When Chaos hits, literally - Toronto Van Attack

• Beau Doboszenski, Owner/Lead Instructor

• Originally published April 30th, 2018

Chaos can hit at any moment.

Last week, a rented van plowed through pedestrians along a street on the north side of Toronto, Canada. For a mile he drove over anyone that happened to be in his way on the sidewalk, including someone pushing a stroller. (images below from HT DailyMail, CTV, Getty, and Reuters)

Once the rampaging drive ended, it was the citizens nearby who became the first responders to save 15 injured and try to help the 10 who were tragically killed.

In this mass casualty event you have several elements playing out:

1. The attack is ongoing until the vehicle or driver is stopped

2. Once the vehicle is stopped, that doesn't mean that the driver has stopped the attack; he could easily emerge from the vehicle to continue the violence with firearms or edged weapons

3. With a mile of victims, where do you even begin to help?

While the attack is ongoing, maintaining your own safety is essential. If you are hurt, you are only adding to the list of people that EMS will have to treat. Vehicle attacks are on the rise, with over a 140 people killed in mass vehicle attacks in western countries in the last 3 years.

In a previous newsletter, I outlined a series of steps to avoid becoming a victim of a vehicle attack. As a reminder:

1. Use your Outside Scanning Process to be aware of the movement of vehicles in
   your area

2. Avoid being in a position where you are trapped by other people

3. Stay away from areas that a car could quickly access

4. Identify places where you could move a vehicle begins coming aggressively in your direction

In the case of this attack, when the vehicle was stopped, the threat emerged from it holding a foreign object pointed toward approaching Law Enforcement. His goal was "suicide by cop" yelling at them to "Kill me!" Law Enforcement did not kill this particular threat because they realized the tool he had was not lethal and that they could control the situation now that the threat was out of the vehicle. But that isn't always the way these attacks end up.

In the UK last year, a vehicle attack continued after the vehicle was stopped, with the threat emerging from the cab with an edged weapon. This means that you, the defender, must be prepared that even when the vehicle has stopped the threat may not have subsided.

Seek to end the threat BEFORE beginning any medical treatment for either you or another victim. You could end the threat to your person by escaping, securing yourself in a hard point with sufficient cover and access control, or ensuring that the threat is neutralized.

In the case of the recent attack in Toronto, after the threat has been stopped, there remained a mile of victims needing to be rapidly addressed. With a vehicle attack, the most serious damage to a victim would most likely consist of crush injuries, including broken bones, and potential spinal and brain injuries from blunt force trauma.

Dealing with crush injuries is tricky, since you may not know to what extent the victim has been damaged. Being crushed can result in broken bones, internal organ/tissue damage, or even over-pressure damage that has destroyed the brain.

Having a tourniquet could enable you to staunch the bleeding of a closed or open broken bone. Internal bleeding can sometimes be seen through the swelling or darkening color of tissue around the break. The swelled areas will also be very very painful.

To help with potential spinal injuries caused by victims falling violently to the ground, knowing how to properly hold C-Spine would also be critical. Holding C-Spine is a technique whereby the rescuer holds the neck and upper shoulders of the victim in place to prevent any further injury.

All of these techniques are predicated on the rescuer being able to identify which victims can't be helped, which can, and which of those he could help should get his first attention. That's a skill called triage and it's crucial to learn.

Most responders use a color code system to identify and categorize the victims:

• Yellow - injured, but not life threatening and should be reassessed by medical professionals in hospital

• Red - life threatening injuries, must be treated as able immediately, must be the first evacuated to hospital when EMS arrives

• Black - injured beyond your help and possibly beyond the help of any medical treatment, may even already be dead/dying

Victims that are "in the black" are the hardest for first responders to deal with on an emotional level. Keep in mind that these are people you cannot help, and you must move on to someone that you can help. Remember that what happened to those victims is not your fault, and your inability to help them is also not your fault. 

For some unfortunate victims of this Toronto van attack, or other types of terrorism or mass slaughter, even having a full team of surgeons on standby would not be enough. But for others, immediate triage and treatment could mean saving a life.