During the summer of 2012, the City of Aurora, CO, suffered an unimaginable horror. On July 20, at approximately 12:40 A.M., a gunman entered the rear emergency exit of Theater 9 of the Century 16 movie complex. When the shooting stopped, 12 moviegoers were dead and more than 70 were injured.
That night, an estimated 1,400 people were at the Century 16 complex to enjoy a summer night out with the main attraction being the premiere of the movie “The Dark Knight Rises.” Four hundred patrons were in sold-out Theater 9. Many Batman fans were in costume to enhance the experience.
The challenges that Aurora’s public safety system faced that night were unfathomable. Many emergency responders are still dealing with the emotional impact of what they witnessed. For the Aurora Fire Department, the emotional impact was seriously compounded when within days the media was issuing inaccurate information. The Aurora Fire Department’s ability to respond was hampered by a gag order issued by the courts due to the ongoing investigation and criminal case.
A team effort
The most important fact of this incident is that the city’s public safety team, including the Aurora Police Department, Aurora Fire Department, Aurora Public Safety Communications Department, Rural Metro Ambulance Co. and the emergency room staffs of several area hospitals worked together in a team effort to establish a perimeter, capture and secure the alleged gunman and triage, treat and transport nearly 70 patients, the majority having suffered gunshot wounds, in less than one hour.
That night, the heroics began the instant the first shot was fired. Movie patrons protected loved ones and strangers alike with their own bodies. Police officers rushed into the scene to engage what was thought to be an active shooter. Unarmed firefighters entered danger areas without body armor, treating patients under the threat of suspected improvised explosive devices (IEDs). Ambulance crews worked in the open, not knowing if they would soon be the target of a sniper. And emergency room staffs worked tirelessly through the night inundated with gunshot victims.
To provide this level of response and accomplish such daunting incident objectives in less than an hour would be an extreme challenge for any community. Were there challenges that could have been addressed more efficiently? Of course. Are there many lessons to learn? Certainly. It is the intent of this article to clear up misconceptions and inaccuracies about the Aurora Fire Department’s response to the Century 16 mass-casualty incident and to share lessons learned with the fire service community.
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Aurora, the third-largest city in Colorado, spreads across three counties on the state’s eastern plains, encompassing 154 square miles. The Aurora Fire Department is an all-hazards agency serving the community with 15 fire stations housing 14 engine companies and four ladder trucks. EMS is a fire-based system and a contract for emergency patient transport has been developed with the Rural Metro, which dedicates 10 ambulances to Aurora for patient transport.
The city is divided into three battalions supervised by three battalion chiefs (at the time of this incident, Battalion 2 was supervised by a shift commander with the radio call sign of Chief 7). Aurora fire companies are staffed with a minimum of four personnel: a company officer, an engineer (driver/operator) and two firefighters, at least one of whom is an emergency medical technician-paramedic (EMTP). Experiencing growth both to the north and south, the city has a population approaching 350,000. Aurora’s 310 firefighters are split into three shifts. During a normal shift, 75 firefighters are on duty. Annually, the department responds to nearly 40,000 emergency calls.
Being a large metropolis, Aurora suffers its share of gun violence and fire personnel are no strangers to responding to gunshot victims. Several years ago, because of the growing threat of violence toward emergency responders, a “scene safe policy” was adopted. This policy mandated that emergency medical responders stage away from the immediate area of potential violence and wait for Aurora police officers to declare the scene safe for medical personnel to enter and begin patient care.
A year before the Century 16 incident, because of police and fire concerns about policy rigidity, the policy terminology was modified from “scene safe” to “stand by for entry.” A request for entry by police officers means that a reasonable degree of security has been established for medical care providers. The change in the policy also allows for more discretion on the part of fire department company officers on when and where to enter the emergency scene. Before the Century 16 incident, the Aurora police and fire departments had conducted several active-shooter training events.
All emergency communications for the city are handled by the Aurora Public Safety Communications Department. The communications center in the Tallyn’s Reach Municipal Complex is routinely staffed with three call takers, six police dispatchers, two fire dispatchers, one supervisor and one lead dispatcher. The night of the theater incident, the communications center was at normal staffing.
