Well-adjusted people seek to help those in need when possible. In the immediate aftermath of tragedy, we often see people at their best; in the wake of natural disasters, we usually witness immense relief efforts, and we often see the same following man-made devastation. Even during mass casualty events perpetrated by active killers and terrorists, we see much heroic action. Images of the rescue effort following the Boston Marathon bombing come to mind, or images of the efforts made at the Las Vegas music festival attack. Many seek to help their injured fellow man in such circumstances.  

However, as it pertains specifically to active killer or terrorist events, there is a good deal of caution that must be exercised by the capable and prepared individuals who find themselves in such a circumstance. The armed citizen should have medical training, in particular, the ability to control life-threatening bleeding. The prepared individual should also keep trauma kits available in the vehicle, preferably within reach when possible. But before quickly reacting to save the lives of injured people in a violent situation, the responder must be cognizant of the extreme danger that may still be within striking distance.  

Scene Safety

I have taken multiple medical classes ranging from CPR to one and two-day versions of TCCC/TECC training. In all such classes, a good instructor stresses the importance of “scene safety.” It should be obvious, but it does nobody any good if the individual who rushes into a situation to help the injured parties gets injured and incapacitated or killed themselves. Scene safety applies to any situation in which someone is injured. If, when on the road, you happen upon a car wreck, scene safety will involve making sure that you do not walk out in front of traffic or get injured yourself on sharp metal or broken glass. Scene safety at an industrial accident may involve not walking into dangerous machinery or exposing yourself to flames or chemicals. 

Pertaining to scene safety during a mass casualty event, the most pressing danger will be the entity, or multiple entities, that perpetrated the event. Is there a single or multiple active shooters? Were explosives used? Was it an edged weapon or a vehicle attack? Most importantly, is the danger still in the immediate area? You cannot risk getting killed on the scene because you leave yourself vulnerable to the threat while you are distracted with triaging and treating a patient. Scene safety must be the first priority if you choose to help the victims of violence.  

Active Killer Scene Safety

The armed citizen should carry two trauma kits on person; a handgun to inflict trauma when necessary to respond to a deadly threat, and a trauma kit of medical devices to treat trauma sustained by an innocent party. To be blunt, the best way to stop the killing during an active killer rampage is to use your emergency rescue gear that you carry on body to inflict trauma. If the attacker, or multiple attackers, are still at large in the vicinity, then you cannot safely turn your attention to the injured. The threat must be neutralized first. Even if the threat is no longer in the immediate vicinity, spending your time treating a single injured individual may mean that the killer moves on to cause ongoing death and destruction. The priority in many such events is to stop the killer.  

I have heard a number of ex-military medics who teach medical classes use the term “shooter first.” This means that, upon encountering violence that has caused casualties, even the individual trained to respond medically must be a shooter first. The priority will be to stop the threat, at least if it is within the vicinity. Once you can make a reasonable assessment that the scene is made safe to start assisting the injured, then do so.  

Explosive Devices and Vehicle Attack Considerations

While most mass attacks within the United States have been in the form of active shooters, we have also witnessed explosive and vehicle attacks. While they remain a minority here, these two forms of terror are used extensively in foreign lands. Now that we have a wide-open border free to anyone who wants to do this nation harm, brace yourself; there will be an increase in such tactics used by terrorists. Likewise, even native-born lone-wolf attackers have, indeed, used such tactics. Consider the Oklahoma City bombing or the Boston Marathon bombing. In the mayhem of such events, scene safety is a misnomer.  

Pertaining to explosives, if there is a detonation, you must consider the high likelihood of a secondary device. In other countries, initial explosions have been used to push a crowd to a point of perceived safety, such as a parking lot outside of the building, just to be victims of a secondary bomb waiting in a vehicle. Explosives are truly scary, thus a favorite tool among terrorists, and after an initial blast, you must act prudently before exposing yourself to the possibility of a secondary device.  

Vehicle attacks have also been used domestically and abroad, the best-known example being in Nice, France, when a terrorist used a rented box truck to kill 86 people in a crowd. Consider the unimaginable chaos following such an event. If you focus on casualties immediately, you may be vulnerable to the course of other vehicles or other forms of attack following the vehicle itself. As witnessed in the London Bridge attack, the combination of a vehicle attack and knife attack was utilized, and there is no reason to think that will be the last such event.  

The armed citizen should be trained and prepared to medically assist injured people at any scene of attack, but the responder must prioritize their own safety so as to be an asset rather than another casualty.