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EMS Corner
EMS placed in 'at risk' situations

By William R. Kerney/College of Southern Nevada

Scene safety has never been in the forefront as much as in the active shooter incidents. Current in the malaise of societal issues is that of the armed citizen, often heavily armed, taking lives of innocent, defenseless individuals in commonplace situations. Active shooters in theaters, schools, shopping malls and other heavily trafficked areas seem to be a common, almost daily, occurrence. EMS providers placed in the situation of an active shooter must remember scene safety and the concept of not putting crew lives in jeopardy. In the EMS arena, not much has changed relative to the involvement of life saving crews except the addition of the tactical medic. 

Police involvement has drastically changed in approach and all initial efforts of law enforcement personnel are now directed to finding and neutralizing the active shooter threat versus standard command and control of isolation and negotiation. Standard police training is changing and augmenting with this new philosophy and responding officers must incorporate a new hierarchy of risk when confronted with these situations. Whereas the previous training was to contain the incident and wait for SWAT, hostage negotiators, etc. all in the interests of public and officer safety; current training places the police officer in the front line and officer safety, far down the list:

• Neutralize perpetrator

• Containment

• Public/hostage safety

• Officer safety

• Perpetrator safety

When investigating multiple active shooter incidents, most victim deaths occurred early in the incident. All deaths in the Columbine High School shooting took place in the first 7 minutes. Perpetrators seek out multiple defenseless targets. Shooters also do not appear to stop the killing until confronted by superior force.  They readily engage this opposing force or end the incident with a suicide. This is truly a law enforcement operation until the neutralization of the threat has taken place. Law enforcement personnel are directed toward neutralization, not negotiation. Stop the threat at all costs. EMS, as well as all other components of incident command, is placed in staging until law enforcement has completed the task. Once the primary goal has been achieved, the standard unified command can take over.

EMS personnel are routinely kept out of harm’s way but sworn uniform personnel may be placed at risk under certain circumstances. Tactical medics have been implemented by many law enforcement agencies but these are typically police officers who have received EMS training in addition to their training as police. They are often part of the initial assault teams not only to tend to wounded officers in the neutralization phase but tend to victims found along the way, facilitating removal to safe areas for those that cannot move themselves. Certain situations have arisen where uniform fire department paramedics have been ordered into the line of fire by medical direction (mostly due to medical direction being unwilling to accept liability for “doing nothing” for injured citizenry). In Chicago, the police and fire departments, in conjunction with medical direction, negotiated an agreement to keep fire department medics out of the danger zone by having the police accept all liability for those decisions. Address this to superiors and have this discussion with all the major players as part of the pre-planning phase, not during the incident itself.

So, how do we train for such a situation?  Broad awareness of all roles is essential for the coordinated response to be effective. Police have integrated these responses into their training regimes, but most others including community leaders, school officials, fire extinguishment and rescue, EMS providers, and ancillary players such as social services may need to have special training or briefings to further delineate each other’s roles within the unified command of the active shooter. This requires further training on all levels.

Training has evolved over the years.  Video and slides have been taken over by PowerPoint and web-training although some of the video produced out there may be effective when used in conjunction with other methods.  A video produced in 2009 by Emergency Film Group (EFG)® addresses some of the issues.  This video, “Active Shooter: Rapid Response”is approximately 30 minutes and offers the broad picture in the approach to these disturbing incidents.  It focuses on the police response. The rest of the video is about unified/incident command and the related players but not insight is offered into further defining the roles of those other than law enforcement. 

The great thing about this video is that it has an accompanying information CD that includes PowerPoint and instructor training materials, including exams and current reports, for the incidents.  This alone makes the $425.00 price tag somewhat palatable. Video is extremely expensive to produce, hence the high price tags.  Also, often times producers seek to maximize the “viewable audience” so they try to hit as many players as possible.  This video does do that and may leave the perception that they hit many includable areas but did not do any of them justice sans law enforcement. I do not recommend this video as stand-alone training for EMS/extinguishment agencies, although it may have value as an addition to a comprehensive total program. It  offers little as an EMS/Fire tool, except in the implementation and overall application of Unified/Incident Command. Contact Emergency Film Group at

For community leaders interested in understanding and revamping their own participation and response in these scenarios, the EFG video may offer at least some tools necessary for city managers, school principals, college and university faculty and staff, as well as some training for social services. Information is key here and this video and training material may fit well into an overall training package when ancillary players are preparing and training personnel.

There may be other training offerings out there.  The Department of Homeland Security and FEMA have a plethora of offerings within their Independent Study Programs in Distance Learning. From Hazardous Materials to Incident Command introductions for all types of services, the DHS and FEMA have a very diverse offering, all distance learning (Web-based or on-line) format. All are free (unless you want to apply for college credit) for the asking. Yes, there is even one for the active shooter that I found comprehensive (for all non-emergency workers) and great for all levels of ‘awareness’ training. All managers should at least consider the active shooter Web training and should also peruse the training listings as there may be other Web-based training opportunities that may be utilized at the FEMA site. Go to FEMA Independent Study ( for the comprehensive list and for the Active Shooter training: Active Shooter (


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