Ep 24: Rescue Task Force (RTF)

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Episode 24: Rescue Task Force

This show is all about Rescue Task Force (RTF), their role in an Active Shooter Event, key tasks the RTF needs to execute, and lessons learned.

Bill Godfrey:

Welcome back to our next podcast. Today we are going to follow our pattern of going back to the basics here. As the country starts to get kids back into school, we're going back to the basics of actor shooter incident management. Today we are going to talk about rescue task forces, and we're going to dive in a little bit deeper than we have in the past. My name is Bill Godfrey. I'm the host of your podcast today. With me, I have Bruce Scott, one of our instructors here at C3. Bruce, thanks for coming in.

Bruce Scott:

Thanks for having me.

Bill Godfrey:

We have Tom Billington, another one of the instructors. Tom?

Tom Billington:

Hello, thank you.

Bill Godfrey:

And Terrance Weems. Terrance, this is your first time, another one of our instructors, but this is your first time doing one of the podcasts, isn't it?

Terrance Weems:

Yes, sir, it is. I'm glad to be here. Thank you.

Bill Godfrey:

Jealous of that deep bass voice he's got going on. Then also joining us by phone is Coby Briehn. Coby, thanks for coming in.

Coby Briehn:

Hey, thanks for having me, Bill. Good to be here.

Bill Godfrey:

Absolutely. Tom, I'm going to start off with you to talk a little bit about rescue task forces. It seems like a fairly simple concept. It's a medical team that has security on it that is able to go into a warm zone because they have their own security. Of course, the security kind of controls the movement of the team, but it's a medical mission. It turns out in practice, it gets a little more complicated than that.

Tom Billington:

Yes, it does, definitely. As we know, firefighters are conditioned where the longer an incident goes, the more dangerous it is for us, flashover, etc. A lot of us don't know that, as an active shooter, history shows that as that active shooter incident goes on, it's over pretty quick. So being educated about how the active shooter incidents from the past have turned out, it kind of helps us. Then we need to talk about what am I going to do if I'm a paramedic on a rescue task force, what's going to happen if somebody starts shooting when I'm going in this warm zone? What's going to happen if something happens where I feel afraid? What should I do? So making sure we talk to each other as a rescue task force team before we go in and then knowing what am I going to do when I enter the room? Hopefully the casualty collection point is already set up hopefully when I enter. What am I going to do as the first Rescue Task Force?

Bill Godfrey:

Well, that's a great introduction. Bruce, take us to the very first thing that we cover. You've checked in at staging, and you've been assigned as a rescue task force. What's the very first thing that need to happen in staging?

Bruce Scott:

Bill, thanks again, for having me today. I think the very first thing that really needs to happen when you get into staging is understanding that in that staging area, that staging manager's actually going to begin forming those rescue task forces, so combining that law enforcement element with your fire/EMS, your paramedics, and put those teams together and pre-form them. One of the things that we notice as we teach across the country is it's not something that's practiced. We haven't adopted it as policies. We haven't practiced it or exercised it in any way, shape, or form. So unfortunately, the first time that we actually have those introductions is on the scene. So as we pre-form those folks up in staging, your staging manager, when the triage calls for it, are ready to move those RTFs downrange with a task and a purpose. I think that's the most important thing is understanding that those teams are formed in the staging area ideally, and you have the opportunity introduce yourself to my law enforcement partners. My background is firefighter paramedic. If I was in a staging area with Terrance or Coby, we're very often going to have to make those introductions there, and we have to understand how we're going to business moving downrange. That has to happen in staging.

Bill Godfrey:

I think that's a great segue. Coby, Terrance, if you're responsible for escorting some medics that may or may not have had rescue task force training, you may not know you, you may never have met them, and they may be with other agencies, how important is it for you guys as law enforcement to have one or two minutes to do a quick briefing, to get the chance to talk to them?

Terrance Weems:

I think it's extremely important because if you don't have trust, then that person or that group of people, they're not going to follow me. They're not going to listen to what I have to say. One of the things that we do in my home area is we try to train together, so we'll do a number of different scenarios throughout the year in different times of the year. We may have one large event where we're working together. In addition to that, we have meetings regularly, so we may meet once a quarter. What that does is before an incident even occurs, we have an opportunity to build a relationship so that relationship is made. Even if I don't know that particular person, that person knows my department.

