Ep 120: CCP vs AEP
Episode 120
Published Dec 15, 2025
Last updated Feb 18, 2026
Duration: 27:34
Episode Summary
Today’s episode explores the roles and differences of Casualty Collection Points (CCPs) and Ambulance Exchange Points (AEPs) in active shooter and mass casualty responses. The conversation focuses on how these sites fit into warm zone operations, how timing and coordination around them affect victim outcomes, and why early planning for both locations matters.
Episode Notes
In this episode, the team breaks down the real-world differences between a Casualty Collection Point (CCP) and an Ambulance Exchange Point (AEP), why they matter, and how to set them up so you save more lives in an active shooter or mass casualty event.
Episode 120 dives into working in the warm zone and explains how CCPs and AEPs function together to move victims rapidly from point of injury to definitive care, while maintaining responder safety. The team discusses who should establish the CCP, how law enforcement Contact Teams drive early triage and security, and why CCPs are not just a “medical” job.
You’ll hear practical tactics on:
- Defining and securing a CCP in the warm zone so Rescue Task Forces can work safely
- What makes an AEP different from a traditional MCI loading zone
- Prioritizing which “reds” go first and using medical judgment beyond simple triage tags
- Matching patient loads to available medics without overwhelming the ambulance crew
- Coordinating tactical, triage, and transport to avoid fatal delays in getting ambulances to the AEP
Whether you’re law enforcement, fire, EMS, or an incident commander, this episode will help you visualize how CCPs and AEPs should work on your next high-threat incident.
View this episode at: https://youtu.be/0tvPO0lvEVs
Transcript
- In an active shooter event, we talk about working in the warm zone, things like casualty collection point or ambulance exchange point. What does that mean though? Why do we need 'em, and how are we supposed to be using 'em? That's today's topic. Welcome to the "Active Shooter Incident Management" podcast. My name is Bill Godfrey, your podcast host. I am joined by three of my other fellow instructors at the National Center of Integrated Emergency Response. Sitting across from me is Leeanna Mims from the fire EMS side. Leeanna, good to have you back in.- Thank you. It's good to be here.
- And Brian Beechner, also from the fire and EMS side. Brian, good to have you.
- Thanks for having me.
- And to my side is my favorite sheriff, Kevin Beary. Kevin, good to have you in.
- Good to be here always.
- All right, so today's topic we're going to talk about kind of warm zone work and casualty collection point, ambulance exchange point, what they are, why we need 'em, why they matter. But let's start by just talking about what is a casualty collection point?
- I'll just go. It's a secure location where we can gather patients that need to be transported, need to be treated or transported. I think that's the simplest form to put it.
- And the casualty collection point is typically established by the first first-
- Contact team.
- [Bill] The contact team.
- The contact team.
- Contact team by law enforcement.
- Yes.
- And this is one that often people are like, wait, what? They think that that's a job of the rescue task force, which if the rescue task force gets down range and there isn't a casualty collection point. Sure. But what we're actually looking for is those first couple of contact teams on the law enforcement side who are getting control of the security situation to get those patients drag into an area that they can secure and hold ground so that we can then insert the rescue task forces to provide the medical care.
- Absolutely. One of the scenarios I always liked was the courthouse one. And so those initial contact teams go in and they're telling, we've got shots fired in the back of the courthouse, but in building five I've got five people down. And that's some very valuable information, not only for the fifth man who's in charge tactically, but it's very important information because now we're starting to find out your rescue task force, your medical branch people have already got that number five and they're starting to put the ambulances and what have you into play.
- Yeah. So the other piece of this is the ambulance exchange point. What is that? What's our definition of an ambulance point and how does it differ than the loading zone that is referenced as part of MCI triage text in every EMT and paramedic book when they tell you to set up triage treatment and transport? What is an ambulance exchange point, and how does it differ from a regular loading zone?
- Well, an ambulance exchange point is where we are gonna take everyone that we have treated, that we've triaged and we've treated, and we're gonna put 'em in an ambulance to be taken to the hospital. It's not a place where we take the ones that we've triaged and treated to do it all over again. Which when we talk about a normal MCI, that's essentially what happens. We go in and we do it all over again. In the case of an ambulance exchange point, we are still fighting the clock and we are still fighting the clock and...
