I got started in EMS in the later 80’s. I can’t remember if it was my original class or one of the recertification classes. Either way, it was soon drilled into our heads that before we began any treatment, we were to make sure the “scene was safe” and that we had our “BSI” or body substance isolation gear donned or ready to donned to protect ourselves. Really, we weren’t good to anyone if we didn’t make it to the patient safely. This included no running and no unnecessary risk. If it was a crash or industrial accident, the fire department always ensured we were in relatively safe environments. Most of the time they would rather have us providing care as early on as possible. This made complete sense to me. Then I heard that in other areas of the country fire departments would bring you the patient and EMS providers just waited in the warm zone. To me, that didn’t make a whole lot of sense, but then again, I was also a firefighter and a mechanic and had a really good idea of what could go wrong and what problems we could incur.
One winter afternoon I was clearing a call from Parkridge Hospital and was by far the closest paramedic to a motor vehicle accident with the operator entrapped. The Spencerport FD was there and had several plans ready to use and put to work to free the driver that was pinned against a HUGE tree. I was also a part-time tow truck driver, and the towing company was on scene pretty quick. The FD and myself quickly ran through every option we had. Nothing worked, the pt was becoming hypothermic, and still trapped. EMS and firefighters are trained to never move the car as it could cause more issues. The two towing and recovery operators were both past chiefs at local agencies. Time was not on this guys side. I called the two guys over along with a couple of the firefighters that were in charge. I had one last ditch effort. Because of my background, and everyone making the same safety versus reward evaluations, we agreed that the tow trucks would hook to the car and pull it away from the tree, and then the FD could finish cutting the car from around him. I sat as close as I could to the patient having a good view of everything, and using hand gestures with the two guys I worked with, we made the room the FD needed to cut the car apart. Together, the FD, the towing company, and EMS saved this guys life because of teamwork and putting ourselves at risk. I know it’s not bullets flying, but it can be done.
One day I had come in after my shift as a paramedic to pick up the tow truck for the evening and overnight. The wife who runs the place said the guys were up on a rural road with a rollover. I said I would take a flatbed up and see if they needed a hand. When I arrived, the patient was still entrapped and a helicopter was on its way to transport. I checked with my boss who said they were all set and helped carry the patient to the landing zone after he was freed. No IV was started yet, and the flight paramedic was one of my instructors. He needed 2 IV’s amongst other things before he could loaded. The flight medic threw me an IV start kit and fluid. I didn’t have to ask, I just went to work on the victim. Now, I was dressed in the sweatshirt and Carhartt coveralls kneeling in some tall grass starting an IV that arrived by tow truck. I was later told many people who didn’t know me were puzzled. A Tow truck driver performing higher level EMS to a victim of a car wreck. Someone even asked the owner “what gives?”. Without missing a beat, he replied with a”we’re a full-service company!”. Again, there weren’t bullets flying, but entirely different industries came together for the benefit of the injured.
We all remember Columbine. Sandy Hook. The Aurora movie theater. Medics are kept in the exclusion zone so they are safe. When it is clear of threats, they are called in, most times much too late. Sometimes police and firefighters start transporting. There are specially trained paramedics that accompany SWAT teams right beside them in the hot zone. They do not carry any weapon and are there in case an officer is struck. In the US Army, medics are deployed with units to the hot zone, and the Geneva Convention says they may carry a pistol for self-defensive. The Marines use Corpsmen from the US Navy for the same.
Hazardous materials response teams, usually comprised of specially trained firefighters make entry into various chemical, biological, radiological, nuclear and energy atmospheres where one breath can kill you. They also have medics that are trained to accompany them into the hot zone to save a team member should something happen. 
Now these extra classes that exceed the normal scope of paramedics standing protocols have additional training, and additional drugs at their disposal. They also volunteer for the job. No one is forced to be a ToxMedic, or a Combat/Tactical Medic.
So, when there is a mass shooting, why is it that we are kept on the sideline? We most certainly make a difference in the lives lost at one of these events. Personally, given a helmet, some body armor and an officer that I have trained with before, I would most certainly make entry into an unsecured scene and attempt to make a difference. I have eyes on the victim, and the officer has eyes on the threats. Yes, it’s dangerous for a medic. It’s a lot to ask of a regular street medic. It is not for everyone, and someone has to transport the injured to a hospital. But for those that want to try and make a difference, we could be training to do so. Yes, there is some extra funding required for the equipment, and for training time. Everyone can live in oblivion with blue skies every day and pretend that it will never happen in our community – but I am sure Sandy Hook thought the same. Is it worth making some grabs or finding shelter and treating a wounded citizen? It could be a teacher, a friend, father, mother. It could be anyone from any place in our society laying there bleeding out. In fact, nearly every law enforcement officer is supposed to carry their own tourniquet. Wouldn’t you want someone to at least make an attempt at saving that person? Yes, there sure is the chance of the paramedic being killed in the line of duty. But every firefighter and every law enforcement officer assumes that day he or she goes to work. Some paramedics are willing to risk it all “so others may live“. But first we need the public to speak up, the suits to get the funding, the agencies to work together, the physicians to agree, and law enforcement to embrace the idea. The realization that it can happen here is obvious. Lest you have forgotten West Webster.
It is time to step out of the box we have gotten into and take care of business, a business where life and death hang in the balance. I listed a couple of articles for you to reference.
JEMS article
EMSWorld article
FEMA recommendation
