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Pre-Hospital (e.g., EMS)
Topic Collection
March 22, 2024

Topic Collection: Pre-Hospital (e.g., EMS)

The time elapsed and treatments rendered between the onset of a medical or traumatic condition and arrival at a hospital are critical and often affect survival, length of hospital stay, and other outcomes. The “chain of survival” begins with bystander and pre-hospital management. This is as true in mass casualty incidents and public health emergencies as it is on a daily basis. Pre-hospital providers are an important resource to support preparedness, response, and recovery. It is important to note that that the pre-hospital scope of practice varies from state to state and pre-hospital providers rely on medical protocols or online medical direction to guide their patient care.

The resources in this Topic Collection include information on both traditional and evolving pre-hospital roles (e.g., mobile on-scene care and community paramedicine) relevant to disaster and mass trauma care. We note that during a disaster/public health emergency, in addition to traditional 911 services, dispatch triage and referral of calls (including to telemedicine) and a community paramedicine framework have broad applications to shelter-based care, home visits, home triage/treatment, and other roles, reducing the burden on traditional emergency medical services (EMS). Included are lessons learned, fact sheets, algorithms, and templates that describe the role of EMS and can help first responders prepare for and respond to a variety of events.

More topic-specific information can be found in the following ASPR TRACIE Topic Collections (listed alphabetically): Active Shooter and Explosives, Alternate Care Sites, Burns, Ebola/VHF, Fatality Management, Influenza Epidemic/ Pandemic, Mass Gatherings/Special Events, Mental/Behavioral Health (non-responders), Pediatric/Children, Pre-Hospital Mass Casualty Triage and Trauma Care (which includes a section devoted to the Performance of Triage Models), Pre-Hospital Patient Decontamination, and Responder Safety and Health. 

Access ASPR TRACIE’s COVID-19 Resources Page for resources specific to the pandemic.

Each resource in this Topic Collection is placed into one or more of the following categories (click on the category name to be taken directly to that set of resources). Resources marked with an asterisk (*) appear in more than one category.

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Must Reads

ASPR TRACIE. (2019). Mass Casualty Trauma Triage: Paradigms and Pitfalls.
This ASPR TRACIE white paper (developed after a national expert roundtable) can help emergency medical system (EMS) medical directors and EMS systems planners to understand and plan for key differences between “conventional” MCIs and mass violence events when: the scene is dynamic; the number of patients far exceeds usual resources; and usual triage and treatment paradigms may fail.
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ASPR TRACIE. (2023). EMS Infectious Disease Playbook.
This playbook (updated in 2023) synthesizes multiple sources of information in a single planning document addressing the full spectrum of infectious agents to create a concise reference resource for emergency medical services (EMS) agencies developing their service policies. The information can be incorporated into agency standard operating procedures and reviewed by the EMS medical director.
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  • Bridget Kanawati Thank you for your interest in this resource. Unfortunately, funding restrictions preclude our being able to provide printed versions of our resources so all of our products, including this one, are only available electronically. ASPR TRACIE Team
    3/26/2020 2:12:41 PM
  • Frances Thorpe I agree with Tracy, is there a way to order this publication in hard copy format? The information contained in this publication highlights agency infection control policies and is a great resource to have in the department library.
    3/26/2020 12:21:36 PM
  • Tracy Miller Is there any way to order a printed and bound version?
    8/9/2018 5:16:09 PM
Bulger, E., Snyder, D., Schoelles, K., et al. (2014). An Evidence-Based Prehospital Guideline for External Hemorrhage Control: American College of Surgeons Committee on Trauma. Prehospital Emergency Care. 18(2):163-173.
This guideline is a culmination of an extensive literature review on the use of tourniquets and hemostatic agents for managing life-threatening extremity and junctional hemorrhage. An expert panel examined the results of the literature review, then provided recommendations for emergency medical services care.
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Federal Emergency Management Agency. (2012). Operational Templates and Guidance for EMS Mass Incident Deployment.
The goal of this detailed report is to share model policies and practices across a variety of disciplines and provider types and help the emergency medical services (EMS) field deploy more effectively to planned and spontaneous mass care incidents. Case studies and event templates are included that can help EMS planners develop related policies and templates.
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Goolsby, C., Schuler, K., Krohmer, J, et al. (2022). Mass Shootings in America: Consensus Recommendations for Healthcare Response. Journal of the American College of Surgeons.
The authors surveyed and conducted discussion groups with emergency medical services staff, emergency medicine physicians, and surgeons who provided care after mass shootings. Eight recommendations emerged regarding triage, readiness training, public education, and mental healthcare for responders.
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National Conference of State Legislatures. (2016). Beyond 911: State and Community Strategies for Expanding the Primary Care Role of First Responders.
This website highlights resources and case studies in the field of Community Paramedicine which may assist others with implementing this type of pre-hospital care.
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National Highway Traffic Safety Administration. (2019). National EMS Scope of Practice Model.
This model explains the four levels of emergency medical services licensure: Emergency Medical Responder, Emergency Medical Technician, Advanced EMT, and Paramedic. The role, skills, and necessary knowledge base are highlighted for each level.
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U.S. Fire Administration. (2013). Fire/Emergency Medical Services Department Operational Considerations and Guide for Active Shooter and Mass Casualty Incidents. Federal Emergency Management Agency.
