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Active shooter incidents (which often devolve into mass casualty incidents) are becoming a concern across the United States, with recent statistics showing that “in 2017, there were 29 active shooter events in the United States” (1). Thus we, as EMS professionals, must be educated in our role and response to an active shooter and/or mass casualty incident situation. 

What classifies an active shooter (AS) or mass casualty incident (MCI) scenario?

The U.S. Department of Homeland Security defines an AS as “an individual actively engaged in killing or attempting to kill people in a confined and populated area; in most cases, active shooters use firearms(s) and there is no pattern or method to their selection of victims” (2). A situation in which an AS leads to multiple deaths is qualified as an MCI. 

Where are AS incidents most frequent?

Data shows that AS incidents typically occur in areas where there is a high density of people and low security or “controlled access”. These areas are referred to as “soft targets” (1). Businesses, schools, places of worship, and government facilities are examples of soft targets that are frequently sites of AS incidents. 

What is the role of EMS in an AS scenario?

In any mass casualty incident, it becomes critical that all agencies work together with high efficiency and communication in order to ensure the safety of personnel, victims, and any potential victim. These scenarios, in particular, require an intentional implementation and thorough execution of the Incident Command System (ICS) (3). Having a clear incident commander, division of responsibilities, and chain of command allows for the best possible chance of survival for all agency personnel as well as victims on the scene of any given AS/MCI. 

In most scenarios, EMS is directed to stage in the “cool” zone (or an area designated as completely safe) until all threats have been mitigated. However, in MCIs, this rule does not necessarily apply. Incidents like this typically require EMS personnel to be placed closer to the “warm” (an area with possible threats) or even possibly the “hot” (the area in which an incident is actively taking place) zones of an incident. In many AS scenarios the threat is eliminated relatively early, however, that is not always the case. Regardless of the status of the threat, both law enforcement and EMS/fire agencies must work quickly, efficiently, and with a great deal of situational awareness in order to preserve their own lives as well as the lives of as many victims as possible. 

All emergency medical responders must implement of means of “ranking” the victims according to the severity of their injuries. This is known as “triage” and there are standard procedures for how victims are identified and “tagged” for care. The basic system for triaging patients can be found here (4). Essentially, a triage system breaks individuals down from, dead, critical, injured, and walking wounded or unharmed. By removing as many patients as possible from the “hot” zone, and quickly identifying and transporting all critical patients to advanced care, EMS workers can provide the best possible care and support to all victims found on-scene (3). 

Active shooter scenarios are scary, and often place a huge demand on resources within a given area. However, if we are able to train and implement effective plans for communication, transportation, and command structure, we can hopefully raise the survivability of these incidents for all personnel and victims involved.

View Sources
  1. Active Shooters In 2018: Key Stats And Facts. Alert Find website. Available at: https://alertfind.com/active-shooter-facts/. Accessed October 17th, 2018. 
  2. Active Shooter Response: On-Site Incident Management. U.S. Department of Homeland Security FEMA website. Available at: http://www.activeshootertest.com/wp-content/uploads/2015/07/LLIS-Active-Shooter-Incident-Management.pdf. Accessed October 16th, 2018.
  3. Fire/Emergency Medical Services Department Operational Considerations and Guide for Active Shooter and Mass Casualty Incidents. U.S. Department of Homeland Security FEMA website. Available at: https://www.usfa.fema.gov/downloads/pdf/publications/active_shooter_guide.pdf. Accessed October 16th, 2018. 
  4. Clarkson L., Williams M. EMS, Triage, Mass Casualty. NCBI website. Available at: https://www.ncbi.nlm.nih.gov/books/NBK459369/. Accessed October 17th, 2018.