ATP Flow: Why Speed and Efficiency Save Lives in an Active S

ATP Flow in Practice

Stop the Killing → ATP Flow → Definitive Care

1. Threat addressed by law enforcement.
2. Access to victims is established.
3. Victims receive immediate lifesaving treatment.
4. Victims are packaged and transported.
5. Patients reach trauma centers.

The concept emphasizes that survival is driven by movement through the system, not just treatment. A tourniquet applied in a hallway is important, but the ultimate goal is to move the patient rapidly through:

Access → Treat → Package/Transport → Trauma Cente

In the context of an Active Shooter Mass Casualty Incident (AS/MCI), ATP Flow commonly refers to:

A – Access

• Gain access to the victims.
• Law enforcement secures corridors, rooms, and casualty collection points.
• Fire/EMS or Rescue Task Force personnel are moved into the warm zone.
• The goal is to reach patients as quickly as possible.

T – Treat

• Perform immediate lifesaving interventions.
• Focus on:
  • Massive hemorrhage control (tourniquets, wound packing, pressure dressings)
  • Airway management
  • Treatment of chest wounds
  • Rapid triage

P – Package / Prepare / Transport

• Package victims for movement.
• Move casualties to casualty      collection points (CCPs).
• Transfer patients to      ambulances or higher levels of care.
• Begin evacuation and      transportation to hospitals.
• 
  

This ATP flow is often used when teaching the transition from “Stop the Killing” to “Stop the Dying” within the Law Enforcement Rescue Model, Rescue Task Force Model, and Hybrid Response Model.

The Danger of “Parking Patients”

One of the biggest mistakes during a mass casualty incident is allowing patients to accumulate at a CCP while responders focus on treatment.

A CCP is not the destination.

A CCP is a transfer point.

Every minute a critically injured patient remains in the CCP is a minute they are not moving toward surgery, blood products, or advanced trauma care.

The objective is:

Stabilize → Move → Save

not

Stabilize → Wait → Save

Throughput Saves Lives

Think of ATP Flow as a pipeline.

When the pipeline is moving:

• Victims are continuously evacuated
• Ambulances continuously load and depart
• CCPs remain open and functional
• Treatment resources are available for new casualties

When the pipeline slows:

• CCPs become congested
• Ambulances become overwhelmed
• Treatment resources become exhausted
• Mortality increases

The most successful responses are characterized by continuous patient movement.

The Relationship Between Law Enforcement and Fire/EMS

Rapid ATP Flow requires both disciplines working together.

Law Enforcement

• Creates access
• Maintains secure corridors
• Conducts casualty movement
• Supports extraction operations

Fire/EMS

• Performs lifesaving treatment
• Conducts triage
• Packages patients
• Coordinates transport

Neither can accomplish ATP Flow alone.

The Modern Mission

The mission is no longer complete when the shooting stops.

The mission is complete when:

1. Victims are reached.
2. Victims are treated.
3. Victims are moved.
4. Victims are transported.
5. Victims reach definitive care.

The agencies that create the fastest ATP Flow consistently create the greatest opportunity for survival.