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Ep 52: Rescue Task Force - Common Challenges and Expectations

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Контент предоставлен C3 Pathways. Весь контент подкастов, включая эпизоды, графику и описания подкастов, загружается и предоставляется непосредственно компанией C3 Pathways или ее партнером по платформе подкастов. Если вы считаете, что кто-то использует вашу работу, защищенную авторским правом, без вашего разрешения, вы можете выполнить процедуру, описанную здесь https://ru.player.fm/legal.

NEW! Watch this show on YouTube at https://youtube.com/live/iXHgu7zomfo

Bill Godfrey:

Welcome to the Active Shooter Incident Management Podcast. My name is Bill Godfrey, your podcast host. I am joined today by three of our wonderful C3 Pathways instructors. On my right here is Tom Billington, one of our Fire/EMS instructors. Welcome, Tom.

Tom Billington:

Good to be back.

Bill Godfrey:

It is good to have you back. Been a minute, that's for sure. We're also joined across the table from us. Russ Woody, one of our law enforcement instructors. Russ, welcome from North Carolina.

Russ Woody:

Yeah, glad to be down, Bill.

Bill Godfrey:

Good to have you here. And then we've got Travis Cox, also one of our law enforcement instructors and our training director. Travis, it's good to have you here in the studio.

Travis Cox:

Hey, it's good to be here. Good to see you guys again.

Bill Godfrey:

It's exciting. It has been a minute. It feels good to be back doing podcasts again. And of course, we've upped the game a little bit. I looked, it was September of last year that we did our last podcast, so we're just shy of a year being off the air. Can you believe that?

Travis Cox:

Yeah. It didn't seem that long, but time flies as they say.

Russ Woody:

It really does.

Bill Godfrey:

It sure does. It sure does. And everybody's due an explanation about why that is. And the truth of the matter is, there has been a lot of changes, all good stuff, but a lot of changes over the last year and it just became difficult to keep up with. You may or may not notice if you have heard the podcast before, we are also videotaping our podcasts now, as well. They're going to be up on our YouTube channel and we're here in our brand new studio.

Travis Cox:

And it's amazing.

Russ Woody:

Yeah, it looks great. Really does.

Bill Godfrey:

It is so exciting to be here. But we've also moved, we are no longer in the building we were in before. We've moved to a new location. We've got new offices set up, new space. We've got a dedicated studio set up and we're getting ready to open a dedicated training center. Granted it fell a little bit behind schedule, some construction delays. It just seems like you can't keep construction on schedule no matter what you do. But that's going to get cleared up and we're going to have this beautiful training center opened up here I think pretty soon.

Russ Woody:

As you know, Bill, when I got here, I started taking pictures. I've been sending pictures to all my friends about how this facility looks, how professional it is, and a lot of people were saying, wow, that's quite an improvement. So it's come a long way.

Travis Cox:

Definitely. Definitely. When I first saw it, it wasn't what I expected, but when I saw it I said, "Oh man, this is the first class all the way." So excited to be here and looking forward to what we're going to be doing in the future.

Russ Woody:

Very much same. It really didn't surprise me. It seems like everything that Bill does, really puts forward every effort and it is a great facility.

Bill Godfrey:

Well, those are gracious words, Russ, but this is a team effort and there's a lot of people involved in doing this from picking out all the stuff. Our producer, Karla, who's behind the scenes, she and a couple of the other people picked out a lot of the carpet and the finishings and the colors and it's just really nice to have a place that we can call our own and do some dedicated training in. And with any luck, we'll get the construction back on schedule and we'll get caught up here pretty soon. So anyways, it's exciting to be back. Let's get into the meat of it. We decided to talk today about rescue task forces and some of the common challenges that we see with RTFs, being a little bit confused about what the expectations are, what they're supposed to be doing, that kind of stuff. So Tom, this was one that you kind of threw out as a suggestion and we were all like, yes, that's a great topic. So why don't you talk a little bit about what was on your mind and what you're thinking.

Tom Billington:

Well, Bill, when we teach a class, we usually don't have enough time to go into all the exact details, but the RTF is such an important part. The Rescue Task Force, and first of all, just talking about what it is the Rescue Task Force is, it's usually a group of four people. So usually two Fire/EMS and two law enforcement working together as a team to go into the casualty collection point and start doing the treatment and get things sorted out. But we've never really talked about how do you do that? Why do you need more than one RTF? What is your goal when you get there? How do you organize things? And I think that's just a good place I wanted to start. But definitely, I think the important part is how are we formed and why are we formed this way, I think is the important part. I may be in a situation where I'm working with law enforcement officers I may have never met if I'm in a large organization. So I want to make sure that I know what's expected of me as the medical person and what I expect of the law enforcement person as far as the medical roles go. So I think that's just some of the things I wanted to cover.

Bill Godfrey:

Yeah, I think that's exciting.

Travis Cox:

It is really important for law enforcement to know what their mission is and what the responsibilities are on RTF because sometimes that can get confusing and sometimes law enforcement thinks they're there for other purposes besides what the RTF purpose is.

Tom Billington:

That's right.

Russ Woody:

Yeah. Seen it so many times where the law enforcement personnel that are attached to that RTF don't understand that they have made a promise to those individuals that, I'm with you. They are there with them throughout the event.

Travis Cox:

Yeah, exactly. Exactly. When I teach that section, I like to use my Top Gun rule. Never leave your wingman.

Russ Woody:

That's right.

Travis Cox:

Never leave your wingman. And the fire counterparts are your wingmen on that mission.

Bill Godfrey:

And before we dive into the meat of where Tom's going with this, which I think is really important and we have not talked about before on the podcast series, even though we've talked about RTFs, we haven't talked about where Tom's want to go with this, but I do want to just remind everybody who's listening, when Tom talked about the typical two and two, that's just a typical. There's no magic to those numbers, but here's what's important. There are people on the team that are responsible for security and they're up on their weapons platform. There's people on the team that are responsible for medical and they are carrying whatever medical gear that you're going to take in and you work together. And I think, Tom, where you were going that starts in staging before you deploy is the conversation to introduce yourselves and talk about what the expectations are and the rules. Because at the end of the day, so if Tom and I are the medical element of the RTF, our job is to take medical care of the patients, but you guys are responsible for moving us safely to where those patients are.

Tom Billington:

It's a hundred percent team effort. It's a hundred percent team effort. And law enforcement has to know the safest route to get to where you need to get to. And then once we get there, it's up to the medical side to start doing their triage and treatment.

Bill Godfrey:

Yeah, absolutely. And at the end of the day, your situation, your staffing, your community, your resources, the threat that you're facing is going to dictate the size of that team and who's on that team. And there may be some communities where the rescue task force is made up of all law enforcement personnel and that's fine, but you still have to divvy up the duties. Some of them have to be on security and some of them have to be on medical. And I just wanted to set that foundation before we go into talking about the CCP.

Tom Billington:

Absolutely. I've seen it where you just mentioned all law enforcement personnel. Sometimes some agencies have what we call TAC medics. So you have EMS-trained folks that are capable of filling that medical function when they go down range as the RTF.

