r/Paramedics • u/TB5537 • Jul 05 '25
US EMS gear for MCI. Looking for input.
Hey everyone,
I’m a paramedic with a municipal EMS agency, and we’ve recently been putting a lot of focus on mass casualty incident and active shooter response readiness. We’ve been working closely with law enforcement in our area to run drills and tabletop exercises, and as a result, we’re taking a hard look at revamping both our gear setup and our operating procedures for these high-threat, multi-patient events.
We cover a mix of high-population locations including malls, schools, and frequent large-scale public events, so we’re aiming to tighten up everything from equipment to tactics to patient flow in the early phases of chaotic scenes.
Our agency is equipped with ballistic vests and trained to operate in warm zone environments alongside law enforcement during active shooter or other high-threat incidents.
Currently, we carry a small, dedicated MCI bag that includes: • NPA’s • Compact BVM • Needle decompression kits • Mylar blankets • Webbing • TQ’s • Chest seals • Israeli bandages • Quick Clot • Gauze and pressure dressings
We’re looking to improve this setup, both in terms of what’s carried and how it’s deployed. We’re also reassessing our staging, triage, extraction, and treatment models for active shooter and MCI situations.
I’m curious how other EMS agencies and tactical medics across the country are approaching this: • What gear do you carry specifically for MCI/active shooter incidents? • Do you use specialized bags or kits? • How do you handle triage, treatment, and extraction in these scenarios? • Any lessons learned from real-world incidents or trainings that have shaped your approach?
We’re in the early stages of researching how other agencies set up their gear and what systems they have in place to support them during large-scale incidents. For example, one of our stations is centrally located within our district, and I’m planning to establish what is essentially a “doomsday bag.” This would be a large, well-stocked bag stored at the station, accessible to any responding resource—EMS, fire, police, or other municipal personnel.
The bag would contain a significant supply of trauma and bleeding control equipment, airway management tools, and other essential resources needed to manage mass casualty incidents. The goal is to ensure that any responder has immediate access to critical equipment when it’s most needed.
We’re trying to balance speed, simplicity, and effectiveness without overloading our people with gear they won’t actually use in the first critical minutes of an incident. Any input, advice, or photos of setups would be hugely appreciated. Thanks in advance!
22
u/Additional-Cheek2427 Jul 05 '25
If you need a BVM they are black tag. Triage tags also are a disaster to use while in the moment especially if you have another agency on your RTF assisting. We have moved to using flagging tape as it’s easier to use and also no confusion as to the classification. I would look into adding a few foldable patient litters to a bag that somebody brings in with you. After the last few MCI/active shooter events and drills you won’t need much for treatment just evacuation to a collection point.
7
u/emergentologist Jul 05 '25
Triage tags also are a disaster to use while in the moment especially if you have another agency on your RTF assisting.
Agreed - triage tags suck and I wish they would fall out of favor in the textbooks.
3
u/Resus_Ranger882 CCP Jul 05 '25
We use tape — they’re like the long colored ribbons used in flag football
2
u/Additional-Cheek2427 Jul 05 '25
Lowe’s or Home Depot has flagging tape that is super cheap. We have kits that have them in a nice roll and bag but no need if your agency can’t afford it.
2
16
9
u/Lurking4Justice Jul 05 '25
Throw bags. Self contained with tqs and stop the bleed. There can be a bigger bag with your binder and tags and airways and tqs for EMS
But assuming you'll be interfacing with pd and fire at an active shooter scene throw bags let you distribute simple life saving equipment to them and your guys while keeping it simple
You'll also have you're additional shit handy for treatment officers in a separate bag/compartment which should be non issue since they should be relatively static and with the bag and your literally hucking the smaller pouches at other crews to triage
Also works really well in systems that use fire/pd hybrid response system and island extrication zones during active responses where an entry squad might drop one fire medic to place a two and drag someone out if they've cleared all the ground behind them iirc from my lil baby active shooter training
2
u/stupid-canada CCP Jul 06 '25
Vacuum sealing the packages with a packing list and expiration, and most critically a pre started tear can also help with space. Something like some chest seals, rolled gauze, quick clot and a tq.
6
u/emergentologist Jul 05 '25
If you're talking about a first in bag for a true large-scale MCI, all you need/want are a shit-ton of tourniquets and maybe some chest seals and hemostatic gauze. Could consider some black/red/yellow tape as well.
Another thing to consider is a cache of "throw kits", which are little self-contained personal bleeding control kits. They usually contain a tourniquet, chest seal, and trauma dressing, and are meant to be 'thrown' out to bystanders or non-medical first responders at a large-scale MCI.
