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Recent improvised explosive device (IED) and active shooter incidents reveal that some traditional practices of first responders need to be realigned and enhanced to improve survivability of victims and the safety of first responders caring for them. This multi-disciplinary edition translates evidence-based response strategies based on military experience in responding to and managing casualties from IED and/or active shooter incidents and from its significant investment in combat casualty care research into the civilian first responder environment. Table of Contents: Executive Summary Purpose General Information: Improvised Explosive Device Active Shooter Take an Active Role in Your Own Safety: Explosions Active Shooter Incident First Responder for Improving Survivability in Improvised Explosive Device and/or Active Shooter Incidents Background: Defining First Responders Defining the Threat Military Lessons Learned and Civilian Adaptation Improvised Explosive Device Incidents Active Shooter Incidents Hemorrhage Control Protective Equipment Response and Incident Management Responder Guidelines: Hemorrhage Control Protective Equipment Response and Incident Management Summary Threat-based Scenarios: Large-scale Terrorist/insurgency Attack Medium-scale Terrorist/insurgency Attack Medium-scale Terrorist/insurgency Attack Small Scale Terrorist/insurgency Attack Involuntary Suicide Bomber Discovery/recovery of Homemade Explosives (Not an Attack) Active Shooter With Access Denial to First Responders Active Shooter in a Public Commercial Facility Active Shooter in an Open, Outdoor, Unbounded Location Active Shooter in a Public Sports Complex Provide First Aid After Improvised Explosive Device and/or Active Shooter Incidents Stop the Bleeding and Protect the Wound First Aid for Specific Injuries List of Major Bombing Incidents in the United States 2007-2017 List of Major Mass Shootings in the United States 2007-2017
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Recent improvised explosive device (IED) and active shooter incidents reveal that some traditional practices of first responders need to be realigned and enhanced to improve survivability of victims and the safety of first responders caring for them. This Federal, multi-disciplinary first responder guidance translates evidence-based response strategies from the U.S. military’s vast experience in responding to and managing casualties from IED and/or active shooter incidents and from its significant investment in combat casualty care research into the civilian first responder environment. Additionally, civilian best practices and lessons learned from similar incidents, both in the United States and abroad, are incorporated into this guidance. Recommendations developed in this paper fall into three general categories: hemorrhage control, protective equipment (which includes, but is not limited to, ballistic vests, helmets, and eyewear), and response and incident management.
First responders should incorporate tourniquets and hemostatic agents as part of treatment for severe bleeding (if allowed by protocol). Tourniquets and hemostatic agents have been demonstrated to be quick and effective methods for preventing exsanguination from extremity wounds (tourniquets) and other severe external bleeding (hemostatic agents).
First responders should develop and adopt evidence-based standardized training that addresses the basic, civilianized tenets of Tactical Combat Casualty Care (TCCC). Training should be conducted in conjunction with fire, emergency medical services (EMS), and medical community personnel to improve interoperability during IED and/or active shooter incidents.
First responders should develop inter-domain (EMS, fire, and law enforcement) Tactics, Techniques, and Procedures (TTPs) — including use of ballistic vests, better situational awareness, and application of concealment and cover concepts — and train first responders on them.
As technology improves, first responders should adopt proven protective measures (e.g., body armor) that have been demonstrated to reliably shield personnel from IED fragments and shock waves.
First responders, when dealing with either IED or active shooter incidents, must remain vigilant and aware of the potential risk posed by secondary IEDs or additional shooters.
Response and Incident Management
Local and state law enforcement and emergency services should institutionalize National Incident Management System (NIMS)-based command and control language through plans and exercises and during ongoing education and training.
Local and state emergency management, EMS, fire, and law enforcement personnel and receiving medical facilities should have interoperable radio and communications equipment.
Local, state and federal partners should consider expansion of Public Safety Answering/Access Point (PSAP) intake procedures to include information gathering vital to the initial response.
Training to improve first responder triaging precision is essential for dealing with IED and/or active shooter incidents.
There should be greater coordination among EMS, fire services, and law enforcement to work more effectively during IED and/or active shooter incidents. The dialogue should focus on potential improvements or changes to the TTPs which have historically been used during law enforcement situations that involve a medical emergency (e.g., EMS waits until law enforcement secures the scene before they enter to render emergency care).
The recommendations presented — early, aggressive hemorrhage control; use of body armor and a more integrated response; and greater first responder interoperability — will help to save lives by mitigating first responder risk and by improving the emergent and immediate medical management of casualties encountered during IED and/or active shooter incidents.
