Ep 91: Load And Go
Episode 91
Published Sep 2, 2024
Last updated Apr 23, 2026
Duration: 41:30
Episode Summary
Officers throwing a patient in a police car and driving to the hospital can be an option – but it can also be indicative of a system failure. While the idea may be to get them care quickly, the goal must be their survival.
Episode Notes
When is it appropriate for law enforcement to transport a patient? What does it really mean to get definitive care? In today’s podcast, our panel explore these topics as well as law enforcement’s understanding of the role of EMS. It’s not just about how fast they reach the hospital – it’s about getting trained resources to the patient’s side.
View this episode on YouTube at https://youtu.be/Mg3L4mbX6tY
Transcript
Bill Godfrey:When we have an active shooter event with critical patients, or even sometimes when we just have critical trauma, we use the phrase, load and go. Load and go, which, if you're on the EMS side, has a specific meaning to you. But does it have the same meaning to law enforcement, or are we talking about two different things? That's today's topic. Stick around.
Welcome to the Active Shooter Incident Management Podcast. My name is Bill Godfrey, your podcast host. I am joined today by two of our other instructors here at the National Center for Integrated Emergency Response. Terry Nichols back in the house. Terry, good to have you here.
Terry Nichols:
Glad to be here, Bill.
Bill Godfrey:
And I'm joined by Joe Ferrara. Always good to have you, Joe.
Joe Ferrara:
Happy to be here, Bill.
Bill Godfrey:
And he sounds thrilled, doesn't he, folks? Okay, so today's topic, we're going to talk about load and go. Now, in fairness, I do wanna share with the audience that this actually came up over lunch, and we got into a very interesting discussion, and I wish we'd actually been recording that discussion. And so we said, hey, this is a really good topic for our podcast today. So Terry, you brought up a very interesting scenario. So let's go ahead and start with that as our framing of this and take it from there.
Terry Nichols:
Sure, let's try to recreate magic from our earlier conversation. Thanks for setting me up for that. So, an active shooter event, we have one. Law enforcement, they do great things. They go down range, then stop the killing. What they find out is the killing's already stopped. They find three casualties, three survivors that are injured, and one deceased with a gun next to him and a bullet wound to the head, obviously a suicide by all appearances. They're ready for ambulances. They're like, you know, this is, warm zone, cold zone, call it what you wanna call it, but I need ambulances. So they call back to maybe tactical's already stood up, maybe tactical's not stood up, but they saw ambulances driving behind 'em, so they know they're there. So they say, "Roll me an ambulance down," 'cause they see three bodies on the ground on the cement and they wanna get them to definitive care. How can we make that happen? That was the fundamental question.
Bill Godfrey:
And it's a very good question. It's a very good question. And it has some interesting twists to it. So Joe, why don't you pick it up from there? So you and I actually worked an ambulance together for quite a few years. That may have been decades ago. But you're on a rig, and you get told to move up to this location, what are some of the challenges as you roll in with your ambulance and you've got the three patients?
Joe Ferrara:
Sure, so law enforcement is calling for us. You know, Terry's sitting there going, "I need an ambulance. I need an ambulance now." We get the call, we move down range. Certainly if law enforcement's calling for us, the whole scene safety thing, or, you know, you said it might be a warm zone, might be even a cold zone by this point, so we're safe to move up. So we're working, there's all these patients. You're pressuring us as law enforcement and say, "Let's go. Load and go. Let's get 'emm outta here. I gotta get 'em to the hospital."
My feeling as a paramedic is, well, first of all, lemme just get this out there 'cause it's on the tip of my tongue. We're not just a ride to the hospital, you know? And I think that's been a past thought process when it comes to EMS. There's a lot that has to go into that. And you said there's three bodies on the ground. There's three bodies on the cement, on the concrete. I've gotta do some level of triage to decide, you know, what acuity do we have here? You're thinking, okay, they're all down. They just need, get 'em off my scene.
Terry Nichols:
I'll do a tourniquet-
Joe Ferrara:
Get 'em to the hospital.
Terry Nichols:
Tuourniquet on two and a chest seal on one, and I need 'em-
Joe Ferrara:
You need 'em gone.
Terry Nichols:
They need definitive care.
Joe Ferrara:
You need 'em gone.
Terry Nichols:
Yeah, right.
