Ariz. Medics/Firefighters Recall Tucson Shooting

It took just 18 seconds for a lone gunman to inflict indescribable horror in Tucson, Ariz., on Jan. 8, 2011. In 18 seconds, the 22-year-old man squeezed off 32 shots, making 31 hits, killing six people, and wounding 13 others including U.S. Representative Gabrielle Giffords.

At Firehouse World, a first due medic and two incident commanders detailed the operations that cleared the horrific shooting scene in just 52 minutes and then dealt with months of aftermath, including media barrages and criminal investigations that wore on those who were dealing with the emergency and the emotional baggage that went along with it.

The class, called “Tragedy in Tucson,” was taught by Northwest Fire/Rescue District Battalion Fire Chief Stu Rodeffer, Fire Chief Jeff Piechura and Firefighter Tony Compagno. It focused on lessons learned from the mass casualty incident and the fallout that plagued the department for weeks after the incident.

“You’d be amazed at how much your jurisdiction can change in just 18 seconds,” said Rodeffer, who acted as a street commander of the incident, reporting directly to the incident commander.

By way of background, Rodeffer reminded the nearly capacity classroom that Giffords was participating in a “Congress on Your Corner” constituent meeting in the parking lot of a busy strip mall and Safeway grocery store parking lot at 10 a.m. That’s when the shooting suspect, Jared Lee Loughner, pulled out a pistol, got himself in a Weaver shooting stance and opened fire. He repositioned himself, got a different angle and shot again.

For Rodeffer, it had already been a tough morning. It started with an unresponsive 51-year-old diabetic who was receiving CPR from his kids. Soon after clearing that scene he responded to a bicyclist struck by a motorist.

The first calls reporting a shooting at the La Toscana shopping center were received at about 10:10 and given the initial reports, a first-alarm medical assignment was toned, bringing lots of resources to the scene.

Rodeffer said the designation was for possible mass casualty incidents on the interstate or possible plane wrecks at the nearby airport. One could never have predicted or fully prepared for the horror they faced that day.

“Our strategy from the start was quick transport to definitive care,” Rodeffer said. “…The people had suffered shock trauma and there wasn’t a lot we could do on the scene. They needed to be in an operating room and it was our job to get them there as quickly as possible.”

All of the victims were in an area about the size of a small living room which made for a very compressed incident scene, Rodeffer said, adding that the death toll could have been much worse, save one thing.

“People in the parking lot had tackled the suspect and were pinning him down outside in front of the store,” Rodeffer said. “If it wasn’t for them, he would have killed many more people… That’s one of the unsung points of the incident.” He said a retired U.S. Army colonel and a couple of other bystanders tackled the suspect as he was changing magazines. A woman grabbed his gun as the colonel tackled him. The suspect was already detained by the time police arrived, he said.

It was also a time for shift change which meant there were far more personnel in the area than normal. It also helped that the police, fire personnel and sheriff’s department in the response area had already developed a cordial relationship, Rodeffer said.

“When you need a friend, it’s not the time to make one,” he said.

The initial response to the parking lot shooting suggested there were four confirmed dead and at least 10 other victims. That brought even more personnel and equipment to the scene.

Quite by chance, the view of the overall incident commander was blocked by arriving apparatus, Rodeffer said, adding that was a “stroke of genius” because it allowed the commander to focus rather than be distracted by the blood and carnage on the floors and walls.

First Due medic Compagno said the scene was almost indescribable, with people wounded, some badly, some dead and some with minor injuries. And virtually everybody was coming after him looking for something.

Rodeffer said an amazing thing happened right after the shooting. The shooting location - in an upscale part of town on a Saturday morning - was teaming with professionals including doctors and nurses, all helping out.

The first Pima County Sheriffs on the scene brought some individual first aid kits, meant to help them if any sheriffs got hurt themselves.

Ironically, the sheriffs' kits contained many items the medics couldn’t use under protocol, such as combat gauze, compression bandages with a clotting agent, a tourniquet and medical shears, Compagno said.

“The only thing I am allowed to use in that kit is the shears,” Compagno said, noting it was the fire department and medics who advocated sheriffs have that equipment.

