"Stopping the Killing" Is the Easy Part. "Stopping the Dying

"Stopping the Killing is a tactical skill. Stopping the Dying is a command skill. The agencies that master the transition save the most lives." 

In Active Shooter/Mass Casualty Incident (AS/MCI) response, law enforcement training has historically focused on what officers know best: finding the threat and stopping the killing.

From the academy through in-service training, officers spend thousands of hours developing skills related to firearms proficiency, room clearing, tactical movement, threat identification, decision-making under stress, and the legal authority to use force. These skills are reinforced throughout an officer's career and become part of their routine operational mindset.

Even law enforcement tactical medical training is largely designed around the realities of routine patrol operations—self-aid, buddy-aid, tourniquets, hemorrhage control, and immediate lifesaving interventions. These skills are important and save lives, but only a small portion of that training becomes relevant during a large-scale Active Shooter/Mass Casualty Incident.

The reality is that "Stopping the Killing" is often the easier phase for law enforcement.

The truly difficult phase is "Stopping the Dying."

Once the threat is dead, contained, has fled, or is in custody, the mission must rapidly transition from tactical operations to casualty survival operations. This transition is not primarily a medical problem—it is a command and control problem. The most important lifesaving skill law enforcement can provide during the Stop the Dying phase is not advanced medical care. It is creating an environment within the crisis site that allows Fire/EMS personnel to bring their expertise to the victims.

Firefighters, paramedics, nurses, physicians, and trauma teams possess medical capabilities far beyond those available to patrol officers. Their ability to save lives depends on law enforcement establishing:

• Security

• Command and control

• Secure corridors

• Casualty collection points

• Rescue Task Force integration

• Resource accountability

• Coordinated movement of patients to definitive care

In other words, law enforcement protects the environment that allows medicine to occur. Unfortunately, this is also the least-practiced portion of the response. Most agencies spend far more time training officers to stop the threat than they do training them to manage the transition to casualty care operations. 

Conducting realistic Stop the Dying training is difficult. It requires:

• Large numbers of officers

• Suitable venues such as schools, campuses, malls, or large facilities

• Victim role players

• Fire/EMS participation

• Dispatch integration

• Unified Command participation

• Significant planning and logistical support

As a result, many agencies rarely conduct full-scale exercises that truly test the transition from Stop the Killing to Stop the Dying. Compounding the problem is that these skills are not part of an officer's routine daily duties. Firefighters and paramedics practice patient care every shift. EMS supervisors routinely manage medical resources and patient movement. Hospital personnel operate in casualty care environments every day. Law enforcement does not. Yet during an Active Shooter/Mass Casualty Incident, law enforcement becomes the gatekeeper to survival. The decisions made in the first few minutes after the threat is neutralized determine how quickly victims receive definitive care.

The future of Active Shooter/Mass Casualty Incident response is not simply becoming better at stopping the threat. It is becoming better at recognizing when the threat phase is over and immediately transitioning to the lifesaving operations that follow. Because in these incidents, the greatest opportunity to save lives often begins the moment the shooting stops.

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