PULSE Nightclub Orange County Fire Rescue After Action Review of Pulse Nightclub active shooter incident on June 12, 2016. August 14, 2016 add88aa EXECUTIVE SUMMARY This After Action Report has been developed from the perspective of responders from Orange County Fire Rescue Department (OCFRD). The authors conducted interviews with OCFRD responders and reviewed documentation available to OCFRD. Orlando Fire Department (OFD) radio transmissions and records were not available to OCFRD at the time this report was written. This report is not an exhaustive review of the entire response to the Pulse incident. On June 12, 2016 at 02:26 units from the Orange County Fire Rescue Department responded to a request from Orlando Fire Department for assistance with an active shooter event with multiple patients. The location of this incident was the Pulse Night Club at 1912 South Orange Avenue which is near the intersection of Orange Avenue and Kaley Street. The initial dispatch included Rescue 50; Captain 4; Captain 5 and Battalion 4. Four additional rescues were quickly added to the initial alarm. Over the course of the incident a total of 11 rescues; 1 engine; 3 Captains; 1 Battalion Chief; 1 Assistant Chief; 1 Rehab Unit; 1 MCI Unit were dispatched by OCFRD to the scene. Units were requested to assist with the treatment and transport of 107 total patients involved in this active shooter incident. Of those 107 patients, 41 were declared deceased and 66 were transported to local hospitals. The primary radio channel used for this incident was Orlando Fire Tac 3. The last Orange County Fire Rescue cleared the call at 07:13. Orange County Fire Rescue Department will break the incident down into three phases as follows:  Phase 1 – Initial Active Shooting o Covers from the initial response and actions of OCFRD units. Upon arrival at the scene OFD was already in early stages of treating and transporting patients. The scene was transitioning from an active shooter scene into a hostage situation.  Phase 2 – Transitional Period o Once the initial patients were treated and transported the incident entered a period when fire/rescue was not able to access other patients that may be on the scene. Law Enforcement is operating in a hostage situation type environment while fire/rescue is preparing for the possibility of more patients. 2  Phase 3 – Secondary Active Shooting o During this phase of the incident fire/rescue and law enforcement was involved with treating and transporting patients involved in a second influx of victims. This period was initiated from law enforcements breech into the building and finished with the conclusion of the incident. 3 Table of Contents Section Executive Summary ........................................................................................................ 1 Table of Contents ............................................................................................................ 2 Definitions ....................................................................................................................... 3 Types of Orange County Units ........................................................................................ 4 Incident Information ......................................................................................................... 5 Crews Actions Summary ................................................................................................. 6 Time Line of Incident ....................................................................................................... 7 Recorded Transport Information ..................................................................................... 8 Lessons Learned ............................................................................................................. 9 Crews Involved with Incident ........................................................................................ 10 IAFF and IAFC Resource ............................................................................................. 11 Florida Field Operations Guide Resource .................................................................... 12 CAD Report Resource .................................................................................................. 13 4 Definitions S.A.V.E. – Swift Assisted Victim Extraction – is a Rescue Task Force concept that utilizes a group of 3-4 firefighters and a group of 4 law enforcement officers. The law enforcement officers provide security zone around the unarmed firefighters and is deployed into a warm zone to treat, stabilize and remove injured victims in a rapid manner. Warm Zone – Area of indirect threat, where law enforcement has cleared or isolated the threat to a minimal level. This area is considered clear but not completely secure. Hot Zone – Area where there is a known hazard or direct and immediate life threat (Active Shooter). This is the primary area of concern for law enforcement. S.A.V.E. equipment – Includes a ballistic vest and Kevlar helmet along with basic medical care equipment. Medical equipment includes tourniquet, basic wound care bandages, clotting agent and patient moving device. Active Shooter – When an individual using a weapon is actively engaged in killing or attempting to kill people in a populated area. Triage – Assigning degrees of priority to injured victims based on severity of injury. Used when treating multiple patients. BLS patient – Basic Life Support patient has non-critical injuries. Trauma Alert – Traumatic injury patient who requires rapid transport to a Trauma Center. 5 Orange County Fire Rescue Units Descriptions Engine E-ONE Fire Engine – Advanced Life Support Unit Staffing: 3-4 personnel with a Company Officer and at least one Paramedic Equipment: 1250 GPM pump with a 750 gallon water tank with tools utilized during firefighting and rescue operations. 6 Rescue / Medic Unit Dodge Transport Vehicle - Advanced Life Support unit Staffing: Two personnel with at least one Paramedic. Equipment: Capable of transporting patient and stocked with various types of medical equipment and medications. 7 Rehab 1 2007 International Staffing: one firefighter Equipment: - Three restroom stalls two of which have a shower with hot water; tables; folding chairs; pop-up tents; coolers for drinks (water and poweraid); misting fans and regular fans. 8 MCI 1 2005 International Staffing: one Engineer (driver/operator) Equipment: medical equipment of various types capable of treating 250 patients; 12 wheeled litters – used to move patients; 54 non-wheeled litters; 82 backboards; inflatable patient care tents 9 Battalion Chief Vehicle Ford F-250 Staffing: one command level officer Equipment: Major incident command board and incident command tools such a vests and radios, used to provide supervision, coordination, and oversight during fire/rescue operations. 