There is nothing like a brief stay in recently war-torn Portland, Oregon, to force you to rethink your security and tactical medical support plan in a high-risk environment.
If you consider yourself a competent tactical medic, besides TECC / TCCC you need to consider managing casualties from fire as a weapon, vehicle ramming, building collapse, and have a plan for vertical extraction of casualties.
– Sean Mckay, Element Rescue
Fire as a Weapon
The intentional use of setting fires to trap and generate casualties is a low-tech, easily executable technique. When used in a high-rise building, a fire on one floor could trap everyone on higher floors until the fire is controlled. What about the fire suppression systems required by fire code? The systems are not hard to control nor disable when access is directly behind a visible door in the lobby.
DHS has an overview on this topic – Fire as a Weapon
Busy public streets and sidewalks provide ample opportunity to generate casualties if a driver intentionally plows a vehicle into a crowd. Unlike penetrating trauma, most of these injures will be blunt. Severe head injuries account for most deaths.
See, the Crisis Medicine article on Pedestrian vs Automobiles
DHS has a brief overview of the topic – Vehicle Ramming Security Awareness
Buildings will be physically compromised by fire or nearby explosions in an attack. The fact it hasn’t completely collapsed yet is only partially reassuring. As the fire service says, “gravity is unforgiving, unpredictable, and always a factor to consider.” Within a collapsed structure, there is exposure to falling debris, unstable working surfaces, exposed electric, dust particles, fires, and the blood of dismembered casualties.
Even a multi-story home could present vertical extraction issues, let alone a large hotel. Sometimes it is easier to lower casualties down stairwells and out windows rather than transport them through partially cleared danger areas or past unexploded ordnance.