The Survival Gap: Comparing Three Active Shooter Response Mo

When viewed strictly through the lens of time from the end of "Stop the Killing" to the beginning of meaningful "Stop the Dying" operations, the primary difference between the three models is who provides the first lifesaving intervention and when it occurs.

One of the strongest arguments for minimizing the time between "Stop the Killing" and "Stop the Dying" is that casualty survival is highly time dependent. While no model can predict exact survival rates because injuries vary dramatically, we can estimate the effect of treatment delays based on trauma literature, military experience, TECC principles, and active shooter after-action reviews.

The Three Casualty Groups

Immediate Deaths (Non-Survivable)

Examples:

• Catastrophic brain injury 
• Aortic disruption 
• Massive cardiac destruction 

These victims die regardless of how quickly rescuers arrive.

Estimated: 15–30% of fatalities

Potentially Survivable Casualties

Examples:

• Extremity hemorrhage 
• Junctional hemorrhage 
• Tension pneumothorax 
• Airway obstruction 

These are the victims who benefit most from rapid intervention.

Estimated: 10–20% of fatalities are potentially preventable.

These are the lives won or lost during the transition from Stop the Killing to Stop the Dying.

Delayed Casualties

Examples:

• Abdominal wounds 
• Liver injuries 
• Splenic injuries 
• Lung injuries 

These patients may survive for tens of minutes to hours but require evacuation and definitive care.

Estimated Survival Impact

Traditional Secure Scene Model

Historically:

• Threat stopped 

• Entire structure cleared 

• EMS staged outside 

• Scene declared safe 

• EMS enters 

Time to care:

20–60 minutes

For critically bleeding patients:

Injury Estimated Survival

Massive extremity hemorrhage - Poor

Junctional hemorrhage - Very poor

Airway compromise - Poor

Tension pneumothorax - Poor

Many potentially survivable casualties die before treatment.

Rescue Task Force Model

Time to care:

8–15 minutes

Advantages:

• Earlier tourniquets 

• Earlier airway management 

• Earlier extraction 

Estimated effect:

• Significant reduction in preventable deaths 

• Better survival among critical patients 

Law Enforcement Rescue Model

Time to first intervention:

1–5 minutes

Advantages:

• Tourniquets applied immediately 

• Casualties moved immediately 

• No waiting for RTF assembly 

Estimated effect:

• Maximum impact on hemorrhage survival 

• Greatest benefit for extremity bleeding 

Limitation:

• Limited medical capability 

• Difficult during large casualty counts 

Example: 50-Victim Active Shooter

Assume:

• 50 victims 

• 10 immediate fatalities 

• 15 critically wounded 

• 25 delayed/minor injuries 

Of the 15 critically wounded:

Model Potential Survivors

     Traditional secure scene: 6–8

     Rescue Task Force: 9–11

     Law Enforcement Rescue: 11–13

     Hybrid LE Rescue + RTF: 12–14

These are not precise predictions, but they illustrate a consistent principle:

Every minute saved in hemorrhage control and evacuation increases survival.

What Matters Most?

The largest survival benefit usually comes from:

First 3–5 Minutes

• Tourniquet 

• Movement from kill zone 

• Airway positioning 

First 10 Minutes

• RTF treatment 

• Extraction 

• Triage 

First 30 Minutes

• Surgery 

• Blood products 

• Definitive care 

The Operational Reality

For most active shooter incidents, the difference between the models is not whether the shooter is stopped.

The difference is: How many victims receive meaningful care in the first 5 minutes?

- A casualty with a femoral artery injury may be dead in 3–5 minutes.

- A casualty with a tension pneumothorax may be salvageable for 10–20 minutes.

- A casualty with an abdominal wound may survive long enough to reach surgery.

Because of this, the greatest survival gains occur when law enforcement begins rescue operations immediately after enough force exists to prevent additional victims, while simultaneously establishing the conditions for Fire/EMS to enter and assume the "Stop the Dying" mission.

For your teaching, a useful way to frame it is: The clock does not start when Fire/EMS enters. The clock starts when the first victim is shot. Every minute between "Stop the Killing" and "Stop the Dying" consumes survivability.