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Tuesday, November 29, 2022

Integrated Public Safety/Rescue Task Force Approach Needed for Tactical Ultraviolence, Hybrid and Coordinated Attacks

Optimal multiagency operational goals must focus on threat elimination and lethality/mortality reduction.

Asymmetric threats, urban warfare and tactical ultraviolence are no longer limited to the battlefields of Iraq, Afghanistan, Syria or Africa.

While foes and enemies have engaged us in urban warfare and terror attacks in the streets and venues of Belfast, London, Paris, New York, Tel Aviv, Munich, Boston, Moscow and other cities throughout the world, the carnage continues today in the form of armed assaults, edged weapons attacks, vehicles mowing people down and, of course, improvised explosive devices at our schools, houses of worship, shopping centers and other locations.

Sometimes, multiple modalities may be used, such as semi-automatic weapons, assault-type rifles, and explosive or even incendiary devices.

These acts of violence are not restricted to jihadists, political revolutionaries, or anti-government extremists.

Oftentimes, these attacks are perpetrated by disgruntled employees, bullied students, delusional individuals, or an individual hatemonger, among other characterizations.

Nevertheless, many are heavily armed and may have explosives or incendiaries at the ready or pre-planted, such as hand grenades, Molotov cocktails, booby traps, or IEDs.

What has been described as “hybrid tactical violence” (HTV), a combination of modalities and tactics utilized to inflict maximum physical injury or death on a targeted population, defies conventional thinking or response by any specific emergency service discipline.

These complex, active violence threat scenarios require unconventional thought and multidimensional, multidisciplinary planning, mitigation and response strategies and tactics.

Mass casualty attacks are on the rise in various parts of the world, and will continue to occur.

These calculated and horrific attacks garner international attention and affect the collective psyche of civilized societies.

The intentional maiming and murder of innocent non-combatants is an atrocious act that leaves our communities as open and vulnerable battlefields where malevolent individuals and groups can wage war.

The unpredictability created by active violence events creates fear, uncertainty and undue stress reactions among the populace, knowing that an attack can occur at any place and any time, even in the most innocent of places such as playgrounds, houses of worship, schools, supermarkets and the workplace.

While any form of violence, whether perpetrated against an individual or a group, is frightening and cause for alarm, the use of military or paramilitary tactics, maneuvers and weapons against a civilian population carries with it especially ominous, vicious and terrifying connotations and consequences.

The realities imposed by confronting an armed attacker(s) who commits arson and is executing individuals utilizing an AK-47, strapped with a bandolier of ammunition and fragmentation grenades wearing head-to-toe ballistic protection and night-vision equipment, is quite different than the urban mugger demanding money or the armed street thug committing a robbery at a liquor store.

In tactical ultraviolence/hybrid tactical violence, the perpetrator(s) has/ have “upped the ante,” possibly thorough tactical planning and sophisticated military-style assault tactics and weaponry.

At this juncture, the emergency services triad of police, fire and EMS assets responding will be confronted with a complex, challenging, evolving and dynamic tactical situation that may exceed the range of operational hazards to which they are accustomed.

Hybrid tactical violence attacks, especially, go beyond the definition of an active-shooter event.

The compound effect of this type of violence requires a paradigm shift of thought which involves a synergistic planning and response strategy.

Essentially, the collective efforts and focus of the emergency services/public-safety sector must stress a comprehensive and integrated counterterrrorism/anti-terrorism approach.

In planning for such attack scenarios, planners need to conduct a historical survey of hybrid tactical violence events by revisiting the occurrences at Mumbai, Columbine High School, the Aurora, Colo., movie theatre attack, the Las Vegas mass shooting, the Christchurch, New Zealand, attack, the Charlie Hebdo event, the Sandy Hook, Conn., mass shooting and the multitudes of other examples of tactical ultraviolence, hybrid tactical violence and coordinated attacks.

The most recent active-shooter tragedy in Uvalde, Texas, is an example of what must not be our response tactics and strategies to these high-impact and high-consequence events.

Lessons learned from these, and more such tragedies, are very valuable and close analysis is warranted to effectuate proper, safe and successful collaborative multiagency responses.

Optimal multiagency operational goals must focus on threat elimination and lethality/mortality reduction.

