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Everyday EMS
by Greg Friese

Rural EMS operations during a mass shooter incident

What can you do if you don’t expect sufficient law enforcement escort into the ‘warm zone’ to arrive in time?

By Greg Friese, EMS1 Editor-in-Chief

In response to one of my previous articles, “EMS operations during a mass shooter incident,” a reader brought up the point that police officers may not always be present to escort medics into the “warm zone,” as a new FEMA guideline recommends. He wrote:

“We have a significant problem. In rural areas there will not be four total law enforcement officers until one hour or more into the incident. What do we do in the rural areas?”

As you probably know, most mass shooter incidents are over in just a few minutes. A hostage situation [link] is more likely to last over an hour, but those incidents don’t usually generate mass casualties — the hostage taker is looking to use the hostages as leverage to meet a demand.

The number, type, and availability of emergency responders is a great discussion question for local planning. In my opinion, based on what I have read and heard presented on this topic, the first arriving police officers should be advancing on the shooter as rapidly as possible. In some situations it may even be a single officer moving towards the sound of gunfire. As additional law enforcement units arrive, decisions need to be made about how many of those units continue to converge on the shooter and how many of those units search the warm zone with EMS looking for patients.

Part of the pre-planning process involves communicating with potential targets in your community, such as schools, hospitals, and churches, and determining the responsibility of the people in those facilities.  Teachers, for instance, will need to choose between running, hiding, or fighting. (I highly recommend the brilliant training video Run, Hide, Fight.)

If people running from the hot zone can bring casualties with them, they should. If people hide (shelter-in-place), they should know basic first-aid for a mass shooter incident. Can you add bleeding control to your regular community education programs on CPR and AED use? Your dispatchers should also be able to train any 911 caller to apply well-aimed direct pressure.

EMS arriving before law enforcement, especially in rural locations, is not unusual. As you wait:

  • Prepare equipment, personnel, and PPE for entry
  • Establish casualty collection point(s) and treatment areas that have cover and concealment
  • Assess receiving facility’s capacity for penetrating trauma patients
  • Stage air and ground transport resources

The only unacceptable planning alternative for rural EMS is to do nothing because your area only has a few police officers.

What are your other suggestions for rural EMS preparation for a mass shooter incident? Leave them in the comment section below.

About the author

Greg Friese is Editor-in-Chief of He is an educator, author, paramedic, and marathon runner. Ask questions or submit tip ideas to Greg by e-mailing him at
The comments below are member-generated and do not necessarily reflect the opinions of or its staff. If you cannot see comments, try disabling privacy and ad blocking plugins in your browser. All comments must comply with our Member Commenting Policy.
Friday, January 17, 2014 4:51:46 PM We have been training new emts in active shooter for several years here at Shasta College in Northern California. All our students are required to take FEMA IC 106.13 Violence in the workplace and FEMA IC 907 active shooter. We run a mock shooting in the classroom,,including an officer down drill and shooter down drill... we make it as realsitic as possible. We have developed an in house PP presentation and a "unofficial" video... Our trainers for this evolution are highly experienced tactical police officers along with the teaching cadre of medics and emts Our county is still backwards and rural and 15 years behind the times so its still "stage and wait "right now.. still some ostrich mentality.. we are slowly peircing this issue, I am happy to share our information with other schools I can be reached at Thank you
Greg Friese Greg Friese Saturday, January 18, 2014 8:00:03 AM Thanks for sharing your experience and training plan.
Shol Ivano Shol Ivano Saturday, January 18, 2014 4:20:39 PM Enter scene and start saving kids. Waiting for one hour too go in would be pointless. IMO
Skip Kirkwood Skip Kirkwood Saturday, January 18, 2014 4:26:31 PM The "team of four" doctrine has (at least in my community) been replaced by "Who's first, goes" for the LEOs. They are building on the doctrine, supported by the data, that these murdering mass cowards kill themselves at the first confrontation. This could be anybody - not just the cops. For my money - once the shooter is down or gone, it is probably safe enough to go in - with a little bit of extra alertness. Just thinking.......
Kip Teitsort Kip Teitsort Saturday, January 18, 2014 4:54:05 PM Well put Chief!
Mark Ellis Mark Ellis Sunday, January 19, 2014 1:05:46 PM Rural communities do present a different approach than the larger ones. I've taken part in Active Shooter exercises in both rural areas (3 officers total) and larger cities that have access to unlimited resources. In my opinion the most important aspects are performing threat assessments before incidents happen, preplanning active shooter scenarios, mutual aid agreements, and communications (especially communications). Rural area police and fire/rescue agencies have limited resources and need to have real-time radio contact (same frequency). As first arriving officers search, F/R can monitor situational progress and assess victim counts before having to make deployment decisions. Police and fire have to learn to work together on tactical channels. If lives are savable, it would be nice to know what you're walking into. When using proper ballistic protection along with good intel, it is possible to enter a warm zone unescorted or with only one police officer providing force protection. Smaller agencies will have to perform just as much, but with a lot less. Keeping in mind, that rural communities also mean that the people involved in these incidents are also probably your neighbors. EMS Chief Hallandale, Florida

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