On the night of July 20, B shift was on duty. At 40 minutes past midnight, the first call for help came into the dispatch center. A rapid succession of gunshots could be heard in the background. The caller indicated that someone had opened fire in the theater with a weapon and that there was a possible gunshot victim. As is standard practice for an Aurora Fire Department response to the report of a gunshot patient, one engine company, a battalion chief and one ambulance were dispatched.
Engine 8, Battalion 1 and a Rural Metro ambulance responded. Assigned to Engine 8 were a lieutenant, an engineer and two paramedics. The lieutenant and engineer maintain their paramedic certifications as well. The ambulance was staffed with an EMP and an EMT-Basic (EMTB). Battalion 1 was a senior captain and certified paramedic acting in the position of battalion chief. Emergency medical responders per policy are expected to stand by for a request for entry from on-scene police officers.
In what can only be described as a stroke of good fortune for emergency responders in this tragedy, the gunman perpetrated his crime at the same time as the Aurora Police Department’s shift change. This significantly increased the number of police officers available to respond. With the theater complex located less than a half-mile from Aurora police headquarters, officers arrived on scene in less than two minutes.
First-arriving police officers found a chaotic scene. Hundreds of people were fleeing the complex. The fire alarm at the building was blaring. Frantic witnesses reported the possibility of multiple shooters. With lessons learned from several active-shooter incidents throughout the nation, these first-arriving police officers, disregarding their own safety, rushed in to engage the gunman or gunmen. Their primary objective was to neutralize the threat and protect innocent lives. Police officers requested an “all call” and law enforcement resources from throughout the Denver metro area responded. Other police officers established a security perimeter. Their objective was to not let the violence and danger spread.
Through dispatch, an Aurora police supervisor initially directed incoming emergency medical responders to stand by at a nearby intersection. Discovering several wounded victims, he then asked for emergency medical response to the front of the theater. Because Aurora police radios were not programmed with the Aurora Fire Department radio channels, all police radio transmissions had to be relayed from police dispatchers to fire dispatchers and then to on-scene fire personnel. The capability to patch the police and fire radios together was not used. The communications center quickly became overwhelmed with telephone calls for help and urgent radio traffic from emergency responders.
While enroute to the scene, Engine 8 learned through radio transmissions that another gunshot victim had been found. The Engine 8 lieutenant requested the response of Tower 8 and additional ambulances. These units were dispatched.
It is the Aurora Fire Department’s stated goal to have the first-due apparatus on scene within eight minutes of the initial 911 call. This includes call-processing time, apparatus turnout time and travel time. Engine 8 arrived on scene in five minutes and found the same pandemonium that confronted police officers. Receiving requests for emergency medical service in the front of the theater, the Engine 8 lieutenant directed his driver to pull directly into the complex. Trying to proceed to the front of the theater, Engine 8 was swamped by frightened and injured people fleeing the area. As they came to a stop, an Aurora police officer ran up to the rig, saying he needed oxygen. The police officer indicated that a noxious gas had been released in Theater 9. The crew realized he needed a self-contained breathing apparatus (SCBA) and helped him into it. The officer rushed back into the building to confront the threat.
The Engine 8 lieutenant received additional police requests for rescue at both the front and rear of the complex. He assumed command and assigned his two paramedics to the rear of the building to assist police and begin triage. The engineer focused spotlights on the area where Engine 8 had set up command and triaged patients around Engine 8 with one of the crew members. A second Engine 8 paramedic went toward the back of the building and was confronted with 10 patients suffering from gunshot wounds ranging from amputations, chest thoracic injuries, abdominal evisceration and profusely bleeding neck injuries. As the initial fire incident commander, the Engine 8 lieutenant established two divisions and requested additional advanced life support (ALS) resources.
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Acting Battalion Chief 1 arrived on scene. While driving to the incident, he thought this call would be like other shootings he had responded to in the past as acting battalion chief. He anticipated the engine crew would already have the patient packaged and in the ambulance on his arrival. Pulling into the parking area for the complex, he too was inundated with fleeing theater patrons, many covered in blood and pleading for help. The acting battalion chief, a veteran company officer and experienced paramedic, had to subdue his caregiving instincts, knowing that his pressing priority was to initiate the Incident Command System (ICS) and bring organization to the scene. As hard as this decision was, he knew that scene organization would let responders more efficiently meet the overwhelming demands that faced them and provide more efficient care to the injured.
