EMS Tips

Tucson Mass Shooting – some thoughts on MCI Response

Like many EMS professionals I have read media accounts from the Tucson mass shooting for lessons we might learn for application to future mass shooting incidents. Tragically, a mass shooting could happen in any community and we all need to consider a mass shooting in our all-hazards pre-planning and cooperative planning with other emergency responders.

Some of the articles that I have read
1. From Blood Scene to ER, Life-saving Choices in Tucson – New York Times
2. The Emergency Response in Tucson: Timeline shows ambulance delays –
3. Paramedics Describe Hellish Scene Following Tragic Arizona Rampage – Associated Press

Some of my thoughts ...

  1. Hospital and Field triage protocols don’t account for the extra importance, understandably so, given to children and VIPs.
  2. Healthcare providers, at all levels of certification and training, are challenged to appropriately distribute resources during a mass casualty.
  3. Bystanders can and should play an important role in life saving care. Public education efforts on controlling severe extremity bleeding could be valuable.
  4. The time between no resources on-scene and an overwhelming number of resources, especially in an urban area, is very short making it especially important to identify the most critical patients rapidly so treatment can be applied and transport can be initiated.
  5. Some patients may self-evacuate or be transported by a bystander before EMS arrives.
  6. Response time is measured from time of the 911 call to actual patient contact. Time to a staging area has little meaning to the public and media.
  7. The actual incident time for EMS response is very short, usually measured in minutes, especially when patients are concentrated in one area.
  8. A  mass shooting incident could have patients at several locations depending on the intent and mobility of the shooter. This could create multiple incident areas, staging areas, and crime scenes.
  9. Safety is not an absolute, it is only relative. It is impossible to wait for the scene to be safe. A public location for a scheduled event could have easily had multiple shooters and secondary devices. Placement of the staging area, rapid extrication of patients from the incident area, and minimizing the number of responders milling around the target area might be important command decisions.
  10. Post-incident analysis by the media and the public will start in the seconds after the actual incident. Patients, bystanders, and emergency responders have instantaneous ability to upload photos, videos, and audio files to social media and networking sites. With this will come rapid media requests to emergency response agencies and hospitals to verify details, comment on what has been posted, and critique the incident. The public information officer has the same access to Twitter, YouTube, and Facebook that the media has. Immediate monitoring of social networking traffic will be critical for the PIO to confirm, deny, and redirect media and public requests.
  11. The return to normalcy will become shorter with each new incident. One week later the Safeway grocery store re-opened. In future incidents this will shorten to days and then to hours.
  12. Every EMS service should pre-plan and practice for a mass shooting. Mental illness and easy access to guns is not unique to Tucson, Virginia Tech, or Nickel Mines.

Finally, my heart aches for the families and friends of the dead, the injured, and the bystanders that witnessed this horrific incident. I also want to offer my praise and best wishes to the EMS, Fire, Law Enforcement, and Hospital professionals. They all had to make incredibly difficult decisions under intense circumstances. I admire and appreciate their efforts.

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By Greg Friese

Greg Friese, Stevens Point, Wisconsin, is an author, educator, paramedic, and marathon runner.

Greg was the co-host of the award winning EMSEduCast podcast, the only podcast by and for EMS educators. Greg has written for,, Wilderness Medical Associates, JEMS Magazine, and EMS World Magazine, and the NAEMSE Educator Newsletter.