Fire superiority and threat elimination are first steps to be implemented in the evolving tactical situation. Neutralize the threat and stop the killing! This will stop the dying.

This cooperative level of response can only be achieved through pre-event dialogue, collaborative planning and joint public safety-emergency services exercises and simulation.

Traditionally, police, fire and EMS have compartmentalized roles, responsibilities, expectations, and rivalries, which need to be adjusted and adapted to form effective and integrated public safety response/rescue task forces to respond to these high acuity, high impact events.

The concept and definition of interoperability is not limited to communications, but needs to be applicable to our public safety/emergency services/first response agencies and its personnel.

The collaborative and interoperable first responder community is an essential commodity when responding to an asymmetric, high-threat event such as a hybrid tactical violence or coordinated  attack situation.

For example, EMS/fire elements must be integrated into a tactical entry to provide immediate lifesaving care and victim extractions while law enforcement provides operational security and tactical overwatch.

There may be one or multiple attackers present in the tactical environment and threat neutralization is of paramount importance, yet medical/rescue elements must be immediately available to provide lifesaving interventions such as tourniquet application for severe extremity hemorrhage or to relieve a tension pneumothorax caused by penetrating chest trauma.

The initial response cannot be delayed for the arrival of a Special Weapons and Tactics team (S.W.A.T.) and emergency medical assets cannot be staged a block away waiting for the ” all clear ” from the incident commander.

The initial arriving units must be trained and ready to form an immediate Integrated Public Safety Response/Rescue Task Force team to address the immediate operational needs of the situation, such as tactical entry, threat elimination, victim rescue and emergency medical care.

As additional units arrive, more assets can be used to serve as backup entry teams; secure the perimeter; establish, staff and secure a casualty collection extraction point; perform render safe operations; and provide additional tactical overwatch and other functions, as needed.

All personnel must be trained to recognize real or potential secondary antipersonnel devices and maintain a high level of situational awareness at all times. Team operational safety is always first and foremost!

It must be solemnly remembered that the lack of engagement due to awaiting scene security by law enforcement and the cost associated with delayed response by fire and EMS response was clearly documented in the RAND Corporation’ s Lessons on Mumbai report [1] and The Report of Governor Bill Owens’ Columbine Review Commission [2].

As in any emergency preparedness and response efforts, citizen engagement, awareness, training and empowerment are integral components to enhance community-wide preparedness and resiliency for tactical ultraviolence, hybrid tactical ultraviolence/coordinated attack events.

This would include grassroots efforts provided by nongovernmental organizations (NGOs) such as the American and International Red Cross/Red Crescent, and other entities such as the Arizona-based Integrated Community Solutions to Active Violence Events (ICSAVE) and the Southeastern Arizona Stop the Bleed Coalition [3].

These entities offer citizen awareness, preparedness and empowerment programs that allow citizens to participate in training and exercises that address topics such extremism, terrorism tactical ultraviolence and community-wide emergencies .

Specifically, courses such as “Stop the Bleed” turn citizens of all ages into “immediate responders” by being trained to control and stop severe hemorrhage through the use of direct pressure, tourniquets, and wound packing.

The “Stop the Bleed” program is a national initiative in the U.S. that has attracted international attention and has been exported to the people and responders in Ukraine.

Similarly, there are other programs such as “A.L.I.C.E.”  and “Run, Hide, Fight” that address active-shooter countermeasures which our communities can take advantage of.

The realities of a Mumbai-style, coordinated, hybrid conventional weapons attack, another domestic bombing event or a Sandy Hook or Columbine-type school mass violence event must be confronted, studied and ingrained into our mindset as professionals responsible for saving lives.

And when lives are being lost to an attacker(s) during those initial few seconds, first responders must have the readiness and adaptable capabilities of acting as a unified force, and without hesitation stare down pure evil as a team and proceed to save lives.



[1] A Rabasa ,RD Blackwell,P Chalk,et al.

     Lessons on Mumbai .( Santa Monica ,CA.

Rand Corporation,2009)

[2] William H.Erickson .The Report of Governor   Bill Owens Columbine Review Commission .

( Denver,CO. ,State of Colorado ,May 2001)

[ 3] ICSAVE.org

[ 4] Eppel ,William R ,Kendall ,Laura J.

