As the recent events in Parisso tragically demonstrate, we continue to face ongoing threats in an uncertainworld. Active shooter events, the use of improvised explosive devices (IEDs),and the threat of complex attacks like those seen in Beslan, Russia; Mumbai,India; and now, Paris, France must be considered as at least plausible, if not probable.

A pre-planned, integrated responseby all first responder disciplines is required in order to maximizeeffectiveness and improve the survivability of those injured in such attacks.Some of the considered actions may seem contrary to those respondersindoctrinated in the time-honoreddoctrine of “scene safety trumps all”. The truth is that the firstresponder community now has decades of response and trauma data to be used asthe foundation for evidence-based best practices.

Many communities have alreadyestablished integrated response programs, and there is no reason for any jurisdiction to “reinvent the wheel” fromscratch. While there is no “one-sizefits all” solution to the challenge of integrated response, there arealready model communities of different sizes and compositions. From rural tourban, volunteer to paid, and everything in between – somewhere, in a system a lot like yours, someone has alreadydone much of the ground work. And the benefits of integrated response extendwell beyond those realized during the rare terror attack. Relationships betweenpolice, fire, and EMS agencies that are formed (and enhanced) duringpre-planning and training will pay great dividends during all requests forservice from routine calls to natural disasters.

Below are just some of the manyresources that already exist to help guide those communities who have decidedto pursue a more prepared community through integrated response.

Integrated response (culture change):

First Responder Guide for Improving Survivability in Improvised Explosive Device and/or Active ShooterIncidents

Fire/Emergency Medical Services Department OperationalConsiderations and Guide for Active Shooter and Mass Casualty Incidents

Improving Active Shooter/Hostile Event Response: BestPractices and Recommendations for Integrating Law Enforcement, Fire, and EMS   (Includesa list of technical experts who may provide best practices)

A Study of Active Shooter Incidents in the United StatesBetween 2000 and 2013

Active Shooter Study: Quick Reference Guide

Hemorrhage Control (Early care saves lives)

See Something, Do Something: Improving Survival – Strategies to Enhance Survival in Active Shooter and Intentional Mass Casualty Events: A Compendium