Since 9/11, firearms have accounted for 95 percent of all deaths from domestic terrorism. While IEDs remain relatively rare in the U.S. when compared with armed attack, the Boston Marathon bombing (2013) and the recent explosions in Manhattan and New Jersey (2016) warn of a growing domestic threat. Both tactics produce mass trauma casualties.

Advances in battlefield trauma care and medical technology during the wars in Iraq and Afghanistan resulted in a sharp reduction in preventable deaths in those conflicts. First-responder combat medics and corpsmen are better trained and equipped to address bullet and shrapnel wounds.

Law enforcement agencies have also adapted their tactics for violent mass casualty incidents. After the Columbine High School Shooting, police departments adopted a more aggressive response in which officers immediately pursue and neutralize an aggressor rather than waiting for a SWAT team. This change was supported by significant enhancements in officer training and equipment.

By comparison, the emergency medical services (EMS) response to violent mass casualty incidents has been slower to adapt. EMS curricula, standards and policies still largely dictate that field EMS providers wait until police mitigate the threat before entering to treat victims. While EMS responders wait for a secure scene, the injured are not receiving care resulting in potentially preventable trauma-related disability and death. Critics point to the Aurora theater shooting to suggest that some lives might have been saved had a more proactive emergency medical response procedure been in place.

To be fair, the need for better field EMS response has not gone unaddressed. Guidelines from the DHS Office of Health Affairs, US Fire Administration, and Interagency Board are just a few examples of resources developed for medical first responders. And law enforcement has begun training officers in Tactical Combat Casualty Care. But greater Federal leadership is needed to support training and equipping local, regional, and tribal field EMS providers for violent mass casualty response.

Read full article here: http://www.securityinsights.org/2016/10/responding-to-ied-attacks-improv...