Ep 125: Who is Medical on a Rescue Task Force?
Episode 125
Published May 11, 2026
Duration: 23:04
Episode Summary
In many communities, EMS is separate from the fire department – which raises a critical question: who actually performs the medical mission on the Rescue Task Force, and how do you keep ambulances in service while you do it? In this episode, we discuss realistic options for staffing RTFs, the balance between putting medics in the warm zone and keeping transport units on the road, the role of training and policy with private and hospital-based EMS, and six key questions every community should answer in writing before the next incident.
Episode Notes
After training over 30,000 responders in 2,700 active shooter exercises across the country, we keep seeing the same gap: when EMS isn’t fire-based, the written plan for who goes inside and how transport capacity is protected is often unclear.
In this episode of the Active Shooter Incident Management Podcast, Bill Godfrey talks with instructors Kevin Nichols and Kelly Boaz about practical ways to solve that problem before the incident happens.
They discuss:
- The “no ambulance if you take the medic off the ambulance” dilemma in non–fire-based EMS systems
- Why getting private, hospital-based, and third-service EMS into RTF training is critical
- Whether you really need paramedics inside the warm zone, or if EMT-level skills are enough for most RTF work
- How smaller communities can use existing EMTs in police/fire, callback systems, hospitals, and CERT-type volunteers
- Working through policies like “who can drive the ambulance” with private providers and risk management
- Six key questions your plan should answer about RTF staffing, warm-zone care, and protecting transport capacity
The theme is simple: the gaps are real, but they’re fixable if you sit down now with EMS, fire, law enforcement, hospitals, and emergency management and work the problem together.
Get the Active Shooter Incident Management Checklist & Help Guide to support your RTF, triage, and transport planning: https://ncier.org/asim/checklist
View this episode on YouTube at: https://youtu.be/an5NNOmbiTg
#ActiveShooterResponse #IncidentManagementSystem #FirstResponders #LawEnforcementTraining #FireEMS #Podcast
Transcript
Bill Godfrey:Every community we visit where EMS is separate from the fire department we ask just one simple question - Who in your community is going to perform the medical mission on the rescue task force? Over 30,000 responders trained in 2,700 active shooter exercises across this country and we have anyone yet to show us a real written plan that says who's going inside and how you're keeping your ambulances on the road. And that's what we're here to talk about today.
Gentlemen, thanks for coming in. Let's frame this out a little bit. So EMS comes in all shapes and sizes across the country. We have many, many, many communities in this country where EMS is a separate department. So you got the police department, the fire department, the EMS department. And let me be clear, I don't really, I'm including that generically. Private ambulance companies, hospital ambulance, county run, third service doesn't really matter. EMS is separate from fire, which is separate from law enforcement. In those non-fire based EMS systems, who's physically gonna staff the rescue task force function and how do you keep the ambulances in service?
Kevin Nichols:
Well, the favorite answer you want to get from anybody in this type of role is it depends, right? It's gonna depend a lot on what your local jurisdiction does. The level of training of the medics or the EMTs assigned to those services, and like you pointed out in your intro, the idea of being able to keep our ambulances on the road, we're still gonna have to keep up with those transport units.
Bill Godfrey:
It's an interesting conundrum, Kelly. I mean, you're law enforcement guy who also is an EMT who works an ambulance every week. It's a real issue because we want the people with medical training doing the medical mission, but if you take 'em off the ambulance, you got no ambulance.
Kelly Boaz:
Absolutely. And I think you're hitting on something here that is a problem nationwide. I don't think I know it's a problem nationwide, like you said, I ride on an ambulance and I even ask them what is our role when it comes to an active shooter? We don't train in that, that's the fire department's role, but the fire department where I'm at, they have ALS but they don't transport, they don't go into other areas of where I live as well.
So this is a great question and a problem that we need to address to try to get these rescue task forces, man. Is it bringing the ambulances services into the fold, which I think we should do and get them into the training. Every training that I've done since I retired and been back with C3, I'll ask the EMS folks, not the fire folks, I wanna make that clear, but the strict EMS folks and they're like, this is the first training we've been to and we're sort of confused because we never even thought about having to go in as an RTF.
Kevin Nichols:
And then the idea of keeping your ambulances on the road. I know we've hit on that a couple of times, but the idea of if we pull the EMS people, the EMS third service off of the ambulance, how do we use that ambulance to transport patients?
Kelly Boaz:
Well, you can, I mean, I could put a firefighter to drive that ambulance, right? Or, and so I can certainly do, I can use a police officer to drive that ambulance if it came down to that, but I'm trying to put the best medically trained individual I can on that RTF and in that ambulance to get them to the hospital.
