High Threat Considerations/Active Shooter Scenario

Table of Contents

Aliases

None noted

Definitions

• Hot Zone/Direct Threat Zone: an area within the inner perimeter where active threat and active hazards exists.
• Warm Zone/Indirect Threat Zone: an area within the inner perimeter where security and safety measures are in place. This zone may have potential hazards, but no active danger exists.

Patient Care Goals

1. Assess scene
2. Mitigating further harm
3. Accomplish goal with minimal additional injuries

Patient Presentation

Inclusion Criteria

High threat environment – when greater than normal conditions exist that are likely to cause damage or danger to provider or patient

Exclusion Criteria

No significant threat exists to provider and patient allowing for the performance of routine care

Patient Management

Assessment, Treatment, and Interventions

1. Hot Zone/Direct Threat care considerations:
   1. Defer in depth medical interventions if engaged in ongoing direct threat (e.g. active shooter, unstable building collapse, improvised explosive device, hazardous material threat)
   2. Threat mitigation techniques will minimize risk to patients and providers
   3. Triage should be deferred to a later phase of care
   4. Prioritization for extraction is based on resources available and the situation
   5. Minimal interventions are warranted
   6. Encourage patients to provide self-first aid or instruct aid from uninjured bystander
   7. Consider hemorrhage control:
      1. Tourniquet application is the primary “medical” intervention to be considered in Hot Zone/Direct Threat
      2. Consider instructing patient to apply direct pressure to the wound if no tourniquet available (or application is not feasible)
      3. Consider quickly placing or directing patient to be placed in position to protect airway, if not immediately moving patient
2. Warm Zone/Indirect Threat care considerations:
   1. Maintain situational awareness
   2. Ensure safety of both responders and patients by rendering equipment and environment safe (firearms, vehicle ignition)
   3. Conduct primary survey, per the General Trauma Management guideline, and initiate appropriate life-saving interventions
      1. Hemorrhage control
         1. Tourniquet
         2. Wound packing if feasible
      2. Maintain airway and support ventilation [see Airway Management guideline]
   4. Do not delay patient extraction and evacuation for non-life-saving interventions
   5. Consider establishing a casualty collection point if multiple patients are encountered
   6. Unless in a fixed casualty collection point, triage in this phase of care should be limited to the following categories:
      1. Uninjured and/or capable of self-extraction
      2. Deceased/expectant
      3. All others

Notes – High Threat Considerations/Active Shooter Scenario