This white paper includes checklists and step-by-step considerations for active shooter event planning and response by pre-hospital providers, and references the framework suggested by the Hartford Consensus.
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Active Shooter

American College of Surgeons. (2015). See Something, Do Something: Improving Survival Strategies to Enhance Survival in Active Shooter and Intentional Mass Casualty Events: A Compendium. Bulletin of the American College of Surgeons. 100(15).
This document was developed by the Hartford Consensus (a team of healthcare leaders) and is a comprehensive compendium of resources and supporting documents that first responders can use to facilitate planning and training and enhance survivability from mass casualty and active shooter events.
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  • Meghan Treber test
    9/21/2019 2:21:41 PM
ASPR TRACIE. (2018). Mass Violence/Active Shooter Incidents: EMS Considerations.
This ASPR TRACIE tip sheet (which is part of a series) can help emergency medical systems planners incorporate issues related to pre-event, initial response, and support for hospitals into their no-notice incident plans.
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Babak, S., Reed, E., Shapiro, G., et al. (2021). Characteristics of Survivors of Civilian Public Mass Shootings: An Eastern Association for the Surgery of Trauma Multicenter Study. (Abstract only.) Journal of Trauma and Acute Care Surgery 90(4):652-658.
The authors reviewed 31 civilian public mass shootings (CPMSs), involving 191 patients to determine trends in injuries sustained and treatments rendered. The most common injuries were extremity fracture (37%) and lung parenchyma (14%). While most survivors were not critically injured, once at the hospital, “32% were taken directly to the operating room/interventional radiology, 16% were admitted to the intensive care unit, and 25% were admitted to the ward.” Orthopedic surgeries and laparotomies were the most common operations performed within 12 hours of arrival and the authors noted “significant delay between shooting and transport.”
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Goolsby, C., Schuler, K., Krohmer, J, et al. (2022). Mass Shootings in America: Consensus Recommendations for Healthcare Response. Journal of the American College of Surgeons.
The authors surveyed and conducted discussion groups with emergency medical services staff, emergency medicine physicians, and surgeons who provided care after mass shootings. Eight recommendations emerged regarding triage, readiness training, public education, and mental healthcare for responders.
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The Joint Committee to Create a National Policy to Enhance Survivability from Mass Casualty Shooting Events. (2013). Active Shooter and Intentional Mass-Casualty Events: The Hartford Consensus II. Bulletin of the American College of Surgeons.
The author summarizes findings from a meeting of The Hartford Consensus on active shooter and mass casualty events. The group emphasizes the need for on-scene collaboration between emergency medical services and law enforcement, and highlights the supportive role that uninjured bystanders can also play in the response effort.
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U.S. Fire Administration. (2013). Fire/ Emergency Medical Services Department Operational Considerations and Guide for Active Shooter and Mass Casualty Incidents.
This document highlights guidelines and concepts that can be incorporated into standard operating procedures to enhance the fire and emergency medical response to an active shooter/ mass casualty incident.
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Community Paramedicine

California Emergency Medical Services Authority. (n.d.). Introduction to Community Paramedicine. (Accessed 10/2/2023.)
This website provides an overview of community paramedicine, as well as information on the 13 Community Paramedicine pilot projects in a dozen California locations that are being conducted by the California Emergency Medical Services Authority (EMSA), in collaboration with the California Health Care Foundation (CHCF). The projects focus on providing services where access to healthcare is limited or when a short-term intervention is needed.
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EMS1. (2023). Community Paramedicine.
This webpage includes articles, training, podcasts, and videos on community paramedicine. Topics include recruiting and hiring, treating in place (particularly during a pandemic), and how community paramedicine can function as a risk reduction program.
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Iezzoni, L., Dorner, S., and Ajayi, T. (2016). Community Paramedicine Addressing Questions as Programs Expand. The New England Journal of Medicine. 374:1107-1109.
The authors provide an overview of community paramedicine in the United States and abroad and highlight several areas for more research.
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Montgomery, M. (2022). Community Paramedicine: What, Why, and How? Fire Rescue 1.
The authors discuss how community paramedics can address gaps in health care access. They examine the history of emergency medical services, including the Emergency Medical Treatment and Labor Act (which mandates emergency treatment in U.S. emergency departments) and how that led to emergency services functioning as the most reliable source of health care for populations without health insurance in the U.S. The article includes key characteristics of an effective community paramedic program, with an emphasis on using data to understand the types of emergency calls and geographic locations where calls are most frequent.
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* National Association of Emergency Medical Technicians. (2023). Community Paramedicine Series.
This website features a paramedicine course for paramedics providing preventive or urgent care, while preparing them to take the International Board of Specialty Certification Community Paramedic Certification exam. Courses cover topics such as motivational interviewing, wellness and nutrition, hospice and palliative care, cardiovascular disorders, and pharmacology.
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National Conference of State Legislatures. (2016). Beyond 911: State and Community Strategies for Expanding the Primary Care Role of First Responders.
This website highlights resources and case studies in the field of Community Paramedicine which may assist others with implementing this type of pre-hospital care.
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Nolan, M., Nolan, K., and Sinha, S. (2018). Community Paramedicine is Growing in Impact and Potential. Canadian Medical Association Journal. 190(21):E636-637.