10 Mobile Command Unit 2009 Dodge Staffing: one incident command technician (Firefighter) Equipment: incident command tools such as multiple radios, TVs, and command vests and command boards. Used to provide incident command support during extended or complex operations. 11 Captain Vehicle Ford F-250 Staffing: one command level officer Equipment: S.A.V.E. equipment for four personnel and replacement medical equipment for field units. Used as a Safety Officer and Medical Officer in support of incident command. 12 S.A.V.E. Equipment Ballistic vests and helmets Thigh bags which carry basic medical care to control bleeding and assist with breathing 13 PULSE Figure 1 INCIDENT INFORMATION Specific information: Building: Built: 1957 Floors: 2 Story Gross Area: 4,853 sq. ft. Exterior Walls: Concrete Block Stucco Location: Near intersection of Kaley St and Orange Ave See Figure 2 on page 16 and 2.5 on page 17 for building layout Weather: Time of incident: Clear, 77 F, with no wind at 85% humidity End of incident: Clear, 76 F, with no wind at 88% humidity Occupants: Time of incident: Approximately 300 occupants at time of incident 15 Pulse Building Layout Second room Bathroom Figure 2 PULSE Building Layout Roofed service alley Dressing room Storage Dr room 't XI g? Exit to atio [Irirwp I Ba\r?~ Stag Dance ?oor Seating Closet VIP seating Emergency exit @m Reception desk Figure 2.5 (Orlando Sentinel) PHASE 1 – INITIAL ACTIVE SHOOTING On June 12, 2016 at 02:25 Orange County Fire Rescue Department (OCFRD) Communications Center received a call from the Orlando Fire Department (OFD) Communication Center requesting mutual aid for an active shooter incident with approximately 15-20 patients. The location for this incident is 1912 S. Orange Ave, Orlando FL 32806 (Figure 1 on page 14). The initial request was for 5 transport units (Rescues). The OCFRD Communications Center contacted Chief Howe (the on duty Shift Commander) for approval. Chief Howe (C10) approved this request with the addition of two Captains and a Battalion Chief to respond with the rescues. Chief Howe also responded to the incident. The initial dispatch at 02:26 was for Rescue 50, Captain 4, Captain 5 and Battalion 4. At 02:27, Chief 10 (C10), Rescue 51, Rescue 70 and Rescue 66 were dispatched. At 02:30, Rescue 72 was subsequently added to the units dispatched. All units were advised to stage at Orlando Fire Station 5 which is located at 1818 S. Orange Ave, near the intersection of Kaley Street and Orange Avenue. R50 was the first Orange County unit on to arrive on scene. They responded from Orlando Regional Medical Center (ORMC) which is located .4 miles from the incident. At the time of this incident R50 was at ORMC after transporting a patient from an unrelated incident. Immediately upon arrival, R50 was assigned two trauma alert patients to transport. C10 and Battalion 4 arrived on scene 02:41. Within one minute R51 and R70 also arrived on the scene. Upon arrival C10 and Battalion 4 ascertained where the Fire Department Command Post was located. Once identified, C10 and B4 immediately made contact with the Orlando Fire Department (OFD) Incident Commander at the OFD Command Post which was located at Orange Avenue and Kaley Street. At this point C10 made brief introductions with the OFD Incident Commander and obtained a brief overview of the situation. OFD advised they have an active shooter event and have treated and transported an unknown number of patients with best guess being in the range of ten to twelve. C10 asked the OFD Incident Commander if this was a Unified Command with law enforcement to which the Incident Commander advised that it was not. The OFD Incident Commander advised C10 that he currently needed Fire Department Officers to fill command staff roles. C10 advised the OFD Incident Commander he had one Battalion Chief and one Captain on the scene at this point. The OFD Incident Commander advised he needed someone for staging and someone for transport. Battalion 4 was assigned as the Staging Officer and Captain 4 was assigned as the Transport Group Leader. C10 advised the OFD Incident Commander that Orange County has a Mass Casualty Incident (MCI) Trailer with the capacity for treating 250 patients. The OFD Incident Commander advised he would like to have that asset on the scene at which point C10 made radio communications with the OFCRD Communications Center to dispatch the 18 MCI Trailer with specific direction of travel indicated. Upon arrival of MCI 1 at 03:21, the MCI operator was directed by B4 to take out and assemble Raven Stretchers. Raven stretchers are military grade portable stretchers that give the ability for one rescuer to move one patient. Eight of these stretchers were assembled and brought to the Triage and Treatment area. Orange Avenue north of Station 5 looking south C10 also requested through OCFRD Communications Center to have a third Captain dispatched to the incident with the consideration of the potential need for utilizing ballistic vests in a Swift Assisted Victim Extraction (S.A.V.E.) scenario. Orange County Fire Rescue as well as the Orange County Sheriff’s Office (OCSO) have been jointly training in S.A.V.E. operations for the past three years. C10 made radio communications on OCFRD Tac 6 to have the ballistic vests from Captain 3, Captain 4 and Captain 5 brought to the Command Post. The ballistic vests from Captain 4 never made it to the Command Post due to him being assigned to Transport Group upon his arrival. C10 then advised the OFD Incident Commander that Orange County has 8 ballistic vests located at the Command Post and an additional 4 ballistic vests and helmets on the scene that can be utilized. The OFD Incident Commander acknowledged the assets were available, however as the incident evolved the assets were not deployed to personnel operating on the scene. Prior to the arrival of C10 and Battalion 4 at the Command Post, the scene evolved from an active shooter scenario to a hostage situation. Based upon the weather conditions and the amount of resources on scene, C10 asked the OFD Incident Commander if OFD had a Rehab Unit to which the