Joe Ferrara:
So what does that definitive care really mean? I mean, you're thinking in terms of hospital, and I know the universal definition of definitive care is that getting 'em to the trauma center, getting 'em to the hospital. But sometimes I think maybe law enforcement or even all emergency responders, we forget what is that phase in between? EMS is there for a reason. EMS is there for a level of care that started with law enforcement, first responder. EMS comes into the role, they're doing triage. They're gonna do some level of care to maintain the patient, and I think we get caught up with the phrase of, you know, let's get 'em there as quick as possible.
The Platinum 10 comes to mind, and Terry and I had this discussion too about, you know, EMS really should be thinking about 10 minute on scene time as a maximal or as a benchmark. If we're going over 10 minutes and there's no practical reason like the patient's entrapped or something, or we're having difficulty getting to 'em, then we really should be thinking about getting to the hospital. But time, time, time. We know time is a killer, but we forget about what's going on during that time. Are they in the back of a patrol car, and we're rushing to the hospital, and they're still bleeding out, and they got an airway problem, and law enforcement, you know, doesn't realize that? Or are they in the back of the ambulance with appropriate level of care, advanced life support, paramedic doing the job? And then sometimes, law enforcement feels like, hey, these three patients, get 'em in that, you know, pretty yellow or orange and white or red and white truck, and take 'em to the hospital where they belong.
Well, what's the paramedic thinking? Is the paramedic gonna be able to take care of those three patients all at once? Or worse yet, hey, this guy's ready to go. Get him in your ambulance. Get him outta here. I have an obligation to the other patients that are still on the scene. And I know I just unwrapped a whole bunch of different issues. Bill is over here looking at me like, oh my God, what did we do here with this discussion? But really, how many, to my law enforcement brother and sisters out there, how many of you have had that very thought when EMS shows up as like, just get 'em in the truck and get 'em outta here. What are you, you know, what's all this magic potion you're doing here? Just go.
Terry Nichols:
Before you respond, Bill, I'd just like to say, this sounds much more-
Joe Ferrara:
I know he wants to.
Terry Nichols:
Much more complicated than my simple description of the situation.
Bill Godfrey:
Well, and I think that's kind of the point that I wanted to talk about is load and go, by and large, I think to law enforcement, means, you know, throw 'em in something that moves quickly and get 'em to definitive care, to the hospital, to the surgeon. But it is a little more complicated than that. You know, Joe kind of alluded to this. We have EMS in this country for a reason. Now, in active shooter events, it doesn't always work the way that we want it to, and that's a different problem. You know, if you have system problem, we'll talk a little bit more about that. But when you say, hey, I've got three people on the concrete. I want 'em, you know, pick 'em up and get 'em off my scene and get 'em gone. That's what I want. I want 'em gone from the scene. I want them on their way to the hospital. What you really want is them to survive.
Terry Nichols:
Good point, good point.
Bill Godfrey:
And here's the reality is not all gunshot wounds need surgery. Not all gunshot wounds get surgery. And even critical gunshot wounds that end up at a trauma center, they don't always do surgery immediately. Sometimes they're waiting 24, 48 hours to provide some blood, stabilize the patient before they ever go in and do surgical intervention.
And so what, and I think Joe was right. We talk about very often the clock and time kills. And I think what we neglected to really clarify in that is that we're talking about how long it takes to get medical care to the patient's side and then determine how urgent is this situation? What best serves this specific patient with the specific injury or injuries that they have? For example, you said three patients, and you threw a tourniquet, I think you said a tourniquet on one, or two tourniquets on, and you did a chest seal. Okay, great. Well, did each patient just get shot one time? Have the tourniquets solved the problem, stopped the bleeding? If the tourniquets controlled the bleeding, that no longer is urgent.
Now, the one that started in the chest, that's shot in the chest, may well be considerably more urgent. But in the case of, you know, Joe mentioned an airway problem. These are fixable things. And so the question is, do any of these patients have something that we need to fix "right now, right now," in our words of our dear friend, Jeff Williams - you know, it's a, right now, right now problem - and they're not going to survive a three minute trip to the hospital if we don't fix this. They're either gonna bleed out, they're gonna have airway compromise, whatever the case may be.
We say as medics that if you're shot neck to navel, there's not a whole lot we can do. And that's true. But there are some things that we can do, and there are some things that can be fixed. There are some things that will absolutely produce a known fatal outcome. And in some cases, that is an avoidable fatality if they're provided that emergent treatment.
