Ep 38: Tips for Working Together at Tactical, Triage, and Transport

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Episode 38: Tips for Working Together at Tactial, Triage and Transport

A discussion about tips and tricks at the tactical, triage and transport location.

Bill Godfrey:

Welcome to the Active Shooter Incident Management podcast. My name is Bill Godfrey, your host of the podcast. Today's topic, we are going to be talking about some tips and tricks for working together at the tactical, triage, and transport location, which is an interesting challenge. We've got quite a laundry list of things I think we're going to be able to go through here today.

We have with us three of the instructors from C3 Pathways, Ken Lamb, on the law enforcement side. Ken, good to have you back in the house.

Ken Lamb:

Yes, sir. Happy to be here.

Bill Godfrey:

All right. And we've got our world traveler, Bruce Scott, from the fire EMS side, like myself. Bruce, good to have you back in town.

Bruce Scott:

Thanks a lot, Bill. Glad to be here.

Bill Godfrey:

And we have Pete Kelting from the law enforcement side. Peter, good to have you back.

Pete Kelting:

Great to be here, Bill. Thank you.

Bill Godfrey:

All right. So today's topic. We're going to be talking about tactical, triage and transport, and some tips and tricks on how to make that more effective, more efficient, work together. Basically take some of the friction out.

So I think, before we get too far into this, we probably ought to just take a minute and make sure that everybody understands. When we talk about tactical, triage, and transport, what those functions do. What's the main thing that happens at those locations before we start talking about how to work better?

Pete, tell me a little bit from the law enforcement perspective, what are the key things that the tactical group supervisor needs to be doing on the law enforcement side to execute their mission?

Pete Kelting:

Yeah. When the tactical supervisor gets on scene, they've got to get that situational awareness. So everything has been going on. They may have been listening to the calls, they're responding, but when they plant the flag where they're going to be, they need to get that situational awareness. They need to talk with the contact teams and see what's going on, determine casualties, initial casualty count from the law enforcement side. They've got to see what additional resources need to support those. Either a solo officer response, or the contact team is down there working. And then they need to request for the fire department to come join them at that location. That's how that tactical, triage, and transport start to form up, and to where the communications can happen immediately, to support what's going on downrange.

Bill Godfrey:

So that tactical position, Pete, on the law enforcement side, primarily responsible for making the security picture better in the downrange, everything in the hot and the warm zone, they're trying to make that better.

Pete Kelting:

Absolutely. Putting the resources downrange that need to engage the threat that's taken place. And then, begin to look at the perimeters and the security cordons, to start to make the other resources available to come downrange. But that tactical supervisor has to request that fire department resource to come to set up triage and transport next to them, to start moving into what is next.

Bill Godfrey:

All right. Perfect segue. Bruce, give us a quick rundown. What are the responsibilities of triage and transport group supervisors at this forward area where tactical, triage, and transport are working together?

Bruce Scott:

Right. So I was standing next to Pete. Pete is my tactical group supervisor. He's got his folks down there doing security work. He's telling me, or I'm listening to what he's saying, or hearing on the radio, basically, what the security image looks like at that particular point in time, as well as some initial patient counts. As his contact teams are moving downrange, and given those, some initial patient counts, myself, as triage, gives me an idea of how many rescue task force I'm going to need. And if I'm the transport group supervisor, how many transport units I'm going to need. So it allows me to start painting my resource picture right off the bat, just because I'm co-located with Pete, and we haven't even sent anybody downrange yet, but we're already starting to go to work.

Bill Godfrey:

All right. Fantastic. I think that's a perfect segue into us talking about the first issue, which is co-locating together. So Ken, why don't you lead us off, talking about that?

Ken Lamb:

Right. In law enforcement, we've recognized that we have to have both triage and transport working together with tactical to ensure that we are beating that clock, and that we are getting those impacted individuals to the hospital as soon as possible. The only way we can do that, is if we are tied at the hip with both triage and transport. And I hate to be over-simplistic, but teamwork makes a dream work. So if we can be tied together with those individuals, and we can be sharing that information as it's coming in, and not have to worry about relaying it over a radio that's probably already being tied up, or sending a runner, obviously that would equal out in us to having more efficient response.