The authors explain the increase in community paramedicine in Canada and elsewhere, as paramedics can provide proactive and preventive services in a way which could increase community trust, reduce emergency department use, and lower costs.
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Rural Health Information Hub. (2023). Rural Community Paramedicine Toolkit.
This toolkit can help rural areas build community paramedicine and related health programs. Its seven modules cover community paramedicine in the U.S., models for paramedicine programs (e.g., programs that focus on prevention and health education, reducing use of emergency resources), examples of successful rural paramedicine programs, potential issues with these programs, evaluations, funding, and sustainability.
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South Carolina Office of Rural Health. (2014). Blueprint for Community Paramedicine Programs Especially for EMS Agencies. Version 1: The Abbeville Experience.
This document was designed around the resources and tools that were paramount in the development of Abbeville’s Community Paramedicine program. Version one, The Abbeville Experience, showcases examples, resources, tools, recommendations, lessons learned and best practices. As a result, the Blueprint is specific to South Carolina and is geared towards emergency medical services agencies.
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University of Minnesota, University of North Carolina at Chapel Hill, and University of Southern Maine. (2014). The Evidence for Community Paramedicine in Rural Areas: State and Local Finding and the Role of the State Flex Program.
The authors of this study examined the evidence base for community paramedicine in rural communities, the role of community paramedics in rural healthcare delivery systems, the challenges faced by states in implementing community paramedicine programs, and the role of the state Flex programs in supporting development of community paramedicine programs. Additionally, the article provides a snapshot of community paramedicine programs currently being developed and/or implemented in rural areas.
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Virginia Department of Health. (2020). Community Paramedicine/Mobile Integrated Healthcare.
This pre-COVID-19 website can help agencies interested in launching a community paramedicine or mobile integrated health program. Resources include frequently asked questions about community paramedics and comprehensive meeting minutes for the Virginia Community Paramedicine/Mobile Integrated Healthcare Workgroup that can be applied to those in the early phases of program development.
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Education and Training

American College of Surgeons. (2023). Stop the Bleed: Resource Hub.
This webpage provides information and links to resources related to the “Stop the Bleed” initiative. This initiative seeks to prepare trauma professionals, professional first responders, and immediate responders (i.e., citizens) who can respond and stop bleeding of victims of mass casualty incidents.
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Center for Domestic Preparedness. (2018). Hospital Emergency Response Training for Mass Casualty Incidents. Federal Emergency Management Agency.
This three-day course prepares healthcare personnel (emergency and hospital-based) to conduct a safe and effective emergency medical response to a mass-casualty incident. Participants will learn how to recognize the procedures for ambulatory and nonambulatory decontamination and select and use appropriate levels of personal protective equipment, among other skills.
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Center for Domestic Preparedness. (2021). Emergency Medical Operations for CBRNE Incidents. Federal Emergency Management Agency.
This federally supported four-day course (usually offered in Anniston, AL) provides emergency medical personnel with hands-on training in the pre-hospital management of chemical, biological, radiological, nuclear, explosives and mass casualty incidents, as well as on-scene triage, and field treatment of victims exposed to chemical hazards, biological agents, radiological hazards and explosions. The course concludes with a multi-task, pre-hospital exercise.
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Department of Emergency Health Services. (n.d.). Emerging Infectious Diseases Videos for Prehospital Providers. (Accessed 10/2/2023.) University of Maryland Baltimore County.
This instructional series, comprised of nine modules (listed at the top of the page), includes an introduction to infectious diseases, basic infection control concepts, considerations for personal protective equipment (including donning and doffing), personnel decontamination, patient transport, and transfer of patient care for patients with Ebola and other highly infectious diseases.
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EMS.gov. (2022). Education. National Highway Traffic Safety Administration, Office of EMS.
This webpage includes training and education resources for emergency medical services (EMS) personnel including content on national EMS core content, educational standards, continuing education guidelines, and the EMS scope of practice model.
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Federal Emergency Management Agency. (2023). Training and Education.
This website provides links to training geared towards first responders and emergency managers and available through the Center for Disaster Preparedness, the Emergency Management Institute, the National Domestic Preparedness Consortium, and similar sources.
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International Atomic Energy Agency. (2006). Manual for First Responders to a Radiological Emergency.
This guide provides helpful information for first responders to use within the first few hours of a radiological emergency. Action guides for the incident commander are followed by guides for specific responders (e.g., fire, emergency medical service, law enforcement, forensic evidence collection team, public information officer, hospitals, and emergency operations centers). Though geared toward an international audience, many of the concepts are transferable.
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* National Association of Emergency Medical Technicians. (2023). Community Paramedicine Series.
This website features a paramedicine course for paramedics providing preventive or urgent care, while preparing them to take the International Board of Specialty Certification Community Paramedic Certification exam. Courses cover topics such as motivational interviewing, wellness and nutrition, hospice and palliative care, cardiovascular disorders, and pharmacology.
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Wolf-Fordham, S., Twyman, J., and Hamad, C. (2014). Educating First Responders to Provide Emergency Services to Individuals with Disabilities. Disaster Medicine and Public Health Preparedness. 8(6):533540.
The authors measured the effectiveness of an online program to increase emergency responder knowledge, planning, and response surrounding children and adults with disabilities. They found significant levels of gains in participant knowledge and simulated applied skills.
