Introduction: Transitioning from Chaos to Control

In active shooter incidents, the ability to transition from threat suppression to coordinated casualty management marks the difference between mass fatalities and survivable outcomes. While much emphasis is placed on the initial Chaos Phase—rightfully focused on stopping the shooter and initiating immediate care—the Stabilization Phase is where agencies must truly demonstrate interoperability, command cohesion, and medical precision.

The Stabilization Phase of the CSR Framework is not a pause—it is a pivot. It begins the moment the immediate threat is neutralized or contained, and it enables Unified Command to consolidate control over a chaotic scene, establish sustainable casualty care operations, and prepare for full-scale tactical evacuation. It is during this phase that Medical Rescue Teams (MRTs) step into full operational tempo, providing trauma care not at remote staging areas, but at forward-positioned Casualty Collection Points (CCPs) located within the Hot or Warm Zones.

The success of this phase depends on five elements: Unified Command, dynamic triage, tactical casualty management, coordinated evacuation, and continuous reassessment. Together, these elements reduce mortality and form the backbone of a modern, integrated response culture.

Defining the Stabilization Phase

The Stabilization Phase begins only after the active threat has been contained—either neutralized, barricaded, or fled from the scene. While the scene may still hold risks (e.g., unexplored areas, possible IEDs, or secondary threats), the tempo shifts from dynamic threat response to coordinated casualty care and operational expansion.

Where the Chaos Phase is characterized by movement, threat suppression, and rapid life-saving interventions, the Stabilization Phase is about building systems of support:

• Establishing and maintaining Unified Command

• Expanding forward CCPs into structured treatment sites

• Executing dynamic triage and continuous reassessment

• Conducting Tactical Evacuation (TACEVAC) under guarded corridors

• Beginning scene documentation and resource scaling

This phase is not about relaxing posture—it’s about solidifying gains. The goal is to provide sustainable, scalable, and survivable care to all casualties while ensuring the scene remains controlled and secure.

Unified Command: The Cornerstone of Control

Once the shooting stops, the leadership vacuum begins—unless clearly defined Unified Command is in place. One of the most common failures in large-scale incidents is fragmented authority, where police, fire, EMS, and dispatch operate under competing priorities and incomplete information.

The CSR Framework addresses this by requiring immediate implementation of a Unified Command structure in the Stabilization Phase. That includes:

• A Tactical Command Post (TCP) positioned in the Warm Zone, managed by law enforcement and integrated with MRT leadership

• A Incident Command Post (ICP) in the Cold Zone, typically overseen by fire or EMS leadership to manage downstream medical, transport, and public information

• Clearly assigned Operations, Medical, and Logistics section leads

• Shared communications platforms and real-time intelligence exchange

Unified Command ensures that MRTs, tactical units, and transport assets work from the same operational picture, minimizing confusion and maximizing efficiency. It also allows incident leadership to scale resources appropriately, activate mutual aid, and transition smoothly into the Recovery Phase.

Casualty Collection Points (CCPs): Pushing Forward for Better Outcomes

Historically, CCPs were placed in the Cold Zone—far from the threat. This made operational sense under legacy “scene safe” doctrine, but it resulted in delayed care and increased mortality, particularly for patients with hemorrhagic injuries. The CSR model flips that approach.

In the Stabilization Phase, CCPs are forward-positioned—ideally within the Warm Zone and close to the point of injury. These locations are secured by law enforcement and supported by MRTs who bring trauma bags, litters, and basic airway management tools to the site.

Key characteristics of a modern CCP include:

• Proximity: Close enough to reduce evacuation times, far enough to be tactically safe

• Security: Covered by armed overwatch from law enforcement

• Medical Capability: Staffed by TECC-trained MRTs with hemorrhage control supplies, airway kits, and triage tags

• Scalability: Able to handle up to 10–15 patients simultaneously with rapid flow

The CCP is not a hospital—it’s a tactical triage and stabilization zone designed for speed. Time spent here is measured in minutes, not hours. Patients are quickly assessed, treated, tagged, and moved for further care.

Dynamic Triage: The Art of Reassessment

Static triage models—such as the color-coded START system—serve as a helpful baseline, but they are insufficient in dynamic, high-threat environments. The Stabilization Phase introduces dynamic triage, which is fluid, continuous, and focused on reassessment.

Key tenets of dynamic triage include:

• Immediate reassessment after initial interventions like tourniquets, airway positioning, or hemostatic gauze application

• Prioritization based on survivability, not just injury severity

• Adjusting triage tags based on evolving patient condition

• Marking patients for immediate TACEVAC if they deteriorate

MRTs must use MARCH (Massive Hemorrhage, Airway, Respiration, Circulation, Hypothermia/Head Injury) as a functional guide—not just a checklist. This allows them to make field-level decisions about which patients require critical evacuation and which can be stabilized in place.

The integration of triage and tactical movement allows medical teams to make data-driven decisions in real time, ensuring the best possible outcomes for the greatest number of patients.

Tactical Evacuation (TACEVAC): Coordinated Movement Under Fire

Evacuating casualties from forward CCPs requires more than good intentions—it requires a tactical evacuation plan supported by secured corridors, coordinated transport, and staging zones.

TACEVAC during the Stabilization Phase includes:

• Corridor Security: Law enforcement provides armed overwatch along designated casualty movement routes

• Litter Teams: MRTs and fire personnel equipped to move patients from CCPs to transport staging areas

• Triage-Linked Transport: Transport priorities matched to triage categories and reassessment findings

• Hospital Notification: Real-time updates sent to receiving facilities via EMS command or regional coordination centers

This is not a disorganized rush to get patients out. It is a disciplined, controlled extraction of patients based on severity, available resources, and known risks. It also ensures continuity of care—what began at the point of injury continues through handoff at the hospital bay doors.

Continuous Reassessment and Incident Growth

Unlike older models that assumed static scenes, the CSR framework recognizes that incidents evolve over time. New information may emerge. Additional suspects may be located. Casualties may continue to be discovered. The Stabilization Phase, therefore, requires ongoing reassessment of:

• Threat levels

• Resource allocation

• Scene expansion needs

• Responder fatigue

• Scene safety for investigative teams

Unified Command must plan for incident expansion, including:

• Additional CCPs as the scene grows

• Re-assigning sectors to manage growing casualty numbers

• Bringing in behavioral health teams and family reunification staff

• Preparing for media, political, and community pressure

The Stabilization Phase is where planning becomes recovery. If executed properly, it allows communities to begin the healing process while maintaining control over chaos.

Conclusion: The Phase Where Lives Are Truly Saved

The Stabilization Phase of the CSR Framework is where tactical decisions turn into survivable outcomes. It is the bridge between the fight and the recovery—where law enforcement secures the space, MRTs deliver focused trauma care, and Unified Command orchestrates a coordinated, multi-agency response.

Without the Stabilization Phase, the scene remains reactive, disjointed, and prone to operational collapse. With it, we create structure, direction, and above all—the opportunity to save lives that would otherwise be lost.

In the world of active shooter response, speed matters. But so does structure. The CSR Framework ensures both—by making the Stabilization Phase not just a plan, but a practice. And if your agency isn’t training for this now, the time to start was yesterday.