EMS Response to Mass Violence

How to keep EMS responders safe to help others during mass shootings and other incidents of mass violence

   Virginia Tech in 2007. Mumbai in 2008. Fort Hood in 2009. As mass-shooting incidents continue, it is important that responders are aware of their dangers and response considerations. Wherever you work, you and your agency will likely face the challenge of responding to a critical mass-shooting or mass-violence event.

   These can occur in urban, suburban and rural settings, and can include mass shooters/active shooters, bombings and even mass stabbings. Targets may include responders as well as civilians. Some responders may face this kind of violence on a smaller scale every day; for others it may be a less-frequent occurrence. But for all, it's something to be prepared for.

   In 2006 the Department of Homeland Security released an information assessment advising that domestic and international terrorist incidents may expose first responders to significant life-safety risks, and that first responders may be the actual targets of attacks or ambushes. Lack of a properly coordinated and planned response can lead to confusion, bad publicity and even death and injury to responders and the public.


   Upon arrival at any mass-violence incident, it is important to conduct a quick "windshield survey," even when a scene is believed to be secure. It is always important to gain as much prearrival information as possible and listen for key indicators such as victim locations, numbers and types. If possible, scan the area using binoculars, spotting scopes or vehicle-mounted cameras before approaching.

   For fire/EMS agencies, typical procedures require that law enforcement be dispatched to any type of incident with a potential for violence, but you may find yourself on such a scene due to a wrong address, victims coming to you or just a sudden discovery or eruption. Never hesitate to call for law enforcement assistance if you even think you may need it. Any type of mass-violence incident should raise a red flag for all responders to be maximally aware of what is occurring prior to and during their response.

   The Incident Command System (ICS) is one of the best tools for agencies to utilize when responding to these types of incidents. During the initial size-up, there are some actions the Incident Commander will need to take, including notifying dispatch of the command post location and assessing the situation as best as possible by quickly gathering information from witnesses and other responders. On-scene responders will also need to direct arriving units and designate at least one staging area, perhaps more. Immediately request partner-agency representatives to come to the command post to start building unified command. It would be counterproductive to have multiple incident command posts. Staging, command, triage and treatment areas may have to be up to a mile away from the scene, due to the distance a round fired from a weapon can travel.

   To maintain situational awareness, command staff should monitor radio traffic and other communications for other, similar situations or incidents. Consider the need for additional personnel and resources in case of secondary shooters or attacks. If an incident area is large, such as a college or mall, divide it into branches or divisions to make the scene more manageable. Your plans and guidelines should be flexible enough to address the changing situation and additional threats.


   When possible, EMS and fire units should remain in the staging area until the scene is secured by law enforcement. Responders may initially run into victims fleeing the incident. Work to gather information from these individuals, and direct them to safe areas using verbal commands or PA systems. Clear communications are necessary for effective operations.

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