Terrance Weems:

Now that we have that relationship built, once we get into a situation, that helps ease all of that uncomfortableness when you're in a high-stress situation. So once you get into there and letting them know, if they know they can trust me, they know that I'm going to have their back and explaining to them that I'm not going to leave you. My goal is we're going to go in here together, and we're going to come out with however many people we need to bring out. But the five of us or the six of us that went in there together, we're coming out together. We might be bringing two or three people with us, but this five or six of us are coming out. Once they understand that, "Hey, if I tell you to move, move. If I tell you to stop, stop. If I tell you to duck, duck."

Bill Godfrey:

Coby, when you're doing those briefings in staging, what are the specific things that you like to cover? Is there a list that you want to hit with the firefighters and make sure they're on the same page?

Coby Briehn:

Not really lists. We'll do the introductions, just give them an idea of where we're going, what we expect to do. We'll guide them in. We'll guide them out. We'll guide them through the hallways to the rooms. They'll stay right not up on our backs. We may have them where they can always see our back or our feet at least so they're not right up on us so we don't look like a conga line going down the hallway. They give us a little room to manipulate walls and angles and stuff. So we'll bring them up as fast as we can to that area. Also when we're having them treat in certain areas, even though they may be focused on the medicine, which is a great thing, that's why they're there is to do some of those advanced skills going along with stuff the police can't do where they're starting to go to the [inaudible 00:07:06] routes.

Coby Briehn:

We may suggest something and actually want them to start moving victims out of the hallway if that's where we locate them. We call it getting off the X. It's an old LE term where if they're in a hallway, we don't like hallways because there's too many open angles, too many things that can happen, materialize right in there, but if we can just keep them in a room, then that's going to be even better where we can control what's coming in the room, what's going out of the room, and we're not exposed to all these angles. So we'll try and pull them out of that medicine hole and just suggest, "Let's move them over here," not just necessarily start the medicine but let's also do the [inaudible 00:07:47] because we don't want to incur any more damages as we're doing the work.

Bill Godfrey:

Yeah, that makes sense. Coby, I don't know that you remember this, but one of the first training sessions we ever did together, there were two things that you drilled into my head in that first session. One was in the pre-brief, not to actually hold on to you, but if I did, just to keep a soft touch but not grab on because if I jerked or you move suddenly, it could cause you to lose your aim.

Bill Godfrey:

The other one that just still makes me laugh to the day, you talked about getting off the X, I remember when we were doing the drill. I'm trying to treat a patient, and you're telling me, "Get off the X. Get off the X," I don't know what the hell the X is. The next thing I know I'm getting pulled off of what I later found out the X is where somebody was standing when they got shot. I happened to be trying to treat a patient in the middle of the T intersection with hallways and a whole bunch of doors. It turns out that that's not really a great place to be. But I didn't know that. I didn't know that till we went through that.

Coby Briehn:

Correct. Correct.

Bill Godfrey:

Yeah, absolutely. Tom, let me hand it back over to you. Let's talk. We've got our team formed up in staging. Everybody's had a chance to get introduced to each other. We've pre-briefed. Law enforcement typically, it's two or three. You're going to have one up front, one in the back, and the medics in the middle. So we're moving in. Law enforcement gets us to where we need to be. They get us to the casualty collection point, or they get us where the injured are. Tom, what does that look like?

Tom Billington:

Well, we go into the casualty collection point. As a paramedic, I know I'm pretty safe in that room now. I have the escort of my RTFs, but the casualty collection point has already established security at doors, windows, etc. So when I go in the room, my first job as the paramedic is take control of the medical needs in this room. Now, you may only have one other paramedic with you, so if you think one RTF's enough, it's not. You need two or three RTFs coming in there. But the first RTF that goes in that room, you take control of the room.

Tom Billington:

Hopefully, law enforcement has done some sort of triage. We teach green tag, red tag, and the green tag, in their opinion, is not too bad off. The person might be able to walk and talk. But the red tag in law enforcement's eyes is somebody that's very serious. So we walk in and we want to do our triage. Now, around the nation most agencies are using the START triage method, which can be sort of cumbersome.

