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EMS providers, agencies underprepared for violent MCIs

As mass violence incidents grow in scale and frequency, less than half of EMS feels adequately prepared to respond

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Recent acts of mass violence during active shooter events and other incidents in schools, churches and businesses continue to highlight the need for a multi-pronged strategy for both training and response.

This special EMS1/Lexipol guide outlines lessons identified from past incidents that can direct EMS involvement in pre-planning mass gatherings, improve multi-agency cooperation, and inform incident command and response strategies on the ground: Mass violence: How lessons identified inform training, response

The first 10 minutes of an MCI and how the response is launched considerably impact emergency operations and survival. Recent acts of mass violence, from active shooter incidents at schools, churches and businesses, to bombings, to bad actors using vehicles as a weapon, have highlighted the need for multipronged training and strategy for an MCI response to violence, including:

  • EMS role in warm and hot zones
  • Incident command
  • Coordination with other agencies and local partners
  • Pre-planning mass gatherings
  • Equipment needs, from ballistic protection to specialty vehicles
  • Triage techniques and casualty collection points
  • Interoperable communications
  • Transporting patients away from the scene

Yet, in a recent poll and data from the 2020 EMS Trend Report show that less than half of EMS providers feel adequately trained for this type of response.

Poll call: Do you feel properly trained to respond to incidents of mass violence?

We asked the EMS1 community about training for incidents of mass violence. Just 40% of respondents noted they feel properly trained to respond to incidents of mass violence. While 8% were unsure, 52% responded that they did not feel adequately prepared to respond to mass violence.

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The 2020 EMS Trend Report painted a similar picture. When asked “how prepared is your organization for an active shooter incident,” just 31% replied that they were well or extremely well (7%) prepared.

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Those numbers – agencies who felt they were extremely or well prepared for an active shooter incident – were highest in public third-service agencies (40%) and fire-based EMS (34%), and lowest in private, for-profit (23%) and public utility (27%) models.

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Mass violence training needs

We asked readers to expand on their mass violence response training by filling out a short form. The responses were split evenly, with 50% of respondents replying that they felt properly trained. Some expanded, with comments, such as, “I have been through TCCC and multiple live trainings for active shooter and MCI.”

The other half of respondents noted they need more when it comes to MCI training:

  • “I personally don’t feel ready for an MCI. I am fresh out of school and only did one day of simulations, which was about a year or so ago.”
  • “I am not sure if my limited MCI experience (multiple vehicle collisions) would transfer well to a violence caused MCI, especially if the threat had not been contained or neutralized. Because of that, I’d like more training, especially high-fidelity training.”
  • “As a security professional and EMT, I feel that I lack sufficient training for a mass casualty incident that can happen here.”

Others pointed to specific experiences that identified a training gap. One respondent noted he hadn’t given much thought to MCIs and no thought to mass shootings, and hadn’t had much training beyond incident command in general and communications, and so, a school shooting in his community came as a “rude awakening.”

Another respondent asked if he felt confident his training prepared him to respond to a mass violence incident put it this way, “Yes I do. But like anything in this field you should not be overconfident.”

As you consider your own training, and your department’s unique capabilities, staffing and equipment, what do you want to know about how to respond to mass violence?

Fill out this short form to submit a question, and your question might be answered by one of our dozens of EMS leaders in an upcoming article or newsletter.

Additional resources on MCI training

Learn more about EMS exercises, training tenets and more to prepare your department for an MCI/incident of mass violence with these resources:

Kerri Hatt is editor-in-chief, EMS1, responsible for defining original editorial content, tracking industry trends, managing expert contributors and leading execution of special coverage efforts. Prior to joining Lexipol, she served as an editor for medical allied health B2B publications and communities.

Kerri has a bachelor’s degree in English from Saint Joseph’s University, in Philadelphia. She is based out of Charleston, SC. Share your personal and agency successes, strategies and stories with Kerri at