Hostname: page-component-78c5997874-mlc7c Total loading time: 0 Render date: 2024-11-19T14:51:59.211Z Has data issue: false hasContentIssue false
  • English
  • Français

3 Echo: Concept of Operations for Early Care and Evacuation of Victims of Mass Violence

Published online by Cambridge University Press:  09 June 2014

Allen W. Autrey ,
John L. Hick ,
Kurtis Bramer ,
Jeremy Berndt  and
Jonathan Bundt
Allen W. Autrey*
Affiliation:
55th CST/WMD, Medical, St. Paul, Minnesota USA Healtheast Emergency Medical Services, St. Joseph's Hospital, St. Paul, Minnesota USA
John L. Hick
Affiliation:
Hennepin County Medical Center, Minneapolis, Minnesota USA Emergency Medical Services, Hennepin County EMS, Minneapolis, Minnesota USA University of Minnesota, Emergency Medicine, Minneapolis, Minnesota USA
Kurtis Bramer
Affiliation:
Emergency Medical Services, Hennepin County EMS, Minneapolis, Minnesota USA
Jeremy Berndt
Affiliation:
Emergency and Trauma Center, St. Vincent Hospital, Green Bay, Wisconsin USA
Jonathan Bundt
Affiliation:
MASA Consulting, Minneapolis, Minnesota USA
*
Correspondence: Allen W. Autrey, MD, MC Medical Officer 55th WMD-CST 612 Militia Drive Saint Paul, MN 55111 USA E-mail allen.w.autrey.mil@mail.mil
Get access Rights & Permissions [Opens in a new window]

Abstract

This report describes the successful use of a simple 3-phase approach that guides the initial 30 minutes of a response to blast and active shooter events with casualties: Enter, Evaluate, and Evacuate (3 Echo) in a mass-shooting event occurring in Minneapolis, Minnesota USA, on September 27, 2012. Early coordination between law enforcement (LE) and rescue was emphasized, including establishment of unified command, a common operating picture, determination of evacuation corridors, swift victim evaluation, basic treatment, and rapid evacuation utilizing an approach developed collaboratively over the four years prior to the event. Field implementation of 3 Echo requires multi-disciplinary (Emergency Medical Services (EMS), fire and LE) training to optimize performance. This report details the mass-shooting event, the framework created to support the response, and also describes important aspects of the concepts of operation and curriculum evolved through years of collaboration between multiple disciplines to arrive at unprecedented EMS transport times in response to the event.

Autrey AW, Hick JL, Bramer K, Berndt J, Bundt J. 3 Echo: Concept of Operations for Early Care and Evacuation of Victims of Mass Violence. Prehosp Disaster Med. 2014;29(4):1-8 .

