Tag Archives: emergency

101 Things We Should Teach Every New EMT

Originally posted at TheEMTSpot

I do not usually steal content or original writings, but this post is too important not to share (and keep for reference).  This was originally posted, with all credit due to the author of origin, at: http://theemtspot.com/2014/03/22/101-things-we-should-teach-every-new-emt/

Though this list is focused towards emergency medical technicians, it has inferred and inherent application in many clinical and non-clinical professions.

1) You aren’t required to know everything.

2) You are required to know the foundational knowledge and skills of your job. No excuses.

3) Always be nice. It’s a force multiplier.

4) There is no greater act of trust than being handed a sick child.

5) Earn that trust.

6) Don’t ever lie to your patient. If something is awkward to say, learn to say it without lying.

7) Read Thom Dick’s, People Care. Then read it again.

8) You can fake competence with the public, but not with your coworkers.

9) Own your mistakes. We all make them, but only the best of us own them.

10) Only when you’ve learned to own your mistakes will you be able to learn from them.

11) Experience is relative.

12) Proper use of a BVM is hard and takes practice.

13) OPAs and NPAs make using a BVM less hard.

14) Master the physical assessment. Nobody in the field of medicine should be able to hold a candlestick to your physical assessment skills.

15) Keep your head about you. If you fail at that, you’ll likely fail at everything else.

16) There is a huge difference between not knowing and not caring. Care about the things you don’t yet know.

17) Train like someone’s life depends on it.

18) Drive like nobody’s life depends on it.

19) Pet the dog (even when you’re wearing gloves).

20) Have someone to talk to when the world crashes down.

21) Let human tragedy enhance your appreciation for all that you have.

22) Check the oil.

23) Protect your back. It will quite possibly be the sole determining factor in the length of your career.

24) Say please and thank you even when it’s a matter of life or death.

25) Wipe your feet at the door.

26) When you see someone who is really good at a particular skill say, “Teach me how you do that.”

27) Nobody can give you your happiness or job satisfaction; it is yours and yours alone, and you have to choose it.

28) We can’t be prepared for everything.

29) We can be prepared for almost everything.

30) Check out your rig. It’s more meaningful that just confirming that everything is still there.

31) Tell your patients that it was a pleasure to meet them and an honor to be of service.

32) Mean it.

33) Keep a journal.

34) Make it HIPAA compliant.

35) Thank the police officer that hangs out on your scene for no good reason.

36) Recognize that he or she probably wasn’t hanging out for no good reason.

37) Interview for a job at least once every year, even if you don’t want the job.

38) Iron your uniform.

39) Maintain the illusion of control. Nobody needs to know that you weren’t prepared for what just happened.

40) Apologize when you make a mistake. Do it immediately.

41) Your patient is not named honey, babe, sweetie, darling, bud, pal, man or hey. Use your patient’s name when speaking to them. Sir and Ma’am are acceptable alternatives.

42) Forgive yourself for your mistakes.

43) Forgive your coworkers for their quirks.

44) Exercise. Even when it isn’t convenient.

45) Sometimes it’s OK to eat the junk at the QuickyMart.

46) It’s not OK to always eat the junk at the QuickyMart.

47) Don’t take anything that a patient says in anger personally.

48) Don’t take anything that a patient says when they are drunk personally.

49) Don’t ever convince yourself that you can always tell the difference between a fake seizure and a real seizure.

50) Think about what you would do if this was your last shift working in EMS. Do that stuff.

51) Carry your weight.

52) Carry your patient.

53) If firefighters ever do #51 or # 52 for you, say thank you (and mean it).

54) Being punched, kicked, choked or spit on while on duty is no different than being punched, kicked, choked or spit on while you’re sitting in church or in a restaurant. Insist that law enforcement and your employer follow up with appropriate action.

55) Wave at little kids. Treat them like gold. They will remember you for a long time.

56) Hold the radio mike away from your mouth.

57) There is never any reason to yell on the radio….ever.

58) When a patient says, “I feel like I’m going to die,” believe them.

59) Very sick people rarely care which hospital you’re driving toward.

60) Very sick people rarely pack a bag before you arrive.

61) Sometimes, very sick people pack a bag and demand a specific hospital. Don’t be caught off guard.

62) Bring yourself to work. There is something that you were meant to contribute to this profession. You’ll never be able to do that if you behave like a cog.

63) Clean the pram.

64) Clean your stethoscope.

65) Your patient’s are going to lie to you. Assume they are telling you the truth until you have strong evidence of the contrary.

66) Disregard #65 if it has anything to do with your personal safety. Trust nobody in this regard.

67) If it feels like a stupid thing to do, it probably is.

68) You are always on camera.

69) If you need save-the-baby type “hero moments” to sustain you emotionally as a caregiver you will likely become frustrated and eventually leave.

