High Threat Considerations/Active Shooter Scenario/Care under Fire 

Definitions  

  • Hot Zone/Direct Threat Zone: an area within the inner perimeter where active threat and active hazards exists.  
  • Warm Zone/Indirect Threat Zone: an area within the inner perimeter where security and safety measures are in place. This zone may have potential hazards, but no active danger exists.  
  • Cold Zone: Normal EMS Operations 

Patient Care Goals 

  • Assess the scene  
  • Mitigating further harm  
  • Accomplish goal with minimal additional injuries  

Assessment, Treatment, and Interventions  

  • Hot Zone/Direct Threat care considerations:  
  • Look for cover
  • Defer in depth medical interventions if engaged in ongoing direct threat (e.g., active shooter, unstable building collapse, improvised explosive device, hazardous material threat) 
  • Threat mitigation techniques will minimize risk to patients and providers  
  • Triage should be deferred to a later phase of care  
  • Prioritization for extraction is based on resources available and the situation  
  • Minimal interventions are warranted  
  • Encourage patients to provide self-first aid or instruct aid from uninjured bystanders  
  • Consider hemorrhage control:  
  • Tourniquet application is the primary “medical” intervention to be considered in Hot Zone/Direct Threat  
  • Consider instructing patient to apply direct pressure to the wound if no tourniquet available (or application is not feasible)  
  • Consider quickly placing or directing patient to be placed in position to protect airway, if not immediately moving patient  
  • Warm Zone/Indirect Threat care considerations:  
    • Maintain situational awareness  
    • Ensure safety of both responders and patients by rendering equipment and environment safe (firearms, vehicle ignition)  
    • Conduct primary survey, per the Trauma Management guideline, and initiate appropriate life-saving interventions: 
      • Hemorrhage Control: 
        • Tourniquet  
        • Wound packing if feasible  
      • Needle Decompression
    • Do not delay patient extraction and evacuation for non-life-saving interventions  
    • Consider establishing a casualty collection point if multiple patients are encountered  
    • Unless in a fixed casualty collection point, triage in this phase of care should be limited to the following categories:  
      • Uninjured and/or capable of self-extraction  
      • Deceased/expectant  
      • All others