Part 6: Project Implementation – Operationalizing the CSR Framework

Translating theory into practice is a critical step in advancing emergency response capabilities for active shooter incidents. This section outlines the implementation of the Chaos, Stabilization, and Recovery (CSR) framework, a comprehensive model designed to bridge the operational gap between tactical law enforcement and prehospital medical care. Through strategic collaboration among law enforcement, EMS, fire services, and trauma centers, this project tested the CSR model in real-world conditions. Core components of the implementation phase included stakeholder engagement, interagency protocol development, MRT (Medical Rescue Team) training, high-fidelity simulations, and structured evaluation processes. This case study demonstrates how CSR can be successfully integrated into multi-agency operations to reduce treatment delays and improve survivability in complex, high-threat environments.

Implementation Goals

The primary objective of this project was to test the practical utility of the CSR framework in a active shooter event.

Specific Implementation Goals Included:

Developing an integrated operational protocol for concurrent law enforcement and medical response within hot zones.

Establishing and training Medical Rescue Teams (MRTs) capable of functioning within hostile environments (Graham, 2018).

Evaluating the efficacy of the protocol in terms of response time, casualty stabilization, interagency coordination, and safety outcomes.

Stakeholder Identification and Collaboration

The implementation process will begin by pinpointing essential stakeholders and securing their active involvement. A coalition will be formed between three primary agencies: The coalition includes five main agencies: law enforcement operating regionally alongside a metropolitan EMS and Fire department, the trauma response section from a neighboring hospital, and Emergency Management Agency Director (EMA) (DHS, 2015). Key stakeholders will sign a formal Memorandum of Understanding (MOU) that establishes the roles and responsibilities while detailing shared goals.

The monthly interagency planning meetings enabled agencies to collaborate and share knowledge. The meetings provided an opportunity to establish feedback loops, which enabled the incorporation of operational issues into the protocol design. All parties involved approved the integration of CSR Framework and Tactical Emergency Casualty Care (TECC) principles and established cross-training standards to develop MRTs (NAEMT, 2020).

Protocol Development

Based on CSR theory, TECC, and ALERRT guidelines, we created a draft protocol to define MRT deployment procedures in hot zones. The protocol addressed several key functions:

• Real-time threat assessment using integrated communication platforms.

• Simultaneous tactical threat mitigation and casualty triage.

• Responders must quickly manage bleeding and secure airways before extracting patients from danger zones (DHA.CMC, 2023).

• The transfer of patient care responsibilities from field MRTs to trauma centers is a vital step in the protocol.

Tactical medicine experts performed peer reviews on the draft protocol, and their feedback resulted in the document being revised to include recommended changes. The protocol development included careful planning to create communication hierarchies and command structures that followed National Incident Management System (NIMS) guidelines (DHS, 2019).

Training and Capacity Building

The finalized protocol led to the development of a four-week training regime to prepare MRT members and counterparts. The training program incorporated three stages of progressive learning based on the "crawl, walk, run" approach.

1. Crawl Phase (Week 1): The initial week of training delivered classroom instruction on CSR principles alongside legal considerations and TECC fundamentals. The training sequence featured lectures and case study reviews, and incorporated knowledge assessments (Foster, 2022).

2. Walk Phase (Week 2–3): The walk phase featured controlled environment scenario-based simulations through force-on-force drills and casualty care under fire exercises. Demonstrated how cross-disciplinary teams trained together to establish coordination and clarify roles (Blair, Martaindale, & Sandel, 2019).

3. Run Phase (Week 4): During the Run Phase (Week 4) responders will participate in a full-scale field simulation at a decommissioned school where they handled an active shooter scenario that produced more than 30 simulated casualties. High-stress dynamic conditions were used to evaluate medical and tactical skills during this phase (DHA.CMC, 2023).