- [Bill] And potentially security.
- [Leeanna] Yes.
- That's what I was gonna mention.
- Yes. Security., yes. And making sure that the triage that we've done goes in the correct order. If we know that we have five reds and five yellows, we're not loading yellows before reds. We're discerning which hospitals that we're going to. That's all part of everything that's fed in through the AEP. But it's fast. It's a load and go. The work's already been done. It's load and go.
- And I would say that's the big difference between the ambulance exchange point and any particular other, like MCI, whether it's an auto accident is during an auto accident I don't have a potential threat unless you're on a highway in a vehicle. But that's a different story. But it's semis, it's the warm zone. You're still operating on that cold, warm zone perimeter where there's still a potential threat. So I wanna be in and out as quickly as possible. Again, not only for the patients, but for our own safety. I wanna be in and out as quickly as possible.
- And so I'm gonna or reflect this back. So casualty collection point is a secured location in the warm zone where we assemble the casualties to do triage and stabilizing treatment until we can evacuate them to an ambulance to get them to a hospital. The ambulance exchange point is a secured location where we're going to bring those patients from the casualty collection point to the ambulance and do the handoff. It's a transfer point, but it has security around it, often just secured by a contact team, so that the ambulances can safely come in and then egress out. So those are our two things. Now you hit a moment ago, Leeanna, on the $23 million issue, which is okay, you've come into the casualty collection point as a rescue task force and you've got eight reds and four yellows. Great. Start triage has really helped you. You got eight reds, which one's going first? Does that matter?
- [Leeanna] Yes.
- [Bill] Why?
- It matters in the sense of the level of their injury, and maybe I'm a red and you're red, but I'm a little bit better off as a red than you are. So if I'm running the show, then I'm putting you in the ambulance first. That's essentially it. But that is up to the medical professional that's standing there to say, yes, you first. That can be a tough call. It can be a tough call.
- Bill mentioned like you do your start triage or whatever method you're using to do your first initial triage to determine they're red, yellow, green. Well, now you're starting to do a little bit of the secondary triage. And I'm getting a little bit deeper into, I'm removing some clothing. I may be able to put a tourniquet on and make that red at least slow down the process or the injuries for that one red so I can take this other red patient. So what are the interventions I can do that I could save a life right here, or what interventions I can't do and I need to get them to the hospital very quickly?
- And then I think the other factor when you just said it is what hospital? Are we both gonna be going, are both your reds, are they going to the same hospital? Are they going to different hospitals? Is one further than the other? What is the definitive care? What is the definitive care?
- And I think the way to kind of talk this through and it's interesting not only having this conversation with EMTs of paramedics, but quite frankly with law enforcement officers that have probably first responder level medical training, but not EMT or paramedic. It's important to get everybody transported as quickly as possible. But if you want to save lives, if you wanna save the maximum number of lives, it's really important to get the most severely injured transported first. And when I say that, because it sounds like, well, okay, that's simple: it's not, because now you've gotta use medical judgment because all the triage systems, which nowadays is the only thing that gets taught in EMT and paramedic school is just these shortcut triage systems. We've got a huge gap in terms of paramedics and especially EMTs using medical judgment to say, okay, this red needs to go in front of this red, and this red is a red but probably is gonna be the last red I'm gonna send. And this red, whoops! This red's way worse than that first one, I need to get them up in line to go. But it's not just the reds. And here's where it gets super complicated. Your medic in the back of the ambulance during transport is really only gonna be able to take care of one patient, but you don't wanna send the ambulance with just one patient. If you can put somebody else on the bench seat and if you've got walking wounded that you can put up in the front seat with whoever's driving to kind of talk to 'em and make sure they don't pass out. You don't wanna send that ambulance away with one if you can send three.
- [Brian] Correct.
- But you've gotta match the load. You've got to match the severity so that you don't overload the medic in the back. Easy to do?
- Not at all.
- [Bill] Why?
