Ep 133: Active Shooter Training Buyer's Guide - Medical
Episode 133
Published Jun 24, 2026
Duration: 21:32
Episode Summary
This episode is Part 2 of our ๐๐ฐ๐๐ถ๐๐ฒ ๐ฆ๐ต๐ผ๐ผ๐๐ฒ๐ฟ ๐ง๐ฟ๐ฎ๐ถ๐ป๐ถ๐ป๐ด ๐๐๐๐ฒ๐ฟโ๐ ๐๐๐ถ๐ฑ๐ฒ, where our panel walks through what solid medical / mass casualty training should cover for law enforcement, fire, and EMS.
Episode Notes
In Part 2 of our Active Shooter Training Buyerโs Guide, Bill Godfrey, Ron Otterbacher, Jill McElwee, and Billy Perry dig into what good medical / mass casualty training should include: perโpatient clocks, real triage instead of โclosest to the door,โ the loadmaster role in casualty collection points, and how to adapt training to your local EMS system. ย
They discuss: ย
- ย โข Why the biggest survival gap isnโt the gunfight, itโs medical care and triage ย
- ย โข How to think about the โclockโ as perโpatient, based on wound location and physiology ย
- ย โข The current state of law enforcement medical training and realistic expectations ย
- ย โข How medical judgment up front changes who actually needs to move first ย
- ย โข Keeping drills in context: radios, movements, casualty collection points, and ambulance exchange points ย
- ย โข How to use afterโaction and postโmortem reports to keep raising your standard of care ย
If youโre selecting mass casualty or warmโzone care training for your agency or region, this episode gives you a practical starting checklist for evaluating the medical side.ย
View this episode on YouTube at: https://youtu.be/tus68ab-uhU
Transcript
Bill Godfrey:We've delivered over 200,000 hours of training, and the biggest survival gap isn't the gunfight, it's medical care. So what needs to be in your medical training? That's today's topic. Jill, let's start off with you.
Jill McElwee:
Yeah.
Bill Godfrey:
What's the problem with the way that we're doing medical training now?
Jill McElwee:
Now medical training is focused, especially on this active shooter incident this situation, is just time. We focused on the clock rightfully because, you know, time is blood loss. But not every person that is shot is gonna need that surgical suite. Now, we hone in on that a lot in training, and you should hone in that... a lot on training, but I think where we're missing the boat is not appropriately triaging or follow on triaging as far as loading the patients and getting them to the appropriate facility.
If it's just one patient, load and go may be the way to go. But when we have multiple patients, if you have seven red tag patients in front of you, how are we training our folks to appropriately identify which red tag is gonna need the surgery? That's who needs to go first.
Ron Otterbacher:
I like it.
Bill Godfrey:
Yeah. And Ron, you know, back in the day, you were a paramedic before you spent a career in law enforcement, which puts you in an interesting position as a cop that would know a lot more about how to assess and triage and which patients needed to go first. What's the state of that level of training for law enforcement officers out there on the road today?
Ron Otterbacher:
For law enforcement officers, it's very limited. There's very limited medical training. They may be trained to stop the bleed or, you know, tourniquet application and stuff like that, but that's about it. They don't understand. You know, we talk about tactical triage and say, "If you hear my voice, move up against the wall. Everyone else is red," which is a good start, but we don't utilize that with all cops. We don't teach that to all cops. We don't teach them why we do that, and I think that's... You know, I don't expect cops to have the same capacity as a paramedic, but I do expect them to... They've got a duty to provide care to their highest level of training, and maybe we need to step up that level of training a little bit.
Billy Perry:
And you know, it's funny, Ron, that you say that 'cause one of the questions that I ask officers when we're teaching a class, when we're having a one-on-one discussion, I'll ask... there's several pointed questions, and one of them is, "How many tourniquets have you ever applied?" And the shocking number is zero. Most of, the vast majority are zero. I'm from Jacksonville, and I know our... We've apply a lot of them, and our SWAT team applies a lot of them on people. And but the number of officers around the nation that don't, that even outside of training, they've been shown it, they've never put it on I'm sure you've seen it too.
Jill McElwee:
Oh, yeah.
Billy Perry:
And it's something we need to look into.