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World Health Organization. (2018). WHO-ICRC Basic Emergency Care: Approach to the Acutely Ill and Injured.
This open-access training course is for frontline healthcare providers faced with managing acute illness and injury with limited resources. Though written for an international audience, this may have benefit for those working in more austere environments.
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Guidance

Adini, B., Bodas, M., Nilsson, H., et al. (2017). Policies for Managing Emergency Medical Services in Mass Casualty Incidents. (Abstract only.) Injury. 48(9):1878-1883.
The authors sought to understand policies facilitating emergency medical services’ decision-making during mass casualty incidents using international experts’ feedback. 16 policies were initially endorsed by the experts, including first responder collaboration, “unified mode of operation,” criteria for evacuation by ground or air, and “support systems for caregivers exposed to violence.” There were some differences in expert opinion by region, but “solutions to most dilemmas were applicable to all organizations.”
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Amadi-Obi, A., Gilligan, P., Owens, N., et al. (2014). Telemedicine in Pre-Hospital Care: A Review of Telemedicine Applications in the Pre-Hospital Environment. International Journal of Emergency Medicine. 7(29).
The authors examined 39 studies related to telemedicine that met their inclusion criteria and determined that telemedicine can have a positive effect on emergency medical care.
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American College of Emergency Physicians. (2019). EMS and Disaster Preparedness.
This webpage features links to disaster preparedness resources geared towards emergency medical service providers.
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American College of Surgeons. (2021). National Guidelines for the Field Triage of Injured Patients.
This guidance can help emergency medical services providers recognize when patients would benefit from specialized trauma care resources. The report includes a list of tools that can be used to assess vital signs; anatomy of injury; mechanism of injury and evidence of high-energy impact; and special considerations (e.g., age, bleeding disorders, burns, pregnancy).
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ASPR TRACIE. (2023). Mass Burn Event Overview. U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response.
This document provides guidance for healthcare coalitions, burn centers, state public health preparedness professionals, healthcare entities, and other stakeholders planning for a burn mass casualty incident.
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ASPR TRACIE. (2023). Opioids: Frequently Asked Questions.
This ASPR TRACIE fact sheet was developed to provide answers to some of the most frequently asked opioid-related questions that affect our audience (e.g., regional ASPR staff, healthcare coalitions, healthcare entities, healthcare providers, emergency managers, and public health practitioners). It includes links to select general and responder-geared resources.
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Beyramijam, M., Farrokhi, M., Ebadi, A., et al. (2021). Disaster Preparedness in Emergency Medical Service Agencies: A Systematic Review. Journal of Education and Health Promotion. 10:258.
The authors reviewed seven articles to understand the most important aspects of emergency medical services (EMS) preparedness and found them to include surge capacity, planning, communication, training, policymaking, and an early warning system. The authors conclude that EMS systems around the world, including in the U.S., are underprepared. Their findings can be incorporated into lessons and plans by EMS trainers and administrators.
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Boone, C., Avery, L., and Malone, T. (2015). A Research Study of Ambulance Operations and Best Practice Considerations for Emergency Medical Services Personnel. Department of Homeland Security, Science and Technology Directorate.
This document summarizes a study and provides guidelines and promising practices for designing ambulance patient compartments for crashworthiness, ensuring patient safety and comfort, and enhancing responder safety.
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Bulger, E., Snyder, D., Schoelles, K., et al. (2014). An Evidence-Based Prehospital Guideline for External Hemorrhage Control: American College of Surgeons Committee on Trauma. Prehospital Emergency Care. 18(2):163-173.
This guideline is a culmination of an extensive literature review on the use of tourniquets and hemostatic agents for managing life-threatening extremity and junctional hemorrhage. An expert panel examined the results of the literature review, then provided recommendations for emergency medical services care.
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Federal Emergency Management Agency. (2022). EMS Functions in ICS-Student Manual.
This manual provides an overview of emergency medical services (EMS) and incident command and the role of EMS during various incidents, including mass casualty, structure fire, wildland fire, and active shooter.
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Hanfling, D., Hick, J., and Stroud, C. (2013). Crisis Standards of Care: A Toolkit for Indicators and Triggers *. (Free registration required.) Institute of Medicine: National Academies Press.
This toolkit contains key concepts, guidance, and practical resources to help individuals across the emergency response system develop plans for crisis standards of care. Chapter 7 includes sample indicators, triggers, and sample tactics for use in the transition from conventional surge to contingency surge to crisis surge, and a return from crisis response to conventional response (detailed specifically for emergency medical services using slow-onset and no-notice scenarios).
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Healthcare Ready. (2018). Controlled Substances in Emergency Situations and the 2017 Protecting Patient Access to Emergency Medications Act (PPAEMA).
This four-page fact sheet provides information about controlled substances in emergencies and the 2017 Protecting Patient Access to Emergency Medications Act (PPAEMA). It discusses how PPAEMA applies to Emergency Medical Services (EMS) Agencies, and Pharmacists and Patients, including how a pharmacist may dispense controlled substances during emergencies upon receipt of “oral authorization from a prescribing individual practitioner.”
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Hodge, J., Orenstein, D., and Weidenaar, K. (2014). Expanding the Roles of Emergency Medical Services Providers: A Legal Analysis. Association of State and Territorial Health Officials.