answer was no. C10 advised the OFD Incident Commander that Orange County has a Rehab Unit and asked if he would like to have that asset on scene as well. The OFD Incident Commander replied he would at which point C10 again through OCFRD Communications Center requested to have Rehab 1 dispatched to the incident with specific travel direction indicated. Upon arrival the Rehab 1 operator loaded up coolers with drinks and snacks and brought them to the Triage and Treatment area. 19 Orange County units assisted with several functions at the scene, included but not limited to the following:  Patient care and patient transportation  Establishing and operating the staging area  Liaison officer at ORMC for offloading patients  Rehab resources  Equipment from Mass Casualty Unit See Figure 3 on page 28 for initial locations of assigned tasks. Chief Howe worked in conjunction with Orlando Fire Department (OFD) Incident Commander to provide any assistance or resources they needed. He was present in the command post and offered suggestions as the Incident Commander made decisions. The fire department command post was separate from the law enforcement command post as each was established in two different locations. The incident occurred within the City of Orlando’s jurisdiction; therefore the majority of radio communications occurred on Orlando Fire Tac 3. Utilizing this radio frequency limited the Orange County Communications Center’s ability to record and track information related to the incident. This included patient counts; patient status (green, yellow and red); when and which units were transporting; and hospital destinations. Several Orange County units operated on Orlando Fire Tac 3 as well as Orange County Tac 6 in an effort to help reduce radio traffic on the primary channel. Battalion 4 commented on how this significantly increased his ability to communicate quickly with the Orange County units that were assigned specific roles at the incident. Battalion 4 and Chief 10 were then able to provide that information to the fire department command post more efficiently. Battalion 4 as previously mentioned was assigned to be the Staging Officer. The location for staging was established prior to Orange County Fire Rescue’s arrival and the designated location was on Kaley Street just west of Orange Avenue. The units were staged facing east on Kaley so they could rapidly cross Orange Avenue to be assigned patients for transport. Several patients with minor injuries exited the club and encountered Rescues in the Staging area, at which point the Rescue personnel assisted these patients to the Triage and Treatment area. Some of the Rescue crews expressed concerns of the location of the Staging area and its proximity to The Pulse night club. The Staging area was later relocated based on the additional information of suspected explosive devices. 20 Treatment / Transport area behind Einstein Bagel Orange County Fire Rescue Captains also played a crucial role during this incident. As stated previously Captain 4 was assigned Transport Group Leader and remained in the position throughout the incident. Captain 4 was in contact with local hospitals throughout the incident to ensure the number and types of patients each facility would be able to handle. The next arriving Captain on the scene was Captain 5. Captain 5 was assigned as ORMC Division where he became a conduit of information between the OFD Incident Commander and the hospital staff. This was a vital role throughout the incident as he kept the OFD Incident Commander aware of ORMC’s abilities to accept additional patients and the type of patients they could accept. At approximately 03:23 there was a report of an additional or separate shooter at ORMC. Captain 5 made radio communications with the OFD Incident Commander regarding this and advised that ORMC was on lock down and not accepting additional patients. The report of an additional shooter was quickly investigated but never substantiated and cancelled at 03:28. The third and last Captain to arrive on the scene was Captain 3. Captain 3 was assigned to assist B4 with Staging and Resource Management. 21 Outside Emergency Room at ORMC On this incident as with any large scale incident the first arriving units are faced with a high degree of uncertainty and unknown factors. Incident Commanders overcome sparse initial information through a process of scene size-up, reconnaissance, feedback from operational crews and communications with other responding agencies. As incidents evolve and more information becomes available, an Incident Commander gains a greater amount of situational awareness and refines the Incident Action Plan accordingly. During Phase 1, or the Initial Active Shooter component of this incident many actions occurred prior to any Orange County units arriving on scene. OFD units were actively working a dynamic scene with the scope or magnitude still unknown. Upon OCFRD arrival, OFD already had a structured Incident Command System (ICS) established and functioning. They were engaged in triaging, treating and transporting patients quickly after the arrival of their first unit, while still trying to obtain overall situational awareness of the incident. OCFRD units came in toward the conclusion of the Phase 1 and assisted OFD with the treatment and transport of approximately ten to twelve patients, as well as the actions previously mentioned. 22 PHASE 2 - TRANSITIONAL PERIOD Once the initial influx of patients were treated and transported, there was a period of time where patients could not be accessed by fire/rescue. The timeframe for this was from approximately 03:30 to 05:02. During this transitional period even though there were no patients to be transported, there was still an abundance of activity on the scene. This time period corresponded with the scene transitioning from an active shooter into a hostage situation and was being dealt with by law enforcement. At some point during this timeframe law enforcement became aware of potential explosive devices at the scene. This new information caused a need for an emergent relocation of all Fire Department units on scene. Staging was rapidly relocated to Pennsylvania Street and Cook Avenue which is located one block north of Kaley Street. The OFD Command Post was also rapidly relocated to a safe location. The new location for the OFD Command Post was in a vacant lot adjacent to Orlando Fire Station #5 which was now next to the Orlando Police Department (OPD) Command Post. However, within minutes of the OFD Command Post being re-established at the new location, the OPD Command Post was moved. This prevented OFD Incident Command from directly communicating with OPD Incident Command. Orange Avenue looking north Due to the lack of a Unified Command between fire/rescue and law enforcement, information was not efficiently shared between the two agencies. In one example, the OFD Incident Commander was advised by the law enforcement liaison of eight potential patients that were believed to be headed to the treatment area. Once this information was relayed, the Fire Department personnel ramped up and took actions in preparation for patients that did not arrive during this transitional phase. 