Bill Godfrey:
You're saying they demonstrated in training, but they never actually practiced putting it on?
Billy Perry:
That is correct.
Bill Godfrey:
That's frightening. That's frightening.
Billy Perry:
Mm.
Bill Godfrey:
I think the, the place where this fundamentally breaks down in the active shooter environment is, you know, if everything goes well, you've got your casualty collection point, and you know, half dozen, dozen that are injured. So you apply START or SALT or whatever triage system you're using du jour. Great. You've got seven reds laying in front of you. Not all of those are necessarily destined for a surgeon just because they're red. And which ones need to go first? And it feels to me like part of what has been lost over the years is that application of medical judgment in triage, and we're missing the opportunity. We've, focused and harped on time, and that was important, and it improved time. It decreased the time it was taking to transport everyone. But the thing that I think we got lost in the shuffle is we're not really looking at the medical assessment of those patients until they're back in the back of an ambulance.
Billy Perry:
Right.
Bill Godfrey:
And by then, we've, we've missed the boat. And I think that's one of the things. So Jill, let's start off with what are the key things that agency leadership should be looking for when they're selecting their mass casualty and warm zone care training for not only the medics and EMTs, but also for their law enforcement officers?
Jill McElwee:
Yeah, I think that the training needs to be focused on the patient itself and injuries-
Bill Godfrey:
Sure
Jill McElwee:
... from a medical standpoint, not just this person was shot, okay, we're gonna take this person to the hospital. Where was the person shot? Let's find training that's gonna dive into that medical component, the physiology of a penetrating wound and what does that mean for triage. Whether you're using the, you know, START, we find across the nation, or SALT is... a lot of agencies have been using that. Whatever method that is used by those fire and EMS personnel, that method needs, the training needs to take into account a follow on triage.
Billy Perry:
Right.
Jill McElwee:
A component of triage that allows you to tell, make medical judgments, use your training to tell how are we going to distribute these patients. Is there someone that's gonna be in that room that's gonna take a lead and maybe, you know in loading appropriately by injuries, how are we gonna get this patient before that patient? How are we gonna make sure that patient number one that has a red tag has priority over patient number two that may also be a red tag?
Bill Godfrey:
Mm-hmm.
Jill McElwee:
And how we find that is through medical judgment. And so the training has got to be one that will allow that, that will allow those fire and EMS personnel to utilize their training.
Bill Godfrey:
Billy, for the law enforcement officers that are in the room in the casualty collection point and those that might be involved in helping move casualties to an ambulance exchange point, getting them loaded, those kinds of things, how important is it for those officers to be aware of the importance of picking the right individuals to go first, that the order matters.
Billy Perry:
It's literally life dependent.
Jill McElwee:
Yeah.
Billy Perry:
Like, literally and when Jill was talking, I was thinking just, like, we had referenced teaching the rescue personnel how to behave in a rescue task force. They need to teach us how to look at that, because I know for eons in the law enforcement community, we set up a perimeter and we didn't render aid. We didn't do that, and now there's been a paradigm shift in that, and we do that. And I think just teaching them to know what to look for, like you're talking about, or even... 'Cause there's gonna be members of the RTF when they're doing triage that are basically standing around, for lack of a better term, and they need to be able to look at something. 'Cause I've seen somebody that, like, had a stab wound that the wound was closed by adipose tissue, and you couldn't tell, but it was a decompensating issue, you know? And they need to be able to say, "Hey, I think this one's more problematic than we thought." Does that make sense?
Bill Godfrey:
Absolutely.
Billy Perry:
Mm-hmm.
Bill Godfrey:
Ron, do you think that there's a reasonable path forward to training basic law enforcement officers? You know, you said, "I don't want them to be... I don't expect them to perform as a level of a paramedic." But is there a missing opportunity here that the training gap needs to fill for officers on how to recognize the ones that probably need to prioritize? Like, if they've been shot in the chest, might be a little more important than somebody shot in the leg.
Ron Otterbacher:
I think that's critical. Also, I look at how many people have perished because they had survivable injuries, but no one took any action to get them to a place where they could get further medical care. Again, that's a training issue-
Billy Perry:
It is
Ron Otterbacher:
... that leaves us all,I wouldn't say vulnerable, but leaves us all in a bad position so we could do a better job at getting them to advanced care and getting them off the scene. We failed.