This document highlights potential methods to increase opportunities to engage emergency medical services (EMS) providers for day-to-day activities in communities across the United States. The report summarizes a review and analysis of the existing legal environment that either facilitates, or imposes barriers to, expanded roles of EMS.
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Klein, T. and Irizarry, L. (2022). EMS Disaster Response. StatPearls.
The authors outline emergency medical services-specific concerns related to the four phases of the disaster cycle. They emphasize that all disasters are local, disaster plans should minimize complexity, and when local resources are depleted, escalation in the form of a request for federal resources by the governor or tribal leader may be important. Multidisciplinary EMS responders who respect the incident command system are key to success.
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Liu, M., Catlett, C., Jenkins, J., et al. (2021). Role of Emergency Medical Services in Disaster Response - National Association of EMS Physicians Position Statement. Prehospital Emergency Care. 25(4):596.
This position statement from the National Association of EMS Physicians asserts that EMS authority should have a lead role in disaster response at the local level within an incident command structure. EMS should participate in the disaster cycle from planning to recovery, and EMS administrators should address licensure, worker protection, liability protection, surge capacity, and documentation.
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National Association of Emergency Medical Technicians. (2017). NAEMT Position Statement: Ambulance Strike Teams.
This document supports the development of Ambulance Strike Teams, which consist of a group of five ambulances with coordinated communications and a leader. The author also recommends using Emergency Medical Task Forces, which refer to a combination of resources such as ambulances, squads, or engines within a span of control.
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National Association of State EMS Officials. (2022). National Model EMS Clinical Guidelines.
These EMS guidelines, developed by several national associations of physicians, are for use at the local, regional, or state levels to facilitate pre-hospital health care. The guidelines include sections on universal care, cardiovascular care, general medical care, resuscitation, pediatric care, OB/GYN care, trauma, and response to poisoning and overdoses.
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National Highway Traffic Safety Administration. (2019). National EMS Scope of Practice Model.
This model explains the four levels of emergency medical services licensure: Emergency Medical Responder, Emergency Medical Technician, Advanced EMT, and Paramedic. The role, skills, and necessary knowledge base are highlighted for each level.
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Newgard, C., Fischer, P., Gestring, M., et al. (2022). National Guideline for the Field Triage of Injured Patients: Recommendations of the National Expert Panel on Field Triage, 2021. Journal of Trauma and Acute Care Surgery. 93(2):e49-e60.
The authors outline the process and evidence base used for developing updated field triage guidelines. The article highlights study design, panel participant recruitment, relevant systematic reviews, and provides a comprehensive overview of the final guidelines.
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Rish, D., Tarhini, H., Amara, R., et al. (2017). Modeling to Optimize Hospital Evacuation Planning in EMS Systems. (Abstract only.) Prehospital Emergency Care. 21(4):503-510.
The authors used an optimization model to develop hospital evacuation plans within a larger emergency medical services system and encourage hospital planners to do the same to guide planning decisions.
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U.S. Government Publishing Office. (2017). Protecting Patient Access to Emergency Medications Act of 2017.
Part of this Act allows emergency medical services agencies to receive DEA registration in order to administer controlled substances (II-IV) “outside the physical presence of a medical director or authorizing medical professional.”
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Infectious Disease (e.g., COVID-19, Ebola, pandemic influenza)

Aengst, J., Walker-Stevenson, G., Harrod, T., et al. (2022). Uncomfortable Yet Necessary: The Impact of PPE on Communication in Emergency Medicine. International Journal for Quality in Health Care. 34(4): mzac095..
The authors describe results from focus groups and interviews with fire-based EMS responders about the effects of COVID-19 on the delivery of care. They found that PPE use affected responders’ efficiency in responding to calls, ability to detect patient symptoms; and ability to communicate with patients and their loved ones, their fellow responders, transport agencies, and hospitals and clinicians. Responders also reported facing hostility from members of the public opposed to their use of PPE. The authors describe some of the solutions used to address communications challenges and suggest areas in need of additional research.
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Al Amiry, A. and Maguire, B. (2021). Emergency Medical Services (EMS) Calls During COVID-19: Early Lessons Learned for Systems Planning (A Narrative Review). Open Access Emergency Medicine. 13:407-414.
The authors explore the global increase in EMS calls during the COVID-19 pandemic, and the effect of COVID-19 on the response to other emergencies and overwhelmed dispatch centers. They included 29 articles in their review, finding that EMS-related factors (e.g., risk of exposure, shortage in ambulances), social factors (e.g., the effect of lockdowns on residents with pre-existing conditions), and patient factors (e.g., reluctance to call 911) had various impacts on EMS calls and responses during the pandemic.
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ASPR TRACIE. (2017). EMS & Infectious Diseases: Challenges & Resources for Provider Protection.
The speakers in this webinar discuss the emergency medical services (EMS) Infectious Disease Playbook and how EMS professionals can use it in their daily practice.
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  • Meghan Treber This is a great resource!
    7/17/2017 2:25:31 PM
* ASPR TRACIE. (2023). EMS Infectious Disease Playbook.
This playbook (updated in 2023) synthesizes multiple sources of information in a single planning document addressing the full spectrum of infectious agents to create a concise reference resource for emergency medical services (EMS) agencies developing their service policies. The information can be incorporated into agency standard operating procedures and reviewed by the EMS medical director.
