Southern Nevada Fire Operations Hostile Event Policy 2018 PDF

1 Table of Contents Command and Control ____________________________________ Page 3 Rescue Task Force __________________________________________ Page 5 Sifting and Sorting Page 6 Extraction Team...

1 Table of Contents Command and Control ____________________________________ Page 3 Rescue Task Force __________________________________________ Page 5 Sifting and Sorting Page 6 Extraction Team Page 7 Transition Area, Casualty Collection Point & Refuge Area ___________ Page 8 Appendices Page 10 Definitions _______________________________________________ Page 14 ​ Hostile Event Policy 2018 Page 2 Command and Control Southern Nevada Fire Operations The fire departments from Southern Nevada and their employees are committed to providing the highest level of emergency and non-emergency service to the citizens. The Fire Chiefs of these departments believe that unifying efforts for consistent operational plans are in the best interest of the safety of firefighters and emergency services provided to the citizens residing in or visiting our communities. For the purposes of providing unified, consistent and safe operational practices, the executive leaders of the departments meet on a regular basis to identify areas for development of unified operations and form the Southern Nevada Fire Operations (SNFO) Committee. Purpose The purpose of this policy is to ensure the highest level of safety for all Southern Nevada first responders, residents and tourists during any hostile event. All Southern Nevada Fire and Law Enforcement agencies have come to a consensus on the best practices for use at hostile events. This is an organized and structured response plan that outlines roles and responsibilities regardless of the size and type of the incident. The response plan ensures a seamless integration when Fire Department (FD) and Law Enforcement (LE) agencies work to mitigate the same incident in Southern Nevada. The intent of the policy is to outline indirect threat care, not care under fire. Scope This procedure shall be used by ​S​outhern Nevada FDs to integrate operations with LE agencies at incidents with a hostile element and the potential for a large loss of life. This procedure outlines the following principles: establish fundamental doctrine for the response mission area, engaged partnership, scalable, adaptable operational capabilities, unity of effort through unified command​ ​and readiness to act. Command and Control Southern Nevada FD response to a violent or potentially violent event will be determined by the number of potential or known patients through the ​Mass Casualty Incident ​(MCI) policy. There are five MCI levels with Level 5 producing the least amount of patients (5-10), and Level 1 producing the most (100+). See “Appendix A” for the outline of the MCI levels as defined in SOP# SNFO-11. Command Considerations: When responding to any act of violence that is, or may become a ​Hostile Event​, the first arriving FD officer or officer responding as a single resource should consider and/or implement the following: 1. Upgrade of the response to appropriate MCI Level 5 through Level 1 2. Deployment of Specialty Teams (i.e. MCI 33, Hazmat, CBRNE, Heavy Rescue, etc) 3. Deployment of Ambulance Strike Teams 4. Declaration of Level 2 staging at an appropriate location Hostile Event Policy 2018 Page 3 Command and Control (​ Continued) The first arriving FD officer shall locate the LE Command Post (CP). If unable to locate or determine if a CP has been established, the first arriving FD officer shall establish Command, deliver a Brief Initial Report (BIR) and designate a Level 2 staging area. Consider using an IOP channel for unification of Command and locating Law Enforcement. The unification of command may be challenging for the initial incident commander if resources have already been deployed. Consider a second command level officer (i.e second Battalion Chief) to assume unified command leaving the initial commander as the appropriate operational position based on the needs of the incident i.e. Operations Section Chief, Rescue Branch Director or EMS Branch Director. Command shall make it a priority to manage the needs of the MCI according to SNFO 11 as early as possible. Once contact is made with LE, a Unified Command post shall be established and the FD officer shall communicate the location to all responding units. A situation status (SIT/STAT) report shall be obtained with the following information in no particular order: a) Type of incident, current and potential threats b) The establishment of a perimeter and perimeter control of the incident c) Type of occupancy, number and location of potential victims d) Additional resources needed e) Unified Command must establish “Hot” and “Warm” zones a. FD personnel should NOT knowingly enter the ​Hot Zone f) Command shall broadcast the level of MCI to the FAO g) 1 FD Paramedic Rescue shall be dedicated to FD and LE personnel h) Private ambulance supervisor(s) shall be on scene Command shall obtain information from the initial LE Strike Team on Hot and Warm Zone locations, threat assessment along with an estimated victim count. A pre-entry briefing between FD and LE shall be conducted and contain the following information in no particular order: a) Location of “Hot” and “Warm” zones b) Identify team leaders for both FD and LE to establish ​Rescue Task Force​ (RTF) c) Confirm that LE must always stay with FD teams to provide for their protection in the Warm Zone d) If a threat is encountered by the RTF, what emergency procedures should be taken - See Emergency Procedures page 5. e) Confirmation of correct tactical channel f) Simplified accountability when entering the Warm Zone g) Estimated number of victims and their general location h) If established, location of ​Casualty Collection Point​(s) i) Additional resources needed j) Once the RTF(s) has finished “​sifting & sorting​”, teams shall stay assembled and remain available for further assignment Hostile Event Policy 2018 Page 4 Rescue Task Force Rescue Task Force:​ A combination of fire and/or EMS personnel and law enforcement who provide force protection. The RTF could provide the following tasks: threat-based care, triage, and extracting victims to a casualty collection point or other designated location. 1. Should operate in the ​Warm Zone​ and provide indirect threat care 2. Shall don ​ballistic personal protective equipment​ (see Appendix B) before entering the Warm Zone 3. Ideally, the RTF is comprised of three or more FD personnel containing one Company Officer and one Paramedic. The Company Officer shall not be the primary Paramedic. The size and exact composition of the FD personnel should be at the discretion of Unified Command based on the threats and capabilities of the RTF. 4. An RTF shall include a minimum of two (2) armed LE personnel, but optimally four(4) or more. The size and exact composition of the LE personnel should be at the discretion of Unified Command based on the threats and capabilities of the RTF. 5. Each RTF shall take a minimum of two(2) ​Hostile MCI Kits ​into the Warm Zone. Each Hostile MCI kit includes equipment designed to sift and sort, and if necessary, rapidly treat approximately 6-8 victims (see Appendix C). Responsibilities: Company Officer/Team Leader - They shall serve as the communications officer and relay information to Command regarding the number of victims, situation status and pertinent information including the need for additional teams (i.e. CAAN, SIT/STAT - multi-level structures, multiple theaters and large interior/exterior areas). They shall also be responsible for overall safety of FD personnel. Paramedic and Additional Crew Members - The paramedic shall be responsible for completing a rapid victim assessment, determine their sifting category (​ORANGE​ or BLACK and WHITE), sort the victims’ injuries and provide immediate life-saving medical interventions if necessary. Additional crew members shall be responsible for documentation, assistance with sifting and sorting, medical interventions and crew safety. RTFs shall be responsible for directing incoming ​Extraction Teams​ to the most critical victims. RTFs may also transition to the role of managing Casualty Collection Points or assemble into Extraction Teams if necessary. Considerations: Form and deploy RTF(s) according to incident priorities. Recognize that force protection is not the same as an RTF but is part of the RTF concept. Force protection is safety and security of personnel who are operating in a Warm or Cold Zone. Force protection can include other things besides RTF. Establish early face-to-face operational communication, fast command and joint roll call for personnel accountability. Emergency Procedures:​ Discuss in briefing with LE prior to deploying. Hostile Contact - ○ FD shall fall back to last safe position (warm/cold zone) or a position of cover. LE team leader shall evacuate or escort the RTF to a safe position and stay in voice contact with FD Task Force Leader if hostile contact is made or is imminent. Down LE Officer or FD personnel- ○ RTF Team Leaders to assess the situation and decide to continue or abandon the mission. LE maintains protection throughout evacuation. FD Task Force Leader shall provide Emergency Traffic with a CAAN (Conditions, Actions, Accountability, Needs) report status (SIT/STAT). Hostile Event Policy 2018 Page 5 Sifting and Sorting Sifting and Sorting: Sifting​ is the process of determining which victims can self-extricate, require an Extraction Team or be left in place. Sorting is the process of assessing a victim’s injuries. Sifting and sorting is done by RTFs in the Warm Zone. This process differs from formal triage in that it is a rapid determination of a victim’s injuries and which victims: 1. Require immediate life-saving interventions 2. Have injuries that are not immediately life-threatening 3. Have injuries not compatible with life Formal triage of the victims shall take place once victims have moved from the Warm Zone, through the ​Dirty/Clean Transition Area​ and into the TTT Area. Uniquely designed markers shall be used during the sifting process in an effort not to confuse “sifting” with “triage”. The purpose of the unique sorting markers is to make identification of victims that need immediate removal out of the Warm Zone easier for incoming Extraction Teams. The three categories below reflect how victims shall be sifted: Walking Wounded o Victims who can self-evacuate should be instructed to do so o Victims that can be assisted to the triage area with minimal assistance from the ​“Walking Wounded” that are self-evacuating o These victims shall not receive a sifting marker as they shall move to the Transition Area on their own Extraction o Victims that do not fit into the categories of ​“Walking Wounded”​ nor "​Expectant​” o Viable victims that cannot evacuate on their own o Life-saving interventions may need to be immediately performed in a rapid manner to extend victim viability prior to removal to a formal Triage, Treatment and Transport Area o These victims shall receive an ​ORANGE​ sifting marker Expectant o Respirations not compatible with life o Injuries not compatible with life o Unresponsive with both of the aforementioned o These victims shall receive a ​BLACK and WHITE​ ​sifting marker and shall be left in place Note: Sifting markers shall be placed on the victim’s ankle. If the legs are not available, the marker shall be placed on the victim’s wrist. Hostile Event Policy 2018 Page 6 Extraction Team Extraction Team:​ ​Extraction Team may consist of any combination of FD or LE personnel based on the safety of the Warm Zone where the sorted victims are located. Due to the dynamic environment and number of RTFs in the Warm Zone, Extraction Teams consisting of FD personnel may not need LE force protection. Extraction Teams communicate on the Operations channel and shall be responsible for removing victims in the Warm Zone who are marked with​ ​ORANGE sifting marker. Victims shall be removed from the Warm Zone by Extraction Teams and moved to the Transition Area where they shall be swept by LE then taken by ​Transfer Teams​ to the Triage, Treatment and Transport (TTT) area(s). 1. Should operate in the Warm Zone 2. Shall don ballistic personal protective equipment (see Appendix B) before entering the Warm Zone 3. Ideally, the Extraction Team is comprised of three or more FD personnel containing one Company Officer. The size and exact composition of the FD personnel should be at the discretion of Unified Command based on the threats. 4. The size and exact composition of LE personnel should be at the discretion of Unified Command based on the threat(s). Responsibilities: Company Officer/Team Leader - They shall serve as the communications officer and communicate with Command, RTF and/or Transition regarding the number of victims needing extraction and pertinent information including the need for additional teams. They shall also be responsible for overall safety of FD personnel. Crew Members - The crew shall extract all orange tagged victims to the Transition Area. Considerations: Appropriate equipment should be assembled prior to entry (i.e. flashlights, soft litters, mega movers, etc.) Coordinate with the RTF(s) to determine the priority order in which victims shall be removed from the Warm Zone Extraction Teams shall be sent into the Warm Zone​ immediately​ following the deployment of RTFs Extraction Teams work in the Warm Zone while Transfer Teams work in the Cold Zone Hostile Event Policy 2018 Page 7 Transition Area, Casualty Collection Point & Refuge Area Transition Area:​ ​An area where ​LE​ shall perform a secondary weapon sweep and collect intel prior to people entering Triage, Treatment and Transport, a Refuge Area or any area located within the Cold Zone. 1. Should ideally operate at a Warm/ Cold Zone perimeter. 