Part 4: The CSR Framework – A Phased Response to Active Shooter Incidents

As active shooter events grow in frequency and complexity, traditional emergency response models have shown critical limitations, especially in integrating medical intervention within tactical operations. The CSR (Chaos, Stabilization, Recovery) framework offers a comprehensive solution by structuring response efforts into three distinct, interdependent phases. Aligned with the National Response Framework (NRF), CSR enhances interagency coordination, ensures timely medical care, and establishes a scalable system to manage high-risk, rapidly evolving incidents. By embedding tactical medical capabilities into all stages of the response, CSR minimizes preventable deaths and streamlines operations from the point of threat engagement through community recovery. This section outlines each phase of the CSR model, demonstrating how it transforms modern response strategies by improving survivability, accountability, and overall mission success in the face of active shooter threats.

The CSR Framework: Chaos, Stabilization, and Recovery

            The CSR framework effectively addresses these complex challenges by organizing the response to active shooter incidents into three distinct and well-defined phases: Chaos, Stabilization, and Recovery (CSR). This method meets the National Response Framework (NRF) and provides a flexible yet structured system that efficiently manages dangerous and unpredictable critical events and ensures coordinated and prompt responses (DHS, 2019).

Chaos Phase

            The Chaos Phase requires law enforcement to immediately enter the building to neutralize threats or perform deliberate clearing operations. Other responding officers will reinforce entry teams in the Hot Zone and establish a tactical command post at the staging point for additional officers and Medical Rescue Teams (MRTs) in the Warm Zone. The tactical command post will evolve into the Incident Command Post (ICP) and stage additional supporting staff for deployment in the Cold Zone. Traditional medical response models can delay life-saving treatment because they require moving victims to external Casualty Collection Points (CCPs) in the Warm or Cold Zone before medical care starts, which raises the chance of avoidable fatalities (Miles & Crook, 2021). The CSR model resolves this problem by integrating Medical Rescue Teams (MRTs) consisting of EMS and fire personnel trained for tactical operations directly with law enforcement teams to deliver point-of-injury care immediately (Hanifen, 2023). During this stage, law enforcement teams work quickly to control threats and deliver medical attention to wounded individuals before MRTs reach full operational status. Law enforcement officers who serve as first responders detect and tackle threats to prevent additional harm despite operating under high-stress situations with minimal available information (Phillip, 2020). To stabilize the situation and minimize casualties, MRTs must be established and deployed swiftly, and work in coordination under these challenging conditions (Dailey & Laskey, 2023).

            During this phase, the ICP is operational with command staff present, and the formation of Medical Rescue Teams (MRTs) is a vital and critical component. MRTs, consisting of law enforcement, EMS, and Fire professionals, collaborate to execute vital life-saving interventions, including bleeding control, airway management, and casualty stabilization. The framework of CSR fills the gaps in the operational Direct Threat Care principles established by the National Association of Emergency Medical Technicians in Tactical Emergency Casualty Care (TECC) (NAEMT, 2020). The main objective is to deliver rapid medical assistance and simultaneously work to eliminate immediate dangers that could threaten the safety of casualties requiring urgent medical attention.

            Emergency response procedures traditionally fail to address the essential integration of medical care during the Chaos Phase. In past models, Medical Evacuation operations prioritized moving patients to designated Casualty Collections Points (CCPs) in the staging area (Pepper, Archer, & Moloney, 2016). This tactical choice caused essential life-saving medical care to be delayed. The obsolete method increased the exposure of vulnerable individuals to additional risks while also raising the chances of medical complications because it delayed necessary medical treatment (Baetzner, et al., 2022). The new Choas, Stabilization, and Recovery (CSR) framework underlines the need for rapid medical care in the Hot Zone at the casualty’s location, and staging Medical Rescue Teams (MRTs) in the Warm Zone allows for rapid deployment. This method reduces treatment delays and boosts patient survival rates while preventing further injuries from excessive movement. The highest life-saving impact in tactical environments comes from prioritizing treatment for preventable causes of death like massive hemorrhage, tension pneumothorax, and airway compromise (Miles & Crook, 2021).

