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Rapid response: MCIs are not contained to any one environment

EMS providers must be prepared to protect their communities at a moment’s notice


Students are evacuated by police from Marjory Stoneman Douglas High School in Parkland, Fla.

Mike Stocker/South Florida Sun-Sentinel via AP

I spent part of Wednesday afternoon watching yet another school shooting unfold on live television – this time in Broward . As these horrible, senseless events have become routine, it is clear that they are not confined to any one location or environment. EMS providers must be trained, equipped and mentally prepared to respond quickly to active shooter situations.

Key take away points include:

1. Train for the worst.

Tabletop and walk through MCI exercises may be mundane, but they absolutely contribute to force readiness. Operational plans are great, but are of no use if they are forgotten or overlooked during an actual event. Several video clips show triage and treatment sites set up several blocks from the active site, indicating that an operational plan was implemented quickly.

2. EMS providers will operate in the warm zone.

While it wasn’t clear from the video that non-law enforcement personnel were within the hot zone, it’s very possible that at least some were managing patients before reaching the treatment area. While some of us may be reticent about operating within an active shooter scene, there will likely be times when that will inevitably happen. Prior interagency inservice and drills can pave the way for smooth ground operations during actual events.

3. Plan to stop the bleed.

With large numbers of victims suffering from penetrating trauma, an ambulance can quickly run out of basic medical supplies to control bleeding, such as tourniquets. Response planners should consider how much equipment could be realistically carried by first-in units, with some type of mobile cache that could be deployed within a few minutes of the initial report.

4. Plan crisis and mental health intervention after MCIs.

The stress of responding to such a dramatic event is likely to affect at least some of the first responders. Immediate defusing teams should be immediately available to rescue personnel, with plans in place to bring in appropriate crisis teams and professional mental health providers.

School and other mass shootings continue to increase in frequency and severity. Until there is a fundamental shift in how Americans view firearms, this trend is very likely to continue. EMS providers must be ready to protect their communities at a moment’s notice.

Additional EMS resources for MCI/active shooter events

Art Hsieh, MA, NRP teaches in Northern California at the Public Safety Training Center, Santa Rosa Junior College in the Emergency Care Program. An EMS provider since 1982, Art has served as a line medic, supervisor and chief officer in the private, third service and fire-based EMS. He has directed both primary and EMS continuing education programs. Art is a textbook writer, author of “EMT Exam for Dummies,” has presented at conferences nationwide and continues to provide direct patient care regularly. Art is a member of the EMS1 Editorial Advisory Board. Contact Art at and connect with him on Facebook or Twitter.