Bill Godfrey:
Yeah. And I think, Kelly, you pointed out an interesting thing. So in your locale, your local fire department is ALS first response. And there are a lot of fire departments across this country that do EMS first response. They may not transport, but they're paramedic level trained. There are others that are EMT level trained and provide basic life support, but there's also an awful lot of fire departments out there, both paid combination and volunteer that have zero medical training and have no medical mission and don't see why they would be called upon to go down range and be part of a rescue task force and in those communities. Little bit of a challenge.
Kelly Boaz:
Oh, it's a huge challenge. And as you're talking about this, I'm wondering what is the answer? Well the answer that sticks out to me is training. Get them to the training first. I don't want an EMT or a paramedic for that matter or an EMR, whatever your medically trained individual is, the first time I'm meeting them is during an incident and they don't know what an RTF is if they haven't had the training either. So to start getting those folks involved in training is paramount to success in your community. If we're in Orlando or in Miami or New York, sure those folks are geared for things like that and they train for that. But if we're in a very small community that might not have that opportunity for training like these larger agencies do, that's a problem. And we've seen it so many times. I don't care where you're at in this country, you are at a threat of an active shooter situation. It doesn't matter where you are.
Kevin Nichols:
I think training's important. I also think sitting down beforehand when it's nice and safe and nobody's hurt right now to work those problems out among the stakeholders. One of the problems I know we talked about, well who's gonna drive the ambulance if I take the medic off the ambulance and put 'em on the RTF, who's gonna drive the ambulance? And we're like, well, we'll put a firefighter on it, we'll put a police officer on it, which is a great answer. We have run into situations and training where you have a third service private ambulance service and their policy forbids anybody but an employee of that private ambulance service from driving that ambulance. So working that out ahead of time and having it in their policies that if this exists, then we'll make an exception in these cases is important.
Bill Godfrey:
Yeah, and I mean, classic example, I know personally one of the nationally EMS providers, ambulance, EMS providers who had that policy, which had everything to do with risk management and their insurance coverage. But when we finally got to the right people and called the question, they went, oh no, we can allow that, we can do this allowance under exigent circumstances. We just need to do an interlocal agreement with the local government. And that stuff can be worked out. Kevin, to your point as well.
I wanna revisit though on the medical mission of the rescue task force. So it, one of the questions that comes up is, do we actually need paramedics inside or is EMTs just enough? You know, it's one of the questions that comes up. And if you're a community where your only paramedics are on an ambulance, or maybe you've got four ambulances on duty and only one of 'em has a paramedic or two of 'em have a paramedic, all of a sudden now it's a very, very high commodity. So this is going to be something that varies from one jurisdiction to another.
There's a lot of difference between the skill level of procedures an EMT can perform versus procedures that a paramedic can perform. But you know what, one of those things is not, is assessing patients. Assessing patients is not an advanced life support paramedic skill. An EMT should be just as good at detecting a tension pneumo as a paramedic. And if they're not, they need to brush up on their skills.
So it, in my mind, I think, Kevin, to your point, when you get together in the local community, you need to take a look at what your staffing situation actually is and what is your distribution of paramedics and EMTs, what is gonna be available, how many ambulances are we gonna get on the road and who can we pull. In most of these smaller communities where paramedics are few and far between, you find out that even though the fire department may not do medical, you've got some people on the squad that are EMTs and you've got some coppers that are EMTs. You know, you've got those resources in your community. And so then the question is, what's the minimum medical training that needs to be established for the team that's gonna perform that rescue task force function?
Kelly Boaz:
Well, as an EMT I do not have the training you do as a paramedic and can't do those skills like give drugs and IVs and things like that. But in the initial assessment, as you said earlier, as a BLS provider, I should be able to do that. Maybe just as good if not better than the ALS provider because you're looking at other things. That's my world. BLS is my world. I should be able to do an assessment on someone and go, okay, airway, breathing, circulation, bleeding, or is this person going into shock? And if that's all I have, if that's all I can do, but I can start rendering aid to that person, then maybe we could save their life. Especially if someone like yourself a paramedic is so scarce and really what are you gonna in, in the warm zone as we're doing the RTF mission, what advanced skill are you gonna perform other than basically a BLS, a BLS assessment? Sure, you might be able to recognize certain things quicker than I can because of your experience, but really has, as it's been told to me, you know what ALS is? ALS or BLS is the foundation of a good ALS provider. You go there first before you go to ALS.