Tom Billington:

What we teach is the field triage score. This was developed by the Joint Trauma System under the Department of Defense. By using 5,000 battlefield injuries from 2002 to 2008 in Iraq and Afghanistan, and this system of triage was 88% effective. It's very simple. If I have a patient, I just check the radial pulse. If they have radial pulse, I give them a one. If they have no radial pulse, they get a zero. Under Glasgow Coma, I just check their motor skills. Can they follow motor skill responses? Raise your hand, move your leg. If they can listen to my command and follow it, they get a one. If they can't, they get a zero. That's the end of that triage: zero, one, or two. You add the score up. It's either going to be a zero. It's going to be a one or a two. That's your red, yellow, green. Zero is red, one, yellow, two is green. That's a very quick method. It shows 88% effective.

Tom Billington:

There's one important thing to note. This was military age, mostly men in very good shape. Obviously, if you're at a school with pediatrics or you have elderly people somewhere, it's not going to also work out as good. But it's a good, quick system to learn to use in situations such as this.

Bill Godfrey:

Tom, I'm really glad you mentioned that because the START triage system, as you said, is the most common one used in the country. But Bruce, it's got a few problems with it, doesn't it?

Bruce Scott:

Absolutely it does. Number one, I think you could probably poll 95% of the fire/EMS folks that are out there in the country right couldn't tell you anything other than, "Hey, if you hear my voice, come to me," the very first part of START. As you go down the rest of that, it gets complicated. It's remembering all the aspects of it. I love the field triage score. I think it's a better way to do business especially when you're in the warm zone. You want something fast to be able to classify those injured folks. If we get outside and for some reason we're not able to get them off the field and we end up setting a treatment area, maybe we do a more detailed triage. But inside that warm zone, I don't think there's anything better than what we're teaching in the field triage score.

Bill Godfrey:

I think so as well. It's plagued with problems. I know it's the most common one out there. That doesn't always make it the best, and it suffers from a terrible over- and under-triage error rate that just leaves us with a lot of challenges. So we've talked about doing that initial triage, so hopefully your law enforcement team on the inside, your first couple contact teams have established a casualty collection point for you. Terrance, is that always possible? Are there going to be times when the first RTF might come up through the door and the CCP isn't established?

Terrance Weems:

That is always a possibility depending on the situation, but at the same time, even though it may not be as warm as you want it to be, but if we have it secure enough where nothing is getting in, there's no fire, we have whoever that suspect is, we have him pinned down, we're know where they're at, whether it'd one or two or more people and we know where they're at, we're able to provide a safe, sort of secure area for you to work on those survivors there and those that are injured so we can get them out. Even if it's a quick assessment, like you said, you're able to get them assessed, and we're able to pull them on out of there so we can to get to moving and moving them to the hospital.

Bill Godfrey:

Yeah, absolutely. Coby, if the first RTF is coming in and the CCP isn't set. Maybe the contact team just didn't have time or they don't have enough people to pull it off, what is that look like for that first RTF to be talking to that contact team to get that organization? We still want to do a CCP, right? We want to pick a location. What does that look like?

Coby Briehn:

Oh, certainly. We can back up even to the doorway coming in to the crisis sites. We would love to have the hallway cleared. We call this secured cordons to where the path to and hopefully out of the area is secured. But in certain worlds, certain areas it may not be able to happen where we've gone in or we've just been able to lock down a certain side of it. So the RTF may come in through the hallway where there's still victims in the hallway, much like an exterior mass casualty [inaudible 00:14:49], you want to start putting them in the best area possible and the same thing with what we're trying to do here is just get them into a room for security sakes and for just logistical management sakes is getting the best care to the worst injured as fast as possible doing the best we can with what we've got. Instead of them having them spread all over the place, we want to get them, like we said, put in to the fewest areas possible. There may be a time where you have one or two CCPs, but eventually we want to get them all into the area where, again, we're just doing the best we can with what we got.

Bill Godfrey:

I'm going to recap for us here. The call comes in to staging that they need an RTF stood up, so the staging manager picks some medical assets. They pick some law enforcement assets. They sign them to an RTF team. We get a pre-briefing while they're in staging. They get a chance to introduce themselves. Law enforcement gives them a chance to give them a briefing, tell them what to expect, who's going where, who's doing what, rules of the road, I like to call it.