Bill Godfrey:

Yeah, very good. So Tom, we're the first RTF. Let's just assume for this conversation that the four of us are RTF-1. We're the first ones down range, other than the contact team who's hopefully organized the casualty collection point or at least established the location, has got some security, has got that done. But we're the first ones that are going to punch through, so let's just kind of talk from that context. You guys are going to move us up, get us where we need to be. Tom, when we punch through the door, what's the first things on your mind?

Tom Billington:

Literal, earlier I took my app out of my phone, the Active Shooter Incident Management checklist, the app, C3 app. It tells you right here, once I'm stood up and I know who the team is and we're going down, one of the things I need to do is make sure tactical knows that I am deploying. I work for tactical, we are on a medical mission, so I need to make sure tactical knows where we're going and they agree with where we're going. And then once we get in there and we find the safe route, we have to know what are we going to do when we're in the room. Remember, if our makeup is two medical and two law enforcement, if that's our case, and we have seven or eight critical patients, are two medical personnel going to be able to handle this? No.So the first thing I want to do when I enter that room as an RTF is I'm going to take the lead, maybe might call it the capture collection point lead, CCP lead. I'm going to take the medical lead right off the bat and say, "Hey, I need more RTFs. I need them now. Let's not mess around." I'm going to call a triage and ask for what I need specifically. I'm not going to say, send me some more. I'm going to say, "Hey, I have three yellows, four reds, I need five more RTFs at this CCP." I get a response from triage. Yes, we copy that, we'll send it. Now my next job is I'm going to start my triage. That's where the law enforcement has already done a great job, hopefully. You want to talk about law enforcement triage a little bit.

Russ Woody:

On the law enforcement side, when we get there-

Bill Godfrey:

Russ, I'm going to bump into you there for just a second because I want to clarify what Tom was saying. He was saying earlier we need to notify tactical and I want to clarify those comments. So Tom and I, as the medical element, are on the radio with triage and the RTF team actually works for triage. What Tom was talking about with the tactical is, our security is on the radio with tactical.

Tom Billington:

Exactly.

Bill Godfrey:

And you need to let them know where you're moving when we get there, that's what Tom was addressing.

Russ Woody:

Absolutely.

Tom Billington:

Yeah. We kind of refer to the tactical position that air traffic controller, that person working tactical is going to give us the direction, the route where we need to get there. And then once we get there, we're going to get our medical personnel in that room and that CCP and then let them go to work.

Bill Godfrey:

And when we hit into the CCP and the numbers that Tom was talking about giving, we're going to give those numbers to-

Tom Billington:

Triage.

Bill Godfrey:

To the triage group supervisor. So just wanted to make that clarification. Russ, with that, talk a little bit about what we're hoping for law enforcement who've set up that CCP to done some triage ahead of time.

Russ Woody:

So hopefully the contact teams that we'll talk about in another podcast, I'm sure, have met some of the goals that are going to help us. And that is setting up that casualty collection point. And in doing that, they should have provided security for that casualty collection point. So they should be there providing that and we should be able to come in with our RTF and arrive safely. We have been guiding through and once we're there have that ability to then function as the lead in that room needs us to possibly for some time. But law enforcement, hopefully, has done some triage. We're only going to go red or green given that casualty count of those particular injuries and then started possibly some of the treatments that would be appropriate for law enforcement.

Bill Godfrey:

And of course, you mentioned the key there is we're not expecting law enforcement to go through and do full assessments. It's a click, red or green. If they're hurt and they follow your commands to get up and move to a particular location, that's a green. And if they didn't, that's a red. Done.

Russ Woody:

That simple.

Bill Godfrey:

Yeah, it really is that simple. So when we get in there, you mentioned, Tom, the importance of taking lead. And I want to visit on that for a minute. So you and I came up in a time, and I don't know, thank God we don't touch patients anymore really.

Tom Billington:

Yeah, I agree.

Bill Godfrey:

But we came up in a time where it was common for us to be the only medic that was covering an area that was covered for four or five ambulances. And so we ran into incidents on a regular basis where you were the only medic and you had essentially four, five, six patients you had to take care of. Maybe not a mass casualty in today's sense of mass casualties, but you had to provide multi-patient care. And over the last, I don't know, 20, maybe 30 years, 20 years, certainly, we have seen the number of paramedics in the field that are deployed really, really go up, which is a great thing. But the result of that is the frequency with which they need to manage multiple patients has really plummeted. And I think it's been a little bit of a lost skill, Tom.

Tom Billington:

The triage part has been a lost skill. Again, like Bill said, I've done triage in the field where I had to decide somebody's not going to survive. Now when you start getting a lot of paramedics in the room, they start looking at each other. So somebody has to take the lead and that should be that first RTF, a medical officer take the lead right off the bat. And a few things when you're taking the lead is, when I come in to the casualty collection point, I'm looking around. How did I come in here? What route did I take? What would be a good area, thinking ahead, where I might be able to set up an ambulance exchange point? Is there a closer door to my right that I didn't come in? Could that be a good ambulance exchange point? I'm thinking about that also. So now I'm thinking about my triage, thinking about a possible ambulance exchange point. I'm calling for more resources. Now, I'm going to start triaging the folks and start doing some treatment.

Bill Godfrey:

So-

Tom Billington:

Go ahead. Go ahead, Bill.

Bill Godfrey:

I was just going to say, tell me a little bit about why you want to think about the ambulance exchange point when you're coming through the door.

Tom Billington:

The ambulance exchange point is one of the areas that we know in our research, a lot of time is wasted. The clock is ticking and that is one area where we can save precious minutes. And since I am the first RTF in, I'm getting situational awareness of where I'm located in the facility. I have a good idea from walking in here, oh, I know that this might be a faster route. So that way I can work with law enforcement to get security set up for AEP, ambulance exchange point, rapidly, so we're not going to be waiting on that. We don't want to wait, we're fighting that clock continually. So always thinking ahead a couple of steps.

Russ Woody:

And we, as law enforcement, hopefully, will realize and talk with you on that and then pass that information on to tactical or the contact teams that are there on the ground with us and they will go and push out and establish that security at that AEP and hopefully maybe a corridor in between.

Travis Cox:

Yeah, I was going to say that's where that teamwork starts to come in as that RTF gets in that room and the medical treatment starts to happening. That's something that law enforcement can start working on is as you come up with a suggestion for where the AEP should or could go, we can provide that intel. Is that the safest route? Is it possible that we can secure that area? All those other factors that come in from a law enforcement perspective to make sure that we're working together to get the best possible location for the AEP.

Bill Godfrey:

Yeah. So let's talk about that for a second, Travis. On the law enforcement side, talk a little bit, the two of you, about what's involved in actually securing an AEP. Okay, so Tom and I go, "Hey, there's an exit door right there, it backs up to a parking lot. We'd like to use that as our AEP." What's involved in you guys actually making that ready so that we can get an ambulance moved up?

