Every Second Counts: Gordon Center Active Shooter Training

There were 656 mass shootings in the United States last year, per Gun Violence Archive’s definition of an incident during which four or more people, excluding the shooter, are shot or killed with a firearm.

That alarming number leads to a question about a number that cannot be known. How many of the thousands of people who have died in mass shootings would be alive if they received medical attention sooner?

That question informs the work of Al Brotons, director of training operations at the University of Miami Miller School of Medicine’s Gordon Center for Simulation and Innovation in Medical Education. Brotons and Vincent Torres, UHealth—University of Miami Health System and Miller School emergency management director and associate director of disaster management for the Global Institute for Community Health and Development, who’s also as a law enforcement officer, don’t know the precise number. But they do know it can and should be smaller.

“Every second counts,” Torres said. “Every single second counts.”

Focus on Medical Attention for Victims

The Gordon Center recently opened Florida’s first regional training hub in Tallahassee to provide its innovative, collaborative active shooter response training to law enforcement. Supported by funding from the Florida Department of Education, the curriculum enhances traditional active shooting response to include basic medical training for the law enforcement officers who try to subdue to shooter.

“It’s not just the paramedics doing medicine,” said Torres. “It’s also the cops doing medicine, too. Cops putting on tourniquets. Cops putting on chest seals.”

Those measures can mean the difference between injury and death for shooting victims.

“It’s all about time,” Brotons said. “A person is going to bleed out within three to five minutes if we don’t get a tourniquet on them.”

The Gordon Center curriculum has benefitted from the U.S. Army Trauma Training Detachment’s expertise and input, which conducts its pre-deployment Army Forward Surgical Teams training at the Miami facility.

“They’re teaching these teams how to work in the battlefield, literally from point-of-care injuries to surgery,” Brotons said. “We brought them in to help us create this course, because who knows better than they do?”

The Sword and the Shield

Going all the way back to Columbine in 1999, active shooter response training advocated for medical personnel waiting for police or SWAT teams to secure the shooting environment, known as the hot zone.

The approach has changed over the years and the Gordon Center curriculum now prepares medical personnel to enter areas where the shooter is known to be absent (the warm zone) alongside law enforcement. This change translates to quicker, potentially lifesaving treatment for victims in safer locations.

“We define this as a rescue task force,” Brotons said. “Law enforcement officers and medics go in together, as a team.”

Torres calls it the sword and shield concept. Officers serve as a protective shield for paramedics and firefighters in the warm zone, enabling quick treatment before receiving safe escort to a casualty collection point. At the same time, a law enforcement contact team—the sword—patrols the hot zone in search of the shooter. If the shooter enters the warm zone, the rescue task force officers can engage and stop the threat.

Coordinating that action isn’t simple. The entities that typically respond to active shooter situations—police, fire departments and emergency medical teams—are distinct organizations operating under separate chains of command and organizational procedures.

This new training approach has to get people in different departments following different sets of orders on the same page. It has to create one cohesive team under a unified command.

Brotons and Torres use classroom time and detailed simulations to develop the trust and communication the curriculum demands.

“We put a law enforcement officer and a medic next to each other in the classroom to get them to talk, to communicate, to start working together,” Brotons said.

In the updated curriculum, law enforcement participants speak to their medical classmates about how they approach an uncontrolled active shooter scene. Medics teach law enforcement classmates about how to assess victims’ injuries. They familiarize themselves with each other’s processes and develop a language everyone can understand.

Realistic Simulations Test Curriculum Comprehension

Brotons and Torres test their students’ mettle with three-tiered, increasingly complex active shooter exercises, with real people playing shooter and victims.

The sequence’s first scenario is relatively simple, with one room and a couple of shooting victims. The second—multiple rooms, multiple victims—poses a greater challenge to the trainees’ communication and coordination of movements. The third and final scenario extends the chaos and uncertainty, with an entire building to account for amidst blaring alarms and the screams of the simulated victims.

The key to succeeding in such a trying circumstance is a unified command structure, with people who know their respective roles and can effectively communicate with their teams.

“You have so many different agencies (at an active shooter situation),” said Brotons. “Someone from each agency needs to come together in a command group to talk about what’s going to happen and who’s responsible for what roles.”

“You can have a million cops and a million firefighters” responding to an active shooting, said Torres. “If they’re not getting direction from a unified command structure, nothing positive is happening.”

The Gordon Center curriculum has trained dozens of agencies and hundreds of first responders in every region of Florida. Brotons and Torres use data from actual active shooter responses to refine the program, and they plan to use the Tallahassee outpost as the first in expanding training opportunities to more locations in Florida and the U.S.

Tags: Active shooter training, Gordon Center for Simulation and Innovation, simulation-based training