Jill McElwee:
Yeah. Ron is so right, Bill. Those, reading the after-action reports and a lot of the post-mortem reports from previous incidents, which is where your training should focus on-
Bill Godfrey:
Right
Jill McElwee:
... continual improvement, continual, especially on the medical side, it is humbling and frankly, sad how we've missed the ball on just taking that training to that next level of, okay, zero in on these injuries. They were not just, it's not just a quick tag them red, throw them in the magic bus, and they'll be fine.
Bill Godfrey:
Right.
Jill McElwee:
Ooh, as so- long as we get them in that ambulance, check, we're high-fiving.
Bill Godfrey:
Exactly.
Jill McElwee:
That's not the answer.
Bill Godfrey:
No.
Jill McElwee:
The answer is to dive down into that medical training. That's why we are there with you.
Billy Perry:
Agreed.
Bill Godfrey:
Billy, what's that saying in the SWAT community? It's something like slow is smooth and...
Billy Perry:
Slow is smooth, smooth is fast. But you know what else is fast? Fast.
Jill McElwee:
Fast.
Billy Perry:
Fast is fast. And we can't do it wrong enough fast enough to make it right enough.
Jill McElwee:
I like it.
Billy Perry:
So-
Bill Godfrey:
Say that again
Billy Perry:
... you can't do it wrong enough fast enough to make it right enough. So I think we need to do good assessments. And I'm not saying a secondary survey necessarily on everybody, but I mean, we do need to do really good assessments on them initially.
Bill Godfrey:
Yeah. It's...
Billy Perry:
And real- Not to interrupt you, but I mean, one of the things,you know,I'm not a proponent of tombstone courage, but we, so many of the delays are implemented because of fear of moving forward or wanting to clear or, and our saying known bleeding doesn't stop for unknown threats. And I think we've got to be able to move forward and do that and treat it as it is, not being afraid that the Romulans are gonna land.
Bill Godfrey:
I think the other thing we have to deal with is a mindset. I'm reminded of a conversation, I've talked about this before on the podcast, that I had with a law enforcement officer who said, "You know, I just want them off my scene. Just get them in the damn ambulance and get them off my scene." And, and my reaction was like, "No, what you want is for them to survive."
Billy Perry:
Right.
Bill Godfrey:
And in order for them to survive, I need to pick, of the seven reds that are in the casualty collection point-
Billy Perry:
Right
Bill Godfrey:
... I need to pick the ones that need to go right now. They're the right now, right now problems.
Billy Perry:
That are viable.
Bill Godfrey:
That are viable.
Billy Perry:
Right.
Bill Godfrey:
Yeah.
Jill McElwee:
Mm-hmm.
Bill Godfrey:
And that has to be grounded in some local knowledge of the local EMS system. What kind of ambulances do we have?
Jill McElwee:
Perfect.
Bill Godfrey:
Do we have the ones that still have bench seats where we can put two stretcher patients, one on a stretcher, one on a backboard on the bench? Or do we have captain's chairs now, in which case we're only transporting one stretcher patient? Can I put a green patient in the front seat of the ambulance or on the observer seat in the ambulance, or is that not prohibited? And does that rule go away if it's a mass casualty?
Billy Perry:
Mm-hmm.
Bill Godfrey:
Am I running BLS ambulances, ALS ambulances, or a combination? How do I know which is which? Those are local issues.
Billy Perry:
Right.
Bill Godfrey:
And so your training program that you adopt has to have a component that allows you to adapt how that action's going to occur for the local conditions, which is one of the reasons we advocated for the new load master position in the casualty collection point.
Jill McElwee:
Yeah.
Billy Perry:
Oh, I see.
Bill Godfrey:
One person whose job it is to say, "This one, this one, and this one, they go in an ambulance together. They're in the next ambulance. Put them by the door." And then when, you know, you know Bruiser and Johnny walk in, "What do you need? Take those to the ambulance and get them loaded."
Billy Perry:
Right.
Ron Otterbacher:
We're sequencing how we're load them up and how we're transporting them, and we miss that right now.