Each MRT member received advanced individual first aid kits (IFAKs), Mass Casualty Kits (MCK), as well as ballistic protective gear and communication radios that worked with law enforcement systems (Miles & Crook, 2021). Documentation of training sessions included evaluations of protocol compliance and participant involvement.

Full-Scale Simulation Exercise

A full-scale high-fidelity simulation that replicated a complex active shooter scenario marked the end of the implementation phase. This simulation is designed to engage 30 participants who adopt roles as both victims and aggressors. The exercise begins with a simulated 911 call and concludes with patient hand-off at the trauma center.

Observers utilized standardized evaluation tools to assess performance across several domains:

• Time from initial contact to medical intervention.

• Triage accuracy based on START and TECC protocols.

• Communication effectiveness between agencies.

• Safety compliance and situational awareness.

• Resource utilization and scene management efficiency.

Initial data indicated a marked reduction in time to hemorrhage control compared to traditional response protocols, validating CSR’s emphasis on concurrent operations (DHA.ASM, 2022).

Evaluation and Feedback Mechanisms

Quantitative and qualitative data will be collected through after-action reviews (AARs), pre- and post-training assessments, and debriefing interviews. Key focus includes:

• A reduction in median time to first medical contact.

• High participant confidence in the interagency model.

• Identification of communication gaps related to radio interoperability.

• Physical readiness of some EMS personnel in high-risk environments (Baetzner, et al., 2022).

The implementation team will develop a series of recommendations based on these findings, including the adoption of unified radio systems, reinforcement of joint command training, and the institutionalization of regular interdisciplinary training exercises.

Implementation Challenges

Implementation of the CSR framework can face several challenges. First, resistance from traditional EMS leadership could rise concerning the deployment of medical personnel into unsecured zones. This can be mitigated through evidence-based presentations demonstrating improved outcomes associated with earlier medical intervention (Hill, 2022). Second, logistical limitations—including the availability of training space and scheduling across agencies—impacted training continuity. A flexible modular training schedule will need to be adopted to accommodate varying shift structures.

Resource disparities between agencies could be evident. Smaller departments lacked funding for advanced protective equipment. In response, grant proposals should be developed collaboratively to secure funding from the Department of Homeland Security’s Urban Area Security Initiative (DHS, 2015). These efforts underscored the need for scalable implementation strategies adaptable to agencies with differing capacities (FEMA, 2023).

Ethical and Legal Considerations

The implementation adhered to all ethical and legal requirements. Informed consent was obtained from all training participants. Legal advisors reviewed the CSR protocol to ensure compliance with local and federal laws, especially regarding medical practice in high-risk operational zones.

Sustainability and Future Integration

To ensure sustainability, the project will conclude with a formal handoff of training materials and protocols to the partnering agencies. Train-the-trainer models will be implemented to enable continued internal capacity building. CSR principles should be included in annual joint-agency training calendars and advocated for inclusion in state-level emergency operations guidelines.

The project will also laid the groundwork for academic-practice partnerships to support further research on CSR efficacy. A follow-up study should be proposed to evaluate long-term adoption and performance metrics across different jurisdictional contexts (Berglund, 2017).

Conclusion – Advancing Interdisciplinary Response Through CSR Integration

The implementation of the CSR framework represents a pivotal advancement in active shooter preparedness and response. By uniting tactical and medical disciplines under a shared protocol and mission, the project demonstrated measurable improvements in response times, casualty stabilization, and interagency coordination. The results affirm CSR’s foundational principle: that simultaneous threat mitigation and point-of-injury care are essential for reducing preventable deaths in mass casualty events. While challenges such as logistical constraints, interagency interoperability, and resource disparities persist, the project confirmed that scalable, cross-trained MRTs are feasible and effective. Sustaining this progress will require institutionalizing CSR practices through policy integration, continuous training, and academic-practice partnerships. With ongoing commitment, the CSR framework has the potential to redefine national standards for integrated emergency response and significantly elevate the standard of care in high-risk scenarios.