Bill Godfrey:
I completely agree with you Kelly and the one that comes to mind for me is obviously the tension pneumo, that's relatively common with gunshots to the chest. Alright? And if you've been shot in the chest, that's something that needs to be looked at and assessed pretty quickly. Now, not all gunshots to the chest result in a tension pneumo. They don't even all result in a regular pneumothorax or a hemothorax, nor do they hit the heart. Some of 'em aren't critical, et cetera. So it is an individual assessment. But a tension pneumo is one in particular where an immediate advanced needle decompression can save the life. And that in most states is an ALS skill. There are some exceptions, but in most states it's a reserve for a paramedic level skill. That not withstanding, I think I can swag it and say 90% of the other stuff is BLS skills. And I would go even further to say that rather than the treatment, the recognition that this patient here and this patient here need to be the first two out the door.
Kelly Boaz:
Yes.
Bill Godfrey:
They need to be on the first ambulance, make that happen.
Kevin Nichols:
This patient is significantly injured enough and is critically injured enough that I can't help them. Get them outta here to the higher levels of care. This guy can wait a minute. I think that's what you're looking for.
Kelly Boaz:
Absolutely, yes.
Bill Godfrey:
Yeah, I completely agree with you. So this idea of minimum medical training, you know, I think at the very least you should strive for EMT level in your community. Well, let me rephrase that. I think you should strive for paramedic level, but in a lot of communities that's simply not gonna be possible. So then your fallback, I think should be EMT. When you get to the point where you can't even put EMTs down range, I think then you have to have a conversation with your elected officials, your city and county managers and say, you know, there's a real issue here. This is a risk management issue where we're telling you ahead of time we may not be able to save lives because of the staffing levels that we're at in our community. And they may not give you what you need. I'm not saying it's a magic solution, but you've now conveyed to leadership ahead of time that you have a risk that you may not be able to save a life that could have been saved if you had the right people down range. Kevin?
Kevin Nichols:
I think also what it does is it gives you the opportunity to solve that problem before it becomes a, before it becomes an emergency. It gives you, if you can at least ask for the help. And if you don't get the help, then you can plan amongst the responding agencies, this is what we're going to have. How do we use what we have to solve the problem?
Bill Godfrey:
Yeah, I think, so let's talk about a couple practical solutions. So we already mentioned you split the ambulance crew, you leave the EMT or the paramedic on the rig, you get them a driver. Now you've got somebody who's doing medicine every day that's inside helping to make those decisions. I think that's a way. You could also make a conscious choice that we're going to take one ambulance out of service, we're gonna park it to the side, and that's our medical crew. That's gonna be down range. And those two individuals, EMT and paramedic, paramedic, paramedic, whatever, whatever that staffing level was on the ambulance, those two individuals are going to provide and direct the medical care by the others that are helping. What other ideas do we have?
Kelly Boaz:
Well, I think what Kevin said a couple seconds ago too is key, is what do I have in my community that is available to me? I might not have a fire department that has medically trained individuals, but maybe I have an ambulance company. You know what else is important? And a key as well, is going to the hospitals. Because a lot of times these ambulance companies run out of the hospitals and those doctors wanted to be able to have assessment before they just show up in their operating room or their emergency room and going to them and saying, Hey look, we should start training under for something along these lines and making sure that we have enough folks out there to get these people here to you so you can do your job and save their lives. And I can't think of any hospital, any doctor that wouldn't bite off on that and go, yeah, this is something that's needed.
Kevin Nichols:
At the end of the day, you're also gonna have cops and firefighters, even if they don't do it in their everyday life. People who have formerly been EMTs or work EMTs or were exposed to a combat lifesaver class course in the military that have some understanding of the criticality of patients. This one's more critical than this one. If that is their last resort, that might be what you're stuck with.
Bill Godfrey:
I can also tell you that doing that assessment for the criticality of patients is a skill that can be taught to non-medical providers. Because I teach it to cops on a fairly regular basis. It's down and dirty, you know, 10, 15 minutes. These are the key things that you need to recognize that says this one goes to the front of the line versus this one that may appear worse.
I think some of the other things you can do in the community is look at callback systems. So typically in these communities we're describing where we don't have a lot of ambulances, we don't have a lot of medics and EMTs, the fire department may not be first response ALS or BLS. It's smaller communities where you're already doing some sort of alert and callback system. How well does that work? How active is it? And does everybody understand their role in that?
I think another opportunity, so you know, Kelly, you mentioned the hospitals and getting them involved. There's a lot of people that work in hospitals 24 7, but they're not there 24 7. They have time that they're off duty. Maybe they need to be part of your callback system. You know we have citizens emergency response teams, the CERT teams in this community. Now largely they get very, very basic medical training. But what about if in your community you say, okay, we're gonna try to recruit some medically trained people, some nurses, maybe some doctors that are off duty and make them part of our call system so that they know how to work on the ambulance, they know how to do that and can supplement our staffing. I think there's an awful lot of ways to get creative, but it comes back down to what the two of you started this with, which is you gotta sit down and talk about it now.