Keywords

mass violencerapid casualty evacuationtourniquets
Type
Case Report
Information
Prehospital and Disaster Medicine , Volume 29 , Issue 4 , August 2014 , pp. 421 - 428
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Nelson, P. Accent Signage Shooting. Minneapolis Police Department After Action Report; September 27, 2012. Minneapolis, Minnesota USA.Google Scholar
2. Aurora, Colorado USA Police Department Scanner Logs & Transcript of Batman Shooter Incident- James Holmes. Truth Seekers Archive, Decrypted Matrix (n.d.). http://decryptedmatrix.com/live/aurora-colorado-police-department-scanner-logs-transcript-of-batman-shooter-incident-james-holmes/. Accessed April 29, 2013.Google Scholar
3. Baker, M. Ambulance crews close to Colorado shooting delayed in being dispatched. JEMS website. http://www.jems.com/article/news/ambulance-crews-close-colorado-shooting. Accessed February 4, 2013.Google Scholar
4. Mell, H, Sztajnkrycer, M. EMS response to Columbine: lessons learned. The Internet Journal of Rescue and Disaster Medicine. 2005;5(1).Google Scholar
5. Shapira, S. ed. Essentials of Terror Medicine. New York, New York USA: Springer; 2009:37.Google Scholar
6. O'Rourke, S. The Emergent Challenges for Policing Terrorism: Lessons from Mumbai. The Proceedings of the 1st Australian Counter Terrorism Conference, Perth Western Australia. November 30, 2010.Google Scholar
7. Smith, R, Iselin, B, McKay, S. Toward the sound of shooting. JEMS. 2009;34(12):48-49.Google Scholar
8. The Hartford Consensus. Improving Survival from Active Shooter Events. Joint Committee to Create a National Policy to Enhance Survivability from Mass Casualty Shooting Events. http://www.naemt.org/Libraries/Trauma%20Resources/Hartford%20Consensus%20Document%20Final%204-8-13.sflb. Accessed December 10, 2013.Google Scholar
9. Hsu, S, Sheridan, M. IEDs Seen as rising threat in the US. Washington Post website. http://www.washingtonpost.com/wp-dyn/content/article/2007/10/19/AR2007101902703.html. Accessed February 4, 2013.Google Scholar
10. Bundt, J, Nelson, P. City of Minneapolis and Minneapolis Public Schools. Operation backpack after action report improvement plan. November 2010; Minneapolis, Minnesota USA. Accessed December 22, 2010.Google Scholar
11. Dobesh, M. St. Louis Park Fire Department. After action report-Operation Mayday Exercise; August 2010; St. Louis Park, Minnesota USA. Accessed December 22, 2010.Google Scholar
12. Mitchell, D. Aurora fire rescue faces criticism over response with ambulances. FOX31 Denver News website. http://kdvr.com/2012/07/25/aurora-fire-rescue-faces-criticism-over-response-with-ambulances/. Accessed February 2, 2013.Google Scholar
13. Nelson, S. 2 Deaths Reported After Boston Marathon Explosions. US News and World Report website. http://www.usnews.com/news/newsgram/articles/2013/04/15/2-deaths-reported-after-boston-marathon-explosions. Accessed May 2, 2013.Google Scholar
14. Report of the State's Attorney for the Judicial District of Danbury on the Shootings at Sandy Hook Elementary School and 36 Yoganda Street, Newtown, Connecticut on December 14, 2012. http://www.ct.gov/csao/lib/csao/Sandy_Hook_Final_Report.pdf. Accessed December 10, 2013.Google Scholar
15. MNC-I Counter IED Smart Book GTA 90-10-046. Department of the Army. Published September 2008;United States. p9.Google Scholar
16. Soldier's Manual and Trainer's Guide for Counter Improvised Explosive Device. Soldier Training Publication 5-1. Headquarters, Department of the Army. Published 2011. Washington DC. United States.Google Scholar
17. Kragh, J. Use of tourniquets and their effects on limb function in the modern combat environment. Foot Ankle Clin N Am. 2010;15:23-40.Google Scholar
18. Mabry, R, McManus, J. Prehospital advances in the management of severe penetrating trauma. Crit Care Med. 2008;36(7);Suppl:s264.Google Scholar
19. Bloch, Y, Schwartz, D, Bar-Dayan, Y, et al. Distribution of casualties in MCI with three local hospitals in the periphery of a densely populated area: lessons learned from the medical management of a terrorist attack. Prehosp Disaster Med. 2007;22(3):176-182.Google Scholar
20. Palmieri, J, Richman, A, Perelman, M. Suicide bombing in the city of Dimona: tactics, techniques, and lessons learned by law enforcement. The Journal of Counterterrorism and Homeland Security International. 2008;14:48-50.Google Scholar
21. Almogy, G, Belzberg, H, Mintz, Y, Pikarsky, A, Zamir, P, Rivkind, A. Suicide bombing attacks update and modifications to the protocol. Ann Surg. 2004;239:295-303.Google Scholar
22. Stack, L. Iraq police and hospital attacked in triple suicide bombing ahead of Sunday election. http://www.csmonitor.com/World/terrorism-security/2010/0303/Iraq-police-and-hospital-attacked-in-triple-suicide-bombing-ahead-of-Sunday-election. Accessed April 2010.Google Scholar
23. Costantini, A. Police, fire practice new emergency approach. Kare 11 News website. http://www.kare11.com/news/article/1012110/391/Police-fire-practice-new-emergency-approach. Accessed February 24, 2013.Google Scholar
24. IAFF Position Statement: Active Shooter. International Association of Fire Fighters website. http://www.iaff.org/Comm/PDFs/IAFF_Active_Shooter_Position_Statement.pdf. Accessed 1 October 2013.Google Scholar
25. Kotwal, R, Montgomery, H, Kotwal, B, et al. Eliminating preventable death on the battlefield. Arch Surg. 2011;146(12):1350-1358.Google Scholar