4
u/Cool-Style7426 Jul 05 '25
Nit picky but i prefer h bandages over israeli, israeli are so easy to snap in a high stress situation when resources matter.
5
u/Resus_Ranger882 CCP Jul 05 '25
Get the orange tourniquets and ditch the black ones. This isn’t Ramadi.
3
u/Asystolebradycardic Jul 05 '25
Our system is moving to Adjuncts, chest seals, decompression needles and a bunch of TQs.
3
3
3
u/jkhu12 Jul 05 '25
Large permanent markers. And think about equipment for night/low light operations like small flashlights to see or glow sticks for marking areas. Also have a bag that can be used at a casualty collection point. Different tarps that are large and match triage colors to make organizing the CP easier
2
u/OddAd9915 Paramedic (UK) Jul 05 '25
It will depend on your doctrine and what mass casualty triage system you use. My experience is in the UK where I am a specialist responders for Marauding Terrorist Attack, what used to be termed active shooter but due to our threat profile being significantly different to the US's. However our risk of explosives is still deemed high, along with vehicle and bladed weapon attacks so our kit is set up to manage a mixture of blunt, penetrating and blast trauma. But these kits would also get deployed for any masscass event like a stadium collapse or just a large RTC such as a coach or bus crash.
My trusts MTA equipment for specialist responders is NPAs, OPAs, tourniquets (mostly CATs but there a decent number of SOF-Ts still in bags) pressure dressings (Israeli or Olyas) blast dressings, haemostatic gauze, triage tags, blue chemist lights (due to police and security service tactical doctrine) and door wedges. Door wedges really can't be undersold as to how useful they are for holding things either open or closed if required. Each responder should have half a dozen as they weigh very little and are much more helpful than you realise, they are also very inexpensive.
Current National Ambulance Resilience Unit guidelines binned off the chest seals as their current thinking is tension disease is a slower process and not treated in the Cat Hem "Treat and Leave" type management we do for MTA type response. But we aren't expecting a large amount of ballistic trauma.
Management of tension for us would be done in the Casualty Collection Point, along with most other interventions that don't really focus on cat hem or basic airway management.
For setting up the CCP, a simple solution is several cheap plastic storage boxes in the back of a commanders or response vehicle. With red, yellow and green tarps to be visual identifiers for where your P1,2 and 3 casualties go and the boxes then just have more dressings, basic airway adjuncts and whatever else you feel is required in the CCP as this way one person can set up the CCP quickly and easily. In the UK we have "Cubes" which are a purpose designed CCP "bag" that's a 2 man carry but you unfold it and it has basically EVERYTHING except medication (IO, cannula, traction splints, pelvic binders, iGel and ET tubes and laryngoscopes, manual suction etc.) but these are probably hideously expensive when simple stackable storage boxes will achieve pretty much the same thing for a fraction of the price.
You also need as many casualty litters as you can carry. I have been at several exercises where we resorted to using tablecloths and curtains as makeshift drag sheets and carry sheets because we simply did kit have anywhere near enough litters. This was also one of the big takeaways from the 2017 Manchester Arena bombing where the signs and awnings were used in pretty much exactly the same way. But our doctrine for casualties is once they are inf a litter it would stay with them to the hospital as it will probably be what they are moved on all the way until they are loaded into the ambulance and we almost certainly won't be getting them back.
2
u/Resus_Ranger882 CCP Jul 05 '25
What gear do you carry specifically for MCI/active shooter incidents? / Do you use specialized bags or kits?
Each truck has 2 triage bags on it which contain tourniquets, needles for decompression, and chest seals.
The fire department keep large triage bags on every truck that has the same equipment but in larger quantities and they carry megamovers.
How do you handle triage, treatment, and extraction in these scenarios?
We train with PD and FD twice a month on MCI drills where we actually have a “shooter” and pd goes in with simmunition and clears the building, then they send an escort for fire who comes in and triages, sets up a CCP and designates a pickup area for the ambulances. Red patients get to transported first. Ambulance shows up to the designated point and the medic and EMT don’t even get out of the truck. Fire brings the patient out and loads them in the ambulance and we leave.
Any lessons learned from real-world incidents or trainings that have shaped your approach?
Green patients go last. Old approach was to get them out in order to clear the space, but the problem that caused is that we had trauma centers being bogged down with minor injuries like scrapes and cuts, so then when the reds and yellows were transported a bunch of the rooms were taken up by people with minor injuries.
1
u/undertheenemyscrotum Jul 05 '25
We don't carry specialized kits. We are all alerrt trained and form rapid response teams with fire and police and go inside and triage and stop the bleeding. After that, normal units respond to a casualty collection point with an ambulance.