Travis Cox:

Well, I think one of the first things we have to consider from the law enforce side is what's the status of the suspect or the shooter? Is the suspect contained? Is the suspect down or is the suspect at large? Obviously, if the suspect's still at large and we don't know exactly where he or she may be, that's going to provide a lot more security elements or security questions that we have to take into consideration when we look at a AEP site bringing those patients outside. So I know, Russ, you've done a lot of that before. And once we take those patients outside, there's a lot of risk factors we have to take into consideration.

Russ Woody:

Absolutely. And it does. It's a resource drain if it's an area, and terrain will dictate if you have to push out quite a ways or if you can get on the edges of buildings and provide the security that's needed there. But certainly, it has to be done early because it won't take that Rescue Task Force long to get in and that first patient that they contact that is in real dire need and us fighting against that clock to now decide to move them out. And that's going to take some time to get that ambulance into the space and make sure we have it secured for them.

Bill Godfrey:

And I think that I wanted to highlight that, Tom, because I think it is one of the most consistent things that we see is that we forget about getting the ambulance loading area, what we call the AEP, the ambulance exchange point, and we call it the AEP instead of the transport loading zone because it requires security. It takes time to get that secured, that area, I don't want to use the word cleared, but to check that area and feel like that you guys have it under cover. And if we've waited until we're ready to transport and now we're doing that, we just pissed away 10 minutes.

Tom Billington:

Absolutely.

Travis Cox:

So if the shooter does go active, again, law enforcement already has a pre-planned situation or pre-planned idea of what they want to do, who's providing cover, who's going to address the threat, and then we can move forward from there. So those are things that we have to take into consideration on the law enforcement side, and communication is key that we're communicating what the plan is to our medical counterparts. So as we're moving those patients, they know what to expect if we get a shooter going active again.

Russ Woody:

And for the law enforcement on that AEP or on that scene, that immediate action plan could be as simple as, if there is a threat that starts again, the two of you are going to stay here and continue to secure this because we've made a promise that this is secure and we've got to keep to that to that Fire and EMS side and the patients we have there on scene. And then, okay, the other two or four that are in that scene, you'll be the ones that will go and go after that active threat.

Bill Godfrey:

I like it. Okay, so we're RTF-1, we've punched through the door, we've done an initial triage call quickly. We've identified an area that we think is good for an ambulance exchange point. We have handed that off to you guys as our security element. You're talking to tactical and working on getting that secured. It's time for you and I to go to, we called for the additional help, now it's time for you and I to go to work, pick it up from there.

Tom Billington:

And that's where our old fashioned triage from way back kicks right in. We have to decide, there's two of us right now using the triage method that we're using in whatever system we're in at that time, who's going to get treated first? What actions can we take immediately to help somebody sustain better? What other quick things can we do? But then we get down to the meat and bones and say, "All right, this person needs intervention now." And that's when we start doing some more advanced procedures. We don't want to go to town on the advanced procedures, folks. We want to get them in an ambulance, get them to a trauma center, but we can do some things that can keep that clock at bay. Some airway management, maybe portal decompressions or things like that.

Bill Godfrey:

Basic bleeding control, tension-pneumos, that kind of stuff that we need to deal with. The other thing that I want to mention, granted, it's a little bit of a pet peeve of mine, the most common triage system used by Fire and EMS across the country is the START triage system. And I hear people tell us on a regular basis, "What's your-" "Oh, we use START." Okay. And then you ask them a few questions and you realize, they've just told you that they use START and they have no idea what the flow chart is or what the criteria is for how to classify people as red, yellow, or green. And it leaves me going, "Okay, you say that you use START, but you don't, because you don't know what the criteria are. So what methodology are you using?" And before I move on from that, I do want to remind everybody that's listening, START has no scientific basis to it whatsoever. It was originally developed out on the west coast in response to training civilians who were going to be expected to do interventions in mass earthquakes. And somewhere along the line, we adopted it in the EMS system. And yet even though we say across the country, more than 50% of the people use START, I think I've had less than 2% of the EMTs and paramedics that I've asked that have been able to tell me what the criteria are. And so it's a huge gap. The other reality is, especially in a shooting, great, I use START, I used it correctly and now I have four reds, which one's the priority?

Russ Woody:

The judgment of what you feel has to happen and hopefully by then these other RTFs are showing up. And so that's when you can start saying, all right, this is my judgment. I can do the best for this person for their longevity to survive. And so that's how we do it. The other RTFs come in, and again, you're not off the hook when the other RTFs come in. You start assigning them immediately to the next patients that need to be treated. But also, remember, you got to talk to triage. Triage is your boss. Triage wants to know what's going on. Triage is saying to the RTFs, "Hey, how many reds do you have? How many greens do you have? How many yellows do you have? What's going on in there? What time is it?" All those things. So again, if you're the lead RTF, you have to think about that. You need to get the color codes of what you have to triage because they need to tell transportation for the ambulance counts. So we have to get that job done also. However, do not get hung up on colors. The triage colors will change. Some will go down, some will go up. We just want to get the best count out there as possible and get these folks out of there and get them into an ambulance as soon as possible.

Bill Godfrey:

Travis, you and Russ have both been coaches at the tactical position countless times where you're coaching tactical triage to transport. How many times have you seen triage and tactical get wrapped around the axle over the colors not matching what they were 10 minutes ago?

Travis Cox:

Oh, all the time. All the time. And you got to be cognizant of the fact that they are going to change and you just have to deal with it as it changes. So again, it's about beating the clock and reducing the clock as much as you can. Not so worried about the colors of the patients, but how quickly can you get the ambulance exchange points set up. How quickly can you get those patients on the move and get them to a trauma center.

Russ Woody:

Not only the color code, but also just the casualty count itself is going to vary as it goes along. Just because the contact teams gave you a count of 15, don't get hung up that we've only got 13 or 14 there. Where's the other? Or we must be missing-

Travis Cox:

Just get the resources there.

Tom Billington:

That's right.

Travis Cox:

Just get the resources.

Russ Woody:

Get the resources. And don't forget-

Tom Billington:

Because this comes up so much, I'm going to even stress it even further. I've had instances where the RTF is saying, "Hey, we're ready for an ambulance." And triage says, "Wait, how many yellows do you have?" No, we need to get these people to the hospital. So don't get wrapped up in that. And that's another discussion for triage and transport.

Travis Cox:

I think it comes down to trusting the people that you've sent down range. If whoever's in that room and is telling you what they need, if you're on the outside, you're triage or transported tactical, you got to trust the judgment of those responders inside the room because they have the best vantage point of what's going on and what's needed.

Bill Godfrey:

I need one more rig. So sometimes just in how we communicate, I think, can probably help that up. And I do want to highlight your point and make it loud and clear that first RTF through the door has got to provide the assignments for the other ones that are coming through, whether that's one more RTF, three more RTFs. If law enforcement sets up a cordon and we dump 15 medical people in there to do ... whoever's coming in, we need to tell them what we need done. "Hey, we've got three reds over there I haven't been able to get to. We're down to the reds. I need to know which one needs to go first." And to talk about that, I've got this kind of injury. I've got these kind of vitals, and have those conversations. So if it's maybe the second RTF coming through the door begins to help us finish up that assessment and that initial care, and then the third RTF coming through the door, they say, "Tom, what do you need? It's time to start moving people." Go ahead. Go ahead, Russ.