24 It was during this Transitional Period that a law enforcement officer was assigned as the liaison to the OFD Command Post in attempt to improve communications. The primary communication the liaison had with the OPD Command Post was via portable radio and through the OPD Dispatch Center (not a direct line of communication with the OPD Command Post). The liaison was also utilizing an ear piece that was attached to his portable radio, which made the communications only audible to him and not others in the OFD Command Post. This only provided minimal improvement of communications between the two command posts. The relocation of units can be seen in Figure 3.5 on page 29. Orange Avenue looking north 25 PHASE 3 - SECONDARY ACTIVE SHOOTING At 05:02 law enforcement breeched the building and subsequently made contact with the assailant. The breech was a loud explosion that caught the Fire Department personnel off guard. This explosion resulted in a very startling event at an already dynamic incident. The breech was later revealed to actually involve explosives, which was the cause of the very loud and unexpected event heard by fire/rescue crews. The Fire Department Command Post was not made aware of this impending breech prior to it occurring. The value of knowing this information prior to the explosion would have been highly beneficial for fire department personnel because it would have allowed them to anticipate the treatment of blast related injuries. Shortly after the explosion was heard, the sound of gunfire was also heard. Immediately following the breech and gunfire, another large influx of patients was encountered. These patients were subsequently treated and transported by both Fire Department personnel and Law Enforcement. There were again communication issues between the two command posts. The OPD liaison assigned to the OFD Command Post was receiving and relaying information that patients were being brought out and staged at the Dunkin Donuts which was south of The Pulse night club on Orange Avenue. The OFD Command Post, Triage, Treatment and Transport areas were north of The Pulse Night on Orange Avenue. The OFD Incident Commander continuously advised the liaison to relay information to law enforcement to have the patients brought north where the Fire Department personnel were ready to receive patients. The liaison relayed the communications many times but continued to receive and relay to the OFD Incident Commander that the patients were at the Dunkin Donuts. These communications went back and forth for brief period. (As stated previously the liaison was not communicating directly with the OPD Command Post, rather communicating with them through the OPD dispatch center). Due to the continued threat of explosive devices and the OFD Incident Commander not knowing the status of the shooter, it was determined to be unsafe to send fire/rescue personnel south on Orange Avenue past The Pulse night club to the Dunkin Donuts where patients were located. At some point shortly after, there were patients transported to ORMC by law enforcement. Without formal notification, law enforcement began to deliver patients to the Staging Area. The Staging Officer immediately communicated this to the OFD Incident Commander and requested additional personnel to this location. The OFD Incident Commander then announced the staging area would become Treatment Area 2 and directed members from the original Triage and Treatment Area relocate to Treatment Area 2. Due to this action and prior to additional personal arriving, the Staging Area was required to quickly adapt and immediately began to triage, treat as well as transport these patients. Through OCFRD Communications Center, Battalion 4 requested five additional transport units to the staging location as it was unknown if additional patients would be encountered. 26 The OFD Command Post was not receiving adequate information from the OPD Command Post regarding the impending patients about to be encountered. The lack of adequate communication prohibited the fire department units from anticipating the influx of critical patients needing transport and properly notifying the hospitals. Captain 4 again was in contact with local hospitals to obtain their ability to receive patients. The patients that arrived were quickly treated and transported to area hospitals under the direction of Captain 4. The conditions of this second wave of patients varied from minor injuries to trauma alerts. Again, this lack of communication between Law Enforcement and Fire Department made tracking the total number and status of these patients difficult. Orange County crews remained on scene and assisted as requested by Orlando Fire Department until released. MCI 1 and Chief 10 were the last Orange County units to clear the scene at 07:13. *Additional information was requested from Orlando Fire Department but their information has not been authorized for release. This information would help in accuracy on patient counts, status, times and etc. 27 Initial locations MCI 1 Police Rehab 1 Command Post OFD St. 5 Transport Staging Area Fire Command Post Treatment/ Transport Area Incident Figure 3 28 Secondary locations Transport Staging Area MCI 1 Fire Command Post Rehab 1 Treatment/ Transport Area OFD St. 5 Incident Police Command Post Figure 3.5 29 Crews Actions (Brief Overview) Chief 10 (Chief Howe) Chief Howe (C10) was notified by the Communications Center that Orlando Fire Department was requesting units for an active shooter incident with multiple patients. He advised them to dispatch five (5) transport units along with two (2) Captains and a Battalion Chief. Chief Howe also added himself to the call and responded with other units. He arrived at the scene at 02:41. Upon arrival Chief Howe