But Joe also mentioned the other problem. You call for an ambulance to come up. Most ambulances, not all of 'em, but well over 90% of the ambulances operating in this country are operating with a crew of two, either two paramedics or a paramedic and EMT. One of 'em stays in the back with the patient and one of 'em is driving. So you've got a crew of two people that's just rolled up on three patients with gunshot wounds. There's a problem right off the bat. We don't have enough resources.
Secondly, as Joe mentioned, in every state, there's abandonment laws. You have a licensure and a duty to act. You can't leave the other patients without providing an equivalent level of medical care as we do that. And so there's all of these things that come up, and the simple answer is just load and go, just load 'em up and go, just load 'em up and go, just load 'em up and go.
Joe Ferrara:
Get 'em off my scene.
Bill Godfrey:
Get 'em off my scene. And in many cases, that will have an okay outcome because, in many cases, patients don't have the kind of problems that produce fatal results in a few moments. But some do. And that's what EMS is there for. Whether it's a gunshot wound, as we're talking about in this case, or heart attacks, which we've been taking care of for a long time, there are things that can be done to put that patient on a better path to survival. And so the subtlety of how EMS systems work is lost on most law enforcement as it should be because they don't live in that world.
Terry Nichols:
We don't know what we don't know.
Bill Godfrey:
Right, and so when we talk about, it's simple as the one chest, let's say that the one patient was shot in the chest with a chest seal, they're in bad shape and they need to go right now. Well, now I got a real problem because one paramedic can't take care of a patient with that level of criticality. Somebody's gotta drive the ambulance. So now are we putting the paramedic and the EMT and we're taking a cop from the scene who's gonna drive, and then we're gonna leave the other two. So it gets complicated real fast, Terry.
Terry Nichols:
Right. And so, and then that's what it sounds like. And go back to what I said a minute ago, we don't know what we don't know. And what I hear both of you saying now is, okay, if I'm that officer down range, and I'm the one calling for the ambulance and they show up and they get to work, basically managing a CCP, they've been basically re-tasked. Their job is no longer just to load and go. They're now managing three patients and calling for more resources like you referenced.
Bill Godfrey:
Correct.
Terry Nichols:
We're light on resources. And then they can start stable, no prioritizing, triaging, and the other ambulances coming downrange can go transport is what I'm hearing, I think I'm hearing you say.
Bill Godfrey:
And that's spot on. And the question, which I don't know that this came out loud earlier, but you said, you know, if this happens in the first three or four minutes, well, if we've skipped over the incident management component, so three or four minutes in, you call for the ambulance. Within one or two minutes, they come up. And we've skipped over all of the incident management that we would typically do, tactical, triage, transport, staging, a command post. That ambulance needs to call for more help. Who are they calling? They're gonna call dispatch? They're gonna try to raise other units that may or may not be there? They don't know which units are there, which units aren't. So there's a, when it comes to saving time, it's not just the time to get the medic to the patient's side, but it's also the time it takes to get the rest of that stuff stood up. And if it's not there when you need it, you've just cost yourself time.
Terry Nichols:
Time. So and I think that adds the value of standardized, like the checklist. Standardized processes. Go with the process and do what we normally do. Yes, you may skip that initial step because you got a rescue task force, for lack of a better term, but it's an ambulance with a medic and a paramedic down there managing your CCP. You've got plenty of cops providing security. But don't forget all the other things that need to be done. Set tactical, set staging, do all these other things because when the ambulance calls for more, another ambulance or two to come down range - 'cause it's secure, we have security there - they know who to call, and a process is already in place. Like you just said, we're not skipping around, bouncing around, getting to where we've been historically in these situations where it's chaos. Did I hear that right?
Bill Godfrey:
Yeah, I think that that's spot on. The other thing that I would add is if the situation is such that I think that the law enforcement officers that are there at the sides of the patients feel like they're in a cold zone, then that changes the equation of how we have to provide security very dramatically. Now, I don't need to just have one ambulance go up. I can have the ambulance or a couple of ambulances. We can have the additional fire and EMS resources. They can all pile in. Now, there's still a management component. There's still a resource component. You still have three patients, potentially three critical patients, who may all need three ambulances to be transported. So there's still this scene management component, but it doesn't necessarily have to be done within the rescue task force concept if it's a cold zone. If it's not a cold zone, then I think the process has to prevail.
