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EMS operations during an active-shooter incident

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


Medics and police officers practice the rescue task force method for finding and treating patients in the warm zone during an active-shooter incident.

Updated April 13, 2015

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. All EMTs and paramedics need to be ready to respond to an active-shooter incident

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 or active-shooter 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. EMS personnel in the warm zone need a law enforcement escort

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. Physical readiness is an important response component

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 an active-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.

Greg Friese, MS, NRP, is the Lexipol Editorial Director, leading the efforts of the editorial team on Police1, FireRescue1, Corrections1 and EMS1. Greg served as the EMS1 editor-in-chief for five years. He has a bachelor’s degree from the University of Wisconsin-Madison and a master’s degree from the University of Idaho. He is an educator, author, national registry paramedic since 2005, and a long-distance runner. Greg was a 2010 recipient of the EMS 10 Award for innovation. He is also a three-time Jesse H. Neal award winner, the most prestigious award in specialized journalism, and the 2018 and 2020 Eddie Award winner for best Column/Blog. Connect with Greg on LinkedIn.