- Well, a couple things. 'Cause typically, whatever your EMS system is, if one medic, two medics on an ambulance, if you have two medics on an ambulance, you're way ahead of the game. Most of the country, I believe has just one medic, but one medic in the back taking care of one red patient, that's really all they can handle. So I need more hands, I need more people, and it could be EMTs, it could be paramedics, but to carry more than one person, I need people. And how do I get those people?
- And even if we do have protocols in place that tell us what we are allowed to take in our ambulance, that doesn't mean anything-
- Correct.
- Depending on the severity.
- Correct.
- The severity of and where they're being transported to. And when we're talking about an active shooter, whoever is running transport is taking into account what hospitals can handle what level of trauma, and how many of them? And there's so much that goes into that. We have to remember that we're not the only thing going on in the community. There's other situations that are impacting those hospitals. And in some cases too, the other thing that we know can happen is that there could have been people that ran from the scene or were taken from the scene directly to a hospital that we have no idea what kind of impact that's been. So again, going back to whoever's running transport, that's a heavy job.
- And I think that communication has to come in early from either through transport up to staging. But if ambulances are coming in staging and I have extra engine companies or other people, the engine company, if I'm fortunate enough, my jurisdiction I'm fortunate enough to have medics on engine companies, I can front load those ambulances coming outta staging. So when I arrive, I've got extra hands, extra medics that now I can, hey, I can take two reds. If you can take two reds in the back of an ambulance you're hitting the mark.
- It's no different. It's no different. You get rolling to a heart attack, it's cardiac arrest, you're doing CPR that's not going to be one medic in the back by themselves. You're pulling extra people either from another ambulance or very often from the engine company, from the fire apparatus. And you've got three, sometimes four people in the back of the ambulance working on that one patient. It's easy to do when it's only that one patient, that one incident. When it turns into a mass casualty incident, now you're down to, well, what is the resource staffing that's available for me in my community? And now it gets dicey 'cause it's a community by community decision. And Sheriff, you and I were together a few weeks ago when I was going through some MCI training we were doing, and we were kinda testing out the new ones with the cards, and Joe and I were talking and we had eight reds. And my job was to figure out which red was gonna go first. Now mind you, we have been teaching for years the idea that you want one red, one yellow, one green to go in every ambulance. And theoretically, I should say philosophically, that's on target because what we're actually trying to say is you don't wanna overload the one medic that's gonna be in the back. You wanna make sure it's manageable. But I don't know if you remember the discussion. So Joe and I were kind of debating about, I had three and we were debating about which one needed to go first. I'm looking at the three reds, and the number two and the number three red, I'm looking at 'em going, wait a minute, this red needs a lot of attention during transport, but this red here needs a surgeon and there's not really anything I'm gonna be able to do for this red at all other than give 'em oxygen. That's it. And I looked up at Joe and I went, as a medic working in the back of the rig I'd be comfortable with these two reds, 'cause this guy just needs oxygen and this guy needs my undivided... You remember that? Undivided attention. And it led to that oh boy moment of this is a lot more complicated than just one red, one yellow, one green.
- And it's important that it's that outside the box thinking. It's not everything that we do. And anything first response, police, fire, EMS is black and white. There's always an audible that can be called, and because of certain circumstances just as that.
- Well, one of those audibles out there when we're talking about CCPs is where are you gonna set up a CCP? Normally the cop from the contact team doesn't have to worry about it. It's where the suspect's already done his carnage. That's your CCP. So you're triaging it that way. Go ahead, chief.
- I'm just... Go ahead. We'll come back to it.
- We talk about that that's an important point is there's an element of triage to be done by the law enforcement teams, even though they may not have the medical. And the idea is is once they get that casual collection point, so you can't really do a whole lot till you get security established. So you get the security over the casual collection point, the next thing to do is divide the room.
- You need the uninjured out of the way up against one wall. You need the injured that are walking wounded up out of the way against another wall. And then the ones that are left that are wounded that didn't get up and move or can't get up and move, those are your reds. So the injured that are walking and up against the wall that moved on command, and it sounds really simple, but what we're doing when we say if you can hear my voice and you're able to, again, if you're injured, you can hear my voice, you're able to get up and move over to this wall. Well, if they get up and move, it means, number one, that their injury is not so severe that they can't move. And that means he and dynamically at the moment that they're stable and they were able to understand and follow command, which means mentally the brain is still functioning and they're not in shock. At least not yet. You could still have some walking wounded that are actually quite serious. We use that example. You could be shot in the chest and be walking wounded for a little bit.