and Chief Haskett (B4) reported to the Orlando Fire Department incident command post and asked what assistance they needed. The incident commander requested assistance with staging and transport groups. B4 was assigned as Staging Officer and Lt. Galeno (Captain 4) was assigned to Transport Group Leader. C10 requested an additional Captain for their ballistic vests and helmets. C10 remained in contact with OFD at their incident command post. The OFD incident command post was not a unified command post with Orlando Police Department (OPD). OPD did provide a liaison officer (late into the incident) at the OFD command post that was in contact with the OPD command post via radio through an ear piece that was not audible to others at the command post. The OPD liaison officer had to communicate through their dispatch center in order to exchange information between the two command posts. Captain Henderson (Captain 5) was assigned to ORMC. While Captain 5 was at ORMC reports of a secondary shooter at/near the hospital were reported. The secondary shooter information was quickly determined to be inaccurate; however, Captain Henderson remained at ORMC to assist with coordinating patient offloads. Chief Howe continued to offer resources to the OFD Incident Command and request resources that were utilized. Those resources included but were not limited to additional command officers, medical transport units, Rehab 1 and the MCI trailer. The scene transitioned into an extended operation due to the active shooter event turning into a hostage situation with an unknown number of additional patients / hostages. Crews remained on the scene for several hours while standing by to be deployed. Chief Howe cleared the scene at 07:13. Battalion 4 (Chief Haskett) Chief Haskett (B4) was dispatched to a mutual aid call to assist Orlando Fire Department for an active shooter incident with multiple patients. He was initially dispatched to Orlando Station 5 which is located at the intersection of Orange Avenue and Kaley Street. B4 arrived on the scene at 02:41. Upon arrival he made contact with C10 and they both made their way to the Orlando Fire Department Command Post. 30 Chief Haskett was quickly assigned as Staging Group Leader. He was communicating on both Orlando Tac 3 and Orange County Tac 6. Chief Haskett was utilizing Orange County Tac 6 to help reduce interference with the communication on the Orlando Tac channel. The initial staging location was on Kaley Street behind OFD St. 5. The staging location was moved at approximately 04:00 due to concerns and reports of possible explosive devices at or around the scene. It was reported through the fire department command post that an explosive detection canine alerted to a vehicle in the parking lot which was reported to be the suspects’ vehicle. The staging location was moved to Pennsylvania Street which was north of the original staging area. B4 remained in charge of the staging area during the entire operation. The situation already transitioned into a hostage incident which suggested it would require units to remain on the scene for a long duration. After law enforcement breeched the building at approximately 05:02, in order to resolve the situation numerous patients were brought from the scene to the staging area located at Cook Avenue and Pennsylvania Street instead of the designated treatment / transport area. As a result the staging area quickly became a secondary treatment and transport location. The patients arrived at the staging area via law enforcement vehicles. B4 requested through OCFRD Communications Center additional units to back fill the transport units that were being utilized during this second wave of patients. After all patients were transported, OFD conducted a short after action review with the command staff. Chief Haskett cleared the scene at 06:37. Captain 5 (Captain Henderson) Captain Henderson was one of the two initial Captains for this incident. He arrived at the scene at 02:49 and reported to the OFD command post. Shortly after his arrival at the scene he was assigned to be ORMC Division. He was to act as a liaison with ORMC staff. At 03:24 while Captain 5 was at ORMC there was a report of a second active shooter at that location. It was quickly determined that no second shooter was found and that area deemed safe at 03:28. Captain Henderson was still assigned to ORMC to assist with coordinating offloads with ORMC staff. He also assisted as patients arrived via alternate transportation such as by foot, personal vehicles and police vehicles. Captain Henderson was released from the scene at 06:50. 31 ORMC staff ready to receive patients Captain 4 (Lt. Galeno) Lt. Galeno was the second of the two Captains that were on the original dispatch for this incident. He arrived at the scene at 02:53. After arriving on the scene he was assigned as Transport Group Leader. Lt. Galeno was located at the intersection of Orange Avenue and Kaley Street. This location was already established by Orlando Fire Department prior to his arrival. Lt. Galeno assisted the Treatment Group with ensuring rescues were available to transport patients as they were packaged. Lt. Galeno was also in contact with local hospitals ensuring how many and what type of patients they could handle. He was operating primarily on Orlando Tac 3 which limited Orange County’s ability to track how many and which units transported patients. Lt. Galeno would contact staging and request units as needed. Lt. Galeno remained in this position for the duration of the incident, however the treatment and transport groups were moved from their initial location further north on Orange Avenue due to the threat of the explosive devices. Lt. Galeno felt that things overall went well other than some confusion that resulted when the treatment and transport groups were moved to a different location during the incident. There was also difficulty gaining information from Orlando Police Department relating to patient locations and how patients would be getting to the treatment and transport areas. He felt this was related to the delays and difficulty in obtaining information from the Orlando Police Department Command post. Captain 4 was released from the scene at 06:33. 