Russ Woody:

That's one of the things, too, you have to be careful of. I know you've seen it, Travis, I have. Be careful, that lead in that room is vitally important to not blurring lines between the casualty collection point and turning the AEP into a casualty collection point. We want to only move them out when it's time appropriate.

Travis Cox:

Good point.

Russ Woody:

So there's not going to be any delay getting them loaded for transport and moving them out. We don't want to take all of our 15 out and have them out there exposed to possible threats or elements. So that's one thing, again, that lead is vitally important.

Travis Cox:

Yeah, I was going to say another thing about that lead that's so critical, and we see it in training all the time. If someone does not take a lead role in that room, you see in training all the time, at least I've seen it in training all the time, that a patient may get reassessed two and three times over when they're ready to transport, but because no one's taking lead and there's no coordination within that room on the medical side, you're wasting time there just reassessing the same patient over and over when they're ready to be transported.

Bill Godfrey:

We didn't tag them. We didn't put a ribbon on them. We didn't mark them. We didn't. Yeah, that's a huge issue. And I also want to reinforce that because as medical guys, we're not typically trained in tactics. And you guys have heard me tell the story about how I learned what the X was. I had a patient that was down in the middle of a hallway that had exposure to about four rooms on each hallway. It was an X intersection. And I leaned over to start trying to take care of the patient and the guy I was with, it was my security goes, "No, no, no, no. We're going to move him." I go, "No, I need to take care of him." And I lost that argument and I got moved along with my patient into a room. And they're like, "You don't treat on the X." And I go, "What the hell's an X?" "Well, that was where that guy was standing when he got shot, and that's a bad place to be."

And then afterwards, they took me out to the hallway and said, "Look at all these exposures." And I think what you're saying is critical. The AEP is a safe location. The CCP is a safe location, but if you take all of your patients out of the CCP and expose them to being laying on the sidewalk, you've taken them from a less secure place, which is an interior, believe it or not, everybody's always in a hurry to get out. You're safer on the inside with security posted than you are exposed to all those elements on the outside. And so on the medical side, we have to remember not to move them until we're ready. There's either an ambulance there or an ambulance that's immediately on the way. Move those out, which requires coordination for us among the RTFs to say, "This one's going next." We should be stacking them by the door. This red, this yellow, this green are going to go next. Whatever the numbers are going to be to try to balance our load. And so our natural tendency is to try to get everybody outside, but that goes against-

Travis Cox:

Yeah. We're more secure inside and we can secure the place better inside. So we want that rescue unit or that ambulance either en route or on station before we start to move. Obviously, depending on how far the room is from the AEP, that's going to dictate that. But we definitely don't want that ambulance just sitting there, nor do we want patients sitting outside waiting on the ambulance. So it's a timing thing.

Russ Woody:

Perfect world, the ambulance would stop rolling at the same time that the patient got to the back of the ambulance.

Tom Billington:

Classic touch and go.

Russ Woody:

Perfect.

Bill Godfrey:

I think, you know what, that's a really good way to kind of talk about and illustrate that. And I think as we are coming up on the end of our time here, I think as we wrap this up, the big thing to just kind of reinforce is underlying is that first RTF has a lot more responsibility than just medical care for the patients they encounter. They've got to take a leadership role. And if you happen to be a medic and a company officer, great. And if you're not, suck it up, buttercup. You're the first one through the door. And oh, by the way, it doesn't have to be a medic. EMTs, I've seen EMTs do magic.

Russ Woody:

Oh, yes.

Tom Billington:

And again, we have our handy dandy right here on my phone, Incident Management Checklist. It tells me, as the RTF, everything we just talked about. So if you start getting behind, pull that checklist out. What did I forget? What can I follow up on? It tells you all these points. Stick to them to get that clock from ticking too fast.

Travis Cox:

And then for my law enforcement friends, when we get in there, they're part of that contact team. There's a lot we can do before that RTF gets there. So as much as we can do, we've evolved as responders, we're carrying tourniquets. Some of us are carrying medical kits, so at least minimum we can triage the room from red to greens. And so we can give some information to the medics when they do get there, and that'll speed up the process to help speed up the clock.

Russ Woody:

Have that security in place, come up with your immediate action plan and start providing medical if you can.

Travis Cox:

Saving lives is everybody's job, not just medicals.

Russ Woody:

It is.

Bill Godfrey:

It is. And Russ, I think your point is well taken. Don't forget to post your security. If you've got a contact team of three or four, you can't all do medical. It's kind of like an RTF. You're splitting your function a little bit, but don't forget where you are. So well, let's talk about any closing thoughts. Anybody have, anything else they want to add?

Tom Billington:

Sometimes I just wish we could take a big stopwatch and put it around the neck of the person who's the first RTF, because you can save lives with time if you do things correctly. Follow that checklist, make sure the AEP is getting set up, make sure you're getting triage done and make sure you have resources coming in to help you. You can save lives just by that timing. So it's very important and it's an important issue to discuss.

Russ Woody:

Absolutely. To Tom's point, we can do certain medical treatments as law enforcement and the medical personnel on scene can do certain things too, but there's some things that can only be cured in an operating room. So moving them off that point and getting them there is key.

Travis Cox:

I'll say this because over half of my law enforcement career, I've been in a training role and you have to train this. You can't wait to disaster day to throw together RTF for the first time. So I would encourage all those agencies out there, whether it's on special events, on smaller incidents, but you got to put RTFs together, get law enforcement and Fire and EMS comfortable with working together, comfortable with trusting each other's judgment. And then when disaster day does hit, you'll be ready to go.

Bill Godfrey:

Yeah, Travis, I completely agree with you. We talk about how we work together all the time on calls and we do, but there's a difference between being on the same call and being integrated into each other's teams. And what we're talking about with a Rescue Task Force is the equivalent of you guys being with Tom and I when we roll up on a structure fire and we're like, "Okay, throw this pack on, grab the hose line and come right in behind us, it'll be fine. It'll be fine. Trust us." So if we don't practice that ahead of time and we don't work on that, it's going to lead to some challenges.

Tom Billington:

Yeah, training is key. Training is so vital to making that concept work, RTFs.

Bill Godfrey:

Gentlemen, thank you so much. It's exciting to be back at it again. I'm certainly glad that we're back doing podcasts again. Thank you for coming in and doing this. And to the audience, thank you for being patient with us as we've negotiated this last year of mass changing and we've tripled the number of deliveries we're doing across the country, which is super exciting. We're doing the Active Shooter Incident Management Advanced Class pretty much every week somewhere in this country, which is fantastic. But it brought with it's some growing pains, and so we fell off the wagon a little bit. But now that we've got our studios set up and we'll get some rotations done and get caught up on podcasts, I'm looking forward to being back on the regular.