- Correct.
- It'll turn into a problem later. How well do you think your average law enforcement officers understand that piece of kind of dividing and conquering when they set up a casualty collection point?
- I think they're getting better at it because of all the emphasis on training on active shooter. 'Cause there's a lot of active shooter training going on. But at the same time, the old days, and I'm old enough to say that: in the old days we used to tell 'em, well, that's the fire department, that's EMT, paramedics job, I'm not gonna touch 'em. Folks, the day of the contact team and an active shooter, once it's secure and there is a level of security, you the law enforcement officer better start touching the patients because you are going to be initially trying to save their lives. Putting a tourniquet on 'em, direct pressure, things like that. That's somebody else's job. No, it's not, it's yours.
- And that bleeds over a little bit into the fire service too, is between the paramedic and EMT is like, oh, I'm just an EMT, I can't assist a trauma patient. Well, you absolutely you can. Your EMT training has taught you that.
- I'm sorry, when did a traumatic assessment become an ALS skill? I don't remember assessment being an ALS skill for trauma patients. No, no, no, no, no.
- Triage is everybody's job. Triage is everybody's job. And what I think about too, and when we're running scenario is like we use the bleeding model. So the bleeding model is like your first tool to look at. And if you've gone through a really good treatment triage and then you've got 'em into the casualty collection point, maybe you've moved them over to the ambulance exchange point, but you can't quite load them yet and you watch them continue to bleed before they are put in. So they essentially could technically move from being a red tag to a black tag while you're standing there with them and you haven't even acknowledged it.
- Well, we know how Bill likes helicopters. That's how we met even further in our careers. But the bottom line is, take it one step further. The worst patient, the one that needs the attention the most, if you've got helicopter assets, use 'em. Triage 'em into that.
- Yeah, if you can. I mean, it's kinda like there's a whole can of worms here. You open one can of worms and inside are three more cans of more worms and it all has to get managed. And I think that's the part that brings all of this back is if this sounds hard, it is and it's chaotic, and there has to be a structure to manage this. Otherwise we're lucky if we just chuck bodies into the back of an ambulance. We might get 'em transported in a good time, but when the autopsies are done, we're probably gonna find out that there were people that bled out just because they didn't get to the hospital fast enough. And that's very, very troubling. Let's talk a little bit about. So we've got a casualty collection point. It's been stood up, the rescue task force gets in. One of the things that we often see is that the ambulance exchange point doesn't get set up until we're ready to move the first patient. And now we're standing by to stand by while a security team, a contact team tries to go and secure an ambulance exchange point. We lose five, six minutes right off the bat. When that RTF comes into the room before they ever get started, is that the best time to start talking to the contact team that's with you about where you wanna do your ambulance exchange point?
- I'd even take that one step further: those conversations could be being had at either tactical triage transport or staging prior to that. If I'm listening to the initial contact team and I know that the shooting has happened in room 101, well, chances are my casualty collection point is gonna be right around that area. So if I'm in staging or if I'm in transport, I'm already looking at a map, where's room 101 and where's my best ingress and egress for that? So when the RTF does get down there and says, hey, we're ready for pick, we already know where we're going. So again, I think those conversations can be had during the incident. We're being very proactive on that.
- And I think a lot of times what we see is there is a big delay in the AEP getting established, and keeping in mind we could have more than one, we could have more than one CCP depending on the location of victims. But it's always late to get established. And I agree with you: it should be a point of discussion in staging. Not that they can set it up, but that they can start looking to see where it might be, especially if they're the ambulances that are sitting there in staging. It should also be a really early discussion with transport. And a lot of times we have to cue that, we have to cue to get that discussion going about where the AEP is gonna go. But we know too that when they leave staging depending on who's they're watching and mentoring staging, the ambulances aren't gonna be able to leave unless they've been told. They've gotta have the location to where they're going or they're never gonna come out of it.
