Task Force response to a simulated active shooter event in a large city. In general, clinical care was appropriate while operational targets can be improved. Objective measurement of response goals may be used for benchmarking and performance improvement for active threat events.