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  • Bridget Kanawati Thank you for your interest in this resource. Unfortunately, funding restrictions preclude our being able to provide printed versions of our resources so all of our products, including this one, are only available electronically. ASPR TRACIE Team
    3/26/2020 2:12:41 PM
  • Frances Thorpe I agree with Tracy, is there a way to order this publication in hard copy format? The information contained in this publication highlights agency infection control policies and is a great resource to have in the department library.
    3/26/2020 12:21:36 PM
  • Tracy Miller Is there any way to order a printed and bound version?
    8/9/2018 5:16:09 PM
* Balaji, A. and Robishaw-Denton, J. (2022). Lessons Learned and Opportunities for CBEMS Growth Following the COVID-19 Pandemic. The Journal of Collegiate Emergency Medical Services. 5(1): 4-5.
In this editorial, the authors highlight areas for growth in emergency medical services (EMS) organizations on college campuses in the wake of the COVID-19 pandemic. Changes due to the pandemic included an increase in graduate medical program applications, burnout for EMS staff working in a high-stress environment, and staffing shortages. These changes present opportunities to include vaccination in the EMS scope of practice, partner with new organizations, and encourage versatility in communities and campuses served by EMS.
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Centers for Disease Control and Prevention. (2015). Interim Guidance for Emergency Medical Services (EMS) Systems and 9-1-1 Public Safety Answering Points (PSAPs) for Management of Patients under Investigation (PUIs) for Ebola Virus Disease (EVD) in the United States.
This guidance was developed to ensure that emergency medical services providers and other first responders are safe and patients are appropriately managed while handling inquiries and responding to patients under investigation.
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Centers for Disease Control and Prevention. (2018). Q&A's about the Transport of Pediatric Patients (< 18 years of age) Under Investigation or with Confirmed Ebola.
This webpage provides first responders with helpful information specific to protecting themselves, younger patients, and patients’ family members by answering the frequently asked questions about Ebola and transporting young patients.
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EMS.gov. (2022). Emerging Diseases. National Highway Traffic Safety Administration.
This website provides emergency medical services-specific information on infectious and emerging diseases. Recent resources include updates on personal protective equipment emergency use authorizations, information on developing interfacility transport plans, and guidance for emergency medical services systems responding to patients with suspected Ebola virus disease.
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Jenkins, J., Hsu, E., Russell, A., et al. (2022). Infection Prevention and Control for the Emergency Medical Services and 911 Workforce. U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality.
This technical brief summarizes current evidence related to EMS and 911 workforce exposures to infectious pathogens and practices to prevent, recognize, and control exposures and illness.
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Lemay, F., Vanderschuren, A., and Alain, J. (2020). Aeromedical Evacuations During the COVID-19 Pandemic: Practical Considerations for Patient Transport. Canadian Journal of Emergency Medicine. 22(5):584-586.
In this commentary, the authors describe five lessons learned from their aeromedical organization’s experience transferring 50 confirmed or suspected COVID-19 patients.
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Lowe, J., Jelden, K., Schenarts, P., et al. (2014). Considerations for Safe EMS Transport of Patients Infected with Ebola Virus. (Abstract only.) Prehospital Emergency Care. 19(2):179-183.
The authors discuss the coordinated response between the Nebraska Biocontainment Unit (through the Nebraska Medical Center in Omaha) and Omaha Fire Department's EMS to transport patients with confirmed Ebola virus from West Africa from the airport to the high-level isolation unit. Three critical areas have been identified from their experience and are addressed in this article: ambulance preparation, appropriate selection and use of personal protective equipment, and environmental decontamination.
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National Emerging Special Pathogens Training and Education Center. (2024). EMS Procedural Guidelines for Special Pathogens.
These model procedural guidelines, created by NETEC's EMS/Patient Transport Work Group, are designed to help EMS agencies develop standard operating procedures for the transport and management of patients suspected or confirmed to have a high-consequence infectious disease. The guidelines address personal protective equipment (PPE) donning and doffing, EMS provider down, PPE breaches, biohazard spills, waste management, ambulance modification, and ambulance cleaning and disinfection. They complement ASPR TRACIE's EMS Infectious Disease Playbook (https://files.asprtracie.hhs.gov/documents/aspr-tracie-transport-playbook-508.pdf).
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New York State Department of Health, and New York State Emergency Medical Services. (2014). Ebola Virus Disease (EVD) In-Service EMS Training Outline.
This document provides information on Ebola (e.g., how it is transmitted, signs and symptoms), and several recommendations to EMS personnel including use of personal protective equipment, cleaning EMS transport vehicles after transporting a patient with suspected or confirmed Ebola, follow-up and/or reporting measures by EMS personnel after caring for a suspected or confirmed Ebola patient, among others.
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Sprague, R., Ladd, M., and Ashurst J. (2023). EMS Resuscitation During Contamination While Wearing PPE.
The authors underscore the importance of emergency medical services (EMS) personnel capability to treat and resuscitate a patient while wearing personal protective equipment (PPE) since chemical, biological, radiological, or nuclear emergencies with historical precedence have required EMS staff to perform lifesaving interventions while wearing PPE.
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Turner, A., Wages, R., Nadeau, K. et al. (2018). The Infectious Disease Network (IDN): Development and Use for Evaluation of Potential Ebola Cases in Georgia. Disaster Medicine and Public Health Preparedness. 12(6):765-771.
