title: Emergency medical services response to active shooter incidents: provider comfort level and attitudes before and after participation in a focused response training program.
abstract: BACKGROUND
  Emergency Medical Services (EMS) routinely stage in a secure area in response to active shooter incidents until the scene is declared safe by law enforcement. Due to the time-sensitive nature of injuries at these incidents, some EMS systems have adopted response tactics utilizing law enforcement protection to expedite life-saving medical care.
  
  
  OBJECTIVE
  Describe EMS provider perceptions of preparedness, adequacy of training, and general attitudes toward active shooter incident response after completing a tactical awareness training program.
  
  
  METHODS
  An unmatched, anonymous, closed-format survey utilizing a five-point Likert scale was distributed to participating EMS providers before and after a focused training session on joint EMS/police active shooter rescue team response. Descriptive statistics were used to compare survey results. Secondary analysis of responses based on prior military or tactical medicine training was performed using a chi-squared analysis.
  
  
  RESULTS
  Two hundred fifty-six providers participated with 88% (225/256) pretraining and 88% (224/256) post-training surveys completed. Post-training, provider agreement that they felt adequately prepared to respond to an active shooter incident changed from 41% (92/225) to 89% (199/224), while agreement they felt adequately trained to provide medical care during an active shooter incident changed from 36% (82/225) to 87% (194/224). Post-training provider agreement that they should never enter a building with an active shooter changed from 73% (165/225) to 61% (137/224). Among the pretraining surveys, significantly more providers without prior military or tactical experience agreed they should never enter a building with an active shooter until the scene was declared safe (78% vs 50%, P = .002), while significantly more providers with prior experience felt both adequately trained to provide medical care in an active shooter environment (56% vs 31%, P = .007) and comfortable working jointly with law enforcement within a building if a shooter were still inside (76% vs 56%, P = .014). There was no difference in response to these questions in the post-training survey.
  
  
  CONCLUSIONS
  Attitudes and perceptions regarding EMS active shooter incident response appear to change among providers after participation in a focused active shooter response training program. Further studies are needed to determine if these changes are significant and whether early EMS response during an active shooter incident improves patient outcomes.
authors.affiliation: 1Department of Emergency Medicine,Boston University School of Medicine,Boston,MassachusettsUSA.
authors.forename: Jerrilyn
authors.initials: J
authors.lastname: Jones
authors.affiliation: 1Department of Emergency Medicine,Boston University School of Medicine,Boston,MassachusettsUSA.
authors.forename: Ricky
authors.initials: R
authors.lastname: Kue
authors.affiliation: 1Department of Emergency Medicine,Boston University School of Medicine,Boston,MassachusettsUSA.
authors.forename: Patricia
authors.initials: P
authors.lastname: Mitchell
authors.affiliation: 3City of Boston Police Department Training Academy,Boston,MassachusettsUSA.
authors.forename: Gary
authors.initials: G
authors.lastname: Eblan
authors.affiliation: 1Department of Emergency Medicine,Boston University School of Medicine,Boston,MassachusettsUSA.
authors.forename: K Sophia
authors.initials: KS
authors.lastname: Dyer
mesh_terms: D001291:Attitude of Health Personnel; D001900:Boston; D004189:Disaster Planning; D004632:Emergency Medical Services / Q000458:organization & administration*; D004634:Emergency Medical Technicians / Q000193:education*; D005260:Female; D005389:Firearms; D006801:Humans; D008297:Male; D054527:Mass Casualty Incidents; D016495:Police / Q000193:education*; D011795:Surveys and Questionnaires; D014948:Wounds, Gunshot / Q000628:therapy*