1
u/Etrau3 Jul 05 '25
Really? So y’all just bring your normal big bulky kits with you
1
u/undertheenemyscrotum Jul 05 '25
Just a bag full of tourniquets and chest seals.
5
u/therealsambambino Jul 05 '25
A big bag of only TQs and chest seals… Isn’t that a specialized kit?
2
1
1
u/themakerofthings4 Jul 05 '25
Our agency carries the NAR bags that are pre made but carry 4 decompression needles, 4 tqs, 4 packs hemostatic, 4 blood stoppers, 4 other trauma bandages, tags, tape, couple npas, couple trauma blankets, and sharpies. We have a second bag that's more bandages and chalk. Beyond that any agency that responds with us (fire or rescue) have their own armor and bag setups that are basically just tqs, bandages, deco, hemostatic, and tags.
Personally I'd ditch the bvm, no need for it in this case.
1
u/the_irons_1873 Jul 05 '25
Off topic question, what bag is that? I’ve been wanting to put a kit together for my car and that looks like a great size!
1
1
u/DrSussBurner Jul 05 '25
As someone who was in a severe MCI: triage tags. Lots of triage tags.
1
u/Additional-Cheek2427 Jul 05 '25
For outside triage sure…for inside warm zone operations absolutely not. They are a disaster and your other members of the RTF have absolutely no clue how to use them. It’s way easier to have flagging tape to quickly wrap around two limbs and move on. Triage tags fall off or get torn off on the wrong level or lost in the shuffle out.
1
u/MolecularGenetics001 Jul 05 '25
Have flagging tape built into the kit or have triage fanny packs that go along side this kit
1
u/Jesus_N Jul 06 '25
You don’t need a bvm , aside from that all other equipment is good just add a lot of triage tags and have trainings on those triage tags and what they mean , in a critical situation most won’t see or acknowledge a triage tag. Also I recommend if possible most of the paramedics do their tactical paramedic Training so instead of working in the work zone you are able to help and service your community to the best of your ability regardless of law enforcement is there or isn’t. But biggest thing is triage tags , triage training and quick treatments if they are good established an access IV/IO and move on. If they are dead don’t waste time and keep it moving. The faster you triage someone and move on gives more time for those who really need the help in that moment it might sound harsh but that’s the best approach to it
2
u/Additional-Cheek2427 Jul 06 '25
In what warm zone setting are you establishing IV/IO access? None is the correct answer. That should never be in the kit you bring inside with you.
1
u/Lanky-Guitar3832 Jul 06 '25
Recommend building around the MARCH algorithm; US military medics have pretty nice setups with labeled/removable pouches.
My $0.02; in an MCI you probably won’t need the BVM, but at some point patients will be triaged and additional care initiated, at which point you may regret not having the BVM.
And as someone else mentioned, the throw bags (IFAKs) could be a force multiplier.
1
u/terraspyder Paramedic Jul 06 '25
Slightly side topic but I feel like I never see it discussed: is fitness a core part of your MCI preparation/training?
Do you practice how to extricate people from those situations? Do you guys practice, as a team, carrying heavy things for distances? People are heavy. Let alone people shot up, trampled, etc who are dead weight. Especially when you’re potentially wearing ballistic gear.
Our RTF guys get together monthly for training sessions, practicing buddy carries, drags, sled pulls, farmer walks, Mogadishu miles and other stuff while wearing gear.
1
u/RJM_50 Paramedic Jul 07 '25
Whatever you plan for won't be the one MCI you actually have to work during your career. It's not common and impossible to plan for; unless you're part of it. Just do your best and don't get stuck with a BVM before you've tagged all the patients.
Best advice is to get Law Enforcement to keep civilians out so you're not confused with additional people entering the area. That's when it becomes chaos, mass civilians walking in to watch or pretend to help.
1
u/Candyland_83 Jul 05 '25
Our bags have what you listed minus the bvm and including triage tags and tape. And I don’t think we need the tags/tape. The bag is the size of a small backpack.
I use it for any shooting/stabbing. I bring that and the cot. It’s super useful because if they need something that’s not in that bag, it’s not really that serious and I can go back and get it.
0
u/starbuckleziggy Jul 06 '25
Best bit of kit: a well informed and voting public to ensure a lack of fire arms and weapons to be carried. Advocacy is one of best tools, alongside any health promotion in our day to day 🤙🏼
66
u/nickeisele Jul 05 '25
Get rid of the BVM, you won’t be bagging anyone at an MCI, at least during the initial phase. Tourniquets, chest seals, decompression needles, hemostatic gauze, webbing, and maybe triage tags or colored tape are all you need. Take a TECC course and see what equipment you’ll need.