70) Emergency services was never about you.

71) The sooner you figure out #69 and #70, the sooner the rest of us can get on with our jobs.

72) People always remember how you made them feel.

73) People rarely sue individuals who made them feel safe, well cared for and respected.

74) You represent our profession and the internet has a long, long memory.

75) Don’t worry too much about whether or not people respect you.

76) Worry about being really good at what you do.

77) When you first meet a patient, come to their level, look them in the eyes and smile. Make it your habit.

78) Never lie about the vital signs. If the patients vital signs change dramatically from the back of the rig to the E.R. bed, you want everyone to believe you.

79) Calm down. It’s not your emergency.

80) Stand still. There is an enormous difference between dramatic but senseless action and correct action. Stop, think and then move with a purpose.

81) Knowing when to leave a scene is a vital skill that you must constantly hone.

82) The fastest way to leave a scene should always be in your field of awareness.

83) Scene safety is not a five second consideration as you enter the scene. It takes constant vigilance.

84) Punitive medicine is never acceptable. Choose the right needle size based on the patients clinical needs.

85) Know what’s happening in your partner’s life. Ask them about it after you return from your days off.

86) If your partner has a wife and kids, know their names.

87) No matter how hard you think you worked for them, your knowledge and skills are not yours. They were gifted to you. The best way to say thank you is to give them away.

88) Learn from the bad calls. Then let them go.

89) When you’re lifting a patient and they try to reach out and grab something, say, “We’ve got you.”

90) Request the right of way.

91) Let your days off be your days off. Fight for balance.

92) Have a hobby that has nothing to do with emergency services.

93) Have a mentor who knows nothing about emergency services.

94) Wait until the call is over. Once the patient is safe at the hospital and you’re back on the road, there will be plenty of time to laugh until you can’t breathe.

95) Tell the good stories.

96) You never know when you might be running your last call. Cherish the small things.

97) You can never truly know the full extent of your influence.

98) If you’re going to tell your friends and acquaintances what you do for a living, you’ll need to embrace the idea that you’re always on duty.

99) Be willing to bend the rules to take good care of people. Don’t be afraid to defend the decisions you make on the patients behalf.

100) Service is at the heart of everything we do. The farther away from that concept you drift, the more you are likely to become lost.

101) There is no shame in wanting to make the world a better place.

See more at: http://theemtspot.com/2014/03/22/101-things-we-should-teach-every-new-emt/

Measuring EMS: Patient Satisfaction

As a paramedic, I become discouraged when so-called academic literature, like that of McLean, Maio, Spaite, and Garrison (2002), Spaite (1993), and Stiell et al. (2008), turns up describing what little impact the emergency medical services, especially advanced life support procedures, have on patients. Instead of dismissing these writings, I tend to focus within the view of my own practice and experience on how I feel that I impact the patients that I see. This exercise allows me to confront the literature in a specific and meaningful manner that might be used in the future to publish a dissenting view. This discussion gives me a lens through which to dissect the import I feel that the emergency medical services has as a public safety entity.

Public safety is typically viewed as the amalgamation of police, fire, and emergency medical services. In all three, the public seems to have the idea that we stop threats before they take hold; however, we typically respond to the aftermath, the police to investigate crimes that have already occurred, the fire department to conflagrations that have already caused damage, and emergency medical services to traumatic incidents or medical conditions that have already caused distress. There are exceptions. The police have learned to integrate crime prevention techniques, the fire department has learned to adopt a fire prevention model of service, and the emergency medical services in many areas support preventative health clinics, such as community immunization, blood pressure checks, and CPR and first aid classes. The public, I feel, has a skewed perception of each one of these departments (e.g. the police should stop crime in progress, the fire department should save their house, and emergency medical systems should save their loved one whenever called upon to do so). Any deviation from the public perception is, in their minds, a failure of the system.

I ask myself, “What is that we, as the emergency medical services, do that really matters?” For the public, it seems that the answer can be given two-fold: “save me” and “make me feel better.” El Sayed (2012) describes the manner in which both aspects, outcomes and patient satisfaction, can be measured, as both are essential. Unfortunately, El Sayed does not go into much detail regarding patient satisfaction scores, except as a means of measure. In contrast, I feel that the most benefit that we offer patients is that we alleviate suffering. From a confident, yet compassionate, bed-side manner to effective and efficient treatment modalities, emergency medical personnel can prove to be the mediator between illness or injury and definitive hospital-based care. Emergency medical providers should be knowledgeable enough about the hospital to calm and educate patients as to what to expect. Further, medical knowledge allows the provider to restore a choking person’s breathing, to stop an epileptic seizure, and to minimize a crash victim’s pain. In my opinion, these measures are just as important, if not more, to quality management as mortality and morbidity. Again, El Sayed mentions the generality of patient satisfaction; however, with the abundance of competing literature questioning the effectiveness of the emergency medical services, patient satisfaction should be expounded upon as a legitimate and important aspect of quality patient care.