32 Orlando Rescue on Orange Avenue near treatment/transport area Captain 3 (Lt. Parsons) Lt. Parsons was requested as an additional Captain in case the need to use the ballistic helmets and vests for crew safety arose. He arrived at the scene at 03:02. He was assigned to assist with the staging area. Lt Parsons ensured units were organized and ID numbers were tracked. He prepared to deploy the units as they were requested by the Orlando Fire Department Incident Commander. Staging operated primarily on Orlando Fire Tac 3 but did utilize Orange County Fire 6 also. Captain 3 was released from the scene at 06:51. Treatment / transport area behind Einstein Bagel 33 Rescue 72 (FP Burleigh; FF Pellot; FP Oliveros) Rescue 72 was clearing Florida Hospital East when this call was initially dispatched. R72 (a three person rescue due to paramedic remedial training of FP Oliveros) was determined to be a closer unit and was added to the call. Rescue 72 arrived at the scene at 02:40. Upon their arrival they were initially assigned to staging area at Cook Avenue and Kaley Street. Rescue 72 became involved with treating patients in the parking lot next to the incident which was also located next to their staging location. They treated approximately 10-12 patients that received minor injuries during the evacuation from the incident building. These patients were then assisted to the treatment and transport area which was located across the East side of Orange Avenue on Kaley Street. Crews state that they were unable to transport these patients from the staging area because units were blocked in and unable to gain access to Orange Avenue due to the numerous law enforcement and transport units located in the intersection of Orange Avenue and Kaley Street. As the incident progressed and the possibility of explosive devices was discovered Rescue 72 was moved to the new staging area located in the area of Pennsylvania Street and Cook Avenue. While in line at the staging area the rescue was several units back in line. During this time frame one of the crew members from R72 (FP Oliveros) assisted RMA units transporting patients as a third crew member. FP Oliveros states these were very quick transport and turnaround times estimating only taking approximately 2 – 3 minutes round trip. Rescue 72 transported 1 GSW – Trauma Alert patient to ORMC. Rescue 72 was released from the incident at 06:16. Rescue 51 (FP Neris; FF Stalter) Rescue 51 was dispatched to the scene of an active shooter with other units. They arrived at the scene at 02:42. Upon arrival Rescue 51 was assigned to staging. Rescue 51 remained in staging area until it was assigned to transport two (2) BLS patients to Florida Hospital Orlando. They were released from the incident at 06:22. 34 Units in staging area Rescue 70 (FP Rodriguez; FP Church) Rescue 70 was dispatched to the scene of an active shooter with other units. They arrived at the scene at 02:42. Upon arrival Rescue 70 was assigned to staging. R70 remained in staging area until they were released from the scene. R70 did not treat or transport any patients. Rescue 70 was released from the scene at 06:18. Rescue 50 (FP Diaconu; FF Stanley) Rescue 50 was dispatched to the scene of an active shooter with other units. Upon arriving at the initial staging area which was Orlando Fire Station 5 they were immediately sent across the street to Einstein Bagel shop where several patients were located. They made contact with the Lieutenant from Orlando Engine 5 who assigned them two patients for immediate transport. Crew from Rescue 50 was advised to return as soon as they offloaded. Rescues 50 took two trauma alert patients to ORMC and immediately returned to Einstein Bagel and were given another trauma alert patient for transport to ORMC. After this second trip Rescue 50 was directed to the staging area where they awaited their next assignment. After the breach that was conducted by law enforcement which began the second wave of patients they were immediately faced with at least five to six patients that were brought to their location. Crews quickly triaged these patients. Rescue 50 assisted with getting the critical patients transported from the scene by other units that were in staging. After critical patients were transported they were then assigned a trauma green patient that they transported to Florida Orlando Hospital. Rescue 50 was released from the call after clearing the hospital at 06:32. 35 Rescue 50 crew expressed concerns of being so close to the location where shots were being fired. One crew member mentioned that he had just attended SAVE training a few shift prior to this incident and during the incident he did not see anyone wearing protective ballistic equipment which was just discussed during the training. Crews state they would have felt more comfortable if they had this equipment to wear during the incident no matter where they were assigned to. R50 loading patient from the scene Rescue 66 (FP Eljabour; FP Chaney) Rescue 66 was dispatched to the scene of an active shooter with other units. They arrived at the scene at 02:58. Upon arrival they staged by Orlando Fire Station 5 located at Orange Avenue and Kaley Street. After the threat of explosives and staging area was moved Rescue 66 remained assigned to staging. Rescue 66 transported one (1) BLS patient to Florida Hospital Orlando at 05:36. Rescue 66 cleared hospital and the call at 06:19. MCI 1 (Engineer Yutzy) MCI 1 was dispatched at the request of Chief Howe. MCI 1 is a tractor trailer unit that holds medical equipment to treat 250 patients. He arrived at the scene at 03:21. Upon arrival it was located in the area of Pennsylvania Street and Orange Avenue so the equipment could be readily available to units. Eng. Yutzy was assigned to get patient transport cots built and sent over to triage and transport area so patient could be easily moved and packaged for transport. Engine 50 was also assigned to assist with task. Other medical equipment was also used from this unit due to the multiple injured patients that were on the scene. MCI 1 cleared the scene at 06:47. 