Recent improvised explosive device (IED) and active shooter incidents reveal that some traditional practices of first responders need to be realigned and enhanced — with an emphasis on early hemorrhage control and a more integrated response by first responders (i.e., emergency medical services [EMS], fire, law enforcement, and rescue personnel) — to improve survivability of victims and the safety of first responders caring for them.1 At the request of first responders and first receivers (e.g., medical technicians, nurses, and physicians) who have encountered mass casualties from IEDs and/or active shooter incidents, this document was developed to provide guidance on how to better approach these incidents.
Responders should also consider the combination of both IEDs and active shooter incidents in an organized, complex attack (such as the Mumbai attacks in 2008) that requires both treatment and extraction of the injured from a still-hostile environment. The conditions during such tactical assaults in a civilian setting speak to the need for first responders and first receivers to adopt evidence-based hemorrhage control, risk evaluation, and casualty management measures in a potentially dangerous environment.
As a result of these developments, the Department of Homeland Security, in coordination with the Department of Defense (DoD), Department of Health and Human Services, Department of Justice, Department of Transportation, White House Office of Science and Technology Policy, and the National Security Staff, has developed recommendations for individuals who provide emergent and immediate medical management of casualties resulting from IEDs and/or active shooter incidents. Based on best practices and lessons learned, this document focuses on the medical response to IEDs and/or active shooter incidents with recommendations for hemorrhage control, protective equipment (which includes ballistic vests, helmets, and eyewear), and response and incident management.
1 Jacobs LM, McSwain NE Jr, et al. Improving survival from active shooter events: The Hartford Consensus. J Trauma Acute Care Surg. 2013 Jun;74(6):1399-1400. http://journals.lww.com/jtrauma/ Fulltext/2013/06000/Improving_survival_from_ active_shooter_events__.3.aspx.
An improvised explosive device (IED) is a bomb worldwide constructed and deployed in ways other than in conventional military action. It may be constructed of conventional military explosives, such as an artillery round, attached to a detonating mechanism. IEDs are commonly used as roadside bombs.
IEDs are generally seen in heavy terrorist actions or in asymetric unconventional warfare by guerrillas or commando forces in a theater of operations. In the second Iraq War, IEDs were used extensively against US-led invasion forces and by the end of 2007 they had become responsible for approximately 63% of coalition deaths in Iraq. They are also used in Afghanistan by insurgent groups, and have caused over 66% of coalition casualties in the 2001–present Afghanistan War.
IEDs were also used extensively by cadres of the rebel Tamil Tiger (LTTE) organization against military targets in Sri Lanka.
The term comes from the British Army in the 1970s, after the Provisional Irish Republican Army (IRA) used bombs made from agricultural fertilizer and Semtex smuggled from Libya to make highly effective boobytrap devices or remote-controlled bombs.
An IED is a bomb fabricated in an improvised manner incorporating destructive, lethal, noxious, pyrotechnic, or incendiary chemicals and designed to destroy or incapacitate personnel or vehicles. In some cases, IEDs are used to distract, disrupt, or delay an opposing force, facilitating another type of attack. IEDs may incorporate military or commercially sourced explosives, and often combine both types, or they may otherwise be made with homemade explosives (HME).
An IED has five components: a switch (activator), an initiator (fuse), container (body), charge (explosive), and a power source (battery). An IED designed for use against armoured targets such as personnel carriers or tanks will be designed for armour penetration, by using a shaped charge that creates an explosively formed penetrator. IEDs are extremely diverse in design and may contain many types of initiators, detonators, penetrators, and explosive loads.
Antipersonnel IEDs typically also contain fragmentation-generating objects such as nails, ball bearings or even small rocks to cause wounds at greater distances than blast pressure alone could. IEDs are triggered by various methods, including remote control, infrared or magnetic triggers, pressure-sensitive bars or trip wires (victim-operated). In some cases, multiple IEDs are wired together in a daisy chain to attack a convoy of vehicles spread out along a roadway.
IEDs made by inexperienced designers or with substandard materials may fail to detonate, and in some cases, they actually detonate on either the maker or the emplacer of the device. Some groups, however, have been known to produce sophisticated devices constructed with components scavenged from conventional munitions and standard consumer electronics components, such as mobile phones, consumer-grade two-way radios, washing machine timers, pagers, or garage door openers. The sophistication of an IED depends on the training of the designer and the tools and materials available.