The authors describe a Georgia network of hospitals and emergency medical service providers which was created after the 2014 Ebola virus disease outbreak in West Africa to treat a “suspected or confirmed serious communicable disease patient” while ensuring health care worker safety. The providers were required to demonstrate infection control practices such as appropriate PPE use, waste management during care and patient transport.
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Lessons Learned

American College of Surgeons. (2018). New Trauma Study Results Show Tourniquet Practice Adopted from the Military Saves Lives and Limbs in Civilians. Journal of the American College of Surgeons.
The authors of this press release describe how tourniquet techniques from battlefields have been implemented by civilians and emergency medical services personnel in the U.S. They note that when tourniquets were left in place for a short time and repair was performed in a timely manner, patient outcomes improved. They also suggest placing bleeding kits in public (similar to defibrillators).
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Arnold, C. (2016). Responders from the Berkeley Balcony Collapse Reflect on Incident Challenges. Journal of Emergency Medical Services.
The author describes the incident, the challenges and strengths of the response, and highlights the lessons learned by firefighters and other responders who worked the scene of a 5th floor balcony collapse during a party.
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Baetzner, A., Wespi, R., Hill, Y., et al. (2022). Preparing Medical First Responders for Crises: A Systematic Literature Review of Disaster Training Programs and Their Effectiveness. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine.
The authors conducted a systematic review to understand the effectiveness of first responder training programs for disasters or mass casualty incidents. They reviewed 55 articles and found that performance in simulated scenarios was closest to real disasters, training using technology is a promising approach to training, but also that more research is needed on less-studied methods such as immersive virtual reality.
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* Balaji, A. and Robishaw-Denton, J. (2022). Lessons Learned and Opportunities for CBEMS Growth Following the COVID-19 Pandemic. The Journal of Collegiate Emergency Medical Services. 5(1): 4-5.
In this editorial, the authors highlight areas for growth in emergency medical services (EMS) organizations on college campuses in the wake of the COVID-19 pandemic. Changes due to the pandemic included an increase in graduate medical program applications, burnout for EMS staff working in a high-stress environment, and staffing shortages. These changes present opportunities to include vaccination in the EMS scope of practice, partner with new organizations, and encourage versatility in communities and campuses served by EMS.
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Basavaraju, S.V., Hunt, R.C., Vikas, K., et al. (2010). In A Moment's Notice: Surge Capacity for Terrorist Bombings: Challenges and Proposed Solutions. Centers for Disease Control and Prevention.
The authors synthesized comments from a series of expert panel meetings on identifying innovative strategies hospitals could adopt to address terrorism-related surge issues.
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Bucher, J., McCoy, J., Donovan, C., et al. (2018). EMS Dispatches during Hurricanes Irene and Sandy in New Jersey. (Abstract only.) Prehospital Emergency Care. 22(1): 15-21.
The authors compared emergency medical services (EMS) dispatch trends during two hurricanes to better inform future planning. They found that calls peaked on day 2 after landfall and many were specific to older residents. Readers are encouraged to take these findings into consideration while also considering storm patterns when planning for and staging EMS resources pre-storm.
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Crutchfield, A. and Harkey, K. (2019). A Comparison of Call Volumes Before, During, and After Hurricane Harvey. The American Journal of Emergency Medicine. 37(10): 1904-1906.
The authors reviewed call volumes from Galveston Area Ambulance Authority (before, during, and after Hurricane Harvey) and found that the highest number of calls were received the last 2 days of the storm and the first 2 days after the storm; calls were primarily for injury, general pain, respiratory distress, chest pain, and generalized weakness.
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Engel, R. (2021). “A Genius Decision:” How Lessons Learned Impact First Responder Efforts in 2021. EMS1.
The author details interviews with responders from Louisiana and Oregon to learn how lessons learned from past disasters (e.g., preparedness, resource allocation and logistics, and resident communication) helped their responses to Hurricane Ida and the heat dome that affected the Pacific Northwest in 2021.
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Everitt, B., Casanova, R., Stringfellow, M., et al. (2023). Medical Mass Casualty: Lessons Learned from the Deadliest Human Smuggling Incident in U.S. History. EMS World.
This article describes a 2023 mass casualty incident (MCI) in which 53 people died while being smuggled in a tractor-trailer during an extreme heat wave. Triage lessons learned from this MCI included identifying and providing care to all triaged “red” patients, then conducting secondary triage in which an EMS physician identified any additional patients requiring care or determined whether they were deceased. The article also includes information on supporting first responders’ wellbeing during and after an MCI.
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Grover, J., Smith, B., Williams, J., et al. (2020). Novel Use of Telemedicine by Hurricane Evacuation Shelters. (Abstract only.) Prehospital Emergency Care. 24(6):804-812.
A cross-sectional study that examined emergency medical services (EMS) and emergency department utilization of patients housed in disaster shelters during a 12-day period following Hurricane Florence found a total of 194 combined telemedicine and EMS patient encounters. The authors noted patterns in the use of telemedicine and offer it as a strategy for reducing EMS and emergency department use after a disaster.
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Hick, J.L., Ho, J.D., Heegaard, W.G., et al. (2008). Emergency Medical Services Response to a Major Freeway Bridge Collapse. (Abstract only.) Disaster Medicine and Public Health Preparedness. 2(S1): S17-S24.