The Rescue Task Force & Tactical Trauma Care Manual

Frank Rando
Frank G. Rando served in the US Army as a Nuclear, Biological and Chemical Specialist/CBRN Specialist and CBRN Non Commissioned Officer, as well as a Special Forces Medical Sergeant with service in Central America, Middle East, Africa and Europe, and as a Liaison Officer with the Czech Chemical Detection Troops during the first Persian Gulf War. Frank is a Hyperbaric Medical Technologist and a Subject Matter Expert in aerospace, high altitude and undersea physiology and medicine. He has also served as a Dive Medical Technician for Special Operations combat dive teams and law enforcement dive recovery teams. Frank continued his service as a military Medical Intelligence Analyst for the Armed Forces Medical Intelligence Center at Ft.Detrick, Maryland, and is a Subject Matter Expert on operational medical and environmental health threats in military and non- military tactical and strategic operations. Frank was one of three Respiratory Therapists who formed the original AARC Committee on Emergency Preparedness and Disaster Response in the mid 1990s. Frank serves as an advanced practice clinician/Physician Assistant and Surgical First Assistant, with over 30 years of experience in emergency medicine, surgical, pulmonary medicine and critical care medicine. He has been both a paramedic and respiratory therapist, and served as a tactical medic, SWAT member and rescue technician in civilian law enforcement and EMS roles, trained in environmental criminal investigations and a former member of the Northeast Environmental Enforcement Project, a multiagency alliance and task force on environmental crimes. He is the former Assistant Director of Environmental Safety and Fire Prevention and Chemical and Biosafety Officer for the State University of New York - Downstate Medical University and Medical Center where he initiated, revamped and implemented a multitude of health, safety and environmental initiatives,including efforts involving recombinant DNA/biotechnology R& D and P5 biocontainment, biomedical research on oncogenic viruses and infectious pathogens, chemical/flammables storage and chemical waste disposal, medical waste, PPE recommendations, microwave and laser safety, radiation safety and emergency operations plans for chemical and radiological casualties and others. For over two years, he continues to serve in COVID-19 clinical research and diagnostics and therapeutics and is a Lead Medical-Healthcare Instructor/Educator for a local college and a Team Lead/Diagnostics Supervisor for a COVID-19 project with Medasource and GinkoBioworks, a leading biotechnology and synthetic biology firm in Boston Massachusetts. He also often serves as a Guest Lecturer at other institutions of higher learning and continues to serve as a speaker/ presenter at professional meetings, conferences, seminars and webinars. He is the US Correspondent and a regular contributor for CBNW Magazine, an international journal specializing in chemical, biological, radiological and nuclear threats and has been a certified DHS/FEMA Instructor and served as an SME and Training and Exercises specialist on healthcare, EMS, public health and public safety aspects of Homeland Security. He also was responsible for curriculum design, development, updating, implementation, course delivery and evaluation. He has received extensive HAZMAT and WMD-CBRNE training, including live agent training, crisis, disaster and emergency management education and training, advanced integrated chemical-biological training, Ebola and other special pathogens training, radiological-nuclear HAZMAT Technician specialist training, advanced radiological incidents operations training, hospital-healthcare mass casualty incident operational and train the trainer course, energetic materials explosives emergency response training ie., terrorist bombings, suicide bombing incidents, medical response to bombing incidents and pandemic planning and preparedness. He also instructs Tactical Emergency Casualty Care, Prehospital Trauma Life Support, Law Enforcement Tactical Emergency Casualty Care and EMS Safety for the National Association of Emergency Medical Technicians. He is a certified CERT Instructor and Program Manager and certified Stop the Bleed Instructor and an Ambassador for the national Stop the Bleed initiative. Frank has been extensively and continues to be involved as a Subject Matter Expert and Instructor in disaster, operational and tactical medicine and the instruction and development of Integrated Public Safety / Rescue Task Force teams. He continues to serve as an SME / Instructor for Integrated Community Solutions to Active Violence Events (ICSAVE.org) and is a core faculty member who has instructed well over 18,000 individuals in the State of Arizona. He is a member of the national honor society Phi Theta Kappa, American Association of Respiratory Care, National Association of Emergency Medical Technicians, International Public Safety Association, Arizona Emergency Services Association, Arizona Trauma Society, International Society for Security and Counterterrorism Professionals to name a few.

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