When we have an active shooter at a school, offices or at a cinema we have to act. The new standard for this counter actions are a closer coordination between police, paramedics and the fire fighters. The model used in Norway today is called Plivo – Pågående LIvstruende VOld; on-going life-threatening violence. Before they used a model called “Skyting pågår”; Shooting is happening. The essence before was first to wait for the experts to manage the active shooter and then enters the zone to help when he is neutralized. Something that could take hours

In the new model, Plivo, the police enter directly the scene with arms pulled and ready to fire. Behind the paramedics start to prepare themselves to enter the scene as the police clear areas. When a floor or semi-limited area is clear the paramedics might enter to help wounded. Paramedics and fire fighters transport wounded out to a safer area with stretches made of textile. We call the area where the police approach the shooter as the HOT zone, and the area where the paramedics work for the WARM zone. The area where the paramedics and fire fighters transport the wounded is called a COLD zone or SAFE zone.

Before the paramedics were waiting for the police to clear the complete area and to neutralize the shooter. Now the paramedics enter the warm zone and that makes them more tactical than before. Remember that the earlyer a paramedic can start his job, the more chance for that the wounded survive. Of course, it is a balance between paramedics safety and the wounded risk, but the earlier a medical treatment starts the higher survival rate according to TCCC. The main clue today in Plivo is to coordinate different parts of the system through understanding important pieces of the ongoing situation. Like paramedics enter when it is safe enough. To coordinate different groups we need a communication that creates a functional interaction. Chaos should not exist anymore. Everybody needs to know what to do and when to do it. Help should not be waiting on distance. Help need to move closer to where it is needed.

Another challenge happens when the police aren’t present. Then the paramedics and fire fighters have to act as police in a pressures situation. The equipment the paramedics and fire fighters are supposed to use is whatever they have for hand. It might sound hard to ask a fire-fighter to attack a shooter with an axe or a paramedic to attack with a knife. In extreme situations when life is on stake Plivo instruct extreme measures. If you need to kill to save others, you have to do it. The paramedic is getting tactical.

In short: More risk taking for Police and Paramedics has to enter before. If needed health care personnel have to be prepared to kill.

Here is the Plivo document: Nasjonal prosedyre for nødetatenes samvirke ved pågående livstruende vold PLIVO

Youtube video Plivo: