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ACTIVE-SHOOTER RESPONSE be lost by a slow methodical search of the office, school or workplace. Another finding was that explosive devices were rarely used. Columbine was an exception in this regard. “What is less clear and defined is the EMS medical response procedure.” Active-shooter incidents can be further broken down into two main types of attacks: spontaneous and well- planned. SPONTANEOUS OR NEAR- SPONTANEOUS SHOOTINGS Spontaneous active-shooter inci- dents are often initiated by a subject who experiences a significant negative event, few common themes. such as job termination, a bad employee review, bullying, isolation or some kind of mental breakdown. This may be the “last straw” for someone who has been ready to act out and may have been fanta- sizing about some kind of retribution. In several situations, the perpetrator leaves the premises to retrieve a firearm, then returns and starts killing people, some on purpose, others at random. These types of incidents have a First, there is little premeditation and planning. It is common for the action to take place on the same day as the triggering event. Second, most attackers do not plan on surviving. In some cases they kill themselves after the initial “flurry,” or when cornered or pinned down by law enforcement. They also have been known to perform “suicide by cop,” where they confront law enforcement in an aggres- sive manner, often with gun in hand, and law enforcement obliges with good reason and ends the event for the perpe- trator; however, the MCI has only begun. PLANNED SHOOTINGS While planned shootings are far less common than spontaneous events, they present additional complications and usually result in more casualties. Some examples include high-profile events like Columbine (Eric Harris, Dylan Klebold), Virginia Tech (Seing-Hui Cho), Fort Hood (Nidal Malik Hasan) and, most recently, Tucson, AZ (Jared Loughner). These inci- dents are often planned to be terminal for the perpetrator. Planned incidents are of a bit more concern to law enforcement, as the perpetrators may factor in police and EMS response to their sequence of events and countermeasures. They may chain or lock doors, plant booby traps, disable surveillance cameras, etc. On occasion, improvised explosive devices have been planted. Chest Seal On-Board of Every Ambulance The Halo Seal is designed to treat penetrating chest wounds. Major bleeding caused by gun-shot, stabbing or other penetrating trauma can cause death in as little as three minutes¹. When time is critical, the Halo Chest Seal is the essential choice for manag- ing penetrating chest trauma. Every ambulance, police vehicle and tactical EMS team should carry a Halo Seal. It creates an occlusive seal that prevents air from entering or escaping the chest cavity and assists in manag- ing the onset of tension pneumothorax. With superior adhesive qualities, the Halo Chest Seal is de- signed to work on patients with heavy perspiration, wet environ- ments and in temperature ranges below 32° F to over 140° F. The Halo Seal comes two per pack to manage both entrance and exit wounds. The Halo Seal is quick and easy to apply. The unique design offers a large pull tab that allows “burping” of the wound if required. The highly aggressive hydro gel adhesive enables the dressing to conform and contour to the patient’s body creating a complete seal while managing bleeding. The Halo Seal mirrors the features and benefits of chest seals characteristics recently released by the Tactical Combat Care Committees (TCCC) and is widely used by our military to treat penetrating injuries. TO SEE LIST OF ALL PREFERRED FEATURES GO TO http://www.health.mil/Libraries/101101_TCCC_Course_ Materials/0609_CoTCCC_Meeting_Minutes_1004_Final.pdf 44 JULY 2011 | EMSWORLD.com When dealing with penetrating chest wounds and when time is critical, the first step to saving a life is to use Halo Chest Seal. REFERENCES: 1. Paul Shubinsky. Survive Injuries Until Backup Arrives. Tactical Response Magazine. Sep-Oct 2010. Copyright of PMI. All rights reserved. 07/2011 HALO FEATURES and BENEFITS • Two per package for entrance and exit wound • Creates an occlusive seal 6-8 inches • Reseals after venting Integrity maintained after folding • Latex free (more features and benefits and usage video on www.haloseal.com or www.progressivemed.com)