El Sayed, M. J. (2012). Measuring quality in emergency medical services: a review of clinical performance indicators. Emergency Medicine International, 2012, 1-7, doi:10.1155/2012/161630

McLean, S. A., Maio, R. F., Spaite, D. W., & Garrison, H. G. (2002). Emergency medical services outcomes research: evaluating the effectiveness of prehospital care. Prehospital Emergency Care, 6(2), S52–S56. doi:10.3109/10903120209102683

Spaite, D. W. (1993). Outcome analysis in EMS systems. Annals of Emergency Medicine, 22(8), 1310–1311. doi:10.1016/S0196-0644(05)80113-1

Stiell, I. G., Nesbitt, L. P., Pickett, W., Munkley, D., Spaite, D. W., Banek, J., Field, B., … Wells, G. A., for the OPALS Study Group. (2008). The OPALS Major Trauma Study: impact of advanced life-support on survival and morbidity. Canadian Medical Association Journal, 178(9), 1141-1152. doi:10.1503/cmaj.071154

SWOT Analysis: Day Kimball Healthcare

Day Kimball Healthcare (DKH) is a non-profit health care organization serving the northeastern Connecticut, southcentral Massachusetts and northwestern Rhode Island communities. The mission of DKH (2011) is “to meet the health needs of our community through our core values of clinical quality, customer service, fiscal responsibility and local control” (para. 4). A comprehensive health care system, DKH offers primary care and a multitude of medical and surgical specialties along with sophisticated diagnostics by offering a comprehensive network of more than 1,000 employees including more than 200 physicians, surgeons and specialists. DKH is comprised of Day Kimball Hospital, four community health care centers, Day Kimball HomeCare, Day Kimball Hospice & Palliative Care of Northeastern Connecticut, Day Kimball HomeMakers, and Physician Services of Northeast CT, LLC.


DKH provides a host of services to the community, including:

  • primary medical care,

  • emergency medical care,

  • surgical care,

  • palliative and hospice care,

  • home health care, and

  • social services

DKH appears to strive towards providing a comprehensive health care solution to the community that is robust, yet limited in specialty, especially critical care, trauma, and pediatric services.



The primary catchment area for DKH includes the Connecticut towns of Brooklyn, Canterbury, Eastford, Killingly, Plainfield, Pomfret, Putnam, Sterling, Thompson, and Woodstock, and the Rhode Island towns of Foster and Glocester. According to the available U.S. Census data (2010), the population served is nearly 92,000 with average growth in the last ten years of nearly 9%. The median age of the catchment population (37.8) is merely 3 months older than the median age of the Connecticut population (37.4). The median household income is $66,422 (CT: $67,034).


DKH is the primary health care provider within the defined catchment area. Some of the population, however, rely on three other community-level hospitals, Backus Hospital (Norwich, CT), Southbridge Hospital (Southbridge, MA), and Windham Hospital (Windham, CT). Additionally, some of the population with advanced disease processes rely strictly on the primary and emergency care services of the nearest urban centers (Worcester, MA, Hartford, CT, and Providence, RI), with many of DKH’s emergency patients transferred to these tertiary care centers for trauma, critical care, and pediatric specialties.


DKH, as a health care organization, can be adversely affected by patterns of infectious diseases within the community. As each season mounts, the health care system becomes overwhelmed and requires coordination between other health care facilities in the area.

Additionally, a large disaster would strain the resources of DKH; however, this would be a temporary issue, resolving as the disaster winds down. There is ample opportunity within the catchment area for a disaster to unfold, including traffic on the major highway that divides the catchment area as well as the number of large manufacturing entities in the area.


Strengths. DKH provides comprehensive long-term health care to community members. DKH enjoys a strong and comprehensive relationship with a large network of physicians and other primary care providers.

Weaknesses. DKH has no intensivists, physicians with expertise in critical care, and provides very limited critical care service. As a result, DKH must transfer many cases to other facilities to rule in or rule out critical illnesses or injuries, which negatively affects earnings.

Another weakness lies in DKH’s reliance on electronic patient care reporting. DKH uses a number of patient care reporting platforms that do not integrate with each other. This creates a need for over-redundancy and opportunities for patient care errors. Further, a fully integrated system would allow for health care partners to access up-to-date patient care information without delay.

Opportunities. Opportunities exist for DKH to expand their services by further decentralizing the current services offered and concentrating on which scopes of service to expand or improve upon. By improving laboratory reporting standards and facilitating full integration of patient reporting, patients of DKH will be able to obtain a more standardized level of care throughout the health care continuum.

