Battling Failure to Rescue with Rapid Response Teams
Rapid Response Teams focus on the critical minutes before first responders arrive and their work plays a huge role in saving lives.
In the context of schools, universities, faith-based organizations and companies with large campuses, a rapid response team is a small group that can be mobilized rapidly to provide acute care for anyone in a health emergency. Their speed, proximity to the victim and practiced skills are the magic. The aim is to prevent “failure to rescue” when every minute counts.
Whether you have an ample, well-equipped fulltime staff of security, medical and risk management personnel or a small organization with a couple of staff and a few security and medical volunteers to respond to emergencies, the consideration of forming an RRT is well worth the effort. The following questions are critical:
- Have you learned from 9/11 and the latest active shooter events?
- Can you define the current and specific risks to those you serve and those who serve?
- Can you get care to any victim within three minutes?
- Are AEDs and care supplies positioned within three minutes of victims?
- Do members from your various departments regularly practice emergency response together?
Any organization can benefit from regularly practicing the process of getting the right people and the right supplies to a victim within three minutes. Many of our campuses are a labyrinth of streets, buildings and sites not easily understood by first responders in the community. We must beat the clock in the face of these time-eroding challenges.
3 Minutes and Counting: Lives Saved or Lives Lost
If the goal of rapid response teams is to prevent “failure to rescue,” what threats must you address? Over the last three years, we have consulted medical specialty organizations and leading subject matter experts, as well as continually reviewed the medical literature. We found eight target areas that are frequent, severe and treatable with bystander care before professional first responders arrive.
In the December issue of Campus Safety, we addressed preventing and responding to medical emergencies with our Med Tac Bystander Care Training Program. These health crises include sudden cardiac arrest treated by CPR and AEDs; severe bleeding treated by direct pressure, tourniquets and wound packing; opioid overdose treated with naloxone; anaphylaxis treated with epinephrine; and choking treated with the Heimlich Maneuver. We also addressed the prevention of non-traffic related drive-over accidents, common accidents, and bullying leading to school and workplace violence, including self-harm.
If most of these medical emergencies are treated within three minutes with bystander care, survival is increased dramatically compared to starting care when the professional first responders arrive, which is 10 minutes on average. For example, the survival rate of sudden cardiac arrest drops 10% every minute without CPR and an AED. Victims of severe bleeding can die in three to five minutes. Opioid overdose, choking and anaphylaxis causes vital organ failure in three minutes from the lack of oxygen.
The health emergencies you target at your organization may differ depending on the age, concentration and flow of people, geographic issues, and other security and medical circumstances. As described below, it will be valuable to review the lessons learned from others and consider if you could start a rapid response team.
‘Teach Us and Train Us’
The message from our youngest author and our youth leaders, school children, and scout groups is: “Teach us, train us, and we can help support your teams.” The stories of rescues assisted by children and youth are rolling in every month.
We have engaged students, boy scouts and athletic team members to help assemble Stop the Bleed kits, develop signage and learn how to help adults in emergencies. Even oceanside communities are becoming involved in “adopt a cove” programs to procure supplies and assemble the public for CPR, AED and Stop the Bleed training for their favorite beaches.
Lessons Learned and Opportunities
Active shooter, mass casualty and terrorism events have taught us that when we are under stress, we revert back to the level of our recurrent training. In our study of threat safety science, we have come to understand that simple predictive analytics can help organizations zero in on their specific threats, vulnerabilities, risks and harm. We have learned that the usual command and control structures inherent to our organizations adapt to usual circumstances but often fail when stressed by crises… even more so when they must interface with professional first responders. One-time education and skills training are not enough. Regular deliberative practice with immersive simulation is critical to successful performance in a crisis. We believe in “competency currency” because skills decay over time. We can combat this with practice.
A retrospective analysis of the 9/11 terrorist attack by Simon and Teperman in the Journal of Critical Care revealed that “the lack of communication probably resulted in more problems than all other factors combined.” The authors further stated that plans must be “tailored to specific scenarios and locations, not preconceived generalized plans.”
The FEMA 1 October After-Action Report on the Oct. 1, 2017, active shooter event in Las Vegas resulting in 58 deaths and 850 injuries revealed the importance of coordinated planning across agencies.
