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FBI seeks images in Boston Marathon bomb inquiry

A Boston police officer wheels in injured boy down Boylston Street as medical workers carry an injured runner following an explosion during the 2013 Boston Marathon in Boston, Monday, April 15, 2013. Two explosions shattered the euphoria at the marathon's finish line on Monday, sending authorities out on the course to carry off the injured while the stragglers were rerouted away from the smoking site of the blasts. (AP Photo/Charles Krupa)

In response to the epidemic of mass shooting and casualty incidents in the United States since 1999, the Federal Emergency Management Agency has issued new recommendations that dramatically change protocols for emergency medical services personnel.

FEMA’s new guidelines say that more lives will be saved in such emergencies if medics are sent into “warm zones” before those zones are secured by law enforcement authorities. Warm zones are areas where a potential threat exists, but the threat is not direct or immediate.

This is a complete reversal for emergency medical services personnel, who traditionally have been directed to take cover in ambulances until a threat is over.

The changes have been made necessary because more than 250 people have been killed in shooting sprees or multi-injury bombings since the Columbine High School shootings left 15 dead — including the perpetrators — in 1999. No law enforcement officials entered the high school for 30 minutes after the shooting began because they were waiting for armor-clad SWAT teams with high-powered weapons, the protocol in place at the time.

The St. Louis region is too familiar with this sort of thing. We will never forget the Kirkwood City Hall shootings in 2008, which left seven dead, including the perpetrator and the mayor, who died months later of complications from his wounds. Or the 2010 shootings at the ABB Inc. plant in St. Louis that left four dead, including the shooter.

The new guidelines were designed after federal officials and medical experts studied this April’s Boston Marathon bombing and recent mass shootings, such as the one in Newtown, Conn., just a year ago, and in Aurora, Colo., in July 2012.

Because there were so many nurses and doctors stationed at the Boston Marathon finish line expecting to care for injured or ill runners, the bombing victims received medical assistance almost immediately. It is believed that the presence of those medical professionals kept the death toll to three, even though more than 200 people were injured, including about a dozen who had limbs amputated.

Those doctors and nurses gave assistance despite the risk to their own safety. When they began helping victims, the scale of the attack and the number of bombs was unknown.

Locally, the St. Louis Area Regional Response System coordinates planning and response for large-scale critical incidents in three Illinois counties (Madison, St. Clair and Monroe), four Missouri counties (St. Louis, Franklin, Jefferson and St. Charles) and the city of St. Louis.

Nick Gragnini, executive director of STARRS, said the agency fully supports the new FEMA guidelines, but stressed that paramedics need special training and equipment before they can rush into “warm zones.”

He said that since the ABB shootings, STARRS has been helping get Homeland Security grants for special training for EMS personnel in the region. So far, grants have gone to paramedics with fire departments or districts in the city of St. Louis, Cottleville in St. Charles County, and Monarch in Chesterfield. Other firefighters also may have special training but not secured through STARRS, Mr. Gragnini said.

Fading fast are the days when a paramedic could expect only to administer oxygen or other modest medical help, he said.

“It’s so new of a concept and a change of paradigm that it’s going to take a lot more dedication and special education,” Mr. Gragnini said, estimating that “within five years you are going to see this required of everyone” in the EMS field.

His sentiments echo those of authorities who put together the new FEMA guidelines. Dr. Lenworth Jacobs is a trauma surgeon who created The Hartford Consensus, which brought together eight experts in emergency medicine, military and law enforcement after the Newtown shooting to try to find better ways to respond.

Dr. Jacobs was the lead author of a paper issued by the group, which said it hoped the plan would be a blueprint for towns and cities to use as a starting point for coordinating emergency response efforts.

“These events like the shootings are usually over in 10 to 15 minutes, but it often takes over an hour for everyone to get there,” Dr. Jacobs said in an interview with the New York Times. “We’re seeing these events in increasing frequency, and unfortunately we have to change how we approach them to keep death tolls down.”

Among suggestions emphasized in the paper is that all levels of responders need to use common terminology, instead of the individual terms currently in use; that the bleeding of victims should be brought under control at the scene; and that medics be trained in weapons and ammunition so they can better assess the damage that different firearms can do.

The group’s next step is to try to get municipalities on board with the suggestions. While this is going on, a number of police departments around the country are trying to educate the public about how to respond to casualty situations. One of the things they are teaching is that anyone caught in a mass shooting needs to “run, hide or fight” instead of waiting for help.

Ideally, no one will ever need to use this special training. But in a nation that failed to tighten gun laws after 20 first-graders and six adults were mowed down at the Sandy Hook Elementary School in Newtown, Conn., you can’t count on it.