Bill Godfrey:
We absolutely do. And unfortunately, it's more than that. It's not even that the seven reds are the first ones to go out to the ambulance exchange point. All too often it's a mixture.
Billy Perry:
Right.
Bill Godfrey:
And then-
Jill McElwee:
It's gonna be the closest one to the door, Bill, let's be honest.
Bill Godfrey:
It is.
Jill McElwee:
That's what's been happening, and that's what training... fixes, should fix.
Billy Perry:
Agreed.
Jill McElwee:
So you need your training to fix that. It isn't just the clock. It is the appropriate medical interventions based on the clock. So, and I think that when you were just talking about the loadmaster in a room, that's exactly what needs to happen. Someone, there's always somebody on a scene, right?
Billy Perry:
Right.
Jill McElwee:
If you don't know who it is, it's probably you. Somebody has to take charge of that casualty collection point, the area where the casualties are, and make clear decisions and, and vocalize those decisions. "These three are going in the first ambulance," if appropriate, or, "This one." Because you've gotta have those answers those questions answered of the local capabilities, and those questions have many follow-on questions to them. You know, can... Do you have the human resources? If you got two bench seats, but our medics, we were riding one, you know, how, what can this person, this resource handle? Those questions have to be answered before the incident. So that's where the training...
Billy Perry:
Agreed. And use everybody to the maximum efficiency. And again, like I keep referring to the officers-
Jill McElwee:
They're key
Billy Perry:
... that are assigned to the RTF. Use them as force multipliers in the sense of they, they should be able to do a pressure bandage, you know? And the time to do it is not that day. They need to know, you know, 'cause again, if we've talked to them and they have never put a tourniquet on, then I promise you they've never done Kerlix or a pressure bandage- ... right?
Jill McElwee:
Right.
Billy Perry:
And, and I think you need to know how to do that before 'cause experience is something you learned that you needed to know 10 minutes ago. And that's true in this.
Bill Godfrey:
Yeah, I think that's a very good point. You have officers assigned to the rescue task force whose job it is to keep the task force safe, to, be their security and move them through areas to where they need to be. But once you're operating in an area such as a casualty collection point or in a warm zone, there may be a contact team that's got that security posted.
Billy Perry:
Right.
Bill Godfrey:
And right now-
Billy Perry:
Has it
Bill Godfrey:
... you don't need to pull security.
Billy Perry:
Right.
Bill Godfrey:
You may be needed five minutes from now to pull security when we're moving.
Billy Perry:
100%.
Bill Godfrey:
But right now, "Hey, can you hold this? Can we do this?"
Jill McElwee:
Absolutely.
Bill Godfrey:
"Can we, you move that on-
Billy Perry:
Yes
Bill Godfrey:
... and pass that around?" I would also add, and I mentioned this when we talked about tactics, and I think it applies here as well. When we're talking about medicine, whether it's for cops, for EMTs, for paramedics, or everybody together, you gotta keep the context true So if you're going to do rescue task force movements, make sure that you're doing it with the radio communications that need to be done, the communications with tactical and triage occurring at the same time, and understanding that the security element is responsible for how they're going to navigate you there and where they're gonna move you and how they're gonna move you, and then the medical element is responsible for that medical mission and keeping all that in context. With a casualty collection point, same thing. If you're gonna operate in a casualty collection point, don't start with one already set up. Talk about how it gets set up. And make everyone work through those communications.
Billy Perry:
Absolutely.
Bill Godfrey:
So again, as you split these up into small pieces, don't lose the context with the small pieces. Make sure that the little things all get done in that small drill.
Billy Perry:
Right.
Jill McElwee:
Bill, earlier, in a podcast earlier, we talked about beginning our training with the end in mind, and you just hit the nail on the head with that component. By establishing that casualty collection point knowing what the ultimate goal is, why we're setting and why it needs to be established in a certain way, knowing, having law enforcement know that this isn't more appropriate position for an ambulance exchange point than that because this is what ambulances have to do, this is what, you know, how they maneuver. This locally is why we can only put one patient in this rig. That rig we can load two or three.
Billy Perry:
Oh.
Jill McElwee:
You know, knowing those, having that local knowledge, knowing, "Begin your training with that ultimate goal and that end in mind," is gonna lead us to success.