- Well, folks, and this is exactly why we have tactical triage and transport, the three headed dog right there in one location. They need to be talking, they contact teams can even add their input in a possibility of having an AEP. And that way tactical go, oh, we we're a little light on people, we need more cops. Now you're starting to work staging to come in, so we get more security in play.
- Well, and I think something we have to be cognizant of those, like to do it from staging, we might have an idea of what everything looks like.
- [Brian] It's not gonna be ideal.
- But we don't know where everybody's parked forward.
- Yeah, correct.
- We might think this is the greatest location ever for an AEP, but you get there and you find that your squad is blocking the road and there's four law enforcement vehicles that have just abandoned their vehicle right in place. So you don't know if you can get it...
- I was gonna come back to that and say, yes, it has to be talked about in staging. It can be talked about in staging, but it has to be confirmed by the RTF that that is the exact location or the RTF's the one to be established in that.
- And I'll tell you the other thing I think is important to remember is it's natural human tendency that the way you came in is the way you think about going out. And for me, the very first thing that I wanna do when I hit the casualty collection point, before I go to work, before I even start looking at patients and maybe even before I go through the door, but I'm looking around doing a quick scan for exit signs, because the door that I came in is probably not the closest door to pavement. And I want to physically carry people as short of distance as possible. And sometimes your casualty collection point might have an exit door right off of it that opens right up into a parking lot. You see that in schools a lot. And if not, you look out in the hallway and you go, okay, where's my exit points? And then you turn to your law enforcement security and you go, hey, I wanna use that door, right outside that door there's pavement. I wanna use that as our ambulance exchange point. Can you see if you can make that happen? And now I'm done, I go to work on my patients, meanwhile, law enforcement coordinating with tactical is figuring out can we make that happen? Is that a safe-ish area? And get a contact team in to secure it.
- I was gonna say, kinda going back from what our conversation, we're talking about the communication and from the RTF getting how many ambulances, whatever. A lot of times in the classes, the ambulances are delayed slightly, it's not because they're not thinking about it. The RTFs think about, hey, I need three ambulances. It's who's communicating that back to transport to send them to the AEP? 'Cause they're the stressful environment, they're taking care of their patients, They're deep in their tunnel vision and they taking care of the patients what they should be. But who's calling for those ambulances to actually come to the scene?
- Yeah. And honestly, as soon as the ambulance exchange point is secured, we want that contact team that's securing the AEP to report that to tactical, which then allows tactical to turn to transport who's standing right there with 'em and go, hey, the AEP of this location is secured if you wanna get your first ambulance up. Now we don't wanna put three or four ambulances there. But getting the first one up and that way when the RTF calls triage and says, hey, I'm ready,-
- They're there.
- We got an ambulance waiting on you at the AEP. This has been a really, really great discussion. As we close out, any final thoughts on clarity that you can bring to people about casualty collection point and the ambulance exchange point?
- The only thing I'll say on the ambulance exchange point, this is so hard for first responders to do at EMTs and paramedics, is when you get to that ambulance exchange point you wanna be in and out as quickly as possible. And a lot of times the driver of that ambulance wants to get out and help manage that patient, but that driver needs to stay in if they can and let the patients get loaded so that they're ready to go. Hey, doors on the back close, this is the hospital you're going to and go.
- And ready to go knowing that they're probably gonna turn around and have to come back. And emphasizing that part of it. And of course the other part of the AEP, like you just said and we talked about earlier, it's not a place where you do it all over again. You don't go through all the assessment all over again. It's time to load, go, you've already done the work. And let's get 'em to the hospital.
- Cops on the contact team.
- Take care of the threat. Take care of the threat. But if you're assigned to an RTF, then you take care of your firemen.
- Absolutely. And yeah, absolutely on that one. We worked really hard to get the model up that works now across the country for putting firefighters into a warm zone and it is completely dependent on the law enforcement element staying with them from start to finish. Start finish.
- Absolutely. Thank you everybody, I appreciate it. Another great discussion. For those of you that are listening, thank you for taking the time to join us. If there's any questions you have or anything we can do to assist you in implementing active shooter incident management, please don't hesitate to give us a call. We are happy to help. Thank you to our producer, Carla Torres. And until next time, stay safe.