I followed the news of the Orlando Pulse nightclub shooting with one question in my mind: Where were the emergency medical services? During the three-hour attack by Omar Mateen, it turns out that the 80 paramedics on the scene were held more than 100 yards away from the club, outside the hot zone. Many of the injured were taken to hospitals in pickup trucks.

This wasn’t a unique situation. A similar pattern occurred during the Columbine High School shooting in 1999, when medics waited for over an hour outside while a teacher lay dying. The same thing happened at the Aurora movie theater in 2012, where 12 people were killed. In that case, police transported victims in their squad cars.

After these tragedies, families and friends have asked the same question: Why were the rescuers kept from the victims?

I understand that frustration. I was a paramedic for nearly a decade, and I know what it’s like to be in the field. We often put ourselves in danger to save lives. But because EMS departments prioritize the safety of their crews, we were trained to stay on the edge of crime scenes rather than rush in.

That approach is outdated. Paramedics need to be trained for high-risk environments and equipped with the tools to protect themselves. With the rise in mass shootings, we can no longer afford to keep them on the sidelines.

In my training, my instructor once presented a simple scenario: a man collapsed in the street. My partner and I rushed over to help, only to be told we were both dead—because we hadn’t checked if the scene was safe. We had stepped on the same live power line that had electrocuted the patient. Now there were three people dying instead of one.

The lesson was clear: if you don’t protect yourself, you can’t save anyone else. Our instructors taught us that we go into dangerous situations to save lives—not to control the scene.

But in the real world, things are more complicated. A scene that seems safe at first can quickly turn chaotic. Just because no weapons were seen when the call came doesn’t mean they won’t appear when we arrive.

That’s why it’s time for EMS to adopt a new model—one that reflects the reality of today’s world. Some departments are already moving forward. For example, Dallas Fire-Rescue and West End Ambulance Service in Pennsylvania have started providing bulletproof vests and helmets to paramedics. In states like Michigan, Virginia, and New York, EMS teams are being trained to enter violent scenes before they’re declared safe, so they can treat patients faster.

These units work closely with armed officers, learning how to identify “warm zones”—safe areas within a shooting scene where patients can be treated and transported. Instead of treating people where they are found, this model focuses on quick triage, stabilizing injuries, and getting victims out as soon as possible. As E. Reed Smith, a medical director in Virginia, said, “We have to get in there to stop the dying. As long as we’re standing outside, we haven’t stopped the dying.”

The increase in active-shooter incidents makes this kind of training even more essential. From 2000 to 2006, there were about six active-shooter events per year. That number jumped to 16 per year between 2007 and 2013.

Many people died waiting for help that was just outside the door. Studies show that patients treated within 60 minutes of injury have the best chance of survival. Those who receive care within five minutes have a much higher chance of living. After the Boston Marathon bombing in 2013, the majority of survivors were helped immediately because EMS was already on the scene.

It’s good that EMS is evolving to meet the demands of a more dangerous world. But as we move forward, we must never lose sight of our main goal: saving lives. Paramedics aren’t cops, and they shouldn’t try to be. Even as we respond faster, our job isn’t to catch criminals or take sides—it’s to help everyone in need.

Imagine if paramedics had entered the Pulse nightclub right away. Picture them in protective gear, surrounded by police, working to save lives on the dance floor. Would more people have survived? The answer is almost certainly yes.

Another active-shooter incident is inevitable. Maybe next time, paramedics will be ready—right in the middle of the action, saving lives. That’s what they're trained for. That’s what they should be doing.

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