Rodeffer said all the patients were gathered in a very small confined area, some stacked on each other, and care and transport were given as the victims could be reached.

“There have been some criticisms that the fire department gave Gabbie Giffords preference treatment because she was a Congresswoman,” Rodeffer said. “She was one of the first to go because she was shot in the head, that’s it.”

Rodeffer said the only special treatment given was to a young girl who was shot and ultimately died from her injuries.

He maintained that the girl was not viable and could not have been saved regardless of the effort the bystanders were providing with good CPR.

Under normal circumstances the girl would have been left for dead, but everyone was focused on saving her, so Rodeffer said he made the decision to have the girl transported regardless of her true condition.

“She was a distraction and I needed to get her out so we could work on the others,” Rodeffer said.

Compagno said the scene was so chaotic that he realized he didn’t have time to deploy his triage cards in the method they were meant to be used.

“The patients were so close together and they all needed something, that I just said ‘no, I am not doing that,” Compagno said. It was a decision he said he regretted later only because of his training, not because it would have made a difference in the outcome.

That decision did, however, require the department to write up patient care reports for all the patients they treated.

Rodeffer said that right from the beginning, the decision was to get the patients out of there as quickly as possible. That’s why they shut down the roads and landed three helicopters on them.

Ironically, the helicopter was not the fastest way to transport victims from the scene.

“I forgot all about the time it takes to get the team together, do the preflight inspection and warm them up,” Rodeffer said.

Some of the most critically injured people were transported the 12 miles to the hospital in ground ambulances because it was quicker.

Rodeffer said he was not against the use of helicopters, but people need to keep in mind that it will take “longer than you think” to get your patient to the hospital.

“Sometimes, as in this case, we decided to put them in the ambulance and start providing care while we are covering some miles at the same time.”

From start to finish, it took 52 minutes to remove all surviving victims and get them to definitive care.

“It was fast,” Rodeffer said. “I will not tell you it was the best. I will not tell you it was accurate. I will tell you it was fast.”

With the scene cleared, Rodeffer was giving the orders to pick up all the equipment and get it back in service. The FBI, however, had different ideas. Because it was a crime scene, they needed everything to stay exactly where it was.

“We had 60 percent of our gear in there for the whole region and we couldn’t get it out,” Rodeffer said. “I had some choice colorful words for the FBI agents, and was I was told to not talk to the FBI any more and let the chief do it,” Rodeffer said.

“We had to rely on mutual aid companies to take care of our calls,” Rodeffer said. “That was not something I had anticipated."

As the day turned to night, the FBI started looking for lights to continue the investigation and a captain with the department was able to negotiate a swap – release of the equipment for the deployment of lights, and the EMS component of the department was back in service.

The FBI also wouldn’t let the workers go without interviews, which kept responders on the scene for hours.

Another issue was the media, which was looking to talk to anyone about the situation and Rodeffer said the department had deployed something they called the “puppy treatment.”

They set up a media site away from the scene with bathroom facilities, food and information and that kept the media away from the scene initially, he said.

All eyes, including internationally, were focused on the shooting in Tucson and at one point, they were looking to talk to the medics and firefighters who responded.

The A shift was given a bit of time off to recuperate from the ordeal and, on top of that, it was their turn for five days off, Rodeffer said. The media was resorting to chasing after the firefighters as they responded and they found Compagno’s telephone number and were calling him at home.

The chief decided to hold a mass press conference with all the firefighters in one place at one time and let the media know they had to respect the fact that they couldn’t say much because of medical privacy laws.

The media scrutiny was so intense, the department was hoping that something else would happen to attract the press corps attention someplace else.

Rodeffer said the department has an on-staff PhD counselor to help personnel process the tragic incident and do so in a meaningful way.

As it turned out, the time the FBI detained the firefighters and medics became the first critical stress debriefing on an informal basis. Rodeffer said it’s the department’s practice to do an after action review of every incident like the shooting.

“We have beaten ourselves up almost every day for the last two years about how we handled that call,” Rodeffer said. “But, in the end, I don’t think there was any other way we could have handled it differently and I don’t think I would… In the end that everybody who was dead, is still dead, and everyone that was living is still living and that’s about all you can hope for.”