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Terrorism and Paramedic Services

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Anthony DiMonte

Terrorism has unfortunately become a reality that we now must be able to face on our soil.We have been fortunate that many terrorist plots in Canada have been disrupted by our security and police agencies before the perpetrators were able to put their plans into action.The “Toronto 18”, “Via Rail plot” and several others are examples that have been publicly reported.However, as is often said by security experts, they have to get it right 100% of the time, but the terrorist only needs to get it right once.

October 22nd, 2014 in Ottawa was one such day when the Police and the Paramedic Service of the City were stretched to respond to an assault on our National War Memorial and Parliament, symbols of our Nation’s democracy.In hindsight, the tragic loss of one innocent life and the death of the gunman do not reflect the required mobilisation and impact on the entire City.For several hours, we did not know how many shooters were involved and the situation was very fluid, as we worked to protect and respond to the needs of our citizens and visitors under siege.During this time the Police Service kept the leaders of our country out of harm’s way to ensure the continuity of constitutional government.

But what can we learn from these events as Paramedic Services?As with any new reality, we must adapt and respond to the needs of the community and patients we serve.Without getting into the debate of are we public safety or health care, I would submit we are both.The day of the Ottawa shooting and many days after, it has become clear that it doesn’t matter.We provide health care in a public safety setting and we need to recognize what that means.

With the understanding that your community may not be as much of a target, I would submit for your consideration some insight that the Ottawa Paramedic Service has begun to action.This insight may be of some help to you while you review your specific situation(s).

First and foremost, we must ensure that our Paramedics have the understanding and are kept informed as to the nature of the threats and risk of this new reality.We should look at whether there is a need for new skills, i.e. incident command process for the frontline Paramedic because they will be first at scene, triage in mass casualty incidents (MCI) with active shooters, new medical skills etc.Organizationally, we need to plan as we would for any emergency, understanding the differences of a terrorist event and its special requirements.

Across the country, post September 11th we began to prepare for a Chemical, Biological, Radiological, Nuclear and / or Explosive (CBRNE) incidents, as we thought that sophisticated terrorist organizations would attack a North American city using these types of weapons.While that threat is still possible, such an event requires planning, communication, funding and as such, our Security Services have been good at disrupting these types of plots.Today, the lone wolf attack like Ottawa or the small group trained in Paris “Charlie Hebdo”, are the more likely scenarios, perhaps even a “Mumbai” style attack.This “low tech”, mass casualty incident that captures the public and media attention to create insecurity, is the objective of terrorism.

If both of these premise are correct, what should we do to prepare for an event that may happen in our jurisdiction?How do we assure that our Paramedic Service will respond effectively and efficiently in the time of crisis?

First we should start with what we are good at – partnerships.We do it on a daily basis and even in our expanding professional partnerships, they are the basis of our evolution, community paramedic programs are but one example of collaboration.We need to engage our hospital partners and work on planning and exercising for a terrorist type MCI event.This is even more crucial in this time of overwhelmed emergency departments and offload delays that everyday are putting our communities and patients at risk and arguably negatively impacting mortality and morbidity.How will our hospital partners be able to receive these patients without handicapping the Paramedic Service response to an event, if on a daily basis they are currently not able to receive our normal patient load?This issue needs to be resolved.

Second, we need to work closely with our Police Services and develop trust that information will be shared with us, as to the threat metric and what we should be preparing for.In some cities, Paramedic Services regularly sit with both Police and Security Services and are briefed as to what world events and trends are occurring.One such model is “Operation Intersect” in Ottawa that is co-chaired by the RCMP and Ottawa Police and has provento be invaluable to our Service’s understanding of issues, and has enabled us to prepare and develop close relationships.We are provided and share the Integrated Terrorism Assessment Center (ITAC) reports that are pertinent to our Paramedics.I encourage you to engage your local Police Service to do this.

Third, we need to recognize and understand the security risk to our members and our infrastructure.On Saturday January 18th, 2015 we were informed and viewed an ISIS propaganda video that spoke to their recent successes.The Ottawa shootings were a prominent feature with video of our Paramedics and vehicles.This was a disturbing first and caused us to review what we call hardening of our HQ and Paramedic stations, as well as informing staff as to the threat.This was a reminder for us to be more vigilant in this new world environment.We were supported by our Police partners in not overreacting but taking responsible actions as a result of our “Operation Intersect” work.We engaged our Joint Health & Safety Committee, openly sharing this new information and challenging them to review and recommend updates to all our operating procedures.Safety is a joint responsibility and there can be no union versus management mindset.We are speaking about the security of all our members and teamwork is the key, we must work together.

Finally, for larger urban centres, having Tactical / CBRNE special team capability should become a program necessity.This allows for a small but elite number of staff to face these types of events.This should not be built after an event, because with the current knowledge one would say we were negligent in not already being prepared.This capability should also be an element of partnerships with smaller services that border urban centres.Urban centres that have these teams could support their neighbours should it ever be required.This capability is not just for the small possibility of a terrorist event, but serves us well on a daily basis.For some services, the new Ebola risk has become very much an all hazards approach and for us having a team already capable of entering a hazardous scene, being equipped and trained was invaluable.

In conclusion, we must learn and adapt to this new reality not from a “sky is falling scenario”, but from a logical based approach that simply prepares us for new world challenges.We must not change the values we hold close as an open society and be in fear, but must simply be responsible Paramedics and Paramedic Services that provide health care in a public safety environment.

Canadian Paramedicine

Canadian Paramedicine

Canadian Paramedicine provides a platform for exchanging ideas and innovative programs, emerging news, trends, research, politics, and association information affecting Paramedicine in Canada and around the world.

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