Tactical Medical Training for Patrol

Many Tactical Medical training programs focus 70% on medical, 25% on drags and caries, on maybe 5% if at all on the command and control of the incident by law enforcement. While that might be appropriate for a single gunshot victim in let's say and attempted robbery, it is the wrong focus for an Active Shooter/Mass casualty incident. 

Let me explain. The definition of a mass casualty incident is that the number of casualties exceeds the available medical resources such as a train derailment. In an active shooter/mass casualty incident, this is not even considering if the ongoing threat to civilians and officers still is ongoing. If there is no threat then why are we not bringing in the medical professionals, Fire/EMS who with their expertise. If there is an ongoing unknown threat, the primary role of law enforcement is to stop the threat. However, if there is an abundance of law enforcement resources, you maybe decide to divide the Law enforcement responsibilities to rendering aid in the warm zone and other officers to pursue to threat in the hot zone. And how is this determine, by officers on the interior of the crisis site exercising command and control of the incident.

This process of determining the responsibilities of law enforcement is all determined by the command and control of officers on the interior of the crisis site. So should this not be the primary focus for law enforcement preparing to respond to and active shooter/ mass casualty incident?

Most tactical medical training programs are misaligned with the reality of active shooter and mass casualty incidents. 

They tend to emphasize ~70% medical skills, ~25% drags and carries, and little—if any—focus on command and control by law enforcement. That approach may be appropriate for a single-victim incident—an attempted robbery, an isolated shooting—where care is the priority.

But it is the wrong focus for an active shooter or mass casualty event.

Here’s why.

A true mass casualty incident is defined by casualties exceeding available medical resources—like a train derailment or large-scale disaster. But in an active shooter, that definition is incomplete, because it fails to account for the ongoing threat.

If there is no active threat, the solution is straightforward:

👉 Bring in Fire/EMS immediately—those with the training, equipment, and expertise to treat and transport.

But if there is an ongoing or unknown threat, the priorities shift:

👉 Law enforcement must stop the killing first.

Only after—or sometimes simultaneously with—that effort can we begin to stop the dying.

Now the real question becomes:

Who does what, and when?

If sufficient law enforcement resources are present, roles may need to be divided:

• Some officers continue to address the      threat in the hot zone 
• Others begin life-saving      interventions and evacuation in the warm zone 

That decision is not made at a command post.

It is made by officers on the interior of the crisis site, in real time, under pressure.

That is command and control.

This dynamic allocation of resources—threat suppression, corridor creation, RTF integration, evacuation priorities—is entirely driven by interior command and control in the first minutes of the incident.

So the critical question is:

👉 If these decisions determine whether victims live or die…

👉 If they shape the entire operational response…

Why isn’t command and control the primary focus of law enforcement training for active shooter and mass casualty incidents?