Bill Godfrey:

Then they get the orders to deploy. They go downrange. They're going to link up with a contact team who's already going to be in there. Hopefully we've got a casualty collection point we're dropping into. So we drop into a CCP. If we're lucky, the law enforcement team, the contact team has had a chance to do at least a preliminary, quick triage: "If you're hurting, you're walking, you're able to walk, come over here against this wall. If you're uninjured, get up against this wall." You got the green on one wall, the uninjured on another wall, and the ones that are still laying on the floor that didn't move, those are the reds. So you drop in as your medical team. You get the lay of the land. You know you need to re-triage. You're obviously going to start with the ones on the floor that haven't moved. They're the reds and we're going to re-triage them between green, yellow, red, and black tag, and call for more resources.

Bill Godfrey:

Bruce, that's a lot for the first RTF team to accomplish, but it seems like sometimes when the additional RTF teams show up, it doesn't always smooth out. Let's talk a little bit about that hand off or that coordination that the first RTF who's already there who has a situation awareness in the room, what should that second RTF do? What should that look like? Let's talk a little bit that.

Bruce Scott:

Bill, that first RTF needs to take control of that room. You brought up a good point. Number one, I'm going to look around and see what I have and understand that I need more resources. Get those folks in there. That's step one to realize I need that help. Number two, give those folks direction when they get in the room, what your expectations are and what you want them to do. As another point, if you have an experienced staging manager out there, they're listening to what's going on and understanding the resource shortfalls and can already be leaning forward. As that RTF starts asking for those additional resources, they can have them ready to go. Again, taking charge of the room, prioritizing what needs to be done, getting that additional help in there. Then working with your law enforcement partners to... Coby brought up a good point. We like a single casualty collection point. They're easier to secure. But if we have multiple, that means not only means more RTFs, but that also means we need more law enforcement as well to secure that area.

Bill Godfrey:

Tom, talk a little bit about the... and I don't want to stereotype it here, but whoever the lead is of that first RTF, that lead medic or whoever's got that lead medical responsibility taking charge of the CCP and then directing the additional resources coming in. Talk to a little bit what that should look like and what we're hoping to see.

Tom Billington:

Well, again, like Bruce just said, you want to get the other RTFs in there to start treating people. But one main thing I'm concerned with with the first RTF, believe it or not, is ambulance exchange point. I need to know that one's getting set up because when we're done treating... Our first obstacle, the bad guy or the shooter is hopefully not around anymore or we're protected from that. Our second obstacle is the clock, and time is ticking. As we're treating these patients, I might look to my law enforcement partners on the contact team and say, "Hey, we came in and we noticed this was an exit out of front right to the driveway. Can you check it out and work with tactical or triage? Let's set up an ambulance exchange point there." Hopefully, they can handle that for you while you go back to work. Because, again, the minute we get these folks treated to the best of our abilities, we want them out of there. We want them in an ambulance on the way to the trauma center.

Bill Godfrey:

Let's pause there for just a second. Terrance, Tom says to you, you guys are working on the same RTF, and Tom says, "Hey, I know we came in through the front door and snaked through these hallways, but here's an emergency exit that goes out to this side parking lot or whatever, can we use that as an ambulance exchange point? What does that look like for you as a law enforcement officer that you need to work out? What needs to happen there before we get a "yes" or "no" and we can do that?

Terrance Weems:

The first thing I want to know if that area's been secured, if we have units in that area that have already swept it and made sure that that is a safe and secure area because we don't want to bring folk into an area where we can't say that it's already secure because now we've taken them literally out of the frying pan and put them into the fire. So if we can say that this is secure, I have the perimeter set, then, yes, we can set that up as an ambulance exchange point, and we can get moving on that. But if we can't say that, now I need to move a team to secure that area to make sure that we have that area secure. Once we have it secure, then we can do that.

Bill Godfrey:

Coby, let's say tactical gets that call in Terrance's example, we don't know whether it's been secured or not. We don't have a team out there. We obviously need some security. Let's say that you're on that contact team, Coby, that gets the call from tactical to go out and secure the ambulance exchange point. What does that mean to you? What are you thinking about? What are you looking for?