Stabilization Phase

            The Stabilization Phase commences once the immediate danger has been neutralized or adequately cordoned, enabling Medical Rescue Teams (MRTs) to concentrate on providing thorough care within established Casualty Collection Points (CCPs). Internal and external cordons must be established to ensure safety and maintain order in the operational area, facilitating effective resource management. The Incident Command Post (ICP) acts as the primary control center, functioning under a Unified Command framework that brings together the Emergency Medical Service, law enforcement, fire services, and the Emergency Management Agency (EMA) for coordinated response efforts (FEMA, 2023). The MRT model guarantees that medically trained personnel, equipped with tactical skills, operate inside secured hot and warm zones, which minimizes delays related to setting up external CCPs and improves the quality of casualty care. The National Protection Framework broadens risk assessment beyond the immediate incident area to protect the surrounding community (DHS, 2016).

            The primary difficulty in this stage lies in determining optimal sites for Casualty Collections Points (CCPs). According to traditional methods, CCPs are placed outside the threat zones, resulting in delayed medical treatment. The CSR model recommends placing CCPs inside the protected boundaries of the Hot Zone to minimize transportation time and allow for immediate care at the site. The ALERRT, ASHER, and ATIRC initiatives promote a comparable strategy inside the Warm Zone by emphasizing the need for early medical responses (NCBRT, 2018). Studies reveal that delayed medical intervention leads to rapid patient decline, underscoring the essential role of establishing CCPs within the buildings (Miles & Crook, 2021). The CSR framework promotes Hot Zone medical treatment, which confronts traditional EMS and fire service methods that previously limited their ability to deliver ineffective care during active shooter and mass casualty events (Graham, 2018).

            Casualty Collection Points (CCPs) are integral to the Stabilization Phase of emergency response operations. These designated areas are intentionally set up to streamline triage, treatment, and vital preparations for swiftly evacuating injured persons, but operating in the hot Zone could delay transport (Miles & Crook, 2021). Thus, it ensures that victims obtain essential life-saving treatments without experiencing long delays in getting external support. These kits contain a comprehensive range of critical supplies, including tourniquets, chest seals, combat gauze, and decompression needles, enabling responders to manage various injuries directly at the scene effectively (DHA.CMC, 2023). The availability of resources is vital for stabilizing patients before they transfer to advanced medical facilities for further treatment. These operations must be conducted efficiently and effectively to maximize emergency survival outcomes (Graham, 2018).

            A vital advancement during this crucial time is implementing a dynamic approach to triage within the building. The medical conditions of casualties are continually reassessed to track any changes and ensure resources are allocated effectively and efficiently (DHA.CMC, 2023). This new approach represents a major departure from standard practices, as traditional triage systems proved ineffective in handling changing tactical situations. Emergency response effectiveness increases through dynamic systems that enable fast adjustments to meet the changing needs of injured individuals (Graham, 2018).

            The Stabilization Phase heavily relies on Tactical Evacuation as a key component. The process ensures that casualties move systematically from the Casualty Collection Point (CCP) to ambulances inside the cordon area, where they receive advanced medical treatment and access to facilities that address serious injuries (DHA.CMC, 2023). The highest priority should be given to individuals with the greatest chance of survival during this phase, ensuring that critical cases receive immediate medical attention (Graham, 2018). Multiple challenges must be addressed during evacuation planning, including managing risks from injured suspects. To ensure that medical resources reach those who need them most, we must implement comprehensive policies that protect civilians and first responders before suspects (Hanifen, 2023). The transportation of injured suspects should occur separately from other evacuees to ensure security levels are maintained while minimizing risk exposure for medical personnel and evacuating suspects. Implementing these strategies will greatly enhance the effectiveness of the evacuation process (NCBRT, 2018).

Recovery Phase

            The Recovery Phase builds community resilience by emphasizing the quick restoration of order and allowing regions affected by incidents to return smoothly to normalcy (DHS, 2016). This significant phase entails comprehensive clearing operations, establishing necessary security perimeters, and guaranteeing the area’s safety for future investigative and restorative measures (Hanifen, 2023). During this time, law enforcement agencies, emergency medical services, and fire services collaborate closely to ensure a complete accounting of all individuals and casualties (DHS, 2019). They strive to verify that there are no remaining threats to safety while also meticulously preparing the site for subsequent operations that are essential for recovery and rebuilding initiatives.

            A vital component of the Recovery Phase requires comprehensive attention to the physical and mental health of every responder and victim affected by the incident (Berglund, 2017). Medical teams should organize debriefings and supply necessary mental health care to victims and responders to mitigate psychological harm from the incident (Kerr, 2024). Organizations can build community trust and resilience during difficult times by keeping the public informed about how the incident is resolved and outlining preventative measures.