Best Practices for Active Shooter Response

The term “active shooter” has worked its way into the emergency services lexicon and brings with it images of barricaded schools, large-scale response and media coverage of high-impact events. Active shooter/hostile events (ASHEs) have been increasing in frequency and severity since 2000.

Unlike many other types of incidents, an ASHE will almost always result in the deployment of all types of first responder. Recognizing the need for EMS, fire and law enforcement to come together for these events in a coordinated manner, the InterAgency Board (IAB) held a summit with participants from these stakeholder groups, from both within the US and abroad. This summit drew on experience from these stakeholder groups with the express purpose of developing a unifying, broad-based document with recommendations from lessons-learned and potential “best practices” for this type of event.

The document, titled Improving Active Shooter Hostile Event Response: Best Practices for Integration of Law Enforcement, Fire and EMS, was released in September 2015 and stakeholders worked in five focus areas, specifically policy, planning, incident command, training and exercises and medical, rescue and equipment.

There were various practices identified in the document and specific recommendations across the emergency service spectrum. These included:

Ensure leadership prioritizes and supports the development and implementation of proactive ASHE-relevant joint policies, procedures, training, exercises and equipment.

One of the more interesting points made in this area is the need to overcome the cultural misperception that “an ASHE incident is only a law enforcement problem and not an all-hazards, all responders problem.”

Integrate and improve coordinated pre-event law enforcement, fire and EMS policy development, planning, training and exercises.

This is probably one of the most important lessons learned from previous events and speaks to the need for a pre-practiced approach as one of the foundations of a successful response to these incidents.

Create and implement a common operating language.

The need for all responders—law enforcement, fire and EMS—to understand each other and communicate critical, time-sensitive messages in a common language cannot be overstated. This section also included the need to use plain language to enhance communication and response, the need to ensure common language and terms are agreed upon and practiced pre-event and allowing for flexibility with terms that need to conform to local uses and definitions.

Integrate and improve coordinated command and incident management across all responder disciplines.

The document stressed that integrated, coordinated incident command is built from the ground up by cross-disciplinary development and execution of policy and procedures, training and exercises. An interesting point was that command decisions should not wait for the arrival of more senior leaders but rather be made by trained, initial responders while waiting for senior leaders to arrive at the scene.

Adopt the Rescue Task Force (RTF) concept.

The recommendation is to utilize a multi-disciplinary team that includes law enforcement protection as a method of quickly getting fire/EMS personnel to victims in an ASHE with an understanding that the RTF concept is actually used depends on the resources and practices of individual jurisdictions. The point is also stressed that all responders should be trained in the concept, and RTF training should be considered a part of a responder’s basic skill set.

Employ Tactical Emergency Casualty Care (TECC).

TECC is a civilian adaptation for civilian first responders of the highly effective Tactical Combat Casualty Care (TCCC) concept developed by the military. This approach advocates that in areas of high threat, casualty triage should be limited only to categorizing the wounded as ambulatory, wounded or deceased. There was also mention of the need to engage in proactive public outreach as well as informing and educating a variety of specialty groups/stakeholders. 

Implement Casualty Collection Points (CCP).

The recommendation is to keep the triage process as simple as possible. This includes limiting triage in high-risk areas according to TECC guidelines. Also, triage should never delay evacuation. Patients may need to wait on scene for ambulances to arrive, but ambulances should NEVER stage or delay transport when patients are available. Also, this document made clear that patients should be evacuated out of the warm zone as swiftly as possible.

Develop and communicate evidence-based guidelines for fire/EMS ballistic protective equipment (BPE).

The recommendation included the fact that any criteria development for the use and need of ballistic equipment must solicit input from all stakeholders (law enforcement and fire/EMS) as well as the point that medical equipment should be prioritized over ballistic equipment.

Establish evidence-based guidelines and education for medical and rescue equipment.

The emphasis here is that lifesaving interventions and rapid extraction are the ONLY required medical interventions in high-threat areas. Also, it is incumbent on decision-makers to limit equipment to that defined by TECC, to issue individual first aid kits to law enforcement officers and to balance training and operational goals against acquisition of equipment.

Promote two-way public communication as an essential component for effective ASHE.

The public is clearly identified in this document as a real first responder and a valuable resource. It was also stressed that it is essential to promptly and effectively communicate critical incident information and clear instructions on the proper public response.

The document that the IAB has taken the lead in developing and promulgating is full of best practices for EMS agencies to utilize as they develop their own individual policies and processes related to these high-impact incidents. For more information, the full document is available here.

Raphael M. Barishansky, MPH, MS, CPM, is a solutions-driven consultant working with EMS agencies, emergency management and public health organizations on complex issues including leadership development, strategic planning, policy implementation and regulatory compliance.

He has previously served as the Director of the Office of Emergency Medical Services (OEMS) at the Connecticut Department of Public Health (2012-2015), as well as the Chief of Public Health Emergency Preparedness at the Prince Georges County, Maryland Health Department (2008-2012).

A frequent contributor to and editorial advisory board member for EMS World, he can be reached at rbarishansky@gmail.com.