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CASE REVIEW 20 MARCH 2015 | EMSWORLD.com There are very important rescue equip- ment considerations for active shooter incidents. EMS personnel must enter the scene with a simple and effective set of tools, leaving the stretcher, bigger bags of equipment and monitors in the out- side casualty collection point. Some sys- tems have created a small bag marked as "Trauma MCI Bag." The needed elements may be as simple as: • A number of large-size non-sterile gloves; • Commercial tourniquets in sufficient quantity for the ingoing personnel; • Trauma dressings for wounds that need to be packed; • Trauma scissors; • Blankets, sheets or other textile devic- es to grab and move patients quickly, or cover victims who are unclothed, or to be cut apart with the trauma scissors to use as dressings; • Some systems have a set of oral air- ways and a device to decompress a tension pneumothorax; and • Triage tags and a marker pen. In the active scene area, the priorities are to stop bleeding and get the patient out to a casualty collection or transportation point. Rapid evaluation and a few critical interventions will minimize the loss of life among those who are seriously injured. Most medical triage systems—START, SALT and others—allow for that medical work to occur in a few seconds with just a pair of gloves. With the small cache of equip- ment lifesaving hemorrhage control can be accomplished, and the patient rapidly pulled or moved out of the hot zone to a secured area before rapid transportation to a hospital. En route to the hospital, or in the event of delayed transport or prolonged extrication, there is the consideration of using advanced life support interventions like definitive airway management, IV lines and pain medications. There must be early implementation of a plan for patient transpor tation. Communication must be made as early as possible to potential receiving hos- pitals, even if no specific patient details are available. A critical element of active shooter incidents is the ability of hospitals to prepare surgical resources, and that requires a little time before the first arrival of seriously injured patients. All hospitals must be prepared for these incidents, as designated trauma centers may not nec- essarily be the closest and most appropri- ate first receivers. Victim transportation must be expedit- ed. Some jurisdictions use police transport of victims, but a more sensible plan is for law enforcement personnel to do their work, and EMS personnel to treat and transport patients. Transport of patients by medical helicopters is generally not an option in these incidents, so ground transport to the closest appropriate hos- For More Information Circle 22 on Reader Service Card