DKH should cultivate their relationship with the public by being more active and visible within the community performing screenings, vaccinations, blood drives, as well as other public relations endeavors.

Another opportunity exists with the patient population who suffer from critical illness or injury that is yet to be determined. These patients face risk in transport to tertiary care centers when, often times, the transfer is unwarranted by later findings. By cultivating relationships with specialties in the tertiary care centers, these patients could be more fully determined to need (or, not need) transfer to tertiary care centers, keeping the financial reward of caring for patients in-house while obtaining specialist coordination.

Threats. The largest threat to DKH, as with any organization, is its reputation within the community. Funding, which is largely based on governmental and private insurance providers, is also a considerable threat that must be managed continuously. However, other threats are significant and can be actively managed.

Pandemics are unlikely to occur but present catastrophic scenarios if they do, indeed, occur. Pandemic influenza, as well as other pandemic diseases, presents a situation of an increasing need for awareness and preparation.

Unpredictable weather in the northeastern Connecticut presents a likely and significant threat to the provision of health care. Recent and historical storms have proven to impede access and egress to and from patients both out in the community and at the hospital.


This SWOT analysis is limited by the a posteriori knowledge and perceptions of the author, a paramedic who is active within the health care system, and it is limited in the scope of an academic exercise to practice SWOT analyses.

However, DKH has overcome many adversities in the past and continues to grow, but seemingly without proper direction. The efforts thus far seem disjointed and without a clear structure or coherent path into the future. DKH would benefit from an internal SWOT analysis that could be performed without the limitations inherent herein.


Day Kimball Healthcare. (2011). Day Kimball Healthcare. Retrieved from http://www.daykimball.org

U.S. Census Bureau. (2010). 2010 census data. Retrieved from http://www.census.gov/

Human Resources & Challenges in Health Care

The function of human resources is not without its challenges and difficulties. No matter the industry or organization, acquiring and managing a pool of employees can be overwhelming (Thompson, 2012). Human resources managers in health care organizations seem to face more challenges than most. From nursing and physician shortages to attracting innovative and contemporary researchers, health care organizations seem to search within thinning pools of prospective employees, yet still demand the best and brightest (Keenan, 2003; Lewis, 2010; Thompson, 2012).

One of the most challenging issues to health care over the last few decades has been a significant nationwide nursing shortage (Keenan, 2003; Lewis, 2010). Thompson (2012) outlines both a declining skilled workforce and an increasing population contributing to the problem. Both Keenan (2003) and Lewis (2010) cite the aging babyboomer population adding to the increased need for nurses through 2020 and beyond. Novel human resources strategies can result in an augmented workforce designed to meet the continually growing impact these forces have on health care organizations, specifically those with emergency departments.

One novel strategy includes consideration of other highly-skilled clinicians that do not traditionally work in hospitals. As Oglesby (2007) considers the possibility, paramedics are, by far, one of the best examples. By introducing paramedics into the emergency department, a hospital can redistribute the nurses to clinical areas more suited towards their training, decrease the patient-to-nurse ratios (thereby increasing patient safety and maximizing outcomes), and tap into a new pool of prospective employees that are well-suited to rise to the stressful demands of the emergency department (Keenan, 2003; Swain, Hoyle, & Long, 2010). Additionally, organizations employing paramedics can augment both their emergency department operations and home health care operations by sending paramedics to certain patients to mitigate their complaints and minimize the number of inappropriate patient transports to the emergency department (Swain, Hoyle, & Long, 2010). This alone would decrease emergency department overcrowding and maximize revenue and efficiency in the delivery of care. Additionally, turn-over rates should be significantly lower with a more productive work environment where stress is managed, outcomes are met, and patients are care for more effectively.

In conclusion, intelligent and novel planning of the workforce can, itself, lead to increases in recruitment and retention; however, efforts still need to focus on each individually in order to attract, maintain, and develop a first-class workforce (Thompson, 2012).


Keenan, P. (2003). The nursing workforce shortage: causes, consequences, proposed solutions (Issue brief #619). The Commonwealth Fund. Retrieved from http://mobile.commonwealthfund.org/

Lewis, L. (2010). Oregon takes the lead in addressing the nursing shortage: A collaborative effort to recruit and educate nurses. American Journal of Nursing, 110(3), 51-54. doi:10.1097/01.NAJ.0000368955.26377.e1

Oglesby, R. (2007). Recruitment and retention benefits of EMT—Paramedic utilization during ED nursing shortages. Journal of Emergency Nursing, 33(1), 21-25. doi:10.1016/j.jen.2006.10.009

Swain, A. H., Hoyle, S. R., & Long, A. W. (2010). The changing face of prehospital care in New Zealand: the role of extended care paramedics. Journal of the New Zealand Medical Association, 123(1309), 11-14. Retrieved from http://journal.nzma.org.nz/

Thompson, J. M. (2012). The strategic management of human resources. In S. B. Buckbinder & N. H. Shanks, Introduction to Healthcare Management (Custom ed.; pp. 81-118). Sudbury, MA: Jones & Bartlett.