Terry Nichols:
And I agree and I think as a cop, as an officer, I would be more inclined to say it's still warm, not knowing. Yeah, I'm pretty sure, you know, this is, but we talked earlier about domestic disturbance where it's just three shot and a suicide. And it's at a house. And was it an active shooter at one time? Sure it was for about five seconds until everybody was shot, you know? And then it turned into just a static, you know, crime scene, basically. Crime scene with some wounded folks. And how do we treat that today, day in, day out? Well, a cold zone. More than likely, you have enough officers there watching, you know, setting external overwatch just because, and roll your resources in and do it. But, you know, more the active shooter, what we're talking about, the type of situations, yeah, you know, the numbers will tell us, traditionally, it's not a Harvest, you know, a festival amount of casualties. It's typically much lower. But we need to have processes in place, you know? And can I change gears just slightly?
Bill Godfrey:
Sure.
Terry Nichols:
So another thing, and I've been reading up on it a little bit myself, and that is that we're officers. I'm not gonna wait for an ambulance. I'm gonna throw 'em in a police car and go. And I know Philadelphia is one of the models that does this a lot, but from professional paramedic perspectives, what is your, how do you view this?
Bill Godfrey:
Joe, I'll let you hit this one first.
Joe Ferrara:
Okay. Well, I don't view it as a bad practice. Certainly, it's working in that community in Philadelphia. But I think we have to drill down and peel back some layers as to why it works there. Is it a, we mention a lot of times, is it a system problem? You know, do they have enough ambulances and resources available? Maybe that's what drove them to look at that type of policy in their community. And, I mean, clearly there's an organized EMS system in Philadelphia, but is it robust enough to handle the call volume? Or are they encountering a number of scenes to where it's just not stable enough to bring fire and EMS directly into the scene. Where law enforcement's being pressured, maybe it was a riot, maybe it was a situation that's gonna turn into a riot. Law enforcement is standing around an injured casualty on the ground, and the crowd's starting to go, why aren't they doing anything?
Terry Nichols:
I could see that.
Joe Ferrara:
Why are they just standing there while my loved one, while my friend, while my brother is bleeding to death?
Terry Nichols:
Do something about this.
Joe Ferrara:
That's a problem. Do something. So I could see that community, or circumstances in urban settings, where they're driven to that. But I think that the leaders need to look at the overall, how did we get there? What system failures occurred and how could we fix that? Now, maybe there isn't an easy fix. Maybe they have to throw money at it, I don't know. But double your EMS system size, make the availability. EMS that is grown and based out of law enforcement happens in areas of this country for that reason too as well. So and those are just some examples.
Bill Godfrey:
And I think that's spot on. The question is why? You know, and I think Joe kinda hit on it. There is an excessive delay in an ambulance getting there, either because one isn't available or because the scene isn't secure enough, whatever the case may be. Or the flip side of this, the security situation says we need to get outta here. We either have a riot that had already occurred, or if we stay here any longer, we're going to have a riot, so let's get outta Dodge. I think the other thing that-
Joe Ferrara:
I think it's Philadelphia. Not Dodge.
Bill Godfrey:
Okay.
Joe Ferrara:
Yeah.
Bill Godfrey:
You ever wanna see a train derail? That's how that happens.
Joe Ferrara:
Yep, yep.
Terry Nichols:
That's exactly how that happens.
Bill Godfrey:
That's shooting right off the track. Now, I think the other thing that gets skipped over here very quickly is that Philadelphia commonly has a lot of vans that they use for transporting prisoners or arrestees. You know, to me, they're paddy wagons. I don't know if that's the technical term or not.
Terry Nichols:
We'll go with it today.
Bill Godfrey:
I'm sure it is not the correct term. But it is a van with an open floor deck area on the back. It's not the back of a patrol car. And so even, you could still render some basic care. That's different than trying to do so in the backseat of a patrol car with a cage in it. There is no room to function, and most adults laying down on the rear seat can't lay down fully because they won't fit within the length of the doors, and so that can be an issue.
The other challenges that occurred during that transport phase is when you look at the actual study, so there's been, and this is what's so interesting, is there's been a whole bunch of studies on this, but they all cited and come from this one study that produced the data. Then there were two good studies that was done on that, and then the rest of 'em all worked from those studies. They interviewed and surveyed some of the patients that were transported in the back of the van, and they indicated that it was very painful, it was very scary because they were bouncing around and sliding all over the place. And that's not to say that if it saved their life, it would matter to them. I'm not implying that.
But here's the other reality is when you look at the raw data, the difference in mortality, survival, depending on which of these studies you look at and what they included and excluded, is about a half a percent. It was barely above the level of statistical significance.