Travis Cox:

Absolutely. We got big things on the horizon. We hope you guys are following us on social media and keeping your eye on us, and hopefully, we'll see you in a training class soon.

Bill Godfrey:

Ladies and gentlemen, thank you for joining us. And until next time, stay safe.

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Bill Godfrey:

Welcome to the Active Shooter Incident Management Podcast. My name is Bill Godfrey, your podcast host. I am joined today by three of our wonderful C3 Pathways instructors. On my right here is Tom Billington, one of our Fire/EMS instructors. Welcome, Tom.

Tom Billington:

Good to be back.

Bill Godfrey:

It is good to have you back. Been a minute, that's for sure. We're also joined across the table from us. Russ Woody, one of our law enforcement instructors. Russ, welcome from North Carolina.

Russ Woody:

Yeah, glad to be down, Bill.

Bill Godfrey:

Good to have you here. And then we've got Travis Cox, also one of our law enforcement instructors and our training director. Travis, it's good to have you here in the studio.

Travis Cox:

Hey, it's good to be here. Good to see you guys again.

Bill Godfrey:

It's exciting. It has been a minute. It feels good to be back doing podcasts again. And of course, we've upped the game a little bit. I looked, it was September of last year that we did our last podcast, so we're just shy of a year being off the air. Can you believe that?

Travis Cox:

Yeah. It didn't seem that long, but time flies as they say.

Russ Woody:

It really does.

Bill Godfrey:

It sure does. It sure does. And everybody's due an explanation about why that is. And the truth of the matter is, there has been a lot of changes, all good stuff, but a lot of changes over the last year and it just became difficult to keep up with. You may or may not notice if you have heard the podcast before, we are also videotaping our podcasts now, as well. They're going to be up on our YouTube channel and we're here in our brand new studio.

Travis Cox:

And it's amazing.

Russ Woody:

Yeah, it looks great. Really does.

Bill Godfrey:

It is so exciting to be here. But we've also moved, we are no longer in the building we were in before. We've moved to a new location. We've got new offices set up, new space. We've got a dedicated studio set up and we're getting ready to open a dedicated training center. Granted it fell a little bit behind schedule, some construction delays. It just seems like you can't keep construction on schedule no matter what you do. But that's going to get cleared up and we're going to have this beautiful training center opened up here I think pretty soon.

Russ Woody:

As you know, Bill, when I got here, I started taking pictures. I've been sending pictures to all my friends about how this facility looks, how professional it is, and a lot of people were saying, wow, that's quite an improvement. So it's come a long way.

Travis Cox:

Definitely. Definitely. When I first saw it, it wasn't what I expected, but when I saw it I said, "Oh man, this is the first class all the way." So excited to be here and looking forward to what we're going to be doing in the future.

Russ Woody:

Very much same. It really didn't surprise me. It seems like everything that Bill does, really puts forward every effort and it is a great facility.

Bill Godfrey:

Well, those are gracious words, Russ, but this is a team effort and there's a lot of people involved in doing this from picking out all the stuff. Our producer, Karla, who's behind the scenes, she and a couple of the other people picked out a lot of the carpet and the finishings and the colors and it's just really nice to have a place that we can call our own and do some dedicated training in. And with any luck, we'll get the construction back on schedule and we'll get caught up here pretty soon. So anyways, it's exciting to be back. Let's get into the meat of it. We decided to talk today about rescue task forces and some of the common challenges that we see with RTFs, being a little bit confused about what the expectations are, what they're supposed to be doing, that kind of stuff. So Tom, this was one that you kind of threw out as a suggestion and we were all like, yes, that's a great topic. So why don't you talk a little bit about what was on your mind and what you're thinking.

Tom Billington:

Well, Bill, when we teach a class, we usually don't have enough time to go into all the exact details, but the RTF is such an important part. The Rescue Task Force, and first of all, just talking about what it is the Rescue Task Force is, it's usually a group of four people. So usually two Fire/EMS and two law enforcement working together as a team to go into the casualty collection point and start doing the treatment and get things sorted out. But we've never really talked about how do you do that? Why do you need more than one RTF? What is your goal when you get there? How do you organize things? And I think that's just a good place I wanted to start. But definitely, I think the important part is how are we formed and why are we formed this way, I think is the important part. I may be in a situation where I'm working with law enforcement officers I may have never met if I'm in a large organization. So I want to make sure that I know what's expected of me as the medical person and what I expect of the law enforcement person as far as the medical roles go. So I think that's just some of the things I wanted to cover.

Bill Godfrey:

Yeah, I think that's exciting.

Travis Cox:

It is really important for law enforcement to know what their mission is and what the responsibilities are on RTF because sometimes that can get confusing and sometimes law enforcement thinks they're there for other purposes besides what the RTF purpose is.

Tom Billington:

That's right.

Russ Woody:

Yeah. Seen it so many times where the law enforcement personnel that are attached to that RTF don't understand that they have made a promise to those individuals that, I'm with you. They are there with them throughout the event.

Travis Cox:

Yeah, exactly. Exactly. When I teach that section, I like to use my Top Gun rule. Never leave your wingman.

Russ Woody:

That's right.

Travis Cox:

Never leave your wingman. And the fire counterparts are your wingmen on that mission.

Bill Godfrey:

And before we dive into the meat of where Tom's going with this, which I think is really important and we have not talked about before on the podcast series, even though we've talked about RTFs, we haven't talked about where Tom's want to go with this, but I do want to just remind everybody who's listening, when Tom talked about the typical two and two, that's just a typical. There's no magic to those numbers, but here's what's important. There are people on the team that are responsible for security and they're up on their weapons platform. There's people on the team that are responsible for medical and they are carrying whatever medical gear that you're going to take in and you work together. And I think, Tom, where you were going that starts in staging before you deploy is the conversation to introduce yourselves and talk about what the expectations are and the rules. Because at the end of the day, so if Tom and I are the medical element of the RTF, our job is to take medical care of the patients, but you guys are responsible for moving us safely to where those patients are.

Tom Billington:

It's a hundred percent team effort. It's a hundred percent team effort. And law enforcement has to know the safest route to get to where you need to get to. And then once we get there, it's up to the medical side to start doing their triage and treatment.

Bill Godfrey:

Yeah, absolutely. And at the end of the day, your situation, your staffing, your community, your resources, the threat that you're facing is going to dictate the size of that team and who's on that team. And there may be some communities where the rescue task force is made up of all law enforcement personnel and that's fine, but you still have to divvy up the duties. Some of them have to be on security and some of them have to be on medical. And I just wanted to set that foundation before we go into talking about the CCP.

Tom Billington:

Absolutely. I've seen it where you just mentioned all law enforcement personnel. Sometimes some agencies have what we call TAC medics. So you have EMS-trained folks that are capable of filling that medical function when they go down range as the RTF.