Future Threats

Aside from hoax attacks, where credible threats occur based on purposeful counter-intelligence efforts of terrorists, I suspect large-scale events to be the modus operandi of terrorists in the next decade. According to LaFree, Yang, and Crenshaw (2009), anti-U.S. terrorists have ample intent on attacking the U.S. on our soil; however, this would be a huge and logistically complicated undertaking. For this reason, any future organized act of terror on U.S. soil will be designed to be significant, causing extreme loss of life or toppling a significant structure or both.

Biologic weapons would be the choice for terrorists who wished to inflict harm to the greatest amount of people, though releasing biologic material lacks the sudden impact usually sought, and weaponized biologics are not easily grown or economical (Levitin, 2005). Chemical weapons are typically easier and cheaper to manufacture, though they lack effectiveness and tend to merely create a scare of equivalent magnitude of a hoax (Levitin, 2005). Aside from basic explosives, this leaves the radiologic threat, a threat that I believe, coupled with a significant target, will cause devastating effects not unlike 9/11.

A dirty bomb is a conventional explosive used to disseminate radiologic materials over an area. I foresee a coordinated attack on the financial districts of the U.S. using dirty bombs. The bombs would, first, cause physical destruction to the buildings causing immediate disruption of the financial sector of the U.S. economy, along with a large death toll. Second, the radiation dispersed over the area would cause difficulty in cleaning up the area, inhibiting recovery and further impacting the financial markets.

A law enforcement response to such an attack would certainly be large in scale. The local police department would be first to respond, along with state police, then the WMD Coordinator at the local FBI field office would be apprised of the situation. As responders start arriving on scene, personal radiation detectors would start to tone indicating the release of radiologic material. This further information would prompt the WMD Dictorate in Washington, D.C., to order a full asset response by the FBI and other federal terrorism partners (e.g. the Joint Terrorism Task Force). The response to this type of incident should be trained on in cooperative exercises involving all levels of law enforcement. Additionally, personal radiation detectors (and other detectors) should, at a minimum, be placed in police vehicles for early warning of environments immediately dangerous to life and health. Adequate training, equipment, and preparation are the only ways in which to prepare for responding to large-scale terrorist attacks.


LaFree, G., Yang, S., & Crenshaw, M. (2009). Trajectories of terrorism: Attack patterns of foreign groups that have targeted the United States, 1970-2004. Criminology & Public Policy, 8(3), 445-473. doi:10.1111/j.1745-9133.2009.00570.x

Levitin, H. W. (2005). Debunking myths: How law enforcement can help diffuse the public’s fear. On the Beat. Retrieved from http://www.adl.org/learn/columns/Levitin.asp

Fear of Terrorism

As terrorism becomes more prevalent within a society, concerns about the psychological effects are brought to the forefront. The psychological effects of terrorism, in general, should have an impact on the ability of law enforcement and the public to interface appropriately. A recent study by Bleich, Gelkopf, and Solomon (2003) of the psychological effects of terrorism on the public in Israel showed surprisingly low levels of post-traumatic stress disorder symptoms despite high incidences of direct exposure to terror events. This study demonstrated that, although up to a third of the respondents acknowledged a “limited sense of safety and substantial distress [they] reported adapting to the situation without substantial mental health symptoms and impairment, and most sought various ways of coping with terrorism and its ongoing threats [, possibly linked to] processes of adaptation and accommodation” (p. 619). The study found that the most effective and widely used coping mechanism was checking on the well-being of friends and family. As people tend to cope well with trauma, attitudes towards protective measures seem to acquiesce for the common good, and this can be assistive to law enforcement.

One of the protective measures people tend to adopt that would help law enforcement is a sense of hypervigilance (Bleich, Gelkopf, & Solomon, 2003). Hypervigilance allows the people to be more attentive to things out of the ordinary (e.g. unattended packages, suspicious loitering, anxious mannerisms of others, et al.). This promotes a line of communication with law enforcement not only regarding terrorism but for other criminal activity, also.