IEDs may use artillery shells or conventional high-explosive charges as their explosive load as well as homemade explosives. However, the threat exists that toxic chemical, biological, or radioactive (dirty bomb) material may be added to a device, thereby creating other life-threatening effects beyond the shrapnel, concussive blasts and fire normally associated with bombs. Chlorine liquid has been added to IEDs in Iraq, producing clouds of chlorine gas.
A vehicle-borne IED, or VBIED, is a military term for a car bomb or truck bomb but can be any type of transportation such as a bicycle, motorcycle, donkey (DBIED), etc. They are typically employed by insurgents, and can carry a relatively large payload. They can also be detonated from a remote location. VBIEDs can create additional shrapnel through the destruction of the vehicle itself and use vehicle fuel as an incendiary weapon. The act of a person's being in this vehicle and detonating it is known as an SVBIED suicide.
Of increasing popularity among insurgent forces in Iraq is the house-borne IED, or HBIED from the common military practice of clearing houses; insurgents rig an entire house to detonate and collapse shortly after a clearing squad has entered.
The fougasse was improvised for centuries, eventually inspiring factory-made land mines. Ernst Jünger mentions in his war memoir the systematic use of IEDs and booby traps to cover the retreat of German troops at the Somme region during the First World War. Another early example of coordinated large-scale use of IEDs was the Belarusian Rail War launched by Belarusian guerrillas against the Germans during World War II. Both command-detonated and delayed-fuse IEDs were used to derail thousands of German trains during 1943–1944.
Starting six months before the invasion of Afghanistan by the USSR on 27 December 1979, the Afghan Mujahideen were supplied with large quantities of military supplies. Among those supplies were many types of anti-tank mines. The insurgents often removed the explosives from several foreign anti-tank mines, and combined the explosives in tin cooking-oil cans for a more powerful blast. By combining the explosives from several mines and placing them in tin cans, the insurgents made them more powerful, but sometimes also easier to detect by Soviet sappers using mine detectors. After an IED was detonated, the insurgents often used direct-fire weapons such as machine guns and rocket-propelled grenades to continue the attack.
Afghan insurgents operating far from the border with Pakistan did not have a ready supply of foreign anti-tank mines. They preferred to make IEDs from Soviet unexploded ordnance. The devices were rarely triggered by pressure fuses. They were almost always remotely detonated. Since the 2001 invasion of Afghanistan, the Taliban and its supporters have used IEDs against NATO and Afghan military and civilian vehicles. This has become the most common method of attack against NATO forces, with IED attacks increasing consistently year on year.
According to a report by the Homeland Security Market Research in the USA, the number of IEDs used in Afghanistan had increased by 400 percent since 2007 and the number of troops killed by them by 400 percent, and those wounded by 700 percent. It has been reported that IEDs are the number one cause of death among NATO troops in Afghanistan.
A brigade commander said that sniffer dogs are the most reliable way of detecting IEDs. However, statistical evidence gathered by the US Army Maneuver Support Center at Fort Leonard Wood, MO shows that the dogs are not the most effective means of detecting IEDs. The U.S. Army's 10th Mountain Division was the first unit to introduce explosive detection dogs in southern Afghanistan. In less than two years the dogs discovered 15 tons of illegal munitions, IED's, and weapons.
In July 2012 it was reported that "sticky bombs", magnetically adhesive IED's that were prevalent in the Iraq War, showed up in Afghanistan.
ISAF troops stationed in Afghanistan and other IED prone areas of operation would commonly "BIP" (Blow In Place) IED's and other explosives that were considered too dangerous to defuse.
IEDs are increasingly being used by Maoists in India.
On 13 July 2011, three IEDs were used by the Insurgency in Jammu and Kashmir to carry out a coordinated attack on the city of Mumbai, killing 19 people and injuring 130 more.
On 21 February 2013, two IEDs were used to carry out bombings in the Indian city of Hyderabad. The bombs exploded in Dilsukhnagar, a crowded shopping area of the city, within 150 metres of each other.
On 17 April 2013, Two kilos of explosives used in Bangalore bomb blast at Malleshwaram area, leaving 16 injured and no fatalities. Intelligence sources have said the bomb was an Improvised Explosive Device or IED.
On 21 May 2014, Indinthakarai village supporters of the Kudankulam Nuclear Power Plant were targeted by opponents using over half a dozen crude "country-made bombs". It was further reported that there had been at least four similar bombings in Tamil Nadu during the preceding year.
On 28 December 2014, a minor explosion took place near the Coconut Grove restaurant at Church Street in Bangalore on Sunday around 8:30 pm. One woman was killed and another injured in the blast.