Now what's critical, as far as being a policeman in the tactical position is, identifying that warm zone, where we can link up with those fire/rescue personnel, and ensuring that we have adequate security measures in place. And preferably a position of cover, whether it be a building, or a fire engine, or some solid cover, so that we're giving our fire rescue partners the warm and fuzzy, that, hey, you can link up here with me, and this is a safe approach.

Because understandably, some fire/rescue personnel, this could be a new concept, or they could be hesitant to approach that warm zone area. And they want to know that their security is taken care of, so we're either providing that officer to provide security, or we're identifying a clearly identifiable location for that link up, to then work that a tactical, triage, and transport function, so that we can be more efficient and effective in getting those individuals the medical care, they need.

Bill Godfrey:

Interesting insight. Bruce, what are your thoughts? What are the key reasons that you see that tactical, triage, and transport need to be shoulder to shoulder, working together?

Bruce Scott:

Well, first off, I think Ken brought up a really great point, and the fact is that number one, I have to feel secure that I can get my fire/EMS folks to fill those two group supervisor positions, the tactical and the transport group supervisor, co-located with the triage and transport group supervisors, co-located with the tactical group supervisor. I need to know that I can get them there in a relatively safe place.

But most importantly, as a triage group supervisor, my primary role is to get my RTFs downrange, and I can not do that until my tactical group supervisor tells me that that warm zone has been established, where they're going to be able to go work. And as Ken alluded to, if he has to tell me that on the radio, we get, radio traffic gets lost, we get lost in that... We're trying to beat that clock, and time is hugely important. Then if, he's standing right next to me and says, "Hey, Bruce, the casualty collections point is set up in the cafeteria. It's a warm zone. We're ready for RTFs to get down there." I'm very sure at that point, that he has set enough security in place for my folks to get down there and work.

So starting off, that's the number one goal. If I'm going to try to get my folks downrange, the guy that knows that information is standing right beside me, and he can give it to me.

Bill Godfrey:

Pete, what are your thoughts on it?

Pete Kelting:

I think exactly what the two of them were talking about is extremely important to make it efficient, and what we have to do to make that happen is training. Training and relationships. If we don't train that, then the fire department, our fire friends are going to respond the way they've always responded, either to the staging or the command post. And we're going to lose that communication, tied at the hip, as Ken was referring to. So, relationships and training and interoperability. And if there's a fallback from that, can the fire department in that jurisdiction hop up on the law enforcement channel? Since 911, our inter-operability is supposed to be to that extent friendly, in that sense, in delegation of authority to operate across all channels. And if you train with that, and you're able to hop up on the channel, if you didn't happen to co-locate, you can at least still get the information from being on that particular tactical channel from the FD side.

Bill Godfrey:

Yeah. I think you guys are all hitting right on it. From my point of view, it's at a very basic level. We need each other to do the job. Law enforcement needs the medical piece of this, and the medical needs the security piece of this. And it takes all of us working together as a unified team, as one team, to make that happen. I think it's a real base level there.

Okay. So we've got tactical, triage, and transport co-located together at a location where they're able to work together face to face. Hopefully, that's a safe location, that the fire department or EMS were able to come up to, if not, they got to get an escort. I think Ken mentioned that. They got to get some security to bring them up. But picking that location... I don't know, Ken, Pete, before we leave that, let's talk a little bit about that for a second, for the location. What are the kinds of decision-making things that should go through the mind of the fifth man? As they're getting ready to assume that position, how are they going to pick their location? What's the split-second decisions that are running through your head, on how to pick a good spot?