And the other reality is how far are you away from a hospital in Philadelphia at any point in the downtown area? How far do you have to go? How many trauma centers do they have? What is the typical transport time in the back of these? And so it's kinda like we're comparing apples to gorillas. It's not even comparing two types of food. What goes on in that community and how they're solving their problem is working for them. It's their community. But to assume that that solution is gonna magically transplant itself and work in your community, it's beyond foolishness.
Terry Nichols:
And I agree. I've read some of those studies as well, and I agree with you, and some of the other content that came out of that that would apply I think anywhere, it was from the healthcare providers. It was the doctors. It was saying like, you know, concerned about weapons being introduced into the ER environment, not knowing what's coming, what's inbound, not knowing, breaking their processes. They have processes in place. So a ambulance rolls up. They have a process in place on recept. Y'all, you know this far better than I do, so I'm speaking from a position of basic ignorance. But I do know there's processes. And the studies that interviewed these doctors and nurses and staff from ERs said these are some of our concerns. This is what that-
Joe Ferrara:
Well, they have no heads up.
Terry Nichols:
Exactly.
Joe Ferrara:
No one's called in with the patient information.
Terry Nichols:
There's no call in, there's no nothing. All of a sudden, they show up at the door, and boom, they're faced with a penetrating trauma that they weren't ready for because they're working something else. So I agree with you. Just 'cause it works for them, and there's some other cities around the nation they referenced in these that are starting to look at these models. But to say that this is the simple model to go with carte blanche, I don't think is the right move to do. Just scoop and go as we're talking about, grab and go, for law enforcement to grab somebody and go. Why would, if that's the case, a traffic crash, okay, you have somebody that got ejected out of a car. Why don't you grab 'em and throw 'em in your car and go to the hospital with 'em? Well, what's different?
Now, I wanna make sure we differentiate. There's that word again. I mess one up every time. Harvest, Pulse, Aurora, the big ones, that, you know, Aurora, they did the best they could. You know, there was a breakdown in the system, and they did the best they could. Harvest is a complete outlier. The sure magnitude of that event, people were in Ubers, they were in cabs, they were trucks. In Pulse, they're in trucks and these kinds of things. So those kind of bits are going to happen, right? But as a matter of routine, as your standard operating procedure, this is what you should do, I think, as law enforcement, I think we ought to be very, very cautious and think very big picture before we decide we need to codify this and this is the way we're gonna act.
Bill Godfrey:
Terry, I think you're right on the money, and I've said this before and I stand by it. We have ambulances, we have EMS in this country for a reason. If you're concerned about active shooter response in your location and not having confidence that EMS is going to work and it's going to be there, that's a system problem, and we ought to be having a discussion about that. You ought to be engaging in that dialogue, don't you think, Joe?
Joe Ferrara:
Sure, and Terry, I know we've talked about this as well. Law enforcement, maybe we need to get together as fire, EMS, law enforcement, and have some real good conversations about how the EMS system works because I think the average boots on the ground law enforcement officer, there's the ambulance. That's the way to the hospital for the patient that is on my scene. And I get that. Guy bleeding on concrete, put 'em in the pretty truck, go to hospital. And that's the limit of that because they have other responsibilities and other things to worry about, and the sooner they feel like they get that person out of their way, out of their scene, that's gonna save their life.
From the EMS perspective, from the paramedic side, there's a whole lot of steps that go in between I've arrived on scene and I've arrived at the hospital. It's not just that piece of it's a ride to the hospital. I mean, you know, just look at simply some of the priorities. You know, we talk about safety priority, we talk about priority of life, we talk about scene priorities, but paramedics are thinking before I even touch the patient, before I even deal with the airway, you know, I've got scene safety, BSI, we've all heard that. I got mechanism of injury. You know, what am I dealing with? And then I've got number of patients. And besides number of patients, now I need additional resources, yes or no? If I got one patient, I'm good. But in this example, we got three patients, I'm not good. I need more ambulances, so I'm working my list of priorities before I even say, okay, does he have an open airway? Is he breathing? What's the circulatory status? Is the bleeding controlled? All those things that I'm gonna go through.
I got a lot of stuff to do before I make that decision. Not only I'm leaving the scene now, I'm loading and going, so to speak, where am I going? Where's my closest facility, and we need to add that word in, where's the closest most appropriate facility to take this person to? Any hospital may not be the right answer. And all hospitals are not created equal. There's community level hospitals, there's level one trauma centers, there's level two trauma centers. In fact, in this country, we go all the way down to level five as far as grading trauma centers. Some states only recognize level one and two, but there's different grades and availabilities of different type of resources. That's what you have EMS for.