Another protective measure, which goes towards acquiescence, is the ability of the people, in general, to accept an increased presence of law enforcement in their daily lives. When faced with a proximal event, the bulk of the citizenship contend that it is, indeed, a function of government to protect the masses from further harm, and these citizens tend to accept limits on personal liberty for perceived increases in security (Klein, 2007). This is a double-edged sword, however. People tend to want to return to a normal state of affairs (Bleich, Gelkopf, & Solomon, 2003). Though an increased police presence is initially welcomed and embraced, the people will eventually resent the loss of liberty and require law enforcement presence to recede. How this occurs will either enhance or detract from the ongoing relationship with law enforcement. An example of this is easy to see when considering both local law enforcement and the federal effort of the Transportation Security Administration (TSA). Local law enforcement seems to have decreased their presence, at least in my area, and are respectfully viewed as helpful, whereas the TSA, an agency that continues to irrationally impede on liberty, is viewed negatively by the traveling public.

Law enforcement is a service-based industry where the public is the customer. Police need to understand both the rights and the fears of the people in order to maintain the appropriate level of service, which waxes and wanes.


Bleich, A., Gelkopf, M, & Solomon, Z. (2003). Exposure to terrorism, stress-related mental health symptoms, and coping behaviors among a nationally representative sample in Israel. Journal of the American Medical Association, 290(5), 612-620.

Klein, L. (2007). Civil liberties and national security in the post 9-11 era: State power and the impact of the USA Patriot Act. Conference Papers – American Sociological Association, 1-8.

WMD Coordinator

According to the Federal Bureau of Investigation (FBI; 2007) and the U.S. Department of Justice (2009), the WMD Coordinator, a designated Special Agent within each field office, is responsible for initiating the federal response to any possible WMD event. “The Attorney General has lead authority to investigate federal crimes, which includes the use or attempted use of a WMD. 28 U.S.C. § 533 (2008) and 18 U.S.C. § 2332(a) (2008). The Attorney General has delegated much of this investigative authority to the FBI” (U.S. Department of Justice, 2009, p. 1). The WMD Coordinator helps to fulfill this mandate by being the point of contact for local and state officials when an event involving an WMD is suspected to have occurred.

In the Mattapan scenario, the initial response by the Boston Police Department and the Massachusetts Bay Transit Authority Police Department unveil a possible attempt to utilize an explosive to disseminate a chemical or biologic material in a public place. As soon as this plot is uncovered, an emergency response plan should be initiated, which involves notifying the Boston FBI field office of the suspected WMD event. The WMD Coordinator of the Boston field office would be the person receiving this notification. The Massachusetts State Police would also be notified to respond as they are able to provide their own subject matter experts and resources.

As a WMD subject matter expert, once notified of the circumstances, according to the FBI (2007), the WMD Coordinator responds to the scene and assists local and state law enforcement in determining the threat. Once it is established that an WMD is involved, whether by direct investigation at the scene or based on reports from law enforcement, the WMD Coordinator would immediately notify the WMD Directorate at FBI Headquarters. This notification would activate a team of WMD experts who would participate in a conference call with the WMD Coordinator to further identify the threat and, also, identify the additional federal resources needed to respond to the event. The additional resources could be individual experts, federal response teams from other departments or bureaus (e.g. the Joint Terrorism Task Force, the Bureau of Alcohol, Tobacco, Firearms, and Explosives), or the special teams of the FBI, including the Chemical and Biological Sciences unit (to identify the particular payload material), photo operations personnel, an explosives team (based on the dispersal mechanism being explosives), the disaster squad (to identify any potential victims), and the national level Hazardous Material Response Unit and the local Hazardous Material Response Team to collect evidence from the scene. The WMD Coordinator would, then, be responsible for leading the investigation.

The WMD Coordinator would most likely fulfill his role within the unified incident command structure as Law Enforcement Command. This position would allow him or her to delegate the responsibilities of the response, including the need to provide information to the public. Public Information Officers provide a critical role in major response efforts. They provide enough information to the public to allay any unfounded fears, provide direction and instructions when needed, and filter sensitive information so that it does not become public knowledge. It is important for the public to be apprised of the situation in a calm and authoritative manner to assure them that everything necessary is being done. It is also important for the public to understand the risks of the situation in a realistic manner to prevent a mass overreaction.

The WMD Coordinator position is a valuable tool of the FBI and the federal government. Though the value of this position has been criticized for the lack of readiness and training, preparations are being undertaken to ensure a quality approach to responding to WMD events in the future (McDonald, 2009; U.S. Department of Justice, 2009).


