Fall Newsletter - November 2020

A Message from the Strategic Operations Team:

It has been a year of challenges and hardships for all. With that in mind, Strategic Operations, Inc. (STOPS) has continued to move forward with safety for both our staff and clients while providing the best in services and products in the midst of this year of crisis.

We continue to stay committed to our Mission and Vision: To excel through state-of-the-art medical training and live action training support. In addition, we continue to make advances in medical modeling and simulation bringing unprecedented realism to any type of training scenario.

Strategic Operations group shot

The Next Nine Minutes

In this newsletter we review the lessons learned and how they were applied six months later at the STEM school shooting in Highlands Ranch.

Last Fall’s newsletter described a unique Hyper-Realistic® training program for mass casualty incidents (MCI). In one of the most ambitious efforts in the U.S., two years of preparation by Denver South Metro Fire Rescue culminated in a month-long Active Threat Response Training called “The Next Nine Minutes,” in November of 2018. It was one of the largest active shooter drills ever performed, with 904 personnel trained in 18 mass casualty active shooter drills.

Three different churches and three hospitals provided support for eighteen training sessions and active shooter scenarios with dozens of role players, many of whom wore STOPS human worn surgical simulators (Cut Suits), others were amputees, and all were made up with medical moulage. Rocky Vista University Medical school provided volunteers, doctors, and equipment. Ambulances took the injured to hospitals where they were admitted to the emergency department. Surgeons performed complex trauma surgeries on the Cut Suit in the operating rooms with STOPS supplied Advanced Surgical Skills Packages (ASSP).

SWAT Paramedics were integrated with law enforcement (LE) in the “hot zone,” while having a rescue task force (RTF) comprised of fire/EMS and LE quickly behind in the “warm zone,” for rescue of known victims reported by interior teams. It is well documented over many MCI events that victims have been dying due to the lack of simple bleeding control measures and rapid access of first responders into the building. This was the lead finding of the Hartford Consensus.

The training was named “The Next Nine Minutes” because the goal was to have the first unit arrive on scene, establish an RTF, and produce the first, most critical, patient for transport in under nine minutes. It also directly correlates to the average length of time in real events that a shooter engages his/her targets prior to shooting ceasing.

Each day of training in November, hours of video and time stamps for tactical benchmarks were tracked and reviewed. Very few times, out of the 18 training sessions, did first responders exceed the benchmark of producing a patient in under nine minutes after their arrival. This was one of the two most significant lessons learned reported in the post training after-action document and through subsequent follow-up training sessions recapping the shortfalls of the drill. The other top lesson learned was failure to immediately start unified command with LE and fire/EMS.

The implications of having full immersive multi-agency training with a uniform regional standard operational guideline for active threat resolution were seen at the STEM School shooting in Highlands Ranch, Colorado on May 7th, 2019. The event occurred only a few miles from The Next Nine Minutes training sites. At 13:53 an active shooter was reported.

The STEM shooting had multiple alleged shooters which added to the complexity. The police response was immediate, arriving slightly more than two minutes later at the school. Within three minutes an officer engaged the first shooter. In a nearly simultaneous series of events, other officers placed three tourniquets and one chest seal on the victims. Two of these tourniquets were placed on one patient with bilateral thigh GSW injuries. There were nine injured victims in total. These events happened before the first South Metro Fire Rescue unit even arrived on the scene.

It was 24 minutes from the initial 911 call until the last injured patient was transported from the scene. The 911 call to the first Fire/EMS RTF entering the building was 11 minutes with a transport time from Fire/EMS arrival of 4 min and 32 seconds for the first two critical patients. Four South Metro Fire Rescue paramedic transport medics transported all patients within 13 minutes of Fire/EMS arrival. The only patient that died in the STEM School shooting, according to the coroner’s report, died due to a through-and-through indeterminate-range gunshot wound to the chest.

78% of the fire/EMS that were a part of the STEM School shooting response had taken part in The Next Nine Minutes training. Multiple responders from these agencies commented that the similarities between the training and real-life shooting aided in the success of their response. However, one of the limitations is that there were not any after-action surveys or interviews given to fully assess the impact that the training had on the responders in fire/EMS, LE, or within the receiving hospitals. The STEM shooting was a tragic and unexpected event that is still an on-going criminal investigation. It did not seem appropriate at the time to subject the responders to a survey. In the future, it would be beneficial to assess the usefulness of this type of training with further surveys and metrics in an attempt identify areas of improvement for upcoming courses.