“When agencies followed pre-established plans and procedures, they improved communication and strengthened the response,” the report said. “Where plans were not integrated or not widely known and understood by responders across all responding agencies, difficulties arose.”
It concluded that cross-agency response training tailored to address mass violence is an especially valuable preparedness investment. Regular coordinated cross-agency planning work to prepare for such incidents is necessary for successful outcomes.
The recent mosque massacre in New Zealand, attacks on churches in Sri Lanka and black churches in America, as well as U.S. synagogues, and the increase in death threats against religious leaders of all faiths should prompt worship center security teams to act. We are currently working with a number of them to help them gear up and assemble their rapid response teams.
Developing a Rapid Response Team Strategy
The goal in starting up an RRT is to get the right people, with the right skills and with the right equipment/supplies to the right place at the right time.
The first task is to understand the vulnerabilities in your environment, then match the people, skills and supplies necessary to initially mitigate or manage those vulnerabilities. Starting with the Med Tac events as the foundation, you can tailor your needs effectively.
The rapid response system has a detection limb and a response limb. The detection limb includes everyone in your organization. Education and training on the recognition of medical emergencies and activation of the team are essential; even if it’s only a sense that something is wrong. The activation of the RRT includes activation of local EMS resources, if appropriate, for definitive care and disposition.
The response limb includes the RRT and its equipment/supplies. RRT members should have knowledge and training in the basic life-saving skills necessary to intervene until professional first responders arrive. There should be time allocated for deliberate practice of those skills on a periodic, ongoing basis to assure team readiness. Think of a NASCAR pit crew. The equipment and supplies should be able to address your vulnerabilities.
Again, the Med Tac equipment and supplies are a great start, and they should cover almost all your medical emergency needs. The best solution is a combination of fixed gear that could be mounted on walls, portable gear that could be placed in the best location for surge events, and mobile gear such as that fitted to golf carts or bikes on large properties. Remember to consider training aids, like CPR manikins, simulated limb wound trainers and medication trainers (such as Narcan and Epi Pen trainers) to facilitate training.
The CARE Huddle Checklist
The Med Tac CARE Huddle tool is especially helpful in performing ongoing or just-in-time risk-vulnerability assessments for special events or surge activities in your organization. Designed as a focused pre-briefing tool, it can be used at the beginning of every shift as a situational awareness multiplier, or before any special event where people cluster for any amount of time.
It includes an introduction of key role players in any response to medical issues at the event. It further maps the key responsibilities of those role players should an event occur. It also gives guidance, like a cognitive aid, in how to activate the RRT and local EMS resources, how to locate and mobilize medical equipment and supplies, or even relocate them closer to the event ahead of time. It also serves as a repository of helpful information like location maps, key phone numbers and medical treatment algorithms.
Make Your 3 Minutes Count
The ultimate measure of safety is to count lives saved… not lost. We challenge you to design your own team to do the same, and we invite you to join our community of practice through free webinars and online briefings OR start your own.
We are honored to be partnering with a K-12 independent school, a mega-church and smaller satellite churches, a remote island Boy Scout Camp, an expansive outdoor education center and regional Boy Scout Council, and lifeguards in Hawaii and California at specific beaches to put together their 3 Minutes and Counting Strategy.
Whether your group is big or small, in an urban center, part of a beach community, or in a remote location, you can design a winning combination: leadership, training, a rapid response team, and critical fixed, portable, and mobile emergency care resources that are placed so that bystander care can be given to any victim at any time within 3 minutes.
Some say small campuses or churches are “overwhelmed and unprepared” and they have to walk before they run. Without dedicated staff, a budget or people to help, they have to wait. We disagree. When David picked up those stones and proceeded down to the Elah Valley to take his shots at Goliath, it was his faith that powered him; not his resources.
For more information on creating your own rapid response team, visit medtacoc.org.
William Adcox is the chief security officer for the UT MD Anderson Cancer Center and UT-Health Chief of Police; Dr. Gregory Botz is a professor of anesthesiology and critical care and UT MD Anderson Cancer Center; Charles Denham III is a Junior Med Tac instructor; Dr. Charles Denham II is the chairman of the Texas Medical Institute of Technology.