Prehospital and Disaster Medicine

Original Research

Emergency Medical Services Response to Active Shooter Incidents: Provider Comfort Level and Attitudes Before and After Participation in a Focused Response Training Program

Jerrilyn Jonesa1a2, Ricky Kuea1a2 c1, Patricia Mitchella1, Sgt. Gary Eblana3 and K. Sophia Dyera1a2

a1 Department of Emergency Medicine, Boston University School of Medicine, Boston, Massachusetts USA

a2 City of Boston Emergency Medical Services, Boston, Massachusetts USA

a3 City of Boston Police Department Training Academy, Boston, Massachusetts USA


Introduction Emergency Medical Services (EMS) routinely stage in a secure area in response to active shooter incidents until the scene is declared safe by law enforcement. Due to the time-sensitive nature of injuries at these incidents, some EMS systems have adopted response tactics utilizing law enforcement protection to expedite life-saving medical care.

Objective Describe EMS provider perceptions of preparedness, adequacy of training, and general attitudes toward active shooter incident response after completing a tactical awareness training program.

Methods An unmatched, anonymous, closed-format survey utilizing a five-point Likert scale was distributed to participating EMS providers before and after a focused training session on joint EMS/police active shooter rescue team response. Descriptive statistics were used to compare survey results. Secondary analysis of responses based on prior military or tactical medicine training was performed using a chi-squared analysis.

Results Two hundred fifty-six providers participated with 88% (225/256) pretraining and 88% (224/256) post-training surveys completed. Post-training, provider agreement that they felt adequately prepared to respond to an active shooter incident changed from 41% (92/225) to 89% (199/224), while agreement they felt adequately trained to provide medical care during an active shooter incident changed from 36% (82/225) to 87% (194/224). Post-training provider agreement that they should never enter a building with an active shooter changed from 73% (165/225) to 61% (137/224). Among the pretraining surveys, significantly more providers without prior military or tactical experience agreed they should never enter a building with an active shooter until the scene was declared safe (78% vs 50%, P = .002), while significantly more providers with prior experience felt both adequately trained to provide medical care in an active shooter environment (56% vs 31%, P = .007) and comfortable working jointly with law enforcement within a building if a shooter were still inside (76% vs 56%, P = .014). There was no difference in response to these questions in the post-training survey.

Conclusions Attitudes and perceptions regarding EMS active shooter incident response appear to change among providers after participation in a focused active shooter response training program. Further studies are needed to determine if these changes are significant and whether early EMS response during an active shooter incident improves patient outcomes.

J Jones, R Kue, P Mitchell, G Eblan, KS Dyer. Emergency Medical Services response to active shooter incidents: provider comfort level and attitudes before and after participation in a focused response training program. Prehosp Disaster Med. 2014;29(4):1-7 .

(Received December 24 2013)

(Revised April 10 2014)

(Accepted April 18 2014)

(Online publication July 09 2014)


  • active shooter;
  • Emergency Medical Services;
  • response;
  • shooting


  • ALS:Advanced Life Support;
  • BLS:Basic Life Support;
  • EMS:Emergency Medical Services;
  • HAZMAT:hazardous materials;
  • MCI:mass-casualty incident;
  • PPE:personal protective equipment;
  • SWAT:special weapons and tactics;
  • TCCC:Tactical Combat Casualty Care;
  • TEMS:tactical emergency medical support;
  • WMD:weapon of mass destruction


c1 Correspondence: Ricky C. Kue, MD, MPH, FACEP Boston EMS Research, Training, and Quality Improvement Division 785 Albany Street Boston, Massachusetts 02118 USA E-mail