Coby Briehn:

So we get the call, we'd like to say that RTFs and the medical [inaudible 00:21:14] an event to happen, and law enforcement makes it happen. So if they want to move somewhere, we make sure it's secure before they go. If they want to go out any door, we're going to send a team out there. So if I'm part of that contact team, ideally we have a perimeter unit set up. Again, if we don't, we're going to push units out, officers out to secure that area, give us a protective bubble protecting that open air exchange point right there so the ambulances just can come in. It's a clear identification for them. The routes in and out are drivable. They're not covered in mud if it's raining outside. It's not locked up, or we make sure that that lock is now taken off so we can get out, certain barricades or wherever [inaudible 00:21:59] schools or businesses just so we can give them the best and easiest route out. We're going to do all we can to make that happen but we're not going to do it, we're not going to move them until we tell them that it's good to go.

Bill Godfrey:

I'm guessing that that doesn't happen in 30 seconds. That takes a little time to make that happen?

Terrance Weems:

Just a couple minutes after that.

Coby Briehn:

Everything takes time, yeah.

Bill Godfrey:

Tom, that's why that's one of the first things on your mind when you're landing in the CCP is... because you know it's only going to be a few minutes before you're going to be ready to start moving somebody. You don't want to be stuck waiting because the ambulance exchange point isn't set.

Tom Billington:

That is so true. The clock is ticking. People are bleeding. They're dying. We're doing the best we can. I want to know as soon as possible, as soon as we have a patient ready to go, a priority patient or red, I want them out of there. I want them to the ambulance. I want them on the way to the hospital. While we're in there, while the rest of the rescue task forces are in there, we do a little extra treatment. Obviously, we don't want to do too much. We just want to make sure we cover the basics. We want to make sure we do wound packing, hemostatic gauze, airway, very important, little decompressions. Things like that that will compromise the airway or not control bleeding we want to handle so that we can get the person to the trauma center in the best condition possible.

Bill Godfrey:

I think that's a great point. I don't believe we've mentioned TECC yet but the Tactical Emergency Casualty Care, which is the civilianized version of the military's Tactical Combat Casualty Care. Is that right, Coby? I got that right? The TCCC is the military one?

Coby Briehn:

Yes, sir. Tactical Combat Casualty Care, and the civilian is Tactical Emergency Casualty Care.

Bill Godfrey:

[crosstalk 00:23:43]-

Coby Briehn:

[crosstalk 00:23:43] combat out for the civilian.

Bill Godfrey:

The TECC model, if you're not familiar with it, I really encourage you to go Google that and look it up. It's all available for free. It outlines the differences in cold zone care, warm zone care, and hot zone care. There are a few things that we would still do in a hot zone that can happen from time to time. So it's probably a little bit too in depth for us to get in on this podcast, but if you're not familiar with that, please go check out Tactical Emergency Casualty Care. That's part of what guides our recommendations about what you do and don't do. A lot of that also has to do with the situation you're dealing with. You obviously want to provide life-threatening care or any stabilizing care but also the exigency or the urgency of the circumstances of how quickly you want to move them. As Tom has said, you want to get them out quick. Tom, I kind of interrupted you there. Where are we going after that? You got your other RTF coming in. You got the ambulance exchange point being worked on. Take me from there.

Tom Billington:

We're making sure our medical team is doing that treatment, as I mentioned. Then it's time. We work with the contact teams, and the rescue task force all work together. Like Terrance said, you want to make sure it's secure. When it's secure we want to start moving patients. Now, we want to move the patients that are going to get in an ambulance. We're not going to start stacking patients up outside of an ambulance exchange point because that's a security issue. If I'm in charge of that room, I'm going to pick out who I think is the highest priority, and we're going to send them out to the ambulance exchange point when we're told it's prepared. Prepared means security's in place. There's an ambulance sitting there with a driver. We're going to go right up to the ambulance and load the patients. Again, obviously, we have to be careful with loading. You can't put two reds in an ambulance. So we recommend maybe a red, a yellow on the second bench, and even a green in the passenger seat of an ambulance if they're stable enough.