Bill Godfrey:
Ron, I'm gonna start with you and go around to everybody for a quick wrap-up here. Perfect wishes, what would you like to see in terms of mass casualty care, medical care, for law enforcement and for fire EMS?
Ron Otterbacher:
I think we need to broaden thetraining. I think that we focus so muchon, okay, law enforcement can teach the RTF how to move with an RTF. Well, I think medical needs to teach the law enforcement component there, "If they need the help, this is what we expect you to do." Same with we talk about a casualty collection point, it's usually constructed by the tactical teams that are downrange, but do they know why we create the casualty collection point, what it's used for, where it should be? We kinda skip over those things, and we just assume that everyone understands that's what should happen. I think we just need to broaden our training so that we understand both sides of it. We don't have to do both sides, but we have to understand what you need to be successful. You need to, need to understand what we need to be successful.
Bill Godfrey:
Right. Jill, mass casualty care, what's, what's your gotta have it list?
Jill McElwee:
This is my gotta have it list is, is that clock, is that having the, those of us in the fire EMS side understand that the clock is vitally important to us, that bleeding begins the minute that a person has a penetrating wound. But that clock is specific to each patient, and how we determine that the clock's needs for this patient is a thorough medical evaluation using the, a rapid triage method that looks at the injury. To your point earlier, a lower leg wound, very different clock than a, you know, neck to navel wound. They have a different clock. While the clock is important, let's train, take our training to that next level where we're focused more on the physiology of the wounds.
Bill Godfrey:
Billy, what's on, what's on your gotta have it list for law enforcement, fire, EMS in terms of medical care?
Billy Perry:
I think that law enforcement officers need to have actually done it a couple of times at minimum. I think if you're on a scene, I mean are y'all gonna stop, stop him from putting a pressure bandage on?
Jill McElwee:
Uh, no.
Billy Perry:
No. And I mean, do it. And I think we let golden opportunities by. I've preached forever about we let firefighters breach on a check welfare. Why? Get an opportunity to do a breaching run, because the worst firefighter in the house can out-breach the best SWAT breacher.
Ron Otterbacher:
Absolutely.
Billy Perry:
Is that not a- That's, and that, those are just hard truths.
Bill Godfrey:
Yeah.
Billy Perry:
And I think we need to learn how to apply tourniquets.
Jill McElwee:
Yeah.
Billy Perry:
We need to learn how to put a pressure bandage on. We need to know how to do Kerlix. And I think that's the do all, end all. Because again, we all got into this, we wanted to get in shootings and car chases and stuff, we wanna save lives, and that's part of it. And I think we gotta be force multipliers on those RTFs, and when we're not even with an RTF, when we find ourselves there, we can help do things when everything is, has slowed down.
Bill Godfrey:
I think Jill said it best when she said the clock is so important, but you've gotta remember that it's a clock for each patient. And the clock is specific to the patient, and specific to the nature of the injury. And I think my must-have list would be everyone, fire, EMS, law enforcement, everyone needs to understand that not everybody has to be rushed out. The injuries that require the rushing need to be rushed out. But if I'm sitting there looking at somebody that, is having difficulty breathing because they've got a tension pneumo, that patient doesn't need to be rushed out. That patient needs-
Jill McElwee:
Needs a needle
Bill Godfrey:
... needs a, a needle decompression so that they can start breathing again.
Billy Perry:
Their clock's in a different time zone.
Bill Godfrey:
Yeah.
Billy Perry:
They're a long time from midnight.
Bill Godfrey:
Yeah. Yeah. They, they, uh-
Jill McElwee:
Oof
Bill Godfrey:
... absolutely. So I think if we could get as a primer the medical training could get everybody in the stack on the same page that, yes, the clock is the almighty clock but that clock is unique to each patient based on their injury, I think we could make a lot of progress on improving this.
Billy Perry:
Brilliant.
Bill Godfrey:
All right.
Jill McElwee:
Agreed.
Bill Godfrey:
Ladies and gentlemen, thank you very much for coming in. For those of you that are listening, we've got a couple more podcasts coming up on how to pick great training for your agency. So be sure to like and subscribe so that you don't miss out on that.
Thank you to our producer Karla Torres, and until next time, stay safe.