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Home > Topics > Mass Casualty Incidents
December 13, 2013
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Everyday EMS
by Greg Friese

EMS operations during a mass shooter incident

Government guidelines recommend having police escort medics into the ‘warm zone’ — are you ready?

By Greg Friese

In September 2013 FEMA released a series of guidelines (Fire/EMS Department Operational Considerations and Guide for Active Shooter and Mass Casualty Incidents) recommending that EMS personnel be escorted by law enforcement into the warm zone to begin lifesaving treatment even when a shooter is still at large, explosive devices might be undetonated, and uncertainty still exists.

For EMS professionals, the key quote from the FEMA document is:

“Considerations, planning and interagency training should occur around the concept of properly trained, armored medical personnel who are escorted into areas of mitigated risk, which are clear but not secure areas, to execute triage, medical stabilization at the point of wounding, and provide for evacuation or sheltering-in-place.”

As you absorb what this document means and consider how it will be operationalized in your community, keep in mind the following:

1. Tactical medics are attached to a law enforcement unit that is pursuing and neutralizing the active shooter. Tactical paramedics are working in the hot zone. During a mass shooting incident, where the top life threat is uncontrolled hemorrhage, EMTs and paramedics (who are not tactical medics), escorted by law enforcement, should triage, treat (with hemorrhage control and airway management), and extricate patients.

2. Body armor for medical personnel is just one component of team and personal safety. Make sure that a medic wearing a ballistic vest is accompanied by at least three armed and attentive police escorts. A critical part of your personal safety will be following the verbal and visual instructions of the law enforcement escort.

3. An “escort” into the warm zone may be at a dead run, a belly crawl, or a lung-busting ascent of a multi-story high rise. In early January 2013 I wrote about physical readiness for a mass shooter incident. I continue to be concerned that too many of us are not fit enough to rapidly reach the wounded or crouch in a small area for 30 minutes assessing and treating several patients. Are you ready? Your community expects you to respond in the warm zone.

Finally, the planning for and response to a mass shooter incident is much more complex than having medics don a ballistic vest and run around. Make sure your community has a plan that is regularly reviewed and updated and frequently practiced by all response agencies. Pre-incident communication and collaboration will be critical to the success of your community’s response to a mass shooter.

About the author

Greg Friese is the Director of Education for CentreLearn Solutions, LLC. He is also an e-learning designer, writer, podcaster, presenter, paramedic, and marathon runner. Read more from him at the blog. Ask questions or submit tip ideas to Greg by e-mailing him at
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Sean Anderson Sean Anderson Friday, December 20, 2013 4:43:06 AM they need to do alot more research into active shooter incidences. these guidelines are not realistic. initial active shooter from the first shot to him or her taking there own life or police taking them down or some reason they surrender is about 2 minutes. only department i know with a response time to met that need is the city of Vernon in California and they are an average of 5 min (city is only a couple square miles less then 100 people) and to get even in a warm zone as you call it three officers to escort one medic is not realistic lucky to get two and depending on the policies of the department they might not be able to go in even if they want to. look at the lax shooting. i think there needs to be more of a focus of training for law enforcement and security officers. i train both and teach medical courses. i think its great that we do have the tccc courses and phtls law enforcement course that was recently released i think it would do more good for them to be trained in initial triage and so forth. time is key. getting a emt from a fire crew or private ambulance whatever properly fitted in the vest/ finding the right vest and then going over tactics and how to properly enter the place many die before they see that emt. to even train an emt in a yearly course good luck they are typically not former military combat medics and you want to send them into hell like that it takes extensive training in tactics and equipment which to be honest department government and private wont want to dish out. even the international school of tactical medicine there courses are meant to now be three weeks long straight and according to some of there instructors it should be even longer. Plus main thing is each local protocol and liability insurance of that emt will play the biggest factor in them going in a hot zone or warm zone even. (note im a EMS educator, AHA instructor and private security instructor)
Greg Friese Greg Friese Saturday, December 21, 2013 5:36:27 PM Sean, thanks for joining the conversation and sharing your ideas and experiences. Stay safe.
Fundacion Ciier Emergencias Rescate Fundacion Ciier Emergencias Rescate Sunday, March 30, 2014 2:24:26 PM es mejor que los cuerpos policiales tengan su propios medicos tacticos, asi como aseguran la escena asi brinden soporte vital en campo tactico.

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