Federal Bureau of Investigation. (2007, March 5). WMD threats: How we respond. Retrieved from http://www2.fbi.gov/page2/march07/wmd030507.htm

McDonald, J. (2009, October 8). FBI WMD Coordinator program needs improvement [Web log]. The OC Sheriff Blog. Retrieved from http://blog.ocsd.org/post/2009/10/08/Audit-of-FBI-Weapons-of-Mass-Destruction-Coordinator-Program-Recommends-Improvements.aspx

U.S. Department of Justice. (2009, September). The Federal Bureau of Investigation’s Weapons Of Mass Destruction Coordinator program (Audit Report #09-36). Retrieved from http://www.justice.gov/oig/reports/FBI/a0936.pdf

The Role of Federal Law Enforcement

The role of federal law enforcement has changed with the inception of the National Response Framework (NRF; U.S. Department of Homeland Security, 2008). In the past, according to the obsolete National Response Plan (NRP; U.S. Department of Homeland Security, 2004), the effort of the federal government was to support local efforts and only take charge if necessary or requested to do so by the responsible jurisdiction. The NRF furthers this goal. However, according to a recent U.S. Department of Justice (2010) report, federal law enforcement is ill-prepared to provide a robust and organized response to an act of terrorism on U.S. soil, save for the Federal Bureau of Investigation (FBI).

For instance, assume that a small group of terrorists detonate a bomb, otherwise known as a ‘suitcase bomb’, designed to shower radiologic material over an area approximately 9 city blocks in downtown Los Angeles. What chain reaction, in regards to a law enforcement response, would this event trigger?

First, calls to 9-1-1 reporting a large explosion would trigger a local response by both the Los Angeles Police Department and the Los Angeles County Sheriff’s Office, along with other emergency services. As local assets begin arriving, hopefully they determine the large and possibly catastrophic nature of the event and advise their communications center to make the appropriate notifications. These notifications would be contingent on the preplanned incident action plans of each agency, which would, hopefully, open emergency operations centers (EOCs) for the City of Los Angeles, Los Angeles County, and the State of California. These EOCs would be responsible for making further notifications and coordinating the response with mutual aid agencies as well as state and federal assets. Common to most all preplans in the event of a suspected terrorist attack is the notification to the FBI’s Joint Terrorism Task Force, which is responsible, according to the Department of Justice (2010) report and the NRF, for coordinating all law enforcement and investigative activities of federal agencies (U.S. Department of Homeland Security, 2008).

A suitcase bomb is significant as it involves the spread of radiological materials that are harmful to humans. According to the Department of Justice (2010) report, the only federal law enforcement agency prepared to deal with such an event is the FBI. Thus, the FBI would be expected to offer expertise and specialized teams to the Los Angeles Police Department in a cooperative effort to begin law enforcement and investigative procedures as soon as possible.


U.S. Department of Homeland Security. (2004). National response plan. Retrieved from http://www.au.af.mil/au/awc/awcgate/nrp/nrp.pdf

U.S. Department of Homeland Security. (2008). National response framework. Retrieved from http://www.fema.gov/pdf/emergency/nrf/nrf-core.pdf

U.S. Department of Justice. (2010, May). Review of the department’s preparation to respond to a WMD incident (OIG Report# I-2010-004). Retrieved from http://www.justice.gov/oig/reports/plus/e1004.pdf

The Need for Multi-Agency Coordination

Terrorists, whether foreign or domestic, typically choose targets that have value in societies or philosophies that they oppose (LaFree, Yang, & Crenshaw, 2009). For instance, according to the Federal Bureau of Investigation (n.d.), al Qaeda, under the leadership of Usama bin Laden, had their sights on the World Trade Center, a symbol of global capitalism, for many years. Another example, involving domestic terrorism, is the bombing of the Alfred P. Murrah Federal Building in Oklahoma City by Timothy McVeigh, Terry Nichols, and Michael Fortier. This target was chosen as a representation of the federal government, which McVeigh and Nichols despised, citing the incident involving federal agents in Waco, Texas, two years earlier.

Considering local community events that might be of significant interest to terrorists as potential targets, the Bristol Fourth of July Parade comes to mind. The parade is a major component of the oldest celebration of our nation’s independence and is attended by over 200,000 people each year (Fox Providence, 2011). The parade is symbolic and casualties could number in the thousands, depending on the tactics and strategies used.

There is limited egress from the Town of Bristol (see figure 1). Hope Street and Metacom Avenue are the only two roads that provide a route in and out of the town. Both lead to the Town of Warren to the north, and Hope Street converges with Metacom Avenue just before exiting the town by way of the two-lane Mount Hope Bridge to the south. Both roads are heavily trafficked during the parade inhibiting both evacuation and emergency response.

In the event that a significant terrorist act was to occur at this parade, the initial law enforcement response would be limited to those officers already on site. These officers, operating under the auspices of the Bristol Police Department would be primarily Bristol police officers with a small contingent of off-duty officers from neighboring jurisdictions. There is usually a small contingent of Rhode Island State Police troopers present. These officers would be on their own for a length of time, some of them probably affected by the attack.

