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amount of pre-incident preparation with joint training and exercises, as well as pre-established policies and procedures. Law enforcement and EMS need to build a trusting and mutually respectful rela- tionship for this effort to be successful. Several agencies across the nation have successfully begun to employ such an approach, and this trend needs to continue and be widely implemented.1 Active-Shooter Scenario Let’s first examine the active-shooter scenario vs. a terrorist attack. Active- shooter incidents can be defined as “an armed person who has used deadly physical force on other persons and continues to do so while having unre- stricted access to additional victims.”2, 3 Incidents ter How EMS can train to better respond to these inevitable unfortunate incidents had a thorough sweep to look for other threats. This may take an hour or more because another shooter could be hiding or the perpetrator could have placed an explosive device somewhere in the building. The search must include every potential hiding place. People may be bleeding to death, but one never knows, and it is “better to be safe than sorry.” After two hours, the scene is deemed clear and you are allowed to enter. Option C: Once law enforcement is reasonably certain the shooter is accounted for and neutralized, a quick sweep of the area is completed. Your EMS team then enters the “warm zone” with a law enforcement escort and begins triage, treatment and extrication, while the law enforcement team surrounds and protects you from any two-legged threat. Option A is obviously dangerous, and Option B is far from ideal in that valuable time is lost and lives are further endan- gered. I am making a case for Option C. This course of action is not to be taken lightly and should include a significant During a full scale training event, law enforcement escorts EMS providers into a scene after the “shooter” has been neutralized. A recent informal research project identified several common in active- shooter incidents. First, the perpetra- tors are virtually always males and are usually Caucasian. It is very important to note that in the vast majority of active- shooter incidents, the shooter acted alone. Columbine High School was an exception, with both Eric Harris and Dylan Klebold involved in all aspects of the incident. Another point to consider is that, in a review of 25 separate active- shooter cases, most incidents were “over” within 10–15 minutes, meaning the perpetrator had committed suicide, was killed by police, was placed under arrest or fled the scene. This is significant in that many minutes or even hours may EMSWORLD.com | JULY 2011 43