2. The Transition Area should be assigned to an Engine company. The size and exact composition of the FD personnel should be at the discretion of Unified Command. 3. The Transition Area shall include a minimum of 2 LE personnel. 4. Shall be identified early in the incident and communicated to FD and LE. Responsibilities: Company Officer/Team Leader - They shall serve as the communications officer and relay information to Command regarding situation status and pertinent information including the need for additional teams. Paramedic and Additional Crew Members - The paramedic shall be responsible for determining victim transition priority. Additional crew members shall direct extraction and transfer teams as well as direct victims to appropriate areas. Considerations: Consider donning Ballistic Protective Equipment (see Appendix B). Funnel all people through the Transition Area, LE shall provide officers here to sweep all people who come through dropping all personal items and checked for weapons. Transfer teams shall stand ready to carry any ORANGE/non-ambulatory victims to the Treatment Area. Triage teams shall assess all victims before moving them to the formal treatment area. Those most critically injured must be prioritized through the Transition Area. Transition Area may change locations depending on incident, this must be clearly communicated. Casualty Collection Point: ​A temporary location used for gathering, triage (sorting), medical stabilization and subsequent evacuation of nearby casualties. Where vehicle access might be limited and is usually occurring in the warm zone. There may be multiple Casualty Collection Points based on the size and complexity of the incident. Refuge Area: ​ Secured area(s) for uninjured evacuees so LE may gather witness statements, intelligence and additional incident information, prior to being released from the scene. Injured victims shall take priority in the initial stages of the incident. Tasks such as evidence collection, witness statements and intelligence gathering should be performed prior to releasing evacuees from the scene. CBRNE related contaminates that were not identified during initial evacuation may mandate further treatment of evacuees thought to be uninjured. These areas may be set up by FD or LE personnel and shall be located in a safe area away from the incident based on the number of evacuees. NOTE: Attention must be given to clearing victims of hazards (i.e. contaminants, weapons, etc.) prior to entering the Triage, Treatment and Transport (TTT) Area. Hostile Event Policy 2018 Page 8 Transition Area Hostile Event Policy 2018 Page 9 Appendices Appendix A SOP# SNFO-11, “Multi-Casualty Incident (MCI) Procedures” Purpose This procedure establishes a standard structure and guideline for the operation of fire department units at multi/mass-casualty incidents. The system may be applied to any multi/mass-casualty incident regardless of the number of patients or incident size. This procedure shall be integrated into the overall incident management system and may include major transportation incidents, explosions or fire with multiple injuries, hazardous materials incidents with exposure victims, structural collapse incidents and hostile events with multiple patients. Scope The policy is to integrate the multi-casualty procedures within the framework of the incident management system. It is the responsibility of the first-arriving company officer to implement these procedures on any multi-casualty incident. This procedure follows the National Incident Management System (NIMS, Dec. 2008). This also follows the Clark County Multi-Jurisdictional Mass Casualty Plan. Definitions A. MCI: ​A Multi-Casualty Incident (MCI) is an incident in which the number of patients combined with the complexity of the event warrants the declaration of a Level 1, 2, 3, 4, or 5 MCI. o Level 5 MCI: ​A level 5 MCI may produce from 5 to 10 patients. These incidents are typically handled by the department having jurisdiction and do not require extended use of multi-agency resources. The Emergency Operations Center (EOC) can be utilized, but is usually not required during a Level 5 MCI. Type 5 NIMS incident. o Level 4 MCI: ​A Level 4 MCI produces 10 to 25 patients. Regional and multijurisdictional medical mutual aid is necessary for further diagnosis and treatment. The EOC may be required to assist with the management of a Level 4 MCI. Type 4 NIMS incident. o Level 3 MCI: ​A Level 3 MCI may produce a large amount of casualties - from 25 to 50 patients. A Level 3 MCI exceeds the capabilities and resources routinely available in a single jurisdiction. These incidents will require a concerted multi-agency effort including the activation and management assistance of the EOC. Type 4 to Type 3 NIMS incident. o Level 2 MCI: ​A Level 2 MCI is a major emergency that may produce 50 to 100 patients. A Level 2 MCI requires resources from multiple jurisdictions and will quickly overwhelm the treatment capabilities of local hospitals. These incidents shall require a concerted multi-agency effort including the activation and management assistance of local EOC and the hospital’s Medical Surge Area Command (MSAC). Type 3 NIMS incident. Hostile Event Policy 2018 Page 10 Appendices ​Continued Appendix A o Level 1 MCI: ​A Level 1 MCI is a major emergency that may produce more than 100 patients. A Level 1 MCI requires resources from multiple jurisdictions and will quickly overwhelm the treatment capabilities of local hospitals. These incidents shall require a concerted multi-agency effort including the activation and management assistance of local EOC and the hospital’s Medical Surge Area Command (MSAC). Type 3 NIMS incident. Medical Alarms:​ A group of engines, truck companies, rescues, and support staff. 1. First Alarm Medical FAO (Task Force): A First Alarm Medical Task Force consists of Three (3) Engines; One (1) Truck; Two (2) Rescues; One (1) BC; One (1) EMS Coordinator/Supervisor and request Two (2) private ambulances 2. First Alarm Medical Henderson (Task Force):​ Four (4) Engines; One (1) Truck; Three (3) Rescues; Two (2) BC’s; and Operations Support Officer (OSO). 3. Additional Medical Alarms:​ Repeat initial Medical Alarm assignment minus the EMS Coordinator/Supervisor or OSO Ambulance Strike Team: ​A group of five (5) ambulances of the same type with common communications and a leader. 1. FD Ambulance Strike Team:​ Five (5) Fire Department Rescues and One (1) Team Leader. 2. Private Ambulance Strike Team:​ Five (5) Private Ambulances and One (1) Team Leader. Hostile Event Policy 2018 Page 11 Appendices ​Continued Appendix B Excerpt from SOP# SNFO-13, “Ballistic PPE” Ballistic PPE (BPPE) The fire department BPPE ensemble includes: (1) Ballistic Vest (with front and back Level IV ballistic plates) (2) Fire/Medical identifiers (1) Level IIIA ballistic helmet Hostile Event Policy 2018 Page 12 Appendices ​Continued Appendix C Hostile MCI Kit contents: Black carry bag (fanny pack) Trauma shears Writing pen Stethoscope Sets of eye protection Sets of hearing protection (6) Pairs of medical gloves Black nylon drag litter (7) Mojo Darts for chest decompression 4” Modular bandage (8) Nasopharyngeal airways -​ ​(4) 28 Fr and (4) 30 Fr (8) SOF Tactical Tourniquets Sensi-Wrap self-adherent bandage rolls 84” x 52” Survival rescue blankets EZ-Gauze FoxSeal occlusive dressing for open chest wounds (2 per pack) Flagging Tape - 1 roll of Orange and Black/White tape Hostile Event Policy 2018 Page 13 Definitions Active Shooter/Hostile Event Response (ASHER) Program:​ - A community based approach to preparedness, mitigation, response and recovery from an ASHER incident, including public and private partnerships, emergency management, the medical community, emergency responders and the public. Ballistic Personal Protection Equipment (BPPE):​ ​An item of personal protective equipment (PPE) intended to protect the wearer from threats that could include ballistic threats, stabbing, fragmentation or blunt force trauma. (see Appendix C for BPPE ensemble). Casualty Collection Point:​ ​A temporary location used for gathering, triage (sorting), medical stabilization and subsequent evacuation of nearby casualties. Where vehicle access might be limited and is usually occurring in the warm zone. There may be multiple Casualty Collection