Ken Lamb:

Oh wow, yeah. I think it's really critical to understand that the fifth man doesn't necessarily have to be a supervisor. I believe in the law enforcement community, we could do a lot of work in educating our line level officers to understand what the fifth man is, and the responsibility in finding this location, so that they could stand up the tactical position, and knowing that. You have to have a good situational awareness of what is going on in the target location, but also, you can be detached so that you can act as that funnel. So when resources are coming to you, your attention doesn't have to be directed on a target location. You can take your attention off of it in a secure area and direct those resources to whatever their task and their assignment is.

So in my mind, when I think of what would be a perfect location, it would be a building that was between you, or some sort of structure that was between you and the target location. And if I couldn't find a building, then that's, I think would be a great time to get a large vehicle. If you had a tactical vehicle, you had the accessibility to that on scene. You could utilize that. You could also utilize a fire engine. Something that that could provide a decent amount of cover, so not only are you covered from the potential subject that's at large, but you could also provide cover for all those resources that would be meeting you at that location to receive their assignment.

Bruce Scott:

I think it's really important, Bill, that we have an understanding of the fire department culture. Right? So for years, and years, and years, we've heard that we're not going to put our folks in harm's way until the law enforcement tells me it's safe. And having that understanding that we've built those relationships, as Pete has alluded to, and that when they're ready for my folks to move up as the triage and transport group supervisors, that they've actually taken that into consideration.

And again, I think Pete alluded to it earlier is, the only way to do that is to train together, plan together, train together and build those relationships so we feel comfortable in that. I have a feeling that the natural pushback around the country is, if that fifth man, or tactical group supervisor, is set up in a too hot zone, we are going to drag our feet, putting our folks up there, and we got to really work through that. So that the training needs to happen on the law enforcement side to say, when I establish that tactical group supervisor position, I have to take into account, pretty soon, there's going to be a triage and transport group supervisor with me, and I need to factor that into my location planning.

It is basically, the trust that I alluded to earlier, as Bruce was saying. The more we train the more similar faces see each other, and start to rely upon each other's trust. If Bruce says to me, "Hey, come with me and dress out. I can take you through this burning building." I'm going to trust in that he can get me through this burning building, and I'm going to come out with no problems. No flames and suit and scorches on me.

The same thing with us, tactical. If we train enough, and we pick the locations that provide that warm and fuzzy feeling, as Ken's talking about, then when it comes to real world, there's no hesitation that the tactical, the triage, and the transport are going to end up locating next to each other and working efficiently.

Bill Godfrey:

Fantastic. So Bruce, Pete said a little bit earlier, he talked about the importance of getting situational awareness for the tactical group supervisor. When triage and transport show up, how does that start? You're part of the team. You and I are part of the team. You're triage, your transport. You need to get your information first. What are you looking for? What does that sound like?

Bruce Scott:

I got to tell you, one of the first things I'm going to ask Pete is, have you got any kind of initial casualty count at this point? I want to know that information pretty quick. And secondly is, what is your, the security posture, as far as where the casualty collection point is going to be? Where they're moving these folks to, and what that security posture looks like. So that I can begin planning accordingly from the triage group supervisor position, to be able to get my rescue task forces into that warm zone, that casualty collection point, and they can start doing their work. So the very first conversation that Pete and I are going to have is number one, what does your initial casualty count look like? And number two, what's our security posture downrange?

Bill Godfrey:

You mentioned the zones, and I think that's a really interesting area to talk about. Something that comes up frequently in our training is, this cultural myth within the fire and EMS service, that the line between the hot zone and the warm zone is like, the line of death. This side of the line, you die, this side of the line, you're fine. Except it's not that clear cut at all. There's a lot of gray, a lot of shades. I often say it looks more like an amoeba than a bunch of circles around each other. Ken, what are some of the things that occur in trying to define what is hot, what is warm?

Ken Lamb:

Right. As a matter of defining both the hot and warm zone, the hot zone, we want to make sure we're crystal clear on where it's located, because it you're assuming that you're under a direct threat, so that a suspect could potentially impact you, when you enter in the hot zone.