Tom Billington:

Again, we also want to make sure that we're checking with our hospitals. Can a hospital take a red and a yellow? How many reds can this other trauma center take? So those are all things that are happening through transportation. It's all constant cogs in the wheel, continually working together. So once we get our patient out there, we want them in the ambulance. We want the doors shut. We want the ambulance to leave. We don't want it sitting there. Again, the clock's ticking. Minutes equal lives. Also we don't want to have the ambulance being a big target if there's another shooter or another obstacle in the way.

Bill Godfrey:

Which is an interesting point, Terrance, I was just going to ask you about that because one of the things that we teach is one ambulance in the exchange point at a time, two max. We don't want more than two up there. This is not some sort of forward ambulance staging point. Why for you as law enforcement is that so important to just have one or two ambulances max downrange in that exchange point at a time?

Terrance Weems:

A number of reasons. One, you're a target so you want to make sure... You don't want to add any more fuel to any fire. So if you're able to limit that to one, two if needed, then you're limiting any other opportunity. Not just that but there may be a need for another ambulance exchange point in another location. So if you're able to do that and you're able to have another ambulance exchange point stood up depending on the size and the scope of your detail, that gives you that opportunity. If you bring in all of those ambulances, now you have a problem with traffic. If you think about traffic during rush hour, that would be a perfect opportunity to have a messed up traffic [inaudible 00:27:20].

Bill Godfrey:

Absolutely. Bruce, Tom mentioned working with the hospitals on what they can take and what they can do. Of course, that's one of the things that we really harp on in class is distributing your patients evenly to the hospitals. Can you talk a little bit about the role of the RTF and coordinating with transport on what they've got and helping transport to get those ambulances distributed to the hospitals? Can you close that loop for me?

Bruce Scott:

Certainly. Most jurisdictions have a method where their 911 center has the ability to poll their hospitals about bed availability. Your bigger cities have multiple hospitals, and smaller jurisdictions, you probably don't have a lot of options. But the truth is you're doing disservice to the patients if you send more patients than what that hospital can handle safely.

Bruce Scott:

We have one of our instructors that teach with us from Las Vegas. His brother during the Las Vegas shooting was shot in the neck. They thought it was a really great plan to just put him in the police car and drive him over to the trauma center. Well, the trauma center was a war zone. They could not treat this police officer that was shot in the neck at that trauma center, and they ended up going to another facility. Obviously, thank the good Lord, and he's fine. It wasn't that significant of a wound as it turned out. But at the time the trauma center turned him down because they couldn't provide treatment for that. So we've done a disservice for our patients if we don't get those hospital counts, have the ability to get those folks where they're going to get the best care, or we're just doing a disservice.

Bill Godfrey:

Because of one of the points of confusion at least, Tom and Bruce, that I can remember coming up in class is we're teaching to establish a triage and a transport group supervisor along with the tactical group supervisor who are at the edge of the warm zone, let's say. They're outside. They're taking up position, but they're kind of the quarterback, quarterbacking the resources. A lot of times we get questions about, why do you need two? Why do you need triage and transport? The answer is because it's two very different functions. You just kind of hit on that. The triage group supervisor's job is to figure out how many are injured, where are they injured, and what are the severity. The RTF is the eyes and the ears for that. So you can't keep that information a secret. You've got to be communicative with your triage supervisor and tell them what you've got. Of course, the numbers are going to be a moving target. A lot of people don't realize that. They're like, "Well, what happened to that yellow?"

Bruce Scott:

I was going to bring that up.

Bill Godfrey:

You didn't account for the yellow. Well, that yellow turned into a red.

Bruce Scott:

Absolutely.

Bill Godfrey:

So it's a moving target, and you can't wrapped around the axle about that. But the triage group supervisor, as they're getting that information, has the opportunity to work with the transport supervisor right there who can begin to game-plan behind the scenes. So while the ambulance exchange point's being set up, the transport group supervisor can get the list of the bed counts or availability, if the jurisdiction does that, and then lay out their game plan for where they're going to send the various ambulances. So that information flowing from RTF about the nature and severity of the victims and then passing it on a transport, getting those loaded and the RTFs being aware of the loading. Tom mentioned, you don't generally want to put two reds in an ambulance. No. I can remember days when it happened to me. Male: Absolutely.