War in both Iraq and Afghanistan has completely changed many emergency survival tactics. Among the most important research indicates that tourniquet use before shock was present is strongly associated with 90% survival. When evaluating the time that it takes for first responders to get to a patient, specifically with bleeding control as the first critical factor, it is easy to understand why critical patients are dying prior to first responder arrival. The more that the time to patient access is reduced, the greater the ability to maximize the survivability of patients due to implementation of life saving interventions. Although active threat incidents are some of the most dynamic and complex of any scene that responders manage, simple bleeding control must be the first critical factor and must be a shared objective of LE and EMS.

Surgeons performing a laparotomy on a role player wearing a Cut Suit with an Advanced Surgical Skills Package (ASSP)

It is indisputable that LE will be the first 911 response into the building or scene and will play a major role in the survival of patients. Newly arriving untasked officers need to be allocated to apply tourniquets, pack junctional injuries, apply chest seals, and report victim locations—this is the second critical factor for the LE response. Therefore, it is imperative that LE are as well trained in these tasks as the EMTs and paramedics in your local jurisdiction. This is why in The Next Nine Minutes, LE underwent static and kinetic training alongside fire/EMS in these tasks and were not allowed to proceed until they showed mastery. This life saving intervention training and division of tasks within LE were critical for the success during the STEM School shooting response. It is mandatory that we train our LE officers in these life-saving interventions.

More details will be seen in a peer-reviewed paper accepted by the American Journal of Disaster Medicine soon to be published, titled “The next nine minutes: Lessons learned from the large-scale active shooter training prior to the STEM school shooting” by Alissa Lenz, BS; Ryan Shelton, MPS, NREMT-P; Rebecca Ryznar, PhD; Kit Lavell BA; David Ross, DO, FACEP; Susan Carter, MD, FACOG, FACS; Andrew Kirkpatrick, CD, MD, MHSc, FRCSC, FACS; Jessica L. McKee, BA, MSc; Anthony J. LaPorta, MD, FACS; Chris Wells, BS

The Operational Training Building (ShootHouse)

The Operational Training Building (ShootHouse) is the newest addition to the STOPS Tactical Training Laboratory (TTL). It is a building of approximately 6,400 square feet and has four levels – each with multiple rooms, hallways, and “hides”. There are internal stairways and an external stairway leading to each floor.

Tactical Training Laboratory
The TTL, is a training/simulation area unlike any other in the industry. STOPS fills the void of realistic training for tactical teams of law enforcement, military, and other professional organizations responsible for public safety. Utilizing a support staff trained to re-create any tactical scenario in the greatest of detail; the physical and sensory environment is both controlled, manipulated, and influenced – creating a Hyper-Realistic® training experience.

STOPS can provide the “opposing force” for exercises -men and women who are fully trained, armed, and dressed in appropriate wardrobe to match the mission specific scenario, freeing all personnel in the unit to participate in the training evolution. Role players add a convincing and haunting reality to each training experience, regardless of the venue. They take the training experience to another level – one in which military and law enforcement teams are faced with circumstances/challenges not available in any other training.

All facilities are approved to use blanks, Simunitions® , or any type of marking round.

Special effects can include smoke, noise, and explosions that add the highest level of realism safely and simulate the “fog of war” or a traumatic event. Special effects make-up artists can simulate actual combat/traumatic wounds, adding a heightened sense of realism to any training.

The Operational Training Building (ShootHouse) Law Enforcement Training inside the Operational Training Building

Special Operations Forces Planning, Rehearsal and Execution Preparation (SOFREP) and SEALs Training

STOPS served as the fourth day capstone of the latest Special Operations combat medicine training. Naval Special Warfare Group 1’s Tactical Medical Cell (NSWG-1 TMC) Tactical Medical Lead, Special Operator 1st Class Noel Sons, explained that “The capstone event provides simulated environments in order to fully immerse the students and allow them to use the skills and training received throughout the course. Environments range from naval vessels and a crashed helicopter to a medical trauma center. Realism is added with explosions, sounds of gun fire, and role-players that utilize prosthetics and fake blood to simulate realistic combat injuries.”
Learn More

SEAL medics participate in the capstone training event at Strategic Operations

Upcoming Training Courses

The latest Training Courses offered by STOPS include:

TECC for Law Enforcement Officers and First Responders (TECC-LEO)
This newly released course from National Association of Emergency Medical Technicians (NAEMT) has replaced TCC LEFR. It is an 8-hour classroom scenario-based skills course designed explicitly for law enforcement and non-EMS first responders. The course covers lessons found in the 16-hour provider course at a level appropriate for first responders.
Classes for 2021 now available.