Now, what I personally like to do is, point out clear identifiable marks of interest within the location to say, once you pass that light pole, or once you pass that building, you are now entering the hot zone, or that building is the warm zone. Because we all understand where the building is located, everyone. It's a common location language, okay, that building. And it's a little easier to say, "Well, the parking lot.", are easier than identifying say, the parking lot is the hot zone. The parking lot can mean one thing to one person, and another thing to another, to a second person.

So when we identify it, and in my opinion, we want to be clear and specific on the point that we're identifying as that line of demarcation between the hot and warm zone, so that it has a common understanding, and everyone is crystal clear, as far as when I'm leaving the warm zone and I'm entering the hot zone, I have now stepped into a different level of security, where I need to have my head on a swivel and ensure that I'm covering all potential advantage points that the suspect may have access to.

Bruce Scott:

Hey, Bill, I think it's important that we also mention that there are no absolutes in this business. Right? So if Ken or Pete roll up and go, hey, their initial description of the incidence is, we're making the entire campus a hot zone, and you have to understand, that's just that moment in time. It is not an absolute that's going to be the entire time. As they gain situational awareness, as they get their contact teams downrange and start beginning to get a better picture on what's going on, those zones may very well change minute to minute, and we just have to be prepared to adapt. I think we've talked about it on the fireside before, when we talk about zones, they're not concentric circles. That's the way we grew up in the hazard materials world. That's what you and I grew up, that they're concentric circles.

But we have to understand that that situation is evolving at all times. Warm may move, and hot may move, and we just have to be prepared to adapt.

Pete Kelting:

And like Ken said, if I'm the tactical command and Bruce rolls up as triage, I'm going to clearly paint that picture to him and say, "Hey, listen, this is what's been going on. This is where our threat is. We still have an active shooter in this area, but we've got plenty of contact teams engaging that active shooter. And we also have additional contact teams of trailer teams, setting up safety cordons. And we have got to get RTFs working downrange right here." Because the first CCP, and the first request for RTFs, come from the law enforcement side, and we have to be crystal clear with each other, that we feel that we can make that happen.

And so, if we paint that picture from the information coming downrange, and again, you've heard me say this before, that information coming downrange comes from folks that take charge downrange, and know what it means to pass that information up, for the bosses above them to start making those decisions. And so when that happens, Bruce feels, "Okay, we can get those RTFs down there." But remember, RTFs are comprised with law and fire for a reason. We're doing the best we can to delineate between hot and warm. But even though we're operating in a warm, at any given time, it could turn hot again. That's where that training into, rescue task forces recognize that, and that there's no hesitation.

Bill Godfrey:

There are no absolutes.

Ken Lamb:

And typically, I'm just kind of thinking this as we talk about it, we always think about things, at least in my point of view, as daytime. But these can happen at night, and that adds an additional complexity. So how are we identifying these areas at night? And that's where I think, if you have these thoughts and you do these training with your partners, then you discuss the usage of a chem light, so that you can identify, well, this is the difference between the hot zone and the cold zone. So that it's, again, it's crystal clear to the fire/rescue personnel that they have security measures in place, and they're comfortable before they move downrange to start providing that rescue.

Bill Godfrey:

So let me see if I can summarize this a little bit. So, zones are fuzzy at best. They're not absolutes. Bruce, I think you said that very eloquently. They're not absolutes. But they give us a pretty good sense of where we can and can't work, or where we should or shouldn't work. And we have to have a little faith and trust in each other, which hopefully has been built with some relationships and some joint training, to know that a law enforcement officer who's downrange, who understands darn good and well, what it means to be asking for an unarmed paramedic to come downrange to help. When they say, "I'm ready for the medics.", send them. That we can take that, and have some faith and some trust in it, that we can go execute that. Is that fair?

Ken Lamb:

Absolutely.

Bruce Scott:

I think it's fair. And the only thing you have to overcome is that fire department supervisor saying, "Is the bad guy in custody? Is the bad guy down? Is there absolutely no threat to my folks?" That's what we have to overcome.

