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EMS in the warm zone: Tactical medicine inter-agency training

Considerations for planning interdisciplinary training and staging include properly equipping EMS providers and developing a common lexicon


There is still much work to be done to increase our readiness for active violence and active shooter attacks.

Image courtesy Josh Kennedy

It is reassuring to see the gradual acceptance of a national standard being developed to encourage EMS personnel to train and integrate with law enforcement to enter secured, but still chaotic scenes to offer life-saving interventions to casualties.

We are slowly seeing a trend away from role-defined emergency responder training with disciplines working in silos with an occasional exercise that brings the various disciplines together.

However, there is still much work to be done to increase our readiness for active violence and active shooter attacks.

An overhaul of siloed approaches to active shooters

Fire suppression, threat elimination and rendering casualty care should not be looked at as separate and sequential events; nor should they be managed by separate disciplines in traditional “lanes” of responsibilities. The new paradigm and reality necessitate a more comprehensive overhaul of our current strategies.

The integration of law enforcement, EMS and fire during active shooter incidents has been established in some enlightened and forward thinking jurisdictions around the country. Others are working their way through the administrative, labor, equipment, training and policy steps to develop rescue task force models. Unfortunately, some areas have yet to address this challenging paradigm shift for one reason or another.

While there are challenges to implementing a multi-discipline, coordinated, seamless response strategy, from linear, perceived responsibilities, as well as historical and political hurdles, it’s an important goal. All public safety responders must plan to respond to the real threat of an active shooter attack together. Continuing to respond to these incidents in a traditional role-defined manner can result in greater loss of life.

Common language, ballistic protection needed

In a newly released positon paper, the International Association of Fire Chiefs notes interdisciplinary training is imperative to successful operations. In the position paper, the IAFC recommends three steps to effective interdisciplinary training:

  • Conducting initial and ongoing training between fire, EMS and law enforcement agencies.
  • Developing a common lexicon (e.g., cleared, secured, cover, concealment, hot zone, warm zone, cold zone).
  • Equipping firefighters and EMS personnel with the appropriate level of ballistic protection if they are to participate in warm zone operations as part of a rescue task force or in hot zone operations as a tactical medic, as specified in NFPA 3000: Standard for Preparedness and Response to Active Shooter and/or Hostile Events, and NFPA 1500: Standard on Fire Department Occupational Safety, Health, and Wellness Program.

The August 2015 Interagency Board (IAB) produced a well-crafted Executive Strategy that not only outlines active shooter background and issues, but also offers recommendations for policy makers to begin a more comprehensive integrated training and response plan.

The IAB recommends this process needs to include federal, state and local government officials, law enforcement, fire, medical (hospitals), EMS; as well as dispatch center, labor, legal and fiscal representatives.

Best practices to effectively prepare for active violence and active shooter incidents will require all public safety disciplines to be part of the same team, with the same priorities, strategies, training, lexicon and protection to most effectively eliminate the threat and provide needed medical care to the casualties. This, of course must be done while offering the utmost priority to public safety protection from the threat itself.

Jim Morrissey is the tactical medical program director for the Alameda County EMS Agency and a former FBI SWAT tactical paramedic. He has a Master’s Degree in Homeland Security from the Naval Postgraduate School. He is an internationally recognized expert in the field of the multi-discipline response to active shooter incidents. He can be reached at