Tuesday, June 9, 2015

DHS Publishes New First Responder Guidance

Today the DHS Office of Health Affairs (OHA) published an availability notice in the Federal Register (80 FR 32588-32589) announcing the availability of the “First Responder Guidance for
Improving Survivability in Improvised Explosive Device and/or Active Shooter Incidents”. The Guide is available on the DHS website.

The Guide

According to the Executive Summary:

“This Federal, multi-disciplinary first responder guidance translates evidence-based response strategies from the U.S. military’s vast experience in responding to and managing casualties from IED and/or active shooter incidents and from its significant investment in combat casualty care research into the civilian first responder environment. Additionally, civilian best practices and lessons learned from similar incidents, both in the United States and abroad, are incorporated into this guidance. Recommendations developed in this paper fall into three general categories: hemorrhage control, protective equipment (which includes, but is not limited to, ballistic vests, helmets, and eyewear), and response and incident management.”

The Guide includes discussion of:

Military lessons learned and civilian adaptation;
Improvised explosive incidents;
Active shooter incidents;
Hemorrhage control;
Protective equipment; and
Response and incident management.

Threat Based Scenarios

The Guide also includes 10 threat-based scenarios. Each scenario includes a discussion of:

Scenario description;
Expected injury patterns;
Protective equipment and barriers;
Protective equipment commonly worn;
Protective equipment risk mitigation considerations;
Response and incident management considerations;
Medical response system;
Prehospital emergency medical services consideration;
System-wide implications;
Hospital-based trauma systems consideration; and
Patient movement/transfer considerations.

The ten scenarios covered are:

Large-Scale Terrorist/Insurgency Attack;
Medium-Scale Terrorist/Insurgency Attack;
Medium-Scale Terrorist/Insurgency Attack;
Small Scale Terrorist/Insurgency Attack;
Involuntary Suicide Bomber;
Discovery/Recovery of Homemade Explosives (Not an Attack);
Active Shooter with Access Denial to First Responders;
Active Shooter in a Public Commercial Facility;
Active Shooter in an Open, Outdoor, Unbounded Location; and
Active Shooter in a Public Sports Complex.


I’ll leave comments on the recommended actions and procedures to the professionals. I was very concerned however at the absence of two specific scenarios; terrorist attack at a chemical plant and terrorist attack at an electrical substation. Both of these scenarios would have to include a number of additional first responder considerations, both for the safety of the first responder and the additional treatment and triage requirements.

I understand that all possible scenarios could not be included in this Guide. I even admit, that based on historical attacks, the scenarios presented are reasonable choices (just not the choices that I would have made). With that in mind, however, I would like to suggest that OHA continue working on additional scenarios based upon the work in this guide. Those Scenarios could be published on the web site where the Guide is posted.

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