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Home > Topics > Mass Casualty Incidents
January 13, 2014
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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

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 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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