Bill Godfrey:

Yeah. And that's a cultural challenge in some ways. Okay. So let's talk about sharing information at your work site there. So tactical triage and transportive got a location. They are shoulder to shoulder. Tacticals work in the law enforcement channel. Triage and transport, of course, work in the medical channel. Tactical's running the contact teams, who hopefully have selected a casualty collection point and begun moving some of the casualties, if not all of them. Triage has worked in the medical channel, trying to get those rescue task forces pushed forward. What are the kinds of information that needs to be shared back and forth between them, between each other face to face, in order for them to do their jobs? Pete?

Pete Kelting:

Yeah, I think we've talked about that, and just as we've been discussing all the other items is again, the most common thing is painting the picture, and what security measures we have in place, when Bruce rolls up, that he's able to glean that from me.

Now, a couple of things working in any position is, do we have enough staffing there? So tactical command, I would say, as quickly as you can to get an assistant, a scribe, or a deputy, or somebody that's there to take notes of what you're doing. And then if you're busy on the radio, when Bruce rolls up, that person can brief Bruce up. Or as you see in our curriculum, we have the tactical T in the transport, triage T. Those are designed so that we can document the information that's coming up to the tactical command, and share that quickly, either by the FD representative, just looking at the command board, and seeing what's taken place, and starting to make decisions. Or having that ability again, to have that briefing that sides up to what's going on downrange.

Ken Lamb:

I think an excellent point that Pete mentioned is, the usage of a board to display information, and using the vehicle in displaying that information, so that when fire personnel, or triage, or transport come up, they have a place to go, a one stop shop, of what has occurred and what the objectives are, so that they get the warm and fuzzy about what you're trying to accomplish. And even moreso is, I think, on the law side, we forget to brief up the security for the rescue task force. Because we just assume the rescue task force is working for triage and transport, so they got it. No, no. We need to make sure they understand what the responsibility is, and what we're trying to accomplish.

Bill Godfrey:

Bruce, from your point of view on the triage and transport side, what are the kinds of things that you're hearing and seeing that need to be shared back with tactical?

Bruce Scott:

Obviously, as my rescue task forces are downrange, and they start identifying maybe a better, or an ambulance exchange point, or what the true patient count is. And then we say this, "Hey, outside the cafeteria is going to be our ambulance exchange point. Hey Pete, can we make sure that we have enough security at that AP? That's the AP that works best for RTFs, or downrange. And this is our current patient count." And giving him that information, and then he certainly would share with me when he has enough security there, so that I can get my ambulances downrange, my transport units downrange, and get those folks off the scene, and to the hospital. And the faster that happens, again, we're trying to shave those seconds off the clock.

And again, "Hey, Pete, ambulance change point's going to be outside the cafeteria. You good with that?" Right? And if he is good with that, "Pete, can you make sure we have enough security there, so I can start bringing my ambulances downrange? Hey, Pete, what's the best way for my ambulances to get there? Are you good with that, me bringing them down Avenue A?" Right? So those are the conversations that Pete and I have to have. Then when he says, "Yes, Bruce, security is there." Good. Ambulance one, or rescue 16, whatever, it is, we're ready for you. Then we can call staging, and get those ambulances out of the staging and to the ambulance exchange point.

Pete Kelting:

And it even starts, Bill, with the first request for CCP location from the contact teams downrange, when Bruce arrives. That I'm able to tell him, "Hey, this is our first location, the CCP, our contact teams downrange." It felt that it's accessible, it's defensible. They're able to move most of the casualties there. There may be a need to leapfrog from room to room, or move into the structure a little bit more, but, that there's a good feeling that that first CCP is set up, so when Bruce decides to send that RTF downrange, that that can take place.

And then, just adding on the AEP, the amble exchange point. You hear us a lot of times coaching up folks in the training that resource is limited sometimes. So, overwatch, using high ground and folks to be able to look at that long road of ingress in with RTFs moving downrange, or ambulances moving downrange, to either CCP or AP, can provide again, an additional layer of warm and fuzzy feeling, that Ken was talking about. So that our fire folks that are working with us, trust us that we're bringing their folks in safely.