Points based on the size and complexity of the incident. Clean Area​:​ ​An area free of hazards and located within the Cold Zone. Cold Zone​: Area(s) that have dedicated LE personnel protecting a defined geographic area that has been cleared and is actively secured. The Command Post, Triage, Treatment and Transport, Staging and Refuge Areas are examples of areas located within the Cold Zone. Dirty Area​:​ An area defined by LE personnel where non-injured evacuees are funneled in order to conduct intel and weapons check on each person, collect personal items (i.e. bags, backpacks, etc.) prior to being directed to a designated Refuge Area. This area will be located a safe distance from the Triage, Treatment and Transport Area as an added safety precaution. Extraction Team:​ ​An Extraction Team may consist of any combination of FD or LE personnel based on the safety of the Warm Zone where the sorted victims are located. Due to the dynamic environment and the number of RTFs in the Warm Zone, Extraction Teams consisting of FD personnel may not need LE force protection. Extraction Teams communicate on the Operations channel and shall be responsible for removing victims in the Warm Zone who are marked with​ ​ORANGE sifting marker. Victims shall be removed from the Warm Zone by Extraction Teams and then taken by Transfer Teams to the Triage, Treatment or Transport (TTT) area(s). ​Extraction Teams shall don proper BPPE. Hot Zone​:​ Area(s) LE is actively pursuing, engaging or containing persons or activity of concern. Persons in this area shall only be LE or armed personnel who are attempting to engage or isolate any hostile threat(s). Hostile MCI:​ A Multi-Casualty Incident caused by a deliberate action of an offender to cause harm to others (as defined in SOP# SNFO-13). Hostile MCI Kit:​ ​A medical kit specifically designed for use in the Warm Zone of any Hostile MCI. The HMCI kit contains medical interventions that are used as life-saving interventions, (i.e. tourniquets, chest seals, chest decompression needles, etc.). See Appendix D for content list. Mass Casualty Incident (MCI):​ ​An incident in which the number of patients, combined with the complexity of the event, warrants the declaration of a Level 1, 2, 3, 4, 5 or Extreme MCI as outlined in SOP# SNFO-13. Hostile Event Policy 2018 Page 14 Definitions C​ ontinued Refuge Area:​ ​ Secured area(s) for uninjured evacuees so LE may gather witness statements, intelligence and additional incident information. Rescue Task Force:​ ​A combination of fire and/or EMS personnel and law enforcement who provide force protection. The RTF could provide the following tasks: threat-based care, triage, and extracting victims to a casualty collection point or other designated location.The primary objective of a Rescue Task Force (RTF) is to sift and sort victims in the Warm Zone under LE protection. See page 5. Sifting​: ​Sifting is the process of determining which victims can self-extricate, shall require an Extraction Team (​ORANGE​) or shall be left in place (​BLACK and WHITE​). Sorting:​ Sorting is the process of assessing a victim’s injuries. Task Force: ​ is a National Incident Management System (NIMS) compliant term for any combination of single resources assembled for a particular tactical need with common communications and a unit Leader. Threat-Based Care​: Medical care provided as determined by the conditions that are present. Transfer Team:​ ​Are part of Triage and move patients in and around the Cold Zone. Transfer Teams communicate on the EMS channel and are responsible for patient being moved in the Cold Zone (i.e. from Transition Area to TTT Area, from Treatment Area to Transport Area or directly from Transition Area to Transport Area). Transfer Teams are not required to don BPPE. Transition Area:​ ​An area where ​LE​ will do a secondary weapon sweep and collect intel prior to people entering TTT, a Refuge Area or any area located within the Cold Zone. This is a functional position assigned to a company. Warm Zone​:​ Area(s) where LE have passed through and swept for hostile threats. Personnel should operate under the pretense that a threat is not expected but cannot be completely ruled out. Casualty Collection Points and Dirty Area are examples of areas located within the Warm Zone. Hostile Event Policy 2018 Page 15 Southern Nevada Fire Operations Hostile Mass Casualty Incident Page left blank intentionally ​ Hostile Event Policy 2018 Page 16