Bill Godfrey:

Yeah, very good. So Tom, we're the first RTF. Let's just assume for this conversation that the four of us are RTF-1. We're the first ones down range, other than the contact team who's hopefully organized the casualty collection point or at least established the location, has got some security, has got that done. But we're the first ones that are going to punch through, so let's just kind of talk from that context. You guys are going to move us up, get us where we need to be. Tom, when we punch through the door, what's the first things on your mind?

Tom Billington:

Literal, earlier I took my app out of my phone, the Active Shooter Incident Management checklist, the app, C3 app. It tells you right here, once I'm stood up and I know who the team is and we're going down, one of the things I need to do is make sure tactical knows that I am deploying. I work for tactical, we are on a medical mission, so I need to make sure tactical knows where we're going and they agree with where we're going. And then once we get in there and we find the safe route, we have to know what are we going to do when we're in the room. Remember, if our makeup is two medical and two law enforcement, if that's our case, and we have seven or eight critical patients, are two medical personnel going to be able to handle this? No.So the first thing I want to do when I enter that room as an RTF is I'm going to take the lead, maybe might call it the capture collection point lead, CCP lead. I'm going to take the medical lead right off the bat and say, "Hey, I need more RTFs. I need them now. Let's not mess around." I'm going to call a triage and ask for what I need specifically. I'm not going to say, send me some more. I'm going to say, "Hey, I have three yellows, four reds, I need five more RTFs at this CCP." I get a response from triage. Yes, we copy that, we'll send it. Now my next job is I'm going to start my triage. That's where the law enforcement has already done a great job, hopefully. You want to talk about law enforcement triage a little bit.

Russ Woody:

On the law enforcement side, when we get there-

Bill Godfrey:

Russ, I'm going to bump into you there for just a second because I want to clarify what Tom was saying. He was saying earlier we need to notify tactical and I want to clarify those comments. So Tom and I, as the medical element, are on the radio with triage and the RTF team actually works for triage. What Tom was talking about with the tactical is, our security is on the radio with tactical.

Tom Billington:

Exactly.

Bill Godfrey:

And you need to let them know where you're moving when we get there, that's what Tom was addressing.

Russ Woody:

Absolutely.

Tom Billington:

Yeah. We kind of refer to the tactical position that air traffic controller, that person working tactical is going to give us the direction, the route where we need to get there. And then once we get there, we're going to get our medical personnel in that room and that CCP and then let them go to work.

Bill Godfrey:

And when we hit into the CCP and the numbers that Tom was talking about giving, we're going to give those numbers to-

Tom Billington:

Triage.

Bill Godfrey:

To the triage group supervisor. So just wanted to make that clarification. Russ, with that, talk a little bit about what we're hoping for law enforcement who've set up that CCP to done some triage ahead of time.

Russ Woody:

So hopefully the contact teams that we'll talk about in another podcast, I'm sure, have met some of the goals that are going to help us. And that is setting up that casualty collection point. And in doing that, they should have provided security for that casualty collection point. So they should be there providing that and we should be able to come in with our RTF and arrive safely. We have been guiding through and once we're there have that ability to then function as the lead in that room needs us to possibly for some time. But law enforcement, hopefully, has done some triage. We're only going to go red or green given that casualty count of those particular injuries and then started possibly some of the treatments that would be appropriate for law enforcement.

Bill Godfrey:

And of course, you mentioned the key there is we're not expecting law enforcement to go through and do full assessments. It's a click, red or green. If they're hurt and they follow your commands to get up and move to a particular location, that's a green. And if they didn't, that's a red. Done.

Russ Woody:

That simple.

Bill Godfrey:

Yeah, it really is that simple. So when we get in there, you mentioned, Tom, the importance of taking lead. And I want to visit on that for a minute. So you and I came up in a time, and I don't know, thank God we don't touch patients anymore really.

Tom Billington:

Yeah, I agree.

Bill Godfrey:

But we came up in a time where it was common for us to be the only medic that was covering an area that was covered for four or five ambulances. And so we ran into incidents on a regular basis where you were the only medic and you had essentially four, five, six patients you had to take care of. Maybe not a mass casualty in today's sense of mass casualties, but you had to provide multi-patient care. And over the last, I don't know, 20, maybe 30 years, 20 years, certainly, we have seen the number of paramedics in the field that are deployed really, really go up, which is a great thing. But the result of that is the frequency with which they need to manage multiple patients has really plummeted. And I think it's been a little bit of a lost skill, Tom.

Tom Billington:

The triage part has been a lost skill. Again, like Bill said, I've done triage in the field where I had to decide somebody's not going to survive. Now when you start getting a lot of paramedics in the room, they start looking at each other. So somebody has to take the lead and that should be that first RTF, a medical officer take the lead right off the bat. And a few things when you're taking the lead is, when I come in to the casualty collection point, I'm looking around. How did I come in here? What route did I take? What would be a good area, thinking ahead, where I might be able to set up an ambulance exchange point? Is there a closer door to my right that I didn't come in? Could that be a good ambulance exchange point? I'm thinking about that also. So now I'm thinking about my triage, thinking about a possible ambulance exchange point. I'm calling for more resources. Now, I'm going to start triaging the folks and start doing some treatment.

Bill Godfrey:

So-

Tom Billington:

Go ahead. Go ahead, Bill.

Bill Godfrey:

I was just going to say, tell me a little bit about why you want to think about the ambulance exchange point when you're coming through the door.

Tom Billington:

The ambulance exchange point is one of the areas that we know in our research, a lot of time is wasted. The clock is ticking and that is one area where we can save precious minutes. And since I am the first RTF in, I'm getting situational awareness of where I'm located in the facility. I have a good idea from walking in here, oh, I know that this might be a faster route. So that way I can work with law enforcement to get security set up for AEP, ambulance exchange point, rapidly, so we're not going to be waiting on that. We don't want to wait, we're fighting that clock continually. So always thinking ahead a couple of steps.

Russ Woody:

And we, as law enforcement, hopefully, will realize and talk with you on that and then pass that information on to tactical or the contact teams that are there on the ground with us and they will go and push out and establish that security at that AEP and hopefully maybe a corridor in between.

Travis Cox:

Yeah, I was going to say that's where that teamwork starts to come in as that RTF gets in that room and the medical treatment starts to happening. That's something that law enforcement can start working on is as you come up with a suggestion for where the AEP should or could go, we can provide that intel. Is that the safest route? Is it possible that we can secure that area? All those other factors that come in from a law enforcement perspective to make sure that we're working together to get the best possible location for the AEP.

Bill Godfrey:

Yeah. So let's talk about that for a second, Travis. On the law enforcement side, talk a little bit, the two of you, about what's involved in actually securing an AEP. Okay, so Tom and I go, "Hey, there's an exit door right there, it backs up to a parking lot. We'd like to use that as our AEP." What's involved in you guys actually making that ready so that we can get an ambulance moved up?

Travis Cox:

Well, I think one of the first things we have to consider from the law enforce side is what's the status of the suspect or the shooter? Is the suspect contained? Is the suspect down or is the suspect at large? Obviously, if the suspect's still at large and we don't know exactly where he or she may be, that's going to provide a lot more security elements or security questions that we have to take into consideration when we look at a AEP site bringing those patients outside. So I know, Russ, you've done a lot of that before. And once we take those patients outside, there's a lot of risk factors we have to take into consideration.

