The Rescue Task Force: Moving Beyond the Cold Zone
Fire News, April 2018
By Kevin F. Reilly,
U.S. Department of Homeland Security
“The fate of the wounded rests with the one who applies the first dressing.”
– Colonel Nicholas Senn, MD;
U.S. Army; 1897
The latest school shooting in Florida reminds us of the ubiquitous nature of intentional mass casualty incidents (MCIs). The horror recently unleashed in Las Vegas speaks to an unimaginable scale, and the 2008 terrorist raid on Mumbai, India, is a harbinger for the ‘complex coordinated attack,’ which is surely coming our way. So, it is the duty of all first responders to heed the counsel of Colonel Nicholas Senn; sentiments that have echoed throughout the trauma response world for lo, these many years. But Senn’s prescience notwithstanding, first responders must also be open to new approaches.
While these incidents are exceedingly complex, their response strategies can be distilled into the simple adage, ‘stop the killing, stop the dying.’ The Columbine shooting was a watershed event that signaled an end to the SWAT-response paradigm. Law Enforcement Officers (LEO) are now duty-bound to immediately engage assailants in order to stop the killing. The Sandy Hook disaster was another bellweather of change. This incident gave birth to the Hartford Consensus, a national strategy to stop the dying at mass casualty incidents. To enhance survival, Hartford extols the benefits of bystander intervention, hemorrhage control at the point-of-wounding, the integration of LEOs and Emergency Medical Services (EMS) into a Rescue Task Force (RTF), and relocating the lines that typically separate the Cold, Warm and Hot Zones.
The Cold Zone provides a safe haven for those providing care but it does so at the expense of those needing care. This is no obscure, risk-reward hypothesis; it takes only minutes to die from an arterial hemorrhage. Gaining early access to victims, conducting Warm Zone triage, and applying medical interventions at the point-of-wounding could significantly increase the number of survivors. These tactics would seem to constitute a moral imperative, but they do not easily reconcile with the ‘scene is safe’ preamble used to initiate EMS operations. But the Cold-Zone-Only concept need not be ripped out by the roots. It cannot be made compulsory for all Emergency Medical Technicians (EMT) to surrender the sanctuary of the Cold Zone. But there’s no reason why willing, trained and properly equipped EMTs cannot make forays into the Warn Zone as part of a RTF. This concept may disturb some very devout EMS practitioners, as some LEOs were likely disturbed by the initial call to make immediate entry into an active-shooter scene. But what was once heresy is now axiomatic.
The peril an EMT might face in the Warm Zone is not unlike the risk a firefighter accepts when entering a burning structure. The firefighter is prepared and willing to accept the risk, and an EMT can be likewise prepared. A number of realistic RTF courses are available for EMTs interested in specializing in scene management, tactical force movement, triage, hemorrhage control, victim extraction and casualty collection points. There are many worthy opinions on both sides of the Cold Zone discussion, but a continued insistence on zero-risk operations for EMS is incongruous to today’s threats.