Secondary responders would include both Rhode Island and Massachusetts State Police, along with mutual aid officers from approximately 10 to 15 neighboring communities; however, as people flee the initial attack, a secondary attack could create further confusion and increase the likelihood of severe traffic jams at all three evacuation points further inhibiting a timely response. Once the degree and scope of the incident is ascertained and the access difficulties are identified, it would make sense for a contingent of law enforcement to board helicopters and boats out of Providence and cross Narragansett Bay. Once on land, these officers (most likely consisting of U.S. Coast Guard, Providence Police, U.S. Border Patrol, and other federal law enforcement entities housed in Providence, RI) would rely on alternative means (walking, bicycles, ATVs, et al.) to reach the scene.

Colt State Park, to the southwest, would make a viable forward area command, allowing access for all types of vehicles, including single-engine fixed-wing aircraft. There is also an added benefit of a strong sea breeze to help direct any plume away from this forward area command post.

I have to consider that the law enforcement entities, along with the local emergency management authorities, have a working disaster plan in place for the Bristol Fourth of July parade; however, the plan must detail the fact that all resources would be overcome due to the scope and severity of such an incident; therefore, contingencies, such as stand-by assets, must be established and ready to respond by alternative means in the event that a catastrophic event were to occur, whether criminal or accidental in nature.


Federal Bureau of Investigation. (n.d.). Famous cases & criminals. Retrieved from http://www.fbi.gov/about-us/history/famous-cases/

Fox Providence. (2011, July 5). Inbox: Fourth of July festivities. Retrieved from http://www.foxprovidence.com/dpp/rhode_show/inbox-fourth-of-july-festivities

LaFree, G., Yang, S., & Crenshaw, M. (2009). Trajectories of terrorism: Attack patterns of foreign groups that have targeted the United States, 1970-2004. Criminology & Public Policy, 8(3), 445-473. doi:10.1111/j.1745-9133.2009.00570.x

Rhode Island Emergency Management Agency. (2008). State of Rhode Island hurricane evacuation routes: Town of Bristol [Map]. Retrieved from http://www.riema.ri.gov/preparedness/evacuation/Hevac_Bristol.pdf

Figure 1.

Bristol RI Evacuation Route
“State of Rhode Island hurricane evacuation routes: Town of Bristol” (Rhode Island Emergency Management Agency, 2008).

Expansion of Law Enforcement Post-9/11

Prior to 1993, federal law enforcement agencies, specifically the Federal Bureau of Investigation (FBI), felt more than adequate in investigating and preventing terrorism on U.S. soil (Smith & Hung, 2010). On September 11, 2001, as has been done on numerous emergent occassions, the U.S. government all but suspended Article III, Sec. 2 and Amendments II, IV, V, VI, IX, X, XIII, XIV of the U.S. Constitution in the name of protecting liberty; a premise I find sadly ironic.

According to an article by Abramson and Godoy (2006), the passage of the USA PATRIOT Act (2001) promotes intelligence sharing among the intelligence community, utilization of technological tools to combat tech-savvy terrorists, allows easier access to the business records of suspected terror supporters, allows search warrants to be affected without undermining other concomitant investigations, and allows wiretaps to be dynamic in order to follow the target suspect more easily. Detractors of the USA PATRIOT Act, however, argue that these measures undermine certain liberties that Americans are right to enjoy. These detractors warn of information cataloging that could lead to massive data stores of private information of regular citizens, unwarranted investigations, searches, and seizures of casual contacts of someone under investigation, and general use of “sneak and peek” warrants for the investigation of petty crimes.

One particular part of the USA PATRIOT Act, the usage of letters of national security that demand secrecy of government involvement from the recipient, was struck down by a federal judge based on Constitutional freedom of speech issues (Liptak, 2007). This is no surprise. Passing 357 to 66 in the House of Representatives and 98 to 1 in the Senate just six weeks after 9/11 and with little debate, this knee-jerk legislation was destined for failure, at least where public relations is concerned (Weigel, 2005).

The USA PATRIOT Act (2001) grants immeasurable power to law enforcement to investigate and prevent terrorism, this is a good thing; however, most of the provisions seem to fail whenever exercised against a U.S. citizen or lawful resident (Weigel, 2005). We need to rethink our approach to terrorism and ask the question of ourselves: is our safety worth every ounce of our liberty?


Abramson, L. & Godoy, M. (2006, February). The Patriot Act: Key controversies. Retrieved from http://www.npr.org/news/specials/patriotact/patriotactprovisions.html

Liptak, A. (2007, September 7). Judge voids F.B.I. tool granted by Patriot Act. The New York Times, pp. A18. Retrieved from http://www.nytimes.com

Smith, C. S. & Hung, L. (2010). The Patriot Act: issues and controversies. Springfield, IL: Thomas Books.

USA PATRIOT Act. P. L. 107-56 Stat. 115 Stat. 272. (2001).

Weigel, D. (2005, November). When patriots dissent. Reason, 37(6). Retrieved from http://www.reason.com/news/show/33167.html