36 Engine 50 (Lt. Keesey; Eng. Smith; FP Scibetta) Upon arrival of Engine 50 at 03:39 they were assigned to assist MCI 1 in the assembly of patient transport cots and relocating the cots over to the treatment and transport area. After completing that task they assisted with the treatment of patients. They were involved with assisting approximately 5-6 BLS patients. Engine 50 cleared the scene at 06:14. MCU 1 (FF. Sudol) At 03:32 Mobile Command Unit 1 arrived on the scene. FF Sudol was working with Chief Howe at the command post and assisted with keeping track of units. FF Sudol also assisted monitoring the radio channels for information about the incident. MCU 1 cleared the scene at 06:46. Rehab 1 (FF Bruno) Rehab 1 arrived at the scene at 03:35. Rehab 1 was initially advised to set up at Pennsylvania Avenue and Orange Avenue in a vacant lot just north of Orlando Fire Station 5. Rehab 1 was advised by Orlando Police Command to relocate to Kaley Street east of Orange Avenue. Rehab set up at the assigned location and provided services to crews until released from the scene at 06:38. Rescue 30 (FP Brazell; FF Mucherera) Rescue 30 arrived at the scene at 05:52 and was assigned to staging. Rescue 30 remained in staging until released by command at 06:18. Rescue 30 was not involved in treating any patients. Rescue 41 (FP Hahr; FF Cobielles) Rescue 41 arrived at the scene at 05:54 and was assigned to staging. Rescue 41 remained in staging until released by command at 06:18. Rescue 41 was not involved in treating any patients. 37 Rescue 71 (FP Beauregard; FF Gonzalez) Rescue 71 arrived at the scene at 05:55 and was assigned to staging. Rescue 71 remained in staging until released by command at 06:17. Rescue 71 was not involved in treating any patients. Rescue 52 (FP Passmore; FF Mitchell) Rescue 52 arrived at the scene at 05:58 and was assigned to staging. Rescue 52 remained in staging until released by command at 06:19. Rescue 52 was not involved in treating any patients. Rescue 43 (FP Loguerra; Lt. Lominy) Rescue 43 arrived at the scene at 06:07 and was assigned to staging. Rescue 43 remained in staging until released by command at 06:19. Rescue 43 was not involved in treating any patients. 38 Time Line of Incident Incident Number:  OF160095303 Timeline of Event:  02:25 OFD request Mutual Aid response from OCFR – Active Shooter at night club, units to stage at OFD FS. 5  02:26 Initial dispatch: B4, Capt. 4, Capt. 5, R50  02:27 Additional unit: R51, R66, R70  02:30 Dispatch R72 – (in the area of the call)  02:35 Dispatch C10  02:40 On-scene R72  02:41 On-scene C10, B4  02:42 On-scene R51, R70  02:43 On-scene R50  02:43 Transport R50 – ORMC, 2 trauma alerts  02:43 Transport complete R50  02:47 C10 request an additional Captain – Capt. 3 added  02:49 On-scene Capt. 5  02:50 C10 request MCI trailer  02:52 Patient offload R50  02:53 On-scene Capt. 4  02:57 C10 request ballistic vests from Capt. 3, Capt. 4 and Capt. 5  02:58 On-scene R66 39  02:59 Capt. 4 assigned in an active Supervisory role on-scene  03:02 Return to scene R50  03:02 Transport R50 – ORMC, 1 trauma alert  03:05 Transport complete R50  03:11 Patient offload R50  03:11 Return to scene  03:15 C10 request Rehab  03:21 On-scene MCI trailer  O3:23 Capt. 5 – ORMC Division  03:24 B4 reports that there is an active shooter at ORMC, requests 3 units to stage just short of ORMC  03:28 Issue at ORMC cancelled, 3 units to remain on-scene  03:32 MCU1 to relocate to ORMC  03:35 On-scene Rehab1  03:35 B4 request 1 Engine non-emergency; E51 dispatched  03:38 Dispatch E50 replaced E51  03:42 Relocation = Rehab to set up on Kaley St. East of Orange Ave.  03:46 On-scene E50  04:20 Capt. 3 reports 3 units in transport staging  05:02 Capt. 3 reports 12 units in transport staging  05:36 Transport R66 – FHO, 1 patient  05:37 B4 requests 5 additional transport units to staging  05:39 Additional units assigned: R43, R42, R41, R71, R30  06:15 Demobilization in progress See Reference section 11 40 Recorded Transport Information Orlando Regional Medical Center is located approximately 0.4 miles from the scene (Figure 4). Florida Hospital Orlando is located approximately 4.7 miles from the scene. 02:43 R50 transported 2 trauma alerts to ORMC 02:43 R50 transport complete > 1 min transport time 9 min offload time 02:52 R50 patient offload 03:02 R50 transport 1 trauma alert to ORMC 3 min transport time 03:05 R50 transport complete 6 min offload time 03:11 R50 patient offload 05:36 R66 transport 2 BLS to FHO 13 min transport 05:49 R66 transport complete 15 min offload time 06:07 R66 clearing FHO 05:42 R51 transport 2 BLS to FHO 8 min transport 05:50 R51 transport complete 40 min offload time 06:32 R51 clearing FHO 05:38 R72 transport 1trauma alert to ORMC 2 min transport time 05:40 R72 transport complete 5 min offload time 05:45 R72 offload 41 Transport Distance from Scene to ORMC I I'm CIwIiod St;- I 9991101; agiggoin I er r.1I1?i 'Ht Hi0 1223Baptist (2h 4 .. Harding 8-1 . Haidmg Sta . St . Whipotle Mexican Grill 1.8'1- - .ouelaa cm 1 Figure 4 42 Lessons Learned for Chief Officers 1. The need to establish and operate in a true Unified Command operation.  Utilizing radio communications between law enforcement and fire department incident commanders does not allow for adequate exchange of information and situational awareness. The liaison officer in this event had to communicate via radio from the fire department command post to the police department communication center that then had to communicate to the police command post and then back. The liaison officer was also utilizing an ear piece for his radio which limited the ability of others in the command post to hear exactly what information was being transmitted. This resulted in long delays of information and not being able to obtain all the pertinent information related to the incident.  Implementing the National Incident Management System (NIMS) and establishing a single Command Post (CP) with a Unified Command (UC) is a standard operating procedure addressed by both the International Association of Fire Chiefs and the International Association of Fire Fighters. See Reference Section 9.  Law Enforcement and Fire Department responses would be enhanced by developing joint operational plans during multi-agency operations.  Specialized training for Command Officers would establish expectations for Unified Command, communication, common terminology, and operational capabilities. 2. Continue expanding the Incident Command Systems with Divisions, Branches and Groups as the scene develops. 3. Consider that at least two Captains are initially dispatched to MCI events.  To ensure adequate supplies, such as SAVE equipment, arrive in a timely fashion. This will also help in establishing divisions, branches and groups as quickly as possible. Chief Howe requested a third Captain in this incident to ensure enough ballistic vests and helmets would be on the scene if that option was utilized to rescue patients. The third Captain was quickly utilized in Staging Group once they arrived on the scene and their equipment was brought to the staging location. Assigning personnel to 43 divisions, branches and groups helps to maintain a manageable span of control. 