Russ Woody:

Absolutely. And it does. It's a resource drain if it's an area, and terrain will dictate if you have to push out quite a ways or if you can get on the edges of buildings and provide the security that's needed there. But certainly, it has to be done early because it won't take that Rescue Task Force long to get in and that first patient that they contact that is in real dire need and us fighting against that clock to now decide to move them out. And that's going to take some time to get that ambulance into the space and make sure we have it secured for them.

Bill Godfrey:

And I think that I wanted to highlight that, Tom, because I think it is one of the most consistent things that we see is that we forget about getting the ambulance loading area, what we call the AEP, the ambulance exchange point, and we call it the AEP instead of the transport loading zone because it requires security. It takes time to get that secured, that area, I don't want to use the word cleared, but to check that area and feel like that you guys have it under cover. And if we've waited until we're ready to transport and now we're doing that, we just pissed away 10 minutes.

Tom Billington:

Absolutely.

Travis Cox:

So if the shooter does go active, again, law enforcement already has a pre-planned situation or pre-planned idea of what they want to do, who's providing cover, who's going to address the threat, and then we can move forward from there. So those are things that we have to take into consideration on the law enforcement side, and communication is key that we're communicating what the plan is to our medical counterparts. So as we're moving those patients, they know what to expect if we get a shooter going active again.

Russ Woody:

And for the law enforcement on that AEP or on that scene, that immediate action plan could be as simple as, if there is a threat that starts again, the two of you are going to stay here and continue to secure this because we've made a promise that this is secure and we've got to keep to that to that Fire and EMS side and the patients we have there on scene. And then, okay, the other two or four that are in that scene, you'll be the ones that will go and go after that active threat.

Bill Godfrey:

I like it. Okay, so we're RTF-1, we've punched through the door, we've done an initial triage call quickly. We've identified an area that we think is good for an ambulance exchange point. We have handed that off to you guys as our security element. You're talking to tactical and working on getting that secured. It's time for you and I to go to, we called for the additional help, now it's time for you and I to go to work, pick it up from there.

Tom Billington:

And that's where our old fashioned triage from way back kicks right in. We have to decide, there's two of us right now using the triage method that we're using in whatever system we're in at that time, who's going to get treated first? What actions can we take immediately to help somebody sustain better? What other quick things can we do? But then we get down to the meat and bones and say, "All right, this person needs intervention now." And that's when we start doing some more advanced procedures. We don't want to go to town on the advanced procedures, folks. We want to get them in an ambulance, get them to a trauma center, but we can do some things that can keep that clock at bay. Some airway management, maybe portal decompressions or things like that.

Bill Godfrey:

Basic bleeding control, tension-pneumos, that kind of stuff that we need to deal with. The other thing that I want to mention, granted, it's a little bit of a pet peeve of mine, the most common triage system used by Fire and EMS across the country is the START triage system. And I hear people tell us on a regular basis, "What's your-" "Oh, we use START." Okay. And then you ask them a few questions and you realize, they've just told you that they use START and they have no idea what the flow chart is or what the criteria is for how to classify people as red, yellow, or green. And it leaves me going, "Okay, you say that you use START, but you don't, because you don't know what the criteria are. So what methodology are you using?" And before I move on from that, I do want to remind everybody that's listening, START has no scientific basis to it whatsoever. It was originally developed out on the west coast in response to training civilians who were going to be expected to do interventions in mass earthquakes. And somewhere along the line, we adopted it in the EMS system. And yet even though we say across the country, more than 50% of the people use START, I think I've had less than 2% of the EMTs and paramedics that I've asked that have been able to tell me what the criteria are. And so it's a huge gap. The other reality is, especially in a shooting, great, I use START, I used it correctly and now I have four reds, which one's the priority?

Russ Woody:

The judgment of what you feel has to happen and hopefully by then these other RTFs are showing up. And so that's when you can start saying, all right, this is my judgment. I can do the best for this person for their longevity to survive. And so that's how we do it. The other RTFs come in, and again, you're not off the hook when the other RTFs come in. You start assigning them immediately to the next patients that need to be treated. But also, remember, you got to talk to triage. Triage is your boss. Triage wants to know what's going on. Triage is saying to the RTFs, "Hey, how many reds do you have? How many greens do you have? How many yellows do you have? What's going on in there? What time is it?" All those things. So again, if you're the lead RTF, you have to think about that. You need to get the color codes of what you have to triage because they need to tell transportation for the ambulance counts. So we have to get that job done also. However, do not get hung up on colors. The triage colors will change. Some will go down, some will go up. We just want to get the best count out there as possible and get these folks out of there and get them into an ambulance as soon as possible.

Bill Godfrey:

Travis, you and Russ have both been coaches at the tactical position countless times where you're coaching tactical triage to transport. How many times have you seen triage and tactical get wrapped around the axle over the colors not matching what they were 10 minutes ago?

Travis Cox:

Oh, all the time. All the time. And you got to be cognizant of the fact that they are going to change and you just have to deal with it as it changes. So again, it's about beating the clock and reducing the clock as much as you can. Not so worried about the colors of the patients, but how quickly can you get the ambulance exchange points set up. How quickly can you get those patients on the move and get them to a trauma center.

Russ Woody:

Not only the color code, but also just the casualty count itself is going to vary as it goes along. Just because the contact teams gave you a count of 15, don't get hung up that we've only got 13 or 14 there. Where's the other? Or we must be missing-

Travis Cox:

Just get the resources there.

Tom Billington:

That's right.

Travis Cox:

Just get the resources.

Russ Woody:

Get the resources. And don't forget-

Tom Billington:

Because this comes up so much, I'm going to even stress it even further. I've had instances where the RTF is saying, "Hey, we're ready for an ambulance." And triage says, "Wait, how many yellows do you have?" No, we need to get these people to the hospital. So don't get wrapped up in that. And that's another discussion for triage and transport.

Travis Cox:

I think it comes down to trusting the people that you've sent down range. If whoever's in that room and is telling you what they need, if you're on the outside, you're triage or transported tactical, you got to trust the judgment of those responders inside the room because they have the best vantage point of what's going on and what's needed.

Bill Godfrey:

I need one more rig. So sometimes just in how we communicate, I think, can probably help that up. And I do want to highlight your point and make it loud and clear that first RTF through the door has got to provide the assignments for the other ones that are coming through, whether that's one more RTF, three more RTFs. If law enforcement sets up a cordon and we dump 15 medical people in there to do ... whoever's coming in, we need to tell them what we need done. "Hey, we've got three reds over there I haven't been able to get to. We're down to the reds. I need to know which one needs to go first." And to talk about that, I've got this kind of injury. I've got these kind of vitals, and have those conversations. So if it's maybe the second RTF coming through the door begins to help us finish up that assessment and that initial care, and then the third RTF coming through the door, they say, "Tom, what do you need? It's time to start moving people." Go ahead. Go ahead, Russ.

