Picture this: You are dispatched to a motor-vehicle collision with pedestrians struck at 10:20 PM on a Friday evening in the heart of the thriving downtown area. Your unit is an ALS response unit, staffed with you and one other paramedic. You are only two minutes from the scene and are the first-arriving EMS unit. No other information is available for this dispatch.
As you arrive on scene, you observe a white minivan positioned through a guardrail, with what looks like bystanders rushing around. Your senses are heightened; there appears to be multiple casualties on a bridge over a major river. You radio back to dispatch your observations and request for additional units. What do you do next?
With your senses heightened, you don your department-issued ballistic PPE (vest and helmet). Imagine exiting your unit and being immediately barraged with wounded and their loved ones. One victim screams for your help to save her husband, who was struck and thrown from the bridge into the river below.
Off in the distance you hear the sound of gunshots. The gunshots are later found to be from police officers engaging terrorists, but at the time, there is no way to know who is shooting at whom.
You instantly recognize you are in the hot zone. You and your partner take defensive postures but quickly realize, from the number of injured and the large and growing gathering of bystanders, that there is no exit from the scene.
You and your partner have trained for this situation. You crouch back to back to create a 360-degree area of visibility while continuing triage. The only things to do is to treat the wounded, communicate your observations to dispatch, including the reported man over the bridge, and prepare the incoming units for the scene they are about to enter, including information for the boat crew for the river rescue.
This real-life scenario played out for the London Ambulance Service (LAS) on June 3, 2017.
These LAS paramedics demonstrated great courage and sound decision-making, concluding that
- Victims may direct violence toward them if they were to retreat from the hot zone.
- Viable victims will die if they place their own safety above the lives of their multiple severely injured patients.
This attack was one of five terrorist attacks that occurred in the United Kingdom in 2017, including the Westminster Bridge vehicle ramming and knife attack on March 22; 8 people were killed and 45 injured in this attack.
The London attack involved three terrorists who conducted a vehicle ramming attack across the span of London Bridge and into the Borough Market. After crashing, the terrorists switched to knife attacks through the Borough Market, randomly stabbing people in and around the pubs. These terrorists, wearing hoax suicide vests, taped knives to their hands so those knives wouldn’t slip when they were covered with blood.
It was later found that their vehicle was laden with Molotov cocktails for fire-bombing the area. The fire-bombing was foiled after the vehicle jumped the curb and crashed through a massive wrought iron fence.
Operating within the Different Zones
The terms hot, warm and cold zones (some jurisdictions may refer to these zones as red, yellow and green zones) describe the degree of hazard.
The hot zone typically describes an IDLH environment; the warm and cold zones describe less-hazardous environments. Depending on the type of event, we may or may not train or be equipped to operate in the hot zone. Hazmat incidents, structure fires, motor-vehicle crashes and technical rescues require specialized training to operate within the hot zones. Conceivably, any response can and arguably should have hot-, warm- and cold-zone designations to describe the possible level of hazard, controlled entry and associated SOPs.
Consider the scenario above and how quickly an MVC-response turned into a scenario with medics in the hot zone of a vehicle-ramming attack and possibly an active-shooter event, which may have risen to a complex, coordinated terrorist attack. The United Kingdom refers to these types of attacks as marauding terrorist firearm attacks (MTFA), that include their own SOPs.
What’s to say a terrorist won’t jump out of the traumatized crowd or from the crashed minivan to unleash the Molotov cocktails they had hidden in their vehicle, targeting the first responders arriving on scene.
Or, worse yet, what if the minivan was a vehicle-borne improvised explosive device with enough explosives to level a portion of the city.
Now, consider in these three different scenarios the different-sized hot zones. In these scenarios, how do responding units define the cold-, warm- and hot-zone perimeters? Who makes the decision?
Do your department’s policies and procedures for responding to these different scenarios include the identification of actions first responders should be trained to perform when they unknowingly find themselves within the hot zone of a high-risk event or MTFA? Have you trained for these types of scenarios? Have you incorporated members from law enforcement, emergency management and your public-safety answering point?
Preincident preparation that includes the development of policies and procedures for a range of terrorist tactics, PPE and other high-threat response equipment, along with interagency training, is critical to successfully executing the tactics needed when a situation arises. Unfortunately, agency leaders no longer have the luxury of ignoring the possibility of a terrorist act or active-shooter incident in their jurisdiction.
These low-probability, high-impact events are occurring everywhere with greater frequency and no regard for the size or status of the jurisdiction. As first responders and leaders of our departments, we are left with the duty to respond to these types of incidents whenever they occur, ensuring our people and communities are protected by mitigating the potentially devastating results.