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Will fire, EMS access to warm zones improve victim survival?

A panel of law enforcement, EMS and medical experts discussed the implications of administering patient care in the warm zone at IACP 2016

By Heather R. Cotter, PoliceOne Senior Editor

We're increasingly seeing more law enforcement agencies training in partnership with EMS and fire departments to triage victims in the warm zone during an active shooter incident. At the 123rd annual International Association of Chiefs of Police Conference (IACP 2016), a panel of law enforcement, EMS and medical experts discussed the implications of administering patient care in the warm zone.  

Quick summary
Since Columbine, agencies across the U.S. are training regularly to improve their response to an active shooter or mass casualty incident. New active shooter training models include rescue task forces made up of fire/EMS/rescue. The concept is simple. The RTF will accompany law enforcement into the warm zone to triage victims to help save lives. The practice, on the other hand, takes regular training and buy-in from all parties in order for the RTF to be successful when called to a scene. During this session, the panel of experts discussed survivability during an active shooter event. 

IACP 2016 Active Shooter Warm Zone Session. (PoliceOne Photo)
IACP 2016 Active Shooter Warm Zone Session. (PoliceOne Photo)

3 key takeaways 
Here are three top takeaways on fire and EMS access to warm zones to improve victim survival.

1. Stop the bleed
Penetrating trauma, gunshot or stabbing wounds, are generally the types of wounds seen as a result of an active shooter incident. Given this, the panel agreed that hemorrhage control is key to treating victims before they are extracted and transported to a hospital.

While the panel and audience debated whether law enforcement should be providing treatment in the warm zone (in addition to their role in stopping the threat), there was a general consensus that law enforcement officers must be trained in hemorrhage control and have tourniquets on them at all times.

To further emphasize this recommendation, the panel used a recent real-life scenario of the shooting of two Boston police officers. They pointed to the care one officer gave the other as helping to save the man's life. 

2. Train citizens in your community on bleeding control
Since 9/11, everyone is more vigilant. Some citizens naturally respond to help during times of crisis, as seen during the Boston Marathon bombing. Boston citizens improvised with the material they had to apply tourniquets after the marathon bombing. However, not everyone is psychologically prepared to provide aid under extreme conditions. The panel touched on some of the qualities that transform a bystander into an immediate responder. First, it's important to train and educate citizens on how to provide first aid and use tourniquets. The panel recommended law enforcement agencies begin working with their communities on how to properly use tourniquets. Second, they recommended educating the public that their assistance in treating someone who is wounded will not make the situation worse. Third, the panel advised to educate the community on the Good Samaritan Law.  

3. Not all gauze is created equal
Hemostatic dressings are not regulated. The panel shed light on the fact that they are generally tested by the manufacturers who produce them, not the FDA or other government oversight agency. Fabbri contended that it's the process of using the gauze that is more important than the manufacturer of it, but Eastman swears by using combat gauze in the operating room every single time. Both physicians agreed that all law enforcement officers should be trained on how to pack wounds. 


  • Alexander Eastman, MD FACS, MPH
  • William Fabbri, MD, FACES 
  • Chief Sam Somers, Jr.  Sacramento Police Department 
  • FBI Supervisory Special Agent Katherine Schweit, moderator

Memorable quotes

  • Lieutenant Eric Cembrook with Metropolitan Washington Airport Authority, "Civilian, RTF and law enforcement training are not mutually exclusive. We must continue to train everyone to provide effective care during an active shooter event."
  • Dr. Alexander Eastman, "You must rapidly triage and evacuate and have an extraction plan to the nearest hospital for definitive treatment."

Other observations
In order to improve survivability, the panel largely agreed that all law enforcement officers should be trained in hemorrhage control and have tourniquets on them at all times. Having tourniquets is one thing, and knowing how to use them under stress is another. It was recommended that officers should perform tourniquet drills often to build it in their muscle memory and also to practice applying tourniquets on themselves. Train regularly and often so it comes naturally. 

There was also a general concurrence between the panel and audience that civilian training in bleeding control is important and needed. Citizens need training because they will be the ones at the scene — the likely victims. 

The big question raised during this session at IACP 2016, is should law enforcement back away from the RTF model and learn how to triage and take responsibility for triaging victims in an active shooter warm zone? Post your comments below.

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