During the 2016 Pathankot attack, several casualties came from IEDs.
In the 2003–2011 Iraq War, IEDs have been used extensively against Coalition forces and by the end of 2007 they have been responsible for at least 64% of Coalition deaths in Iraq.
Beginning in July 2003, the Iraqi insurgency used IEDs to target invading coalition vehicles. According to the Washington Post, 64% of U.S deaths in Iraq occurred due to IEDs. A French study showed that in Iraq, from March 2003 to November 2006, on a global 3,070 deaths in the US-led invading coalition soldiers, 1,257 were caused by IEDs, i.e. 41%. That is to say more than in the "normal fights" (1027 dead, 34%). Insurgents now use the bombs to target not only invading coalition vehicles but Iraqi police as well.
Common locations for placing these bombs on the ground include animal carcasses, soft drink cans, and boxes. Typically they explode underneath or to the side of the vehicle to cause the maximum amount of damage; however, as vehicle armor was improved on military vehicles, insurgents began placing IEDs in elevated positions such as on road signs, utility poles, or trees, in order to hit less protected areas.
IEDs in Iraq may be made with artillery or mortar shells or with varying amounts of bulk or homemade explosives. Early during the Iraq war, the bulk explosives were often obtained from stored munitions bunkers to include stripping landmines of their explosives.
Despite the increased armor, IEDs have been killing military personnel and civilians with greater frequency. May 2007 was the deadliest month for IED attacks thus far, with a reported 89 of the 129 invading coalition casualties coming from an IED attack. According to the Pentagon, 250,000 tons (out of 650,000 tons total) of Iraqi heavy ordnance were looted, providing a large supply of ammunition for the insurgents.
In October 2005, the UK government charged that Iran was supplying insurgents with the technological know-how to make shaped charge IEDs. Both Iranian and Iraqi government officials denied the allegations.
During Iraqi Civil War (2014-present) ISIS makes extensive use of suicide VBIEDs, often driven by children, elderly and disabled.
United Kingdom/Republic of Ireland
Throughout The Troubles, the Provisional IRA made extensive use of IEDs in their 1969–97 campaign. They used barrack buster mortars and remote controlled IEDs. Members of the IRA developed and counter-developed devices and tactics. IRA bombs became highly sophisticated, featuring anti-handling devices such as a mercury tilt switch or microswitches. These devices would detonate the bomb if it was moved in any way. Typically, the safety-arming device used was a clockwork Memopark timer, which armed the bomb up to 60 minutes after it was placed by completing an electrical circuit supplying power to the anti-handling device. Depending on the particular design (e.g., boobytrapped briefcase or car bomb) an independent electrical circuit supplied power to a conventional timer set for the intended time delay, e.g. 40 minutes. However, some electronic delays developed by IRA technicians could be set to accurately detonate a bomb weeks after it was hidden, which is what happened in the Brighton hotel bomb attack of 1984. Initially, bombs were detonated either by timer or by simple command wire. Later, bombs could be detonated by radio control. Initially, simple servos from radio-controlled aircraft were used to close the electrical circuit and supply power to the detonator. After the British developed jammers, IRA technicians introduced devices that required a sequence of pulsed radio codes to arm and detonate them. These were harder to jam.
Roadside bombs were extensively used by the IRA. Typically, a roadside bomb was placed in a drain or culvert along a rural road and detonated by remote control when British security forces vehicles were passing. As a result of the use of these bombs, the British military stopped transport by road in areas such as South Armagh, and used helicopter transport instead to avoid the danger.
Most IEDs used commercial or homemade explosives, although the use of Semtex-H smuggled in from Libya in the 1980s was also common from the mid-1980s onward. Bomb Disposal teams from 321 EOD manned by Ammunition Technicians were deployed in those areas to deal with the IED threat. The IRA also used secondary devices to catch British reinforcements sent in after an initial blast as occurred in the Warrenpoint Ambush. Between 1970 and 2005, the IRA detonated 19,000 improvised explosive devices (IEDs) in the Northern Ireland and Britain, an average of one every 17 hours for three and a half decades, arguably making it "the biggest terrorist bombing campaign in history".
In the early 1970s, at the height of the IRA campaign, the British Army unit tasked with rendering safe IEDs, 321 EOD, sustained significant casualties while engaged in bomb disposal operations. This mortality rate was far higher than other high risk occupations such as deep sea diving, and a careful review was made of how men were selected for EOD operations. The review recommended bringing in psychometric testing of soldiers to ensure those chosen had the correct mental preparation for high risk bomb disposal duties.
