I was deeply troubled by the news of the Orlando Pulse nightclub shooting, and one question haunted me: Where were the emergency medical services? As Omar Mateen carried out his 3-hour attack, we now know that the 80 medics on site were kept more than 100 yards away from the club, outside the hot zone. Many injured victims were taken to hospitals in pickup trucks.

This pattern repeated itself during the Columbine High School shooting in 1999, when medics had to wait over an hour outside for a SWAT team while a teacher lay dying. Similarly, at the 2012 Aurora movie theater shooting, paramedics were prevented from entering the building, and victims were transported in police cars.

After such tragedies, families and friends often ask: Why were the people who save lives kept away from those in need?

I understand this frustration. I spent nearly a decade as a paramedic, and like many of my colleagues, I believed that saving a life was worth any risk. But EMS departments have always prioritized the safety of their crews, which often means staying on the periphery of dangerous scenes.

This approach is outdated. Paramedics must be trained to work in high-risk environments, and they should be equipped with the tools to do so safely. With the increasing number of mass shootings across the country, it's time to stop keeping them on the sidelines.

During my training, I remember a scenario where a man collapsed in the street. My partner and I rushed 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 power line that had killed our patient, resulting in two more deaths. The lesson was clear: without self-protection, we can't save anyone else.

Our instructors emphasized that we are sent into dangerous situations to save lives, not to control chaos. But in real life, things don’t always go as planned. A scene that seems safe can quickly turn deadly. Just because no weapons were seen on the phone call 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 modern emergencies. Some departments are already taking action. 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 officially declared safe, allowing for faster treatment and better outcomes.

These programs, supported by FEMA, teach paramedics how to work alongside armed officers, identify safe zones, and perform rapid triage. Instead of treating patients where they’re found, the focus is on stabilizing injuries and getting victims out as quickly as possible. “We have to get in there to stop the dying,” said E. Reed Smith, a medical director in Virginia. “As long as we’re standing outside, we haven’t stopped the dying.”

The rise in active-shooter incidents makes this training even more crucial. From 2000 to 2006, there were about six active-shooter events per year on average. That number jumped to 16.4 between 2007 and 2013.

In many cases, people died waiting for help just outside the door. Those treated within 60 minutes of injury have the best chance of survival. And those who receive care within five minutes have a much higher survival rate. After the Boston Marathon bombing in 2013, the success of the response was largely due to the fact that EMS was already on the scene and could begin helping immediately.

It’s encouraging 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 primary goal: saving lives. Paramedics aren’t cops, and they shouldn’t try to be. Their role isn’t to catch criminals or take sides—it’s to provide care under the most challenging conditions.

Imagine if paramedics had been able to reach 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.

An active-shooter incident is likely coming again. Maybe next time, paramedics will be there, ready to act. That’s the way it should be.

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