Terry Nichols:
I think we, as law enforcement, need to get out of our head, and you said it best earlier. It's not Uber. You're not calling Uber to take these casualties to the hospital. And when the professionals get there, we have to recognize it's their scene now. Maybe not their scene.
Joe Ferrara:
Not their scene.
Terry Nichols:
These patients, these casualties are theirs. I'll get back on my gun, I'll start my investigation, whatever that case is. But now the professionals are here-
Joe Ferrara:
Let them do their job.
Terry Nichols:
Let them do their job. If it takes longer than you expect it to be, too bad so sad, it's not your role anymore. You're not the professional in this role, they are. And just like we talked in one of our earlier podcasts that we did about breaching. We talked about partnering with our fire and EMS partners, especially fire, about breaking things, breaking into places, right? And this is another conversation that helps bridge that integration and talking ahead of time is like, okay, if I call you to this scene, what should I expect from you, you know? And you said, "Don't expect me just to throw 'em on a backboard and throw 'em and go."
Joe Ferrara:
And go. Yep.
Terry Nichols:
I mean, throw 'em in and put 'em in, maybe put 'em in and start working 'em. And guess what? The wheels aren't moving for another 10 minutes like-
Joe Ferrara:
No, I would ask, how many law enforcement officers have had that conversation with their local EMS and fire about what are your priorities? What does happen when I call you and I need you on my scene?
Terry Nichols:
It's just, I think it sounds like it's an education piece across the board, and especially on the law enforcement side about expectations, you know? I know what I see. I know the outcome I want. And you brought it up where, well, I want them to live. I know immediately I want them off the ground 'cause I know they're gonna have a lot better chance of living if I get 'em off of there and get 'em somewhere else. But at the end of the day, I want 'em alive. And if I have professionals by their side, I'm getting 'em medical care. They're getting medical care if I get professional care.
Joe Ferrara:
We've got the same goals in mind. Just how we get there is different.
Bill Godfrey:
And I think I would wrap that piece of this up by saying, look, if you're a law enforcement officer serving in the United States today, and you don't have confidence or faith that your EMS system is going to be there when you need them and able to further survival of the patients, you do not need to invent something new. You need to fix the problem.
If it's a perceived problem, then discussion should resolve it. But look, we all have been into communities training across this country where there are EMS systems that are not prepared. They haven't had these conversations with law enforcement. They haven't worked out the details. The teams have not trained together. There are problems. The solution is to fix the problem, not try to invent something new.
We're seeing law enforcement officers be just literally drug out in the public square over bad decision making. What do you think is gonna happen when you throw a patient in the back of a car and drive 90, 100, 110 miles an hour down the street and that patient had a fixable airway problem and is a fatality. But it was a survivable injury. It was a survivable injury.
Terry Nichols:
That's gonna be a problem.
Bill Godfrey:
And that's going to be a problem. And so is the same of driving 100 miles an hour and getting T-boned and killed somebody else. You know, it's not to say that ambulances can't get into car accidents. They do.
Joe Ferrara:
And they do.
Bill Godfrey:
They do. But we are providing medical care in the back of the ambulance during the transport phase. And not all trauma is created equal. Some of it is extremely urgent. Most of it isn't. It still needs to get taken care of in a timely fashion. But what we really need to do is get the trained medical responders to the patient's side as quickly as possible to determine what of these injuries do I need to mitigate right now and then get 'em transported to the definitive care.
Now, all that said, that's very different than we had a plan and the plan went to shit, and what are we gonna do now? When you got lemons, you make lemonade. And the two that you named, you know, Aurora, Pulse, horrible challenges on the integrated response and incident management side at both of those events. You know, Pulse explicitly, it happened not 15 minutes from where we are sitting recording this right now. It wasn't a lack of ambulances. And yet, the pickup truck that everybody saw on CNN transported more patients than the ambulances put together. It's because the system failed. The response plan failed. And so the people that were there, the officers that were there, made the decision. They had lemonades, they had lemons and they made lemonade, and God bless 'em for doing it. Because they saved a lot of lives.
And the question is, okay, in the aftermath, what do we learn from that and how do we fix the problem? And it seems like a lot of people's answer is, well, we should just transport 'em in the back of a police pickup truck all the time, or the back of a police van all the time. And it just makes me wanna, you know, slap myself in the head. If that's all you've got left to save lives, then yes. But if that's part of your response plan on paper, what are you doing?
Terry Nichols:
Yeah, there's much bigger problems.