Bill Godfrey:

So lot of information there. Let's talk a little bit about the AP for a second, and the overwatch issue. You mentioned training. One of the things that we see pretty commonly is, as soon as we start getting ready to transport patients, is the transport group supervisor wants to push 15 ambulances up to the ambulance exchange point, which is not a good idea. Ken, talk a little bit about some of the security challenges that you face to secure an image exchange point, when not one or two ambulances show up, but when four or five show up.

Ken Lamb:

Yeah. Well, you're expanding your footprint, which is requiring additional resources. And the additional resources you get, you obviously need to make sure they're briefed on what they're trying to accomplish. They have different angles they're trying to cover, which complicates their job. Particularly, if the suspect is still outstanding. Right? I think the easy response is, if the suspect has been neutralized. But the more complex response is, a suspect is outstanding, and we've identified and established this warm zone to move in, and established the ambulance exchange point. When we take the latter situation, we need to ensure that we're moving those ambulances up, and in a manner that we can provide security for. And again, that's a detailed conversation that needs to take place between tactical, as well as transport and triage, to say, "This is the amount of ambulances that I can support with my security downrange." And if you're expecting to move more ambulances up, well, then I need some additional time, and work with staging to get some resources up here to provide an expanded security perimeter.

Bruce Scott:

Yeah. And I'd like to jump in here if I can Bill, because if we're having that conversation with our tactical group supervisor, and I'm the transport group supervisor, and he's letting me know, or he or she are letting me know, that we are very limited, we do have some security in place, but it's not absolute. I'm not going to send 15 ambulances. Transport to staging. One ambulance to the ambulance exchange point. When they're in route to the hospital, go ahead and start the second ambulance. Right? Go ahead and delegate that to your staging manager, let them get downrange, with a complete understanding that ambulance, there's nothing but big targets. Right?

And again, it sounds like I'm saying the same thing over and over again, there are no absolutes, right? We're going to bring them into that warm zone where that ambulance exchange point is, get them off, bring another one in. Limit our exposure with our folks and not stack 15 ambulances at the ambulance exchange point.

Pete Kelting:

You've heard us coach up before Bill, in the sense of also contact teams downrange knowing that. What's their task and purpose? If they're done with finding the bad actor, and they're moving into other things, but they talk back to tactical and say, "Hey, we've got a couple of contact teams that can be repurposed." That's information for the tactical officer to know, because we struggle sometimes where we probably need to bubble out from downrange to put resources on ambulance exchange points, and try to hustle up contact teams, or trailer teams, to come in.

So, it's again about painting that picture, and situational awareness. You look at Pulse. Obviously, they had the hospital right down the road. But even look at Las Vegas, that you've got to get a lot of ambulances down to red patients that need to be transported, and that frequency and volume is going to go quick. And so we have to be prepared for that, to be able to protect that ingress of ambulances going down. But then again, like Ken said, not to overload it and increase our footprint before we're ready for it.

Bill Godfrey:

Pete, I completely agree with you, and I think it's probably important to remind everybody that the whole reason that we're trying to do this ambulance exchange point, as opposed to just shuttling patients away from the impacted site to a safe area, quote, unquote, safe area, where we can load ambulances in a cold zone. It's not that you can't do that, it's just slow. If you're-

Bruce Scott:

Kind of exhausting.

Bill Godfrey:

And exhausting, yeah. If you want to save lives, and everybody who gets in this business, they want to save lives. If you want to save lives, then you got to take minutes off the clock. You have to save time. And so these things are part of the process that's just necessary to get to taking that time off the clock. I think these are all critical elements.

Let's go around the table and see. I'd like to hear your number one tip that you, when you're coaching for tactical, triage, and transport, what's the tip that you give the most often? What's the thing that comes up the most?