Kevin Nichols:
Yeah, absolutely. And then also engage...
Bill Godfrey:
Hope. Hope is not a plan.
Kevin Nichols:
Hope is not a plan. It's not one that will be successful. And then obviously you'll need to engage your emergency managers. I mean, get your memos of understanding and your mutual aid agreements in place in case if you are aware of the fact that I have this deficiency in my agency looking at outside resources that can come in.
Kelly Boaz:
That is a great point, Kevin, because they're the ones that are supposed to be the key to get everyone together as well. And if you go to them as a medical provider or you're concerned about your, you know, your medical providing in your community is like, listen, this is a gap that we have. How can you help us correct this problem and get them involved as well? And most emergency managers that I know are gonna take that on and run with it and find answers.
Bill Godfrey:
I completely agree. And as we wrap up, I want to give everybody kind of the six key bullet points that your plan need needs to have.
Number one, who can be assigned to the rescue task force based, again, you know, this is for your community. So these decisions are gonna be different for everybody. Number one, who can be assigned to the rescue task force?
Number two, who owns the warm zone medical care? And I don't mean tactical owns the warm zone, that's not what I'm talking about, right? I'm talking about which agency, which group within this city county is gonna be responsible for warm zone medical care.
How do we protect transport capacity? Doesn't do us a lot of good to rescue the people from inside if we put 'em into an ambulance that sits there and can't go anywhere 'cause there's nobody in it.
Who is in charge of the rescue task force element? Now in our system that's prescribed, that's going to be the triage group supervisor is in charge of the rescue task force and then the transport group supervisor oversees the ambulances. But this question goes to who's staffing that triage group supervisor position.
Kevin Nichols:
Who fills that spot?
Bill Godfrey:
Who fills that spot? And it needs to be somebody that understands a little bit about triage and multiple casualty and mass casualty incidents.
Number five, how do we request and stage rescue task forces for our community? So if we're gonna use some of these exigent procedures for calling people back, for pulling staffing from off-duty hospital or medical people, whatever, how do we activate 'em? How do we get 'em to staging? Once they get into staging? We can get 'em organized as long as everybody knows the procedures.
Number six, how do we backfill when units are committed? And this is a big one. This is a big one.
So again, number one, who can be assigned to the rescue task force? Number two, who owns the warm zone medical care? Number three, how do we protect transport capacity? Number four, who commands the RTF element? Who staffs that? Number five, how do we request and stage the staffing for RTFs? Number six, how do we backfill when units are committed? Those are the biggies. If you can sit down in your community and just pencil out some answers to those questions, you're already in the top 1% in this country.
Kevin Nichols:
And then taking those questions to the rest of the agencies that will be responding with you, your regional assets. So we're all on the same page, I think is also, yeah.
Bill Godfrey:
Yeah.
Kevin Nichols:
Key.
Bill Godfrey:
Kelly, any last closing thoughts on this?
Kelly Boaz:
I just think this is such an incredibly important topic because I see the gaps out there and, but they're fixable. There's answers to these questions, but we have to get it out there. And the bottom line is we're trying to save lives your, the people that live in your community's life. So we're not saying, Hey, okay, you have this gap. That's a bad thing. We're saying, Hey, you have this gap, let's fix this gap. And no matter where you're at, who you are or who you work for, and because part of answering questions is knowing what the problem is. And I think this, I know this is a problem out there.
Kevin Nichols:
If you can clearly define a problem, you've almost solved it.
Bill Godfrey:
And the one thing I would add is you don't have to accept no as the answer. And I say this, having helped a few communities who dealt with a private ambulance provider and no was their answer and they said, arms up in the air, we can't do anything about it. I said, oh, nay, nay, yes, you can, it'll take a little bit of time, but everybody has pressure points. There's leverage all over the place. It would be nice if we could get everybody on the same page because it's the right thing to do. That's not real life all the time. And so sometimes pressure needs to be brought to bear. You have a contract, you can leverage the contract.
But here's the other thing and I'll leave this as a closing thought for those of you that are dealing with the private EMS providers, even the national ones. I had a particular region of a national EMS provider that said, can't do it, won't do it, the company doesn't support it corporately. And I said, really? Well then why are they doing it in this city, this city and this county in these three different states. So don't be so easy taking no for an answer. This is a solvable problem. And Kelly, as you said, it's worth solving.
Kelly Boaz:
Absolutely.
Bill Godfrey:
Gentlemen, thanks for coming in to talk about this. I appreciate it. If you have any questions or comments about this, please send them to us at info@c3pathways.com. info@c3pathways.com. Thank you to our producer, Karla Torres. And until next time, stay safe.