As police officers swept the interior of the theater and established perimeters, more and more injured people were found. Fortunately, one of the police officers involved in clearing the theater was also a certified paramedic. He was able to triage patients in the extremely hostile environment. Sadly, he found 10 patients with non-survivable injuries.
Police officers extricated the most seriously injured out of Theater 9. This eliminated the need for emergency medical providers to enter the theater. Police officers in the area of Dillard’s department store at the nearby Aurora Town Center found that many injured people had self-evacuated or had been assisted from the theater by fellow moviegoers. They too radioed for emergency medical response.
Patients were being reported throughout an approximately four-block area. Concerns and suspicions of more gunmen and possible IEDs were aired. The acting battalion chief was bombarded with all this information on his arrival. The magnitude of this incident was immediately evident and he also requested additional ALS resources. Aurora Engines 2, 4, 5 and 7 as well as Truck 2 were dispatched. A Denver Fire Department assistant chief, who had started his fire service career in Aurora, was monitoring his scanner and heard the tense radio traffic in Aurora. He had Denver Pumper 19, Truck 19, and Denver Assistant Chief 4 dispatched to assist at the Century 16 incident.
Arriving at approximately the same time as Battalion 1, Aurora Fire Tower 8 heard police requests for rescue in the Dillard’s parking lot and under the direction of a paramedic lieutenant went directly into the scene. To enter the area, Tower 8 had to move police cruisers left on the perimeter by officers who had rushed into the theater to confront the possible threats and then maneuver through the exiting crowd to reach patients in the parking lot. Tower 8 was stopped by an Aurora police officer on perimeter duty who needed help with a female suffering gunshot wounds in her abdomen and extremities. This patient was placed in an ambulance and the Tower 8 crew went on to triage and treat more patients. At least seven patients were triaged and carried to waiting ambulances by the Tower 8 crew.
Aurora Truck 2 arrived on scene and was impeded by what the company officer described as a mass exodus of vehicles trying to leave the area. The unit was forced to cut through the parking lot and drive over multiple medians. Truck 2 began working with Aurora police officers in the rear of the theater to gain control of the scene and triage many seriously injured patients.
Worried about patient transport by ambulance because of a limited number of ambulances immediately available, a paving operation in progress on the main street serving the Town Center complex on the east side of the theater, tight perimeter control blocking entrances and heavy traffic volume of people trying to drive out of the area, first responders made the life-saving decision to use police cars for patient transport. This decision was made jointly and independently by police officers and firefighters in several locations. Three hospitals are within four miles of the theater. The Children's Hospital is a Level 1 trauma center. The Medical Center of Aurora South and the University of Colorado Hospital are Level 2 trauma centers. The unconventional tactic of using police cars as alternative transportation for the injured got patients with massive penetrating trauma to trauma surgeons in an expedient manner and truly saved lives.
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The acting battalion chief knew he had units actively engaged in areas that could be considered immediately dangerous to life and health (IDLH). With reports of possible multiple active shooters, the suspicion that IEDs could be present and even rumors of a sniper, the acting battalion chief wondered how he could live with himself as the incident commander if an emergency responder was killed in action. The fleeting thought of pulling everyone back until the scene was secure crossed his mind, but he knew this was not an option.
Patients were being reported on all sides of the complex. The acting battalion chief was briefed by the Engine 8 lieutenant. Battalion Chief 1 assumed command and organized the scene by dividing the incident into three divisions. He named his divisions the Dillard’s Division, the Century Division and the East Division. The Century Division’s geographical area encompassed the Alpha side of the building including the front area and north side of the theater. The East Division had the rear of the complex and the Dillard’s Division had the area by the department store where many theater patrons had fled and gathered.
The incident objectives he gave to all divisions were to develop and implement extrication, triage, treatment and transport teams for each division. Knowing that his resources were limited, the incident commander ordered that only patients needing immediate medical attention be transported by ambulances. Several of the initial ambulances had already received patients and were enroute to area hospitals. The incident commander requested that fire dispatch initiate the Emergency Medical (EM) system in an attempt to prevent any one hospital from being overwhelmed by patients. Battalion 1 designated a staging area so that immediately deployable resources arriving on scene could be disbursed to requesting divisions in an organized and efficient manner. Throughout the incident, as fast as units arrived, they were deployed.
