LEXINGTON TWP.: Three paramedics heard the dispatcher’s report: A shooting had just taken place in a church. There were multiple casualties.

They responded to the scene in helmets and ballistic vests and waited near the entrance. Two police officers entered the building, wielding rifles and sweeping the room to check for the shooter. They found a woman on the floor of the hallway who said she had been shot and wounded in the head.

Rather than wait for police to clear the building of all potential shooters, the paramedics, on the officers’ signal, entered behind officers who aimed their weapons toward the end of the adjoining hallway. That gave the paramedics cover to get to the woman, help her get to her feet and accompany her out to the “casualty collection point.” There the woman — an actor covered in fake blood — would be “treated” as part of the simulated shooting scenario Tuesday in eastern Stark County.

Instructor Vinny Romanin of the Canton Police Department gave the responding officers feedback about their tactics.

“Perfect,” he said. “All you were doing is getting in front of them while they pick up the casualty and move back to where you were at. ... Take time to breathe. After you solve every single problem, breathe.”

Paramedics and police officers, 18 in all, were taking part in a two-day Tactical Emergency Casualty Care training course. The classroom instruction and exercises were held at the Alliance Police Department’s training facility at the city’s wastewater treatment plant.

After classroom instruction Monday, the police officers and firefighter/EMTs trained in simulated scenarios Tuesday. One was the mass shooting in a church. The second was a mass shooting in a parking lot of a Walmart store that included being exposed to potential sniper fire while trying to remove victims from vehicles. The third scenario was a mass shooting at a parade with instructors firing at the training range to simulate the challenge of treating victims, one a wounded police officer, under live fire and getting them to a casualty collection point and then to a helicopter landing zone. A fourth scenario involved responding to a bombing.

Newer philosophy

Andy Bolgiano, the EMS coordinator for Mercy Medical Center in Canton who started to help put together the local course in December 2015, said he first heard of the concept of Tactical Emergency Casualty Care (TECC), in response to the growing number of mass shootings taking place around the nation since the Columbine school attack in 1999.

In the past, paramedics would not enter the scene of a mass shooting until police thoroughly had searched the area and declared it clear of shooters, a process that could take hours. That meant the elapsing of crucial time before victims could get medical attention, which could lead to hemorrhaging, even death, within minutes of being shot.

Under the newer TECC philosophy, the first police officers who appear at the scene seek to confront the shooter or shooters. A rescue task force behind them — made up of paramedics wearing bullet-resistant helmets and vests, protected by two armed police officers — enters the scene, even though it hasn’t been entirely secured, and seek to treat victims in hallways and rooms or outdoors and in vehicles. Working under the threat of being exposed to hostile fire, they immediately decide who can be stabilized with a tourniquet around their wound to staunch bleeding. They also determine who needs to be evacuated quickly, perhaps to a helicopter to rush them to a hospital.

Adapted from military

According to a 2014 article in the Journal of Emergency Medical Services, the Arlington (Va.) Fire Department began putting together TECC protocols for paramedics in 2005. That culminated in a nationwide committee adopting standards in 2011 based on what the military had done in Iraq and Afghanistan to significantly reduce the number of fatalities. They applied the lesson that immediate treatment and staunching of bleeding saves lives.

Bolgiano said while many police and fire departments in larger communities have adopted the new protocols, it has not happened in Stark County.

Nearly all of his students Tuesday were from agency outside Stark County — the Bainbridge Township Fire Department in Geauga County and the Grandview Heights Fire Department in Franklin County, for example. One participant is a member of the Marlboro Police Department.

Bolgiano brought up the incident at Jackson Middle School from February, in which a student who originally had planned to conduct a mass shooting instead took his own life.

“We needed to basically catch up with the times,” he said, adding that his course is certified by the National Association of Emergency Medical Technicians. “If it can happen in Jackson Township, it can happen anywhere,”

Josh Harris, a Grandview Heights paramedic, found the training scenarios realistic.

“The whole purpose of this training is so that we are comfortable working with these guys, because these guys are going to be saving our lives — the police officers. They’re going to be the ones guarding us. We have to have trust in them, so that’s why we’re doing this training,” he said.

Harris said he’s trained to decide whose life to try to save first.

“You have to take it one step at a time. ... If you let it all sink in, then you’ll get overwhelmed.”