4. Position Triage, Treatment, Transport and Staging areas in a manner that allows patients to transition through them in the proper orderly fashion. Also attempt to ensure these areas are identified and made known to all agencies operating at the scene.  Walking wounded and uninjured victims had to be assisted through Staging in order to get to the initial treatment and transport area. 5. Add additional S.A.V.E. equipment onto Battalion Chiefs units to ensure enough equipment arrives on the scene. S.A.V.E. equipment consists of ballistic vests and helmets and medical care packs.  Even with 3 Captains it was noted that enough S.A.V.E. equipment would not have been available based on the number of patients at this incident. Battalion Chiefs are dispatched to every multi-unit response. This additional equipment would help decrease time delays waiting on Captains that may be responding from long distances.  The International Association of Fire Chiefs and the International Association of Fire Fighters recommends the use of ballistic vests and helmets for a scene utilizing S.A.V.E. (Rescue Tasks Force) teams. See Reference section 9. 6. Include engine companies to assist with manpower.  Transport units noted the need for extra hands during the incident especially when transporting multiple patients. This translates into better care of the patients being transported  Consider dispatching one engine company for every two transport units that are sent to mass casualty incidents. This is consistent with Florida Field Operations Guide in the Mass Casualty Section 10B on page 198 under Uniform Pre-Hospital Multiple Casualty Incident Procedure Predetermined Response Plan (October 2012). See Reference section 10. 44 Lessons Learned for Company Officers 1. Initiate Unified Command upon arrival at the scene and begin setting up Divisions, Branches and Groups when possible.  Implementing the National Incident Management System (NIMS) and establishing a single Command Post (CP) with a Unified Command (UC) is a standard operating procedure addressed by both the International Association of Fire Chiefs and the International Association of Fire Fighters. See Reference Section 9.  Law Enforcement and Fire Department responses would be enhanced by developing joint operational plans during multi-agency operations. 2. Ensure properly tracking the number of patients and types of patients that are transported to include destination. (Assign a scribe) 3. Ensure proper tracking and recording of times as to when transport units depart scene with patients and when they arrive at hospitals including offload.  This incident occurred in Orlando Fire Departments jurisdiction which limited OCFRD’s ability to track units that transported patients. This limited ability to track via radio each unit transport information including: i. Transport time ii. Number of patients transported iii. Hospital destination iv. Patient condition v. Arrived destination time vi. Offload time vii. Time clearing the hospital and available 4. Request additional engine companies to assist with manpower.  Transport units noted the need for extra hands during the incident especially when transporting multiple patients. This translates into better care of the patients being transported  Consider dispatching one engine company for every two transport units that are sent to mass casualty incidents. This is consistent with Florida Field Operations Guide in the Mass Casualty Section 10B on page 198 under Uniform Pre-Hospital Multiple Casualty Incident Procedure 45 Predetermined Response Plan (October 2012). See Reference section 10. 5. Have good situational awareness and report suspicious activity, items or people to the command post. Lessons Learned for Firefighters and Medical Personnel 1. Ensure incident and patient care reports are completed and proper and detailed narratives are completed especially by staff officers that take active rolls in command staff functions.  The narratives from this incident were very brief and non-descriptive. After speaking with crew members that were involved with this incident they provided much more information than what they documented in their reports. 2. When transmitting on radio ensure information is brief and concise to avoid tying up radio channel any longer than absolutely needed.  With multiple units operating on the same scene can lead to confusion with radio transmission especially if these transmissions are lengthy.  Important transfer of information can be delayed when the radio channel is occupied with unnecessary transmissions. 3. Remember to keep good situational awareness and be cognoscente of potential IEDs targeting first responders along with possible secondary assailants.  Threats of explosive devices were discovered inside vehicles in and around the parking area when police and fire department personnel were operating. 46 Crews Involved C10 ................................................ M. Howe #0769 B4 .................................................. J. Haskett #0605 Captain 4 ....................................... W. Galeno #0969 Captain 5 ....................................... K. Henderson #0550 Captain 3 ....................................... S. Parsons #0904 R50 ................................................ R. Stanley #1587; M. Diaconu #1650 R51 ................................................ R. Neris #2019; B. Stalter #1436 R66 ................................................ A. Eljabbour #2011; R. Chaney II #1691 R70 ................................................ J. Rodriguez #1088; K. Church #1696 R72 ................................................ C. Burleigh #1195; M. Pellot #1938; S. Oliveros #1926 MCI 1 ............................................. B. Yutzy #1375 Rehab 1 ......................................... J. Bruno #1139 MCU 1 ........................................... M. Sudol #1867 E50 ................................................ S. Keesey #1122; G. Smith #1424; M. Scibetta #2049 R30 ................................................ N. Brazell #1827; A. Mucherera #1988 R41 ................................................ V. Hahr #1975; A. Cobielles #1802 R52 ................................................ T. Passmore #1647; B. Mitchell #1798 R71 ................................................ C. Gonzalez #1873; J. Beauregard #1857 R43 ................................................ A. Loguerra #1818; D. Lominy #1593 47