Second, first responders should develop and adopt
evidence-based standardized training that addresses
the basic civilianized tenets of Tactical Combat Casualty Care. Training should be conducted in conjunction
with fire, emergency medical services (EMS), and medical community personnel to improve interoperability
during IED or active shooter incidents or both.
Use of protective equipment
First responders should develop interdomain (EMS,
fire, and law enforcement) tactics, techniques, and
procedures—including the use of ballistic vests, better
situational awareness, and application of concealment
and cover concepts—and train all first responders in
Next, as technology improves, first responders
should adopt proven protective measures that have
been demonstrated to reliably shield personnel from
IED fragments and shock waves (for example, body
Finally, first responders, when dealing with either
IED or active shooter incidents, must remain vigilant
and aware of the potential risk posed by secondary
IEDs or additional shooters.
Greater response and incident management
First, local and state law enforcement and emergency
services should institutionalize National Incident Management System–based command and control language
through plans and exercises, as well as during ongoing
education and training.
Second, local and state EMS, law enforcement,
fire, and emergency management personnel, as well
as receiving medical facilities, should have interoper-able radio and communications equipment.
Third, local, state, and federal partners should consider an expansion of Public Safety Answering/Access
Point intake procedures to include information gathering vital to the initial response.
Fourth, training to improve first responder triaging
precision is essential for dealing with IED and active
Fifth, there should be greater coordination among
EMS, fire services, and law enforcement to work
more effectively during IED or active shooter incidents or both. The dialogue should focus on potential
improvements or changes to the tactics, techniques,
and procedures that have historically been used during
law enforcement situations that involve a medical emergency (for example, EMS personnel wait until law
enforcement personnel have secured the scene before
they enter to render emergency care).
These recommendations are now available in the
new DHS publication The First Responder Guide for
Improving Survivability in Improvised Explosive Device
and/or Active Shooter Incidents and can be down-loaded at www.dhs.gov/sites/default/files/publications/
This document includes several scenarios to guide
local community first responder education and training
efforts toward the incorporation and institutionalization of these guidelines in a variety of likely IED and/
or active shooter situations.
To prepare for and reduce death and suffering following an IED detonation or active shooter event in a
civilian environment, it is imperative that the lessons
learned from these incidents, as well as the continuing combat medicine experience of the Department
of Defense, be more widely disseminated and adopted
within the U.S. civilian first responder and first receiver
Recent IED and active shooter incidents have shown us that some
traditional practices of first responders need to be realigned and
enhanced to improve the survivability of victims and the safety of
the first responders caring for them.