Bill Godfrey:
Yeah.
Terry Nichols:
If that is your plan, there's much bigger problems.
Bill Godfrey:
And the October 1, Harvest in Vegas, that's a pure example of just an absolute honest to goodness mass casualty incident that completely overwhelmed the local jurisdictions and the local resources. And I actually think that they did a pretty phenomenal job of managing what they had.
Terry Nichols:
Yeah, thank God that is an outlier.
Bill Godfrey:
Yes.
Terry Nichols:
That that is an outlier. It could happen again tonight -
Bill Godfrey:
It could.
Terry Nichols:
somewhere around the nation.
Joe Ferrara:
But three people laying on the concrete in front of the officer is not an outlier.
Terry Nichols:
No.
Joe Ferrara:
And that's my concern that-
Bill Godfrey:
It's also not a mass casualty.
Joe Ferrara:
And it's not a mass casualty. But are they looking at that as, hey, ambulance, come here. Pick these up and get 'em off my scene. That becomes the problem. What is the expectation, and what is that officer's mindset on the role of EMS in that and what we have to do? And as Bill has already said it, it's not about the time to the hospital, it's about the time to get the trained resources to the patient's side.
Bill Godfrey:
Yeah, agreed. I would acknowledge though, Joe, if it's one of those where the only thing that's gonna save 'em is the surgeon cutting them open as soon as they hit the door, that is about time to the hospital. But that's also one of those things that paramedics are trained to recognize when they see that.
Joe Ferrara:
Yep.
Bill Godfrey:
And to say-
Joe Ferrara:
I'm not.
Bill Godfrey:
And to say, okay, this, this is a right now, right now problem, and this one's gotta go. This one's gotta go. By any means necessary, this one's gotta go. So I think it's, I think it's good for law enforcement to ask this question. It is a valid question. I'm three or four minutes in, I've got three patients here, my suspect is down. I need, and you used the phrase, I need an ambulance. And what I would say is, what you need is EMS.
Joe Ferrara:
Mm-hm.
Terry Nichols:
I need medical resources.
Bill Godfrey:
You need the medics. You need the medical teams. Now, whether they show up in an ambulance or in a fire truck or on foot as part of an RTF with their own security detail, we need the medical people there.
Terry Nichols:
Yeah, to let them start doing their job, making the decisions they make. Again, I'm looking at it from a very novice perspective. The best I can do is slap a tourniquet or chest seal. That's the level, or wound packing, that's the level of my skill that I'm capable of doing. But once you folks show up, professionals show up, I'm out. I'm out. I just know these people need to go to the hospital, and I need medical resources.
And I think a lot of cops have this question, you know, as we go around the country, cops say, "Hey, why can't I just do this?" You can, okay? But understand, have a realistic expectation of what's gonna occur when they get there. Don't just think they're gonna throw 'em in the back of a ambulance and drive off. Don't have that in your mind 'cause when it doesn't happen, if that's your expectation when they get there and it doesn't happen, you're getting frustrated. And it's gonna lead to confusion, it's gonna lead to all kinds of issues. That's why we need to train together ahead of time, know each other, know what to expect, so when you don't see them moving immediately, you understand why. The why behind it will help a lot.
Bill Godfrey:
Yeah, and a perfect illustration of that, let's say that, you know, you've got nine or 10 patients down. Well, nine or 10 patients that have all been shot, there's a decent chance that at least one of those is gonna be a right now, right now patient. But how do you figure that out if you don't go through them?
Terry Nichols:
Through the process.
Bill Godfrey:
If you don't go through the process and triage 'em, you don't know which one's the right now, right now problem. And that's the kind of the challenge of this, so I just, I said it earlier, I'll say it again. If you're in a community where you know that you have an issue, or you don't have faith in your EMS system, then you need to fix that problem. You need to bring attention to it and fix that problem because you don't need to invent police department transporting patients. They did that a lot of years ago, and for decades now, we've had ambulances and organized EMS systems that have saved a lot of lives.
And that's not to say that we don't have challenges on this front. We do. We do. Almost every community that we go into where EMS is a separate, what they sometimes call a third service, but EMS is separate and standalone and does all the medical, and there's not any other cross-trained medical providers, I would say more than half of the time, those communities, they don't have a plan for who the medics are that are going down range. That's a problem.
Joe Ferrara:
Yeah.
Bill Godfrey:
It's a problem we ought to be talking about now in my opinion. Joe, what do you think?