Bill Godfrey:

It's extremely, extremely difficult to do. You don't have enough equipment. You don't have enough hands. Now, if it's the only option you got, I mean I get that. Sometimes things happen. But generally speaking, you want to balance the load of the severity in the ambulance. Then once that ambulance leaves and calls transport, we want that transport group supervisor to spread those ambulances out to the various hospitals. So we just kind of rinse and repeat as we go through that until we get everybody off the scene.

Bill Godfrey:

One of the best things that the RTF can do is stay in touch with triage to let them know what they still have. If triage is not getting that, triage ought to call them and say, "Triage RTF One, what do you have left? Give me an update on what you have left." Don't worry about whether the numbers add up. That doesn't matter. Focus on what's left. So we finally get all the patients transported. The RTFs make the all-critical call to triage to say, "No more viable patients remain in my location. Then where else do you need me?" Tom, let's talk a little bit about that process.

Tom Billington:

Well, one thing to think about is this is a crime scene, without a doubt, so the minute the RTFs are done what they're doing, you want to check to make sure if they're needed anywhere else. If they're not, we need to try to get them off there and get them back to staging. Now, most scenes you're going to want to have an RTF there with the contact team in case something else happens. That's all right. As soon as we can get another assignment, it's up to the RTF to call triage and say, "Hey, we're done. All the patients are gone. All the treatment is over. Triage, what do you want us to do?" Because so many times the RTF's just hanging out. You have people everywhere. It's a crime scene. There's still unknown hazards. So we have to make sure triage knows what has happened and then we get direction.

Bill Godfrey:

Yeah, absolutely. Coby, Terrance, how do you feel about that idea of...? Let's say there's three or four RTFs downrange. You return most of them to staging, but you keep one of them back downrange with you guys as you begin to stabilize and go through your clearing operations. Coby, let's go to you first. Do you like that idea?

Coby Briehn:

I'm not opposed to it because it's good to have them close by there. We don't need a whole... We're not going to clear them [inaudible 00:33:07] to a secondary or tertiary search with the RTF unit following along behind us, but you get to have them close by when we needed it, if we do find some of those people that are hiding from whatever made them go into the closets or the caverns of the buildings. So I'm not opposed to it. Again, it's whatever that agency that those people are comfortable with, but it's certainly a great options to have those highly-trained medical guys downrange with us. They're already there. They're going to be doing the medicine anyway, so why have them go back when we could have them right there in a secure area while we're doing that search?

Bill Godfrey:

I think that's a great point. Coby, I'm glad you clarified that for me because I realize I didn't really say that very clearly in the way I implied that. I don't actually mean that the rescue task force forms up with the contact team and is part of the clean up operation. Not at all. That's not what I was saying. You keep one RTF that's still downrange in a warm zone, maybe still in the CCP. But if you have a problem, you don't have to wait for them to come back up from staging. Terrance, what are your thoughts on that?

Terrance Weems:

Actually I'm in agreement especially if we know that that area is secure, we know that the suspect is down, we can account for them whether it'd be one or multiple people, in that instance, sure, having one with you because we know in a lot of situations you're going to have people hiding in different places that may or may not be injured.

Tom Billington:

Bill, also to add, again, remember, an RTF is not just medical. It's your security system with law enforcement, so those law enforcement officers have to stay with that team. They have to keep protecting us. We cannot be left alone, so we don't want to just think we're going to take the law enforcement officers from the RTF, put them in a contact to search. They stay as a team together.

Bill Godfrey:

Yeah, absolutely, or else you have a medic that stands in the middle of a T intersection of a bunch of hallways and 20 doors and tries to treat somebody on the X.

Bruce Scott:

I'd just like to say that although I certainly understand the concept, I do that we continue to struggle around the country with fire/EMS chiefs are putting firefighters and paramedics into warm zones. Then we'd have those continued conversations. Terrance and Coby bring up a great point. We're going to leave them in that warm zone for an extended period of time. That's more conversations and more understanding that has to happen with those leaderships and those agencies. Because even if you get them to buy in, "Hey, we're going to commit them into a warm zone as long as we have that law enforcement protection," as most of your fire chiefs are going to say, "and I want them out of there as soon as possible till you tell me it's completely clear." So just more training and more understanding, more relationship building that has to take place on the front end.