Ken Lamb:

Get a scribe, and someone to operate the radio. Because there is so much going on, and you're trying. If you're doing it right, in my opinion, you're thinking strategy to avoid a blue on blue, particularly on some of the larger structures, and it just takes time to think it through. And it's difficult to think through these concepts and strategies if you're constantly answering the radio and trying to write down notes. So I know it's a really simple trick, but in my experience, you're never short resources. You're going to have people that are going to come to you and say, "What can I do? Where do you need me?" And in those cases, if you've recognized that we're addressing the priority, and we're addressing the active threat, and we have resources that are also addressing rescue, then start grabbing individuals to assist you in the radio operation, as well as writing down information.

Bill Godfrey:

I think that's great. Bruce, what's on your list?

Bruce Scott:

My number one thing is talk to your tactical group supervisor. If I'm the triage group supervisor, and I'm ready to move my resources, or I'm anticipating what my resources are going to be doing downrange, I don't know how many times in these trainings we've heard, "Well, I'm ready for my rescue task force." I'm like, "Oh, have you talked to your tactical group supervisor? Do they have a casualty collection point? Is it warm?" Have those communications. Don't be shy. If you have a question or information, turn to the person that has the best picture of what's going on downrange. Don't work in a bubble. Don't work in a silo. Reach over and talk to your tactical group supervisor, get that information from them, and then make the decision based on that information.

Bill Godfrey:

Pete, how about you?

Pete Kelting:

I think mine is, really putting a priority on identifying and delineating that warm zone from the hot zone. Because you really don't have an idea how long that hot zone, whatever size it's going to be, where the bad actor is going to be, is going to go on. It could be a barricaded situation and that hot zone's going to be there. So that priority of really not waiting to get that warm zone identified and secured up with the security forces and cordons done, to get those RTFs downrange. You have to get the RTFs downrange.

Bill Godfrey:

I think mine would probably be, and I think this is true for triage, transport, and for tactical. Don't get hung up on what the casualty numbers were 10 minutes ago, or the colors, or the numbers of colors. Don't get hung up on that. Because they're never going to match. They're not going to add up, so don't get wrapped around the axle. Focus on what is left. Triage to RTF one. What do you have left at your location? And if you're working more than one casualty collection point, triage to RTF, whichever, at the other casualty collection point. What do you guys have left? And just focus on what's left.

One of the most common issues I see is, we tend to lock on to those early numbers. Then, if they don't add up 20 minutes later, then something's wrong, and it's not. You got, greens have become yellows, yellows have become reds, reds have become black tags. You have black tags that were initially labeled as reds, that were never really reds. I mean, the numbers are just going to be a moving target. So I think that's mine. Everybody got enough for another one?

Ken Lamb:

I do.

Bill Godfrey:

Go around again?

Ken Lamb:

Absolutely.

Bill Godfrey:

All right, Ken, hit it.

Ken Lamb:

I think in the tactical position, because you have so much that's going on, it's very easy to lose the concept of managing your resources downrange. And oftentimes, these contact teams are mixed resources and they vary in experience, and you could... I work on a midnight watch. I could have a contact team full of one month probation officers. So they need my leadership and guidance as far as what to do next. They understand the basic concept of stop the killing, stop the dying, but they also need to know, do you have security in place? Do you have an immediate action plan? Are you providing medical?

And I need to be listening on the radio, or have someone who's assisting me, listen on the radio, to ensure that they're thinking about some of those contingencies, and they're planning on addressing the contingencies, if they come up, so that they can be more efficient in their response. Because if we've learned anything in these situations, you cannot be stuck in concrete. And your job is not done when the threat is eliminated, there are more tasks that need to be completed.

Bill Godfrey:

Yeah, that's a great one. Bruce, how about you? You got another one?

Bruce Scott:

Yeah. It's going to come back to that same thing, communication. Right now, as a triage group supervisor, if I'm starved for information, who do I get that from? Whether it's my RTFs downrange. Right? Give me that information. What's my viable patient count now? Right? So I'm going to be starved for information so I can make decisions. So consistently, and if you come back a third time, I'm probably say something very similar, because communication is where we seem to fail just about every time. And people think we fail because our radios don't work, it's because we don't turn to each other and have a conversation about what our needs are, what we're trying to accomplish. And we're all working, rowing the boat in the same direction, if you will. And so much of that could be solved if we just learn to communicate with each other.