Coming from the west, Engine 4 was immediately assigned to the Dillard’s Division. The company officer was to take the role of division supervisor. His acting engineer, a certified paramedic, suddenly found himself in the back of a Rural Metro ambulance with a Rural Metro medic in a desperate attempt to save the life of a 6-year-old girl who had suffered what proved to be mortal injuries. The two Engine 4 medics went right to work providing medical attention to two adult patients who had multiple gunshot wounds necessitating immediate transport. With his entire crew involved in patient care, the Engine 4 officer continued coordinating the work in his division with the help of Truck 8, Rural Metro crews and police officers.
Aurora Engine 2 arrived on scene and was quickly deployed in the Century Division assisting Engine 8. The Engine 2 crew was assigned to patient care. Using all the tactical tourniquets they carried and direct pressure to stop bleeding, the crew treated many severely injured patients and prepared them for transport to area hospitals. Engine 2 reported patients with multiple gunshot wounds. One patient had suffered a near amputation of a lower limb. Aurora Engines 2 and 8 would later be assisted in the Century Division by Denver Pumper 19.
As Aurora Fire Engine 5 arrived in the staging area, the crew was approached by an Aurora police officer who requested that they proceed to the rear of the theater to assist with wounded victims. For years, the fire service has preached against freelancing on the emergency scene and firefighters are routinely instructed about the dangers of freelancing and operating outside of the accountability system established by the incident commander. To prevent his engine company from being drawn into a freelancing situation, the captain called the fire incident commander to clarify and confirm their assignment. Engine 5 was deployed to the East Division and the captain was directed to assume the role of division supervisor. The Engine 5 crew quickly joined Truck 2 crew members in triaging and treating patients. Two Truck 2 medics would later enter Theater 9 to reassess the 10 non-viable patients initially triaged by the Aurora police officer and call for field pronouncements for the deceased.
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With the threat of multiple shooters and reports that the shooters may have been in costume, patients were checked for weapons before transport. While searching for the gunman, police officers noticed an individual dressed in body armor. Their first impression was that he was a SWAT officer, but they quickly realized that his gear did not match gear issued by the Aurora Police Department. The suspect was taken into custody without resistance. This information, however, did not reach emergency medical providers until much later in the incident.
The threat of IEDs further increased when the suspect revealed that his apartment had been rigged with explosives. Police officers were fearful that his car may also have been an explosion hazard. Emergency medical responders and police officers continued to work and provide care under this hazardous condition.
Aurora Engine 7 was out of service on another medical call when units were dispatched to the theater. After clearing the medical call, Engine 7 was dispatched to the theater. Engine 7 was the last Aurora unit to arrive on scene. The acting lieutenant was assigned to staging as the staging officer. Working with a Rural Metro supervisor, the company officer and his crew worked to develop a transportation plan. The acting lieutenant reported that the majority of critical patients had already been transported to hospitals. Remaining ambulances assisted with rehabilitation for emergency responders, sheltered displaced theater patrons and provided care to less seriously injured patients.
Because of the overwhelming number of calls and the intense radio traffic, a second on-duty chief officer had not been dispatched to the scene. After being paged, the Aurora Fire Department deputy chief of operations recognized the oversight and the shift commander was alerted and responded along with the deputy chief. Arriving on scene, Chief 7 was briefed by the incident commander and assumed the role of liaison between police and fire. Unified command was established. With the arrival of the chief of operations, the training chief and the emergency medical bureau director, a full incident management team was established.
In total, 20 patients were transported to six hospitals by ambulance. Nineteen patients were transported to hospitals by police vehicles. Other patients went to hospitals by private vehicle or were treated and released on scene. The Medical Center of Aurora, The Children’s Hospital, University of Colorado Hospital, Parker Adventist Hospital, Denver Health Hospital and Swedish Medical Center all received patients. In little over a half-hour, all critically injured patients triaged as category red for immediate transport were in trauma centers.
Many of the Century 16 responders soon found themselves at another complex and stressful scene as Aurora Fire Department personnel were dispatched to assist local, state and federal emergency responders at the suspect’s apartment. There, bomb technicians had discovered potentially destructive and lethal IEDs. Unified command was established at this site with Aurora fire and police, FBI, Bureau of Alcohol, Tobacco, Firearms, and Explosives (ATF), Adams County Bomb Squad, Arapahoe County Bomb Squad and Aurora city leaders. Neighborhoods had to be evacuated and this incident took several days to mitigate.
