When violence erupts, time becomes the enemy. At IACP 2025, Dr. Dominique Wong urged police leaders to confront a vital question: Who is the first to provide life-saving care? Her research reveals that police, not EMS, are often the ones performing lifesaving care long before the scene is secure — and that the next evolution in response must start with them.
Why can’t EMS enter immediately during active-shooter incidents?
Because the scene isn’t secure. Traditional EMS responders aren’t trained or equipped to operate in high-threat or active-threat environments. That means in the most time-sensitive moments — the first minutes after an attack — victims are often left without medical aid.
Dr. Dominique Wong, emergency physician and chair-elect of the American College of Emergency Physicians Tactical and Law Enforcement Medicine Section, told attendees that this operational gap costs lives.
“Conventional EMS personnel are neither trained nor equipped to operate in high-threat environments where the scene has not been secured,” she said. “We need alternative systems to deliver rapid, lifesaving care before EMS can enter.”
Her premise is simple but urgent: if police are first on scene, they must be prepared to act as first medics.
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So who’s providing that first lifesaving care now?
Dr. Wong’s team reviewed 150 after-action reports of mass-casualty incidents across the country and found that in nearly every case, officers were the first to render aid.
“We know the police can do the most critical medical care that needs to be done,” she said, “and that’s the care for the first several minutes before fire and EMS arrive.”
Her data show that police initiated medical care within 10 minutes in almost half the incidents studied — often applying tourniquets, moving victims to safety, or transporting them directly to hospitals. In comparison, other response models, such as Rescue Task Forces, were far slower to reach victims.
Wong summarized the time pressure with what she calls the 10-and-60 rule: 10 minutes for critical medical care, 60 minutes to reach the operating room. Those first 10 minutes, she stressed, belong to police. “Our mission isn’t just to stop the shooter,” she said. “It’s to stop the shooter so that we have fewer deaths.”
What does the data reveal about how victims die — and what can actually prevent those deaths?
Most preventable deaths don’t come from limb bleeding, as commonly assumed, but from treatable chest wounds. Wong’s review showed that while tourniquets are vital and easy to teach, they’re not the intervention most likely to save lives in high-threat events.
“Everyone loves tourniquets — they’re cool and easy to teach — but it’s the vented chest seal that’s saving lives, and hardly anyone carries them,” she told the audience. She noted that civilian mass-casualty shootings differ from battlefield trauma: explosives are rare, so extremity amputations and fatal limb bleeding are less common. What’s more frequent — and often deadly — are penetrating chest wounds that lead to tension pneumothorax or preventable respiratory failure.
Her takeaway: Every officer should carry vented chest seals alongside tourniquets, and every department should train on how and when to use them.
| WATCH: How to apply a chest seal
Does that mean Rescue Task Forces aren’t working?
Not necessarily — but Wong believes agencies need to re-examine whether RTFs are achieving their intended goal. “Rescue Task Forces are designed to go into the scene,” she said, “but almost half of the time they never did. They were ready, they had the gear, and they never got in.”
Her analysis showed that RTFs often stalled outside because commanders couldn’t declare the scene safe quickly enough. The result: Victims remained untreated during the critical 10-minute window. The challenge, Wong said, isn’t bad planning — it’s operational reality.
“If we’ve built this system to close the gap, we need to ask if it’s really working.” She encouraged agencies to collect standardized medical data from after-action reports and use it to drive reform rather than relying on assumptions.
What kind of medical training should officers have?
Dr. Wong’s philosophy is rooted in simplicity and safety: teach what works under stress, and nothing that can cause harm if done incorrectly.
“When I train police, I never teach anything that can cause significant harm if they do it wrong,” she said. “They don’t need to know how to do a cricothyrotomy — they need simple things they can do right every time.”
She recommends departments train officers to perform just three interventions under pressure: apply tourniquets, seal chest wounds and move casualties quickly. “When you go to your bag in a high-stress, high-threat situation,” she said, “you should have only a few tools you know how to use perfectly.”
What should command staff take away from this?
Leadership, Wong said, must accept that perfect information doesn’t exist in the first minutes of an unfolding incident.
“You can’t get complete or accurate information in the first 10 minutes,” she said. “But we still have to do something in those first 10 minutes. Police are already doing that — they move, they act, they make decisions. That’s what saves lives.”
She urged leaders to embrace that reality by providing clear priorities, concise training and data-driven evaluation. “We’ve talked about closing this gap for more than 20 years,” she said. “Now it’s time to prove what actually saves lives.”
What are some next steps to strengthen police medical response?
Dr. Wong’s findings point to several practical steps agencies can take to close the lifesaving gap:
- Equip every officer for immediate care: Every patrol officer should carry an IFAK stocked with tourniquets and vented chest seals to provide critical medical aid before EMS arrives.
- Make casualty movement a core skill: Train officers to move the wounded rapidly and safely; extrication must be treated as a fundamental competency, not an afterthought.
- Coordinate across disciplines: Standardize warm-zone operations so police, fire and EMS can communicate and work together under pressure.
- Use data to drive improvement: Collect and share medical response information from after-action reports to shape more effective future training.
- Re-evaluate the rescue task force model: Ensure any RTF deployment actually delivers lifesaving care within the crucial 10-minute window.
Does your department work with local law enforcement to help prepare officers to deliver effective medical care before EMS can safely enter the scene? Share below.
About the speaker
Dominique Wong is an experienced emergency physician with a focus on medicine applied to homeland security and law enforcement concerns.
She is the Medial Readiness Committee chair at Cabell Huntington Hospital in West Virginia. Her out of hospital experiences include EMS medical direction and operational overisght of EMS for large-scale, national and international mass gatherings.
Dr. Wong is a former tactical physician and continues to serve as a tactical medicine educator, regularly instructing law enforcement officers in first aid and mass casualty response. As the current Chair-Elect of the American College of Emergency Physicians, Tactical and Law Enforcement Medicine Section, she has worked to broaden the section’s impact, advocating for a more includsive and evidence-based approach that reflects the realities faced by law enforcement officers.
Dr. Wong completed the Executive Leaders Program at the Naval Postgraduate School’s Center for Homeland Defense and Security where she now functions as a program co-facilitator and guest lecturer. She holds a B.A. from Cornell University, and earned her MD at The Ohio State University, College of Medicine.