The IRA came up with ever more sophisticated designs and deployments of IEDs. Booby Trap or Victim Operated IEDs (VOIEDs), became commonplace. The IRA engaged in an ongoing battle to gain the upper hand in electronic warfare with remote controlled devices. The rapid changes in development led 321 EOD to employ specialists from DERA (now Dstl, an agency of the MOD), the Royal Signals, and Military Intelligence. This approach by the British army to fighting the IRA in Northern Ireland led to the development and use of most of the modern weapons, equipment and techniques now used by EOD Operators throughout the rest of the world today.
The bomb disposal operations were led by Ammunition Technicians and Ammunition Technical Officers from 321 EOD, and were trained at the Felix Centre at the Army School of Ammunition.
The Lebanese National Resistance Front, the Popular Front for the Liberation of Palestine, other resistance groups in Lebanon, and later Hezbollah, made extensive use of IEDs to resist Israeli forces after Israel's invasion of Lebanon in 1982. Israel withdrew from Beirut, Northern Lebanon, and Mount Lebanon in 1985, whilst maintaining its occupation of Southern Lebanon. Hezbollah frequently used IEDs to attack Israeli military forces in this area up until the Israeli withdrawal, and the liberation of Lebanon in May 2000.
One such bomb killed Israeli Brigadier General Erez Gerstein on February 28, 1999, the highest-ranking Israeli to die in Lebanon since Yekutiel Adam's death in 1982.
Also in the 2006 War in Lebanon, a Merkava Mark II tank was hit by a pre-positioned Hezbollah IED, killing all 4 IDF servicemen on board, the first of two IEDs to damage a Merkava tank.
Homemade IEDs are used extensively during the post-civil war violence in Libya, mostly in the city of Benghazi against police stations, cars or foreign embassies.
IEDs were also widely used in the 10-years long civil war of the Maoists in Nepal, ranging from those bought from illicit groups in India and China, to self-made devices. Typically used devices were pressure cooker bombs, socket bombs, pipe bombs, bucket bombs, etc. The devices were used more for the act of terrorizing the urban population rather than for fatal causes, placed in front of governmental offices, street corners or road sides. Mainly, the home-made IEDs were responsible for destruction of majority of structures targeted by the Maoists and assisted greatly in spreading terror among the public.
Boko Haram are using IEDs during their insurgency.
Taliban and other insurgent groups use IEDs against police, military, security forces, and civilian targets.
IEDs have also been popular in Chechnya, where Russian forces were engaged in fighting with rebel elements. While no concrete statistics are available on this matter, bombs have accounted for many Russian deaths in both the First Chechen War (1994–1996) and the Second (1999–2008).
Al Shabaab is using IEDs during the Somalia Civil War.
During the Syrian Civil War, militant insurgents were using IEDs to attack buses, cars, trucks and tanks. Additionally, the Syrian Air Force has used barrel bombs to attack targets in cities and other areas. Such barrel bombs consist of barrels filled with high explosives, oil, and shrapnel, and are dropped from helicopters.
ISIS is using VBIEDs also in Syria, including during 2017 Aleppo suicide car bombing.
In the 1995 Oklahoma City bombing, Timothy McVeigh and Terry Nichols built an IED with ammonium nitrate fertilizer, nitromethane, and stolen commercial explosives in a rental truck, with sandbags used to concentrate the explosive force in the desired direction. McVeigh detonated it next to the Alfred P. Murrah Federal Building, killing 168 people, 19 of whom were children.
In January 2011, a shaped pipe bomb was discovered and defused at a Martin Luther King Jr. memorial march in Spokane, Washington. The FBI said that the bomb was specifically designed to cause maximum harm as the explosive device was, according to the Los Angeles Times, packed with fishing weights covered in rat poison, and may have been racially motivated. No one was injured during the event.
On April 15, 2013, as the annual Boston Marathon race was concluding, two bombs were detonated seconds apart close to the finish line. Initial FBI response indicated suspicion of IED pressure cooker bombs.
On September 17–19, 2016, several explosions occurred in Manhattan and New Jersey. The sources of the explosions were all found to be IEDs of various types, such as pressure cooker bombs and pipe bombs.
IEDs were used during the Vietnam War by the Viet Cong against land- and river-borne vehicles as well as personnel. They were commonly constructed using materials from unexploded American ordnance. Thirty-three percent of U.S. casualties in Vietnam and twenty-eight percent of deaths were officially attributed to mines; these figures include losses caused by both IEDs and commercially manufactured mines.
The Grenade in a Can
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