Introduction: Redefining the Medical Timeline

Active shooter incidents are defined by speed, confusion, and rapid deterioration of conditions. In the early minutes, known as the Chaos Phase within the Chaos-Stabilization-Recovery (CSR) framework, decisions must be made in real time—under stress, under fire, and with limited information. The ability to adapt in those critical moments can be the difference between life and death.

Medical Rescue Teams (MRTs), trained in Tactical Emergency Casualty Care (TECC) and familiar with tactical operations, are at the heart of the CSR model’s medical response. Their role during the Chaos Phase is not to wait—it is to move. MRTs deploy forward into secured segments of the hot zone to deliver immediate interventions, relieve point-of-injury care from law enforcement or civilian bystanders, and initiate casualty collection. They do this by establishing Hasty Casualty Collection Points (Hasty CCPs), where rapid triage, hemorrhage control, and airway stabilization can begin before transport resources arrive. This allows law enforcement to move forward neutralizing or containing the threat.

This blog explores the essential function of MRTs and Hasty CCPs during the Chaos Phase and how these elements reshape modern active shooter response from a delayed-care model to a forward-focused, lifesaving operation.

Understanding the Chaos Phase

The Chaos Phase begins the moment the first shot is fired. It is characterized by uncertainty, fluid threats, and the absence of command clarity. The shooter may still be active, the scene is not fully secured, and there is often a lack of real-time situational awareness. Yet, this is precisely when the most lives are lost—often from hemorrhage or airway compromise within the first 5–10 minutes.

Historically, EMS and fire personnel have remained staged during this phase, waiting for law enforcement to “clear” the building. But waiting until a scene is “cold” ignores the operational reality: most preventable deaths occur before formal staging ends. The CSR model disrupts this timeline by preparing MRTs to stage in the Warm Zone and to operate within secured portions of the hot zone under law enforcement escort, even before full command and control is established.

Who Are the Medical Rescue Teams (MRTs)?

MRTs are specially selected and trained EMS and Fire personnel capable of operating in tactical environments. They are not traditional ambulance crews. These teams are:

• Cross-trained in Tactical Emergency Casualty Care (TECC)

• Equipped with trauma kits optimized for rapid, high-threat interventions

• Equipped with tactical vests and ballistic helmets for protection in hot and warm zones

• Skilled in operating within the hot and warm zones under limited security

• Integrated with law enforcement for communications, movement, and security

MRTs are the connective tissue between tactical engagement and medical care. Their job is not transport—it is on-scene stabilization. Their presence allows law enforcement officers to hand off casualties and continue pursuit or area clearing, thereby increasing both force momentum and casualty survivability.

Hasty CCPs: Casualty Care Without Delay

In the Chaos Phase, the traditional model of placing Casualty Collection Points (CCPs) in cold zones is no longer effective. That legacy approach delays care and ignores the realities of high-threat incidents. In modern response, casualties—not maps—determine CCP placement. Hasty CCPs are established where they’re needed most: near the greatest number of wounded, within secure-enough areas of the hot and warm zone.

Hasty CCPs are rapidly deployed, temporary triage sites—not full treatment centers—where MRTs initiate critical interventions like hemorrhage control, airway management, and basic triage. Key features include:

• Proximity to Point of Injury: The closer to casualties, the higher the survival rate.

• Rapid Setup: MRTs carry compact TECC-based kits to treat multiple patients quickly.

• Tactical Positioning: Locations offer cover and security—cleared rooms, protected corridors, or structural barriers.

• Law Enforcement Integration: MRTs coordinate with officers to maintain a security corridor and ensure safe operations.

Importantly, multiple Hasty CCPs may be needed simultaneously during an active shooter event. Until the shooter is neutralized or contained, casualties often cannot be moved freely. MRTs must be empowered to establish localized CCPs wherever casualties are concentrated.

This forward-focused posture shortens the time from injury to care and allows transport units to stage and focus on evacuation, not initial interventions. Hasty CCPs shift the model from delayed evacuation to immediate stabilization—saving lives in the minutes that matter most.

Hemorrhage Control and Airway Management: Priorities at the Front

The medical priorities in the Chaos Phase mirror those of the MARCH algorithm:

Focused Interventions (MARCH):

         M – Massive Hemorrhage: Tourniquets, wound packing, pressure dressings.

         A – Airway: Positioning, basic airway adjuncts.

        R – Respirations: Chest seals, ventilatory assessments.

         C – Circulation: Addressing junctional and non-compressible bleeds, assessing for shock, initiating fluid resuscitation if capable.

         H – Hypothermia & Head Injury: Early insulation to prevent shock and basic management of traumatic brain injury (TBI), including positioning and monitoring for signs of increased intracranial pressure.

The focus is speed, not perfection. MRTs are not there to provide definitive care. Their goal is to prevent preventable deaths—those that occur from bleeding out in the first minutes or from airway collapse while awaiting delayed transport.

The power of MRTs lies in their ability to treat multiple casualties with minimal equipment and within operational constraints. They are the trauma equivalent of a combat lifesaver squad—light, mobile, and mission-critical.

Deployment Considerations: Coordinated Movement Under Fire

Deploying MRTs into the Chaos Phase requires more than bravery, demands structure. Not every active shooter event permits immediate MRT access. The conditions must be evaluated for:

• Security corridor creation: Can law enforcement establish a protected path for MRT movement?

• Communication integrity: Are radio channels aligned between law enforcement and MRT personnel?

• Threat containment: Is the shooter isolated or actively moving? If mobile, MRTs must stage until threat stabilization.

The CSR framework empowers Unified Command (Tactical Command Post personnel) to make deployment decisions based on evolving intelligence—not fixed thresholds. MRTs are trained to respond to a “secure enough” environment, not wait for a cold scene. They move with purpose, with cover, and with immediate medical effect.

From Hasty to Formal: Transitioning the CCP

As the threat stabilizes and command structures solidify, the Hasty CCP transitions to a formal CCP. This transition must be:

• Planned: MRTs relay casualty counts, severity, and CCP status to the Incident Command Post (ICP).

• Supported: Fire and EMS resources bring additional equipment, transport stretchers, and communications.

• Sustained: MRTs shift focus from triage to care management and casualty documentation.

Once the formal CCP is established, MRTs can redeploy forward, or begin extraction with transport crews depending on the operational phase.

Training Implications: Practice Like You Respond

For MRT and Hasty CCP deployment to work in the Chaos Phase, agencies must train accordingly. TECC certification alone is not enough. Teams must rehearse:

• Rapid gear deployment in low-light or high-threat environments

• CCP setup using only what they carry

• Working under escort with law enforcement

• Coordinating triage and casualty movement through warm corridors

• Communicating real-time status updates to Tactical and Incident Command Posts

Joint exercises, scenario-based drills, and after-action reviews must focus on the first 10 minutes—the most dangerous and impactful window of any active shooter response. Hasty CCPs and MRTs must be second nature, not theory.

Conclusion: Acting Decisively in Chaos

The CSR framework revolutionizes how we think about casualty care in high-threat incidents. By embracing MRT deployment and the use of Hasty CCPs in the Chaos Phase, we shift from reactive to proactive, from delay to decisive action. MRTs, operating under coordinated threat intelligence, bring trauma care to the front edge of the crisis—saving lives that would otherwise be lost waiting for “scene safe” declarations that may never come.

This isn’t a question of bravery—it’s a question of readiness, coordination, and operational clarity. MRTs and Hasty CCPs don’t just fill a gap in response—they redefine the standard.