TECC logo

Tactical Emergency Casualty Care (TECC)
The newly validated Second Edition of the NAEMT TECC course is designed to present a strong foundation of topics, concepts, principles, and skills specific to delivering emergency medical care for patients in a civilian tactical environment.

Topics include: Hemorrhage control; surgical airway control and needle decompression; strategies for treating wounded responders in threatening environments; caring for pediatric patients; and techniques for dragging and carrying victims to safety.
Classes for 2020 and 2021 are now available.

TECC NAEMT combined logo

Tactical Medicine Technician (TMT)
This 40 hour course meets and exceeds California POST and EMSA guidelines for Tactical Medicine and provides 40 hours of CAPCE (formerly CECBEMS) credits and/or POST CPT for LE officers. It is held at STOPS; utilizing STOPS Hyper-Realistic® capabilities.
Class for 2021 now available.

TMT combined logo

Featured Product: Wounds Shirt

STOPS is proud to share a new line of Hyper-Realistic® and affordably priced moulage skins. They were designed for emergency medical trainees, professionals, and agencies in the military and public service fields. Combining high-end hypoallergenic silicone with form-fitting moisture-wicking fabrics provides versatility, unlike any other product on the market. All wearable wounds are available in medium and dark skin tone options.

Our handcrafted wounds, molded by Hollywood-style special effects artists, combine hyper-realism with exceptional expediency - in a product that is both durable and comfortable.

Over the years, STOPS has created and used these wounds for training our nation's militaries, first-responders, medical professionals, and police forces to be prepared for any emergency medical situation.

STOPS wearable wounds, along with our flagship Cut Suit and Hyper-Realistic® Moulage Kit (HRMK), form the basis for Hyper-Realistic® MedSim training.

Strategic Operations Wounds Shirt variations

Strategic Habitats™

Innovative, Affordable, Long-Term Solution for Temporary Housing for Homeless Families

In 2002, STOPS grew from San Diego’s Stu Segall Productions, which was once one of the largest independent, full-service television and movie studios. STOPS combines the magic of Hollywood moviemakers with the professional knowledge of military, law enforcement, and first responder trainers. STOPS offers unprecedented Hyper-Realistic® training with leading-edge products and services that have solved a myriad of problems encountered by military, law enforcement, first responder, and medical personnel. The company is now committed to solving one of our nation’s biggest problems - housing our homeless population - with the introduction of Strategic Habitats™, an innovative, affordable, long-term solution for temporary housing for homeless families.

STOPS has modified thousands of these 40-foot-long shipping containers to create training facilities at military bases all over the world. STOPS craftsmen cut up these large metal containers and then weld them into replicas of commercial, residential, and industrial buildings. Then artisans attach movie industry type facades to transform these them into hyper-realistic interiors and exteriors that look just like the real thing.

Strategic Habitats™ will be constructed in much the same way - producing 480-square-foot single-family homes that are equipped with full plumbing for bathrooms and kitchen, as well as air conditioning and heating for year-round comfort. The all-electric kitchen comes with fully equipped double-burner stove, microwave, and refrigerator/freezer. The fully furnished bedrooms can comfortably sleep two adults and two children with multiple storage options for the whole family. Horizontal and vertical configurations of the homes can be easily assembled into safe, secure family habitats with minimal site prep.

View from kitchen into living room of one of the two-family duplexes to house the homeless and a Strategic Habitats™ bedroom

“Strategic Habitats™ are larger than hotel rooms, which recently have been converted to homeless housing, while priced 30 to 40 percent less than converted hotels or new construction,” said Cory Segall, Program Manager, Strategic Habitats™. “Additionally, Strategic Habitats™ are much quicker to complete over new construction and the units can easily be assembled in a variety of configurations including multi-story, and placed on parking lots or any open property.”

Segall said that there are about 8,000 homeless in San Diego County, the fourth highest in the U.S., with more than half living on the street and the rest in shelters. Strategic Habitats™ can be an essential solution to help homeless individuals and families re-enter society with dignity in a safe and special environment.

For more information about any of the services and/or products featured in this newsletter and to see what else we have to offer, visit our other pages on our website or contact us via the links provided below.

Three 40-ft shipping containers converted into a "Strategic Habitats™" two-family duplex to house the homeless
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