Bill Godfrey:

Pete, how about you? You got another one?

Pete Kelting:

Yeah. Kind of like Bruce, I was going to say, delineate between the hot and warm zone, because it's that important. But reassess, constantly reassess your strategy. We say on the gun range, "Did it hit, did it work?" If it's not hitting, not working, then we need to change our strategy. So we've got to constantly reassess. There's going to be more than one CCP in a lot of these incidents, there's going to be potentially more than one AEP. So as Ken alluded to, the footprint's going to expand, sometimes out of our control, and we've got to reassess, be flexible, and be adaptive at the tactical command.

Bill Godfrey:

I'm not going to torture you guys, come around another pass. But I think my last one would be, we all have to work together and communicate together, but it's important for us to stay in our lane and remember what our role is. What I'm specifically thinking about is, before triage and transport, get to the tactical group supervisor position. Then tactical owns all of it. Their own in the contact teams, their own in the security, their own in the medical. They're trying to get patient information, and numbers, and all of that kind of stuff. And it's very overwhelming. My job when I get there as the triage group supervisor, once I get briefed up, should be to take all of that off of the plate of the tactical group supervisor, and frankly, the contact teams downrange.

Once we get stood up on the fire/EMS side, we should be managing that medical piece. It shouldn't be necessary after we've stood up, to continue to have medical information being transmitted, and taking up space on the law enforcement channel. We should be taking that off of their plate. That's our responsibility. And it does require a little bit of shifting gears, but I think it's important, because in the beginning, tactical has a whole lot on their plate. There's a lot going on and our job should be, not just to do our job, but to help them out. And if I execute my job by staying in my lane and keeping tactical from having to mess with that other stuff, then I've helped.

Bruce Scott:

The alibi I would have to that though, Bill, is the beauty of triage, transport, and tactical all standing together. If I can't get it, if I'm on an RTF and I cannot get my message to the triage group supervisor, my law enforcement element that's with me, can certainly tell that tactical guy, and he can lean over and say, "Hey, Bruce, this is what we're hearing from RTF one."

Bill Godfrey:

Absolutely. And we have seen that time and time again. And of course it goes the other way as well.

Bruce Scott:

Yeah.

Bill Godfrey:

If triage can't get ahold of an RTF, "Hey tactical, can you get ahold of this RTF and tell him to answer the radio?"

Bruce Scott:

Yeah.

Bill Godfrey:

And tactical will call down to the law enforcement element on RTF three and go, "Hey, triage has been calling you. Get your medical guys to answer the radio.

Bruce Scott:

Absolutely.

Bill Godfrey:

Yeah.

Pete Kelting:

Bill, if I can add as a summary, in a sense, from a law enforcement profession to fire side profession is that, me as a tactical commander, I want to be successful in the sense of putting the bad guy down, or contain the bad guy, or winning on my side. But I also have to remember that, Bruce coming in as a triage or a transport, he wants to be successful. He has his goals to be successful. We all have our bosses to be successful too, and I have to show and share as much information to make him successful at that tactical man as he does back to us. So that's the important thing, knowing the success of both of us is what is important.

Bill Godfrey:

Pete, I think that's a fantastic way to summarize it and wrap it up, so we will leave that one there.

Gentlemen, thank you very much. Ladies and gentlemen, thank you for tuning in. We hope you enjoyed this. If you haven't subscribed to the podcast, please do so. Click the subscribe button on your device, or wherever you consume them. If you have any suggestions or questions for us for future podcasts, please email those to us at info@c3pathways.com. Again, that's info@c3pathways.com.

Also, I'd like to say a special thanks to our producer, Karla Torres, for doing a great job editing these things. We do not always get these. We are not the one cut wonders, and she does a fantastic job putting these things together for us. Until next time, stay safe.

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