Bill Godfrey:

I think that's a good point. I guess Terrance, Coby, that would probably also depend on what the lay of the land is: the building, what you've got secured, the configuration. Yeah, okay. We get the patients treated. We get them off the scene. We get our unneeded RTFs back to staging. We break those teams down and let people get reassigned. Is there anything else that we need to address? Because we've walked from A to Z, from getting the assignment in staging all the way back to staging. Anything you left out?

Bruce Scott:

A couple of things and I want to make sure that we... and I'm not sure we talked about it. Say, for example, you have two law enforcement folks and two fire/EMS folks as part of that RTF, you're understanding they work for triage. I think Tom mentioned that. But understanding that your communication, your law enforcement element still talks to tactical on their radio, and your fire/EMS are talking to triage. They get their direction from triage, and they get their approvement for movement from the law enforcement side. So you don't flip over to one channel or the other just because you're assigned on one RTF. You stay on your tactical channels.

Bruce Scott:

Bill, the second thing I want to understand from RTFs is you're going downrange. You're not taking every jump box, every trauma kits, your respiratory box, your oxygen, your stretcher. You're not taking a truckload of equipment with you. You're moving fast and light. The things that Tom brought up, that indirect threat care that you can do, that's not dependent on taking a whole lot of equipment with you.

Bill Godfrey:

Yeah, absolutely. Bruce, I really glad you brought up that bit about the radio channel because that is a source of questions and confusion from time to time: who's talking to who? It seems like we got the RTF reporting to two different bosses. It's really not that complicated when you look at... The RTF is a medical team with a medical purpose. It is run and managed by the triage group supervisor, plain and simple. But the law enforcement security detail on that RTF, they have to be on the radio with tactical. They have to be listening to what's happening on the tactical channel. They have to be able to update tactical about where they are in the building and what's going on and get any warnings or be able to convey any warnings. It's essential. But that's not a problem because you're standing together, so the security part of the detail is literally standing with the medical part of the detail. You can have them on two different channels. It's always interesting to me how that comes up as a point of confusion, so I think that's great. Tom, anything else from you?

Tom Billington:

No. Excuse me. I'm sorry. Just as Terrance pointed out to begin with, understanding each other, having relationships is so important. I know I would go anywhere with Terrance and Coby because I know their capabilities. Now, as Terrance said, in large jurisdictions that might not be possible, but if the jurisdiction has a reputation in our training with them that we know they're going to take care of us, it's very important to do that ahead of time. You don't want to be going in cold with somebody you have no idea who they are or what they're about. The lives of the paramedics are dependent on these law enforcement officers, and you want to feel secure when you're going in there.

Bill Godfrey:

I absolutely agree with you. The interesting thing, I think law enforcement by and large, and when I say that, I mean damn near every officer I've ever met understands that when they're asking for a medic to come downrange, I don't think they take that lightly. I think they are well aware that they're asking for an unarmed, non-law enforcement person to come downrange and that that complicates things a little bit for them because they've got somebody who may not know the tactical rules of the road coming down into their scene, and they got to manage that. I've never met any law enforcement officer anywhere in the country in our training or travels that hasn't understood the seriousness of that responsibility and that call. I feel really good about that.

Bill Godfrey:

You obviously want them to stay with you and not run away and all that kind of stuff, going and chasing the bad guy in the threat. I think most of them understand that pretty well. We probably need to continue to hammer on that message. But in terms of understanding when they're making that radio call saying, "Send me the medics," I think they get exactly what that means. So I think that's a great point. Terrance, any last things from you you want to throw in or out?

Terrance Weems:

No. I appreciate the opportunity. I enjoyed the conversation. You all are awesome. I just want to say that.

Bill Godfrey:

Well, it's good to have you on the team and glad to finally be able to get you into one of the podcasts. Coby, coming over to you? Anything you want to add?

Coby Briehn:

No, sir. Everything sounds great.

Bill Godfrey:

All right. Well, gentlemen, thank you very much for your time on this one. I hope everybody enjoyed it. If you haven't subscribed to the podcast, please do so. We are on our schedule to do new releases every Monday and holding up on that well. Until next time, stay safe.

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