Excerpts from the Washingtonpost.com:

I followed news of the Orlando Pulse nightclub shooting with one thing on my mind: Where was EMS? As Omar Mateen’s three-hour assault played out, we now know, the 80 medics on the scene were kept more than 100 yards from the club, outside the hot zone. Many of the injured were transported to hospitals in pickup trucks.

The same was true during the Columbine school shooting in Littleton, Colo., in 1999, when crews waited outside nearly an hour for a SWAT team as a teacher lay dying. Medics were also kept from entering the Aurora, Colo., movie theater where 12 people were killed in 2012. Cops took many of the victims to hospitals in their squad cars.

After these tragedies, grieving friends and family have pressed officials for answers — why were the lifesavers kept from the victims?

I understand that frustration. I was a paramedic for nearly 10 years. In that time, my job certainly put me in danger’s way; like many of my co-workers, I believed that saving a patient’s life was worth losing my own. But because EMS departments (rightly) prioritize the safety of their crews, we were encouraged to stay on the periphery of crime scenes.

This approach is outdated. Paramedics must be trained to respond in dangerous environments, and they should be given the tools they need to stay safe. With the uptick in mass shootings across the country, we can’t afford to keep them on the sidelines.

Early in my training, my instructor presented my class with a seemingly simple scenario: man down in the street. But after my partner and I rushed to his side and began rendering care, our teacher yelled that we were both dead. By not confirming that the scene was safe, we’d stepped on the same downed power line that had electrocuted our patient. Now there were three people dying in the street.

The point of that exercise was to drill into our heads that if we don’t protect ourselves, we can’t save anyone else. Our instructors told us that we’re sent into very dangerous situations not to impose order but to save lives.

Yet once I got into the field, I realized how tough it is to follow this advice. Often, a scene considered safe at the time of dispatch quickly and unexpectedly spirals into chaos; just because nobody had pulled a weapon when 911 was called doesn’t mean that won’t happen when we show up.

Which is why it’s time for [EMS personnel] to adopt a new model, one that acknowledges the reality of the job.

Some places are already heeding this call. Departments such as Dallas Fire-Rescue and Pennsylvania’s West End Ambulance Service have ordered bulletproof vests and helmets for paramedics. In states including Michigan, Virginia, and New York, EMS departments are teaching paramedics how to enter violent scenes long before they’re deemed safe in order to speed up treatment and save more lives. In this rescue task force training, endorsed by FEMA, paramedics learn the language and choreography of armed entry.

They learn how to team up with armor-clad cops to enter buildings where active shooters are on the loose. They learn how to identify warm zones — relatively safe areas at a shooting scene where patients can be collected, treated and readied for transport. Rather than diagnosing and treating patients where they’re found, the rescue task force model focuses on rapid triage, stabilizing life-threatening injuries, and getting patients off the scene as quickly as possible. “We have to get in there to stop the dying,” E. Reed Smith, medical director of the Arlington County Fire Department in Virginia, told the Los Angeles Times. “As long as we’re standing outside, we have not stopped the dying.”

The rise in active-shooter situations makes this training all the more important for cops and paramedics. Between 2000 and 2006, there were an average of 6.4 active-shooter incidents a year; that jumped to 16.4 between 2007 and 2013.

In many cases, people died while waiting for help that was just outside the door. Patients treated within 60 minutes of an injury have the best chance of survival. The majority of gunshot victims who receive care within five minutes survive. After the 2013 Boston Marathon bombing, an article in the Journal of the American Medical Association attributed the miraculous survival rate — 261 of the 264 casualties — to the fact that EMS units were already on the scene when the bombs detonated and went to work immediately.

It’s good that EMS is shifting to meet the demands of a new, more dangerous world. But as we make this transition, we need to stay focused on our core goal — patient care. Paramedics cannot be cops, and they shouldn’t try to be. Even as we enter crime scenes faster, our goal cannot be helping only the good guys, or working with police to catch criminals.

Imagine if paramedics had entered the Pulse nightclub and started treating patients immediately. Imagine medics in flak jackets and helmets, surrounded by police assault rifles, setting about the critical work of saving lives right there on the dance floor. Would more people have survived if EMS had been able to treat patients sooner? The answer is almost certainly yes.

Another active-shooter incident is all but certain. Maybe next time, the paramedics will be right there, in harm’s way, saving lives. That’s as it should be.

Tags: E. Reed Smith medical director of the Arlington County Fire Department, EMS and active shooter incidents