Russ Woody:

That's one of the things, too, you have to be careful of. I know you've seen it, Travis, I have. Be careful, that lead in that room is vitally important to not blurring lines between the casualty collection point and turning the AEP into a casualty collection point. We want to only move them out when it's time appropriate.

Travis Cox:

Good point.

Russ Woody:

So there's not going to be any delay getting them loaded for transport and moving them out. We don't want to take all of our 15 out and have them out there exposed to possible threats or elements. So that's one thing, again, that lead is vitally important.

Travis Cox:

Yeah, I was going to say another thing about that lead that's so critical, and we see it in training all the time. If someone does not take a lead role in that room, you see in training all the time, at least I've seen it in training all the time, that a patient may get reassessed two and three times over when they're ready to transport, but because no one's taking lead and there's no coordination within that room on the medical side, you're wasting time there just reassessing the same patient over and over when they're ready to be transported.

Bill Godfrey:

We didn't tag them. We didn't put a ribbon on them. We didn't mark them. We didn't. Yeah, that's a huge issue. And I also want to reinforce that because as medical guys, we're not typically trained in tactics. And you guys have heard me tell the story about how I learned what the X was. I had a patient that was down in the middle of a hallway that had exposure to about four rooms on each hallway. It was an X intersection. And I leaned over to start trying to take care of the patient and the guy I was with, it was my security goes, "No, no, no, no. We're going to move him." I go, "No, I need to take care of him." And I lost that argument and I got moved along with my patient into a room. And they're like, "You don't treat on the X." And I go, "What the hell's an X?" "Well, that was where that guy was standing when he got shot, and that's a bad place to be."

And then afterwards, they took me out to the hallway and said, "Look at all these exposures." And I think what you're saying is critical. The AEP is a safe location. The CCP is a safe location, but if you take all of your patients out of the CCP and expose them to being laying on the sidewalk, you've taken them from a less secure place, which is an interior, believe it or not, everybody's always in a hurry to get out. You're safer on the inside with security posted than you are exposed to all those elements on the outside. And so on the medical side, we have to remember not to move them until we're ready. There's either an ambulance there or an ambulance that's immediately on the way. Move those out, which requires coordination for us among the RTFs to say, "This one's going next." We should be stacking them by the door. This red, this yellow, this green are going to go next. Whatever the numbers are going to be to try to balance our load. And so our natural tendency is to try to get everybody outside, but that goes against-

Travis Cox:

Yeah. We're more secure inside and we can secure the place better inside. So we want that rescue unit or that ambulance either en route or on station before we start to move. Obviously, depending on how far the room is from the AEP, that's going to dictate that. But we definitely don't want that ambulance just sitting there, nor do we want patients sitting outside waiting on the ambulance. So it's a timing thing.

Russ Woody:

Perfect world, the ambulance would stop rolling at the same time that the patient got to the back of the ambulance.

Tom Billington:

Classic touch and go.

Russ Woody:

Perfect.

Bill Godfrey:

I think, you know what, that's a really good way to kind of talk about and illustrate that. And I think as we are coming up on the end of our time here, I think as we wrap this up, the big thing to just kind of reinforce is underlying is that first RTF has a lot more responsibility than just medical care for the patients they encounter. They've got to take a leadership role. And if you happen to be a medic and a company officer, great. And if you're not, suck it up, buttercup. You're the first one through the door. And oh, by the way, it doesn't have to be a medic. EMTs, I've seen EMTs do magic.

Russ Woody:

Oh, yes.

Tom Billington:

And again, we have our handy dandy right here on my phone, Incident Management Checklist. It tells me, as the RTF, everything we just talked about. So if you start getting behind, pull that checklist out. What did I forget? What can I follow up on? It tells you all these points. Stick to them to get that clock from ticking too fast.

Travis Cox:

And then for my law enforcement friends, when we get in there, they're part of that contact team. There's a lot we can do before that RTF gets there. So as much as we can do, we've evolved as responders, we're carrying tourniquets. Some of us are carrying medical kits, so at least minimum we can triage the room from red to greens. And so we can give some information to the medics when they do get there, and that'll speed up the process to help speed up the clock.

Russ Woody:

Have that security in place, come up with your immediate action plan and start providing medical if you can.

Travis Cox:

Saving lives is everybody's job, not just medicals.

Russ Woody:

It is.

Bill Godfrey:

It is. And Russ, I think your point is well taken. Don't forget to post your security. If you've got a contact team of three or four, you can't all do medical. It's kind of like an RTF. You're splitting your function a little bit, but don't forget where you are. So well, let's talk about any closing thoughts. Anybody have, anything else they want to add?

Tom Billington:

Sometimes I just wish we could take a big stopwatch and put it around the neck of the person who's the first RTF, because you can save lives with time if you do things correctly. Follow that checklist, make sure the AEP is getting set up, make sure you're getting triage done and make sure you have resources coming in to help you. You can save lives just by that timing. So it's very important and it's an important issue to discuss.

Russ Woody:

Absolutely. To Tom's point, we can do certain medical treatments as law enforcement and the medical personnel on scene can do certain things too, but there's some things that can only be cured in an operating room. So moving them off that point and getting them there is key.

Travis Cox:

I'll say this because over half of my law enforcement career, I've been in a training role and you have to train this. You can't wait to disaster day to throw together RTF for the first time. So I would encourage all those agencies out there, whether it's on special events, on smaller incidents, but you got to put RTFs together, get law enforcement and Fire and EMS comfortable with working together, comfortable with trusting each other's judgment. And then when disaster day does hit, you'll be ready to go.

Bill Godfrey:

Yeah, Travis, I completely agree with you. We talk about how we work together all the time on calls and we do, but there's a difference between being on the same call and being integrated into each other's teams. And what we're talking about with a Rescue Task Force is the equivalent of you guys being with Tom and I when we roll up on a structure fire and we're like, "Okay, throw this pack on, grab the hose line and come right in behind us, it'll be fine. It'll be fine. Trust us." So if we don't practice that ahead of time and we don't work on that, it's going to lead to some challenges.

Tom Billington:

Yeah, training is key. Training is so vital to making that concept work, RTFs.

Bill Godfrey:

Gentlemen, thank you so much. It's exciting to be back at it again. I'm certainly glad that we're back doing podcasts again. Thank you for coming in and doing this. And to the audience, thank you for being patient with us as we've negotiated this last year of mass changing and we've tripled the number of deliveries we're doing across the country, which is super exciting. We're doing the Active Shooter Incident Management Advanced Class pretty much every week somewhere in this country, which is fantastic. But it brought with it's some growing pains, and so we fell off the wagon a little bit. But now that we've got our studios set up and we'll get some rotations done and get caught up on podcasts, I'm looking forward to being back on the regular.

Travis Cox:

Absolutely. We got big things on the horizon. We hope you guys are following us on social media and keeping your eye on us, and hopefully, we'll see you in a training class soon.

Bill Godfrey:

Ladies and gentlemen, thank you for joining us. And until next time, stay safe.

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