Joe Ferrara:
I agree. You know, and Terry, as you said it, it's not your wheelhouse. How about that stay in the lane mentality that we always talk about? Law enforcement, you got us to this point. Here's the patients. It's your scene. I get it. But when those medics arrive in that ambulance that you call for the proverbial ambulance, they've got a lane to be in, and they've gotta deal with the patient. You've got a lane to be in moving forward from that point to maintain scene security, to maintain the crime scene, all that stuff law enforcement's gonna do, and really, the medics, they got it from here.
And as Bill's already said, if that's not working in your community, and it's not just a simple matter of an understanding between law enforcement and fire and EMS, then it's a system problem. Deal with the system problem. Don't just apply, hey, I read a study about what happens over there in Philadelphia. They're throwing 'em in the back of paddy wagons, and that's working and saving lives. Yeah, in that community in those specific circumstances.
I think we're in a mentality today in our society where we hear one solution that works somewhere, and we're like, oh, that sounds like a good idea! Here's the pretty shiny new pet. Let me grab that and put it on, you know, in action in my community, and that's not the answer. You've gotta dig down, you gotta dig deeper as to why they're doing something that way and answer the question, is that gonna work in my community, or is there something I can do to fix the system?
Bill Godfrey:
Yeah.
Terry Nichols:
I concur.
Bill Godfrey:
Yeah, it is a good question, and it's a good question for spirited debate, and I think it's one that we have to have a conversation on on both sides.
Terry Nichols:
I've been asked numerous times about this. I've thought about it myself. It's like, you know, what would I do? You know, if I'm standing there looking at three people potentially dying in front of me, and I know there's an ambulance that I saw him drive in, you know, just down the road. I could see 'em and park and wait. So I've had this question myself. So this has been very educational to me. You know, we've talked about this before. But it is still educational, and you're right, we need to work together, you know, and prepare the system and not just wing it on game day.
Bill Godfrey:
And leadership, police chiefs, fire chiefs, EMS chiefs, emergency managers, city managers, county managers, you gotta deal with these problems. You gotta deal with these problems. Don't force your people, who are working on the street on the line, to have to clean up this mess and be making lemonade the day of an event when they knew three years ago that it was gonna have this kind of outcome. That's crap, and that's a failure of leadership.
So when your leaders, when your line people tell you they have concerns, take it seriously and do something about it. Get the dialogue started, and don't just drop it at, well, you know, we're not gonna support that. If your EMS agency literally says to you, we're not gonna support that, we're not gonna do RTFs, we're not gonna go down range. We'll transport your patients from a cold zone location. Okay, that's a terrible answer. But if that's the answer, and nobody's going to throw down the trump card, then at least now as a executive police leader, you know what you're dealing with, and now you can make decisions and design a system that's gonna work.
Terry Nichols:
Yep. You know, Allen, Texas, they did that very thing at a mall shooting they had recently, that it was still, they didn't think it was a warm enough zone where they had the shooting, so the officers moved 'em to ambulances off in a cold zone. So I don't think they planned that way, but it worked that way, so they probably have a plan now that in a similar situation, we'll do the exact same thing. It worked this time, but they plan for it now. And I think that's a message we leave today from that simple question I thought I asked earlier.
Joe Ferrara:
Not that simple, brother.
Terry Nichols:
It's not that simple as that. You know, work through this, work through this ahead of time.
Bill Godfrey:
And the thing I would add to your plan is "and practice".
Terry Nichols:
Oh, there's that. Exercise.
Bill Godfrey:
Yeah, you've gotta practice. You've gotta give, we've said it I don't know how many times. You don't get to the Super Bowl by doing one practice. You get there by doing a lot of work, and this is no different than that.
Terry Nichols:
Yeah, the gym, you don't bench press 200 pounds if you've never bench pressed 100 pounds.
Bill Godfrey:
Amen. If you do, you end up being one of those memes that are out there. Joe, any final thoughts?
Joe Ferrara:
No, I think we've had enough metaphors.
Bill Godfrey:
Is it metaphors or analogies? All right, Terry, any final thoughts?
Terry Nichols:
I'm good, thank you.
Bill Godfrey:
All right, ladies and gentlemen, thank you for tuning in. We hope you found this informative. If you have some thoughts or questions about it, shoot 'em to us. We're happy to have email and interaction with the listeners. You can send it to us at info@c3pathways.com. Again, that's info info, I-N-F-O, @c3pathways.com. We'd like to thank our producer, Karla Torres, and until next time, stay safe.