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There is not a police officer who does not wish that they could have confronted the shooter earlier. There is not an emergency medical care provider who does not wish they could have reached one more patient quicker. There is not an Aurora Police Department or Aurora Fire Department supervisor who does not wish that the implementation of unified command would have gone smoother, but on the night of July 20, 2012, all responders pulled together, worked with the resources available and efficiently dealt with one of the worst mass shootings in American history. These emergency responders remain dedicated to the residents of Aurora.
This article is dedicated to the 12 innocent victims who lost their lives in what was supposed to be a fun night out at the movie.
LESSONS LEARNED:
Century 16 Mass-Casualty Incident
In October 2013, the Aurora, CO, Fire Department was allowed by the district attorney to conduct an internal post-incident analysis of the Century 16 mass-casualty incident. All fire department responders to the shooting had the opportunity to share their experiences and lessons they took away from it. More than a year later, emotions were still raw.
Following are the lessons drawn from this incident analysis:
• The Incident Management System (IMS) must be initiated immediately at an incident of this magnitude. This reduces duplication of effort and allows for greater accountability of on-scene units and personnel. The IMS is critical for an organized and professional response to a mass-casualty incident.
• All responders involved in a mass-casualty incident must be well versed in the National Incident Management System (NIMS). Early recognition of the scope and magnitude of an incident of this nature will aid responders in scene size-up and identifying resource needs.
• Communication between responding agencies is critical to an organized and efficient response.
• Coordinated response between police, fire and emergency medical agencies balancing the incident priorities of patient care, scene security, crime-scene preservation and scene control is essential. Unified command must be established as soon as possible.
• All-hazards pre-planning, preparation and training are invaluable to an organization’s response to such an emergency incident.
• Ingress and egress avenues must be considered and established to facilitate organized treatment and transport of patients.
• Where patient volume is overwhelming, access compromised and travel time to and from trauma center emergency rooms short, the use of police cars and other vehicles as alternative transportation to a hospital for patients may be a viable tactic in patient care and rapid transport.
• Consider the emotional and physical needs of emergency responders both for short-term and long-term recovery.
• Establishing an area command or city emergency response coordinator will help ensure that community emergency needs are considered outside of the affected area.
• The Office of Emergency Management is a valuable asset and should be activated early to assist unified command and city coordinators with resource allocation.
• At a major incident necessitating a unified command and generating extensive media interest, a joint information center staffed with public information officers from involved agencies should be established to ensure that accurate, consistent, coordinated and timely information is being delivered to the community.
• If the actions of an emergency response agency are being unfairly or inaccurately portrayed in the media, management must respond quickly to support responders consistent with any ongoing criminal prosecutions and involvement of the agency’s legal team should occur. Inaccurate criticism can be very detrimental to emotional recovery of emergency responders after a significant emotional event.
• An emergency response agency involved in this type of event must be prepared to accept accurate and constructive criticism to let the organization make corrections and improve response.
(It must be noted that the City of Aurora contracted with a private investigation company to conduct an independent study of the city’s public safety organizations’ response to the Century 16 Theater tragedy. At this writing, the independent study has not been completed or released. The lessons drawn from the Aurora Fire Department post-incident analysis was developed independently and without input from the city-contracted independent study.)
Actions that have been taken by the Aurora Fire Department post-Century 16 are:
• A Peer Support Team has been created and trained. The fire department was granted a $13,000 budget increase specifically for the team’s operation. This team will augment the city’s Employee Assistance Program (EAP).
• Police department radio channels have been programmed into fire department radios and vice-versa.
• A high-risk extraction protocol for active-shooter incidents has been developed between fire and police and is being fully implemented.
• The Aurora Fire Department has been given the approval by city management to hire and train tactical emergency medical support paramedics to work directly with the Aurora Police Department.
• Mass-casualty trauma kits, including tactical tourniquets, trauma shears and trauma dressings and bandages, have been placed on all online fire apparatus.
• Several active-shooter/multi-casualty drills have been conducted involving Aurora police, aurora Fire, Rural Metro and neighboring fire protection districts.
• The Aurora Fire Department has made a commitment to ongoing training and efforts to improve service to the community.
—John Scott
