EMS Response to Active-Shooter Incidents

How EMS can train to respond to these inevitable unfortunate incidents


You are doing an EMS medical standby for an ongoing “active-shooter” incident. All you and your crew know is that a disgruntled man went into the office where he was previously employed and started shooting people. It’s rumored that he was shot and killed by police in a “suicide-by-cop” manner. There is uncertainty among the first responders, and law enforcement officers are not sharing much information. Fleeing employees report that at least several people inside the office are critically injured and are in immediate need of medical care.

Responding to Shooting Incidents

Active-shooter incidents are not uncommon in the United States. This type of incident frequently makes headlines and is likely to happen in your jurisdiction at some point. Let’s look at three possible courses of action regarding this hypothetical event.

Option A: Grab your medical gear, get into the building ASAP, and start triage, treatment and extrication. You don’t believe you need a police escort, as it is highly likely the shooter was alone and the only threat. Law enforcement has a job to do and you have yours. There need not be a whole lot of interaction with the cops; your EMS medical team should focus on saving lives.

Options B: You and other EMS personnel are not going to get close to this crisis site until you are given an “all clear” by law enforcement and assured the office and rest of the building have had a thorough sweep to look for other threats. This may take an hour or more because another shooter could be hiding or the perpetrator could have placed an explosive device somewhere in the building. The search must include every potential hiding place. People may be bleeding to death, but one never knows, and it is “better to be safe than sorry.” After two hours, the scene is deemed clear and you are allowed to enter.

Option C: Once law enforcement is reasonably certain the shooter is accounted for and neutralized, a quick sweep of the area is completed. Your EMS team then enters the “warm zone” with a law enforcement escort and begins triage, treatment and extrication, while the law enforcement team surrounds and protects you from any two-legged threat.

Option A is obviously dangerous, and Option B is far from ideal in that valuable time is lost and lives are further endangered. I am making a case for Option C. This course of action is not to be taken lightly and should include a significant amount of pre-incident preparation with joint training and exercises, as well as pre-established policies and procedures. Law enforcement and EMS need to build a trusting and mutually respectful relationship for this effort to be successful. Several agencies across the nation have successfully begun to employ such an approach, and this trend needs to continue and be widely implemented.1

Active-Shooter Scenario

Let’s first examine the active-shooter scenario vs. a terrorist attack. Active-shooter incidents can be defined as “an armed person who has used deadly physical force on other persons and continues to do so while having unrestricted access to additional victims.”2, 3

A recent informal research project identified several common in active-shooter incidents. First, the perpetrators are virtually always males and are usually Caucasian. It is very important to note that in the vast majority of active-shooter incidents, the shooter acted alone. Columbine High School was an exception, with both Eric Harris and Dylan Klebold involved in all aspects of the incident. Another point to consider is that, in a review of 25 separate active-shooter cases, most incidents were “over” within 10–15 minutes, meaning the perpetrator had committed suicide, was killed by police, was placed under arrest or fled the scene. This is significant in that many minutes or even hours may be lost by a slow methodical search of the office, school or workplace. Another finding was that explosive devices were rarely used. Columbine was an exception in this regard.

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