The authors discuss the emergency medical services response to the bridge collapse, noting the successes and lessons learned (e.g., patient tracking, communications).
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Jakonen, A., Manty, M., and Nordquist, H. (2021). Safety Checklists for Emergency Response Driving and Patient Transport: Experiences from Emergency Medical Services. Joint Commission Journal on Quality and Patient Safety. 47(9): 572-580.
The authors describe the development and pilot testing of safety checklists for emergency response driving and patient transport. Overall, paramedics reported that the use of these tools improved safety due in part to the systematic planning that had to be in place to use them.
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Kearns, R.D., Myers, B., Cairns, C.B., et al. (2014). Hospital Bioterrorism Planning and Burn Surge. Biosecurity Bioterrorism. 12(1):20-8.
This article discusses how using an all-hazards approach to bioterrorism response planning helped to prepare hospitals in the Raleigh/Durham, NC area to care for casualties from a plant explosion in June 2009. The rescue, response, and resuscitation of survivors by first responders and first receivers, as well as efforts to develop burn surge, are described.
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Kellerman, A. and Peleg, K. (2013). Lessons from Boston. New England Journal of Medicine. 368:1956-1957.
The authors summarize three key points from the Boston bombing incident: the low mortality rate and related factors; the vital role played by bystanders who offered on-scene medical care; and the role the well-exercised disaster plan played in the successful response.
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Martin, A., Lohse, C., and Sztajnkrycer, M. (2015). A Descriptive Analysis of Prehospital Response to Hazardous Materials Events. (Abstract only.) Prehospital Disaster Medicine. 30(5):466-71.
The authors analyzed 2,527 unique activations involving HazMat response from 2012 National EMS Information System (NEMSIS) Public Release Research Data. Overall, the mass casualty incident code was used for 5.6% of activations, and the most common on-scene level of care was basic life support (only 2.1% required advanced life support response). Most common incident locations were the home (36.2%), streets or highways (26.3%), and health care facilities (11.6%). Pain (29.6%), breathing problems (12.2%) and changes in responsiveness (9.6%) were the main symptoms observed by pre-hospital medical professionals.
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Mountain Plains Regional Disaster Health Response System (MPRDHRS). (2023). Marshall Fire Learning Series: EMS.
This 1.5-hour video is part of a four-video series which details how Mountain View Fire Rescue, EMS, and the Boulder County Sheriff’s Office responded to the Marshall Fire on December 31, 2021. The panel is composed of emergency responders who discuss their experiences during the fire.
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Mulvey, J., Shaw, B., Betzner, M., et al. (2022). Columbia Icefield Bus Rollover: A Case Study of Wilderness Mass Casualty Triage, Treatment, and Transport. (Abstract only.) Prehospital Emergency Care. 26(4): 608-616.
When an all-terrain bus rolled over while transporting tourists to explore a glacier inside a remote area of Jasper National Park, three people died and 21 needed transport. The authors examined the pre-hospital response and emphasized the importance of aeromedical surge capacity and the involvement of local physicians in the response to and management of wilderness mass casualty incidents.
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National Association of Emergency Medical Technicians. (2017). National Survey on EMS Preparedness for Disaster and Mass Casualty Incident Response.
This report highlights results from surveys returned by 1,150 respondents from all 50 states and Washington, D.C. Overall, most practitioners reported some training in preparing to respond to major incidents, but it is often sporadic and few respondents reported training in chemical, biological, or radiological events or pandemic response. Individual preparedness was also a challenge; the report concludes with suggestions for the future.
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Newgard, C., Mann, N., Hsia, R., et al. (2014). Patient Choice in the Selection of Hospitals by 9-1-1 Emergency Medical Services Providers in Trauma Systems. Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine. 20(9): 911919.
This retrospective study examines the reasons cited by emergency medical services providers for selecting hospital destinations based on criteria such as injury severity, field triage status, and patient or family choice. The authors found that hospital selection was most influenced by patient or family choice.
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Pereira, B.,Morales W., Cardoso, R., et al. (2013). Lessons Learned From a Landslide Catastrophe in Rio de Janeiro, Brazil. (Free registration required.) American Journal of Disaster Medicine. 8(4):253-8.
The authors discuss lessons learned from this flood and landslide event in 2011, with a focus on pre-hospital and hospital organization and management of patients. They also describe the most common injuries treated (injuries were to the extremities, most requiring only wound cleaning, debridement, and suture), and note that the primary cause of death was from asphyxia due to drowning or mud burial.
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Ramme, A.J., Vira, S., and McLaurin, T.M. (2015). Superstorm Sandy's Forgotten Patient: A Lesson in Emergency Preparedness in Severe Obesity. Obesity. 23(2):253-4.
The authors describe the challenges associated with evacuation of a morbidly obese patient during Superstorm Sandy, and how those challenges influenced the decision not to evacuate the patient, even in the absence of power and running water.
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Rankin, J. (2016). These are War Wounds: Brussels Hospitals Treat Terror Attack Victims. The Guardian.
The author describes the revisions to hospital emergency plans since the Paris terror attacks and the types of injuries treated by staff from Erasmus Hospital in Brussels.
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Redhead, J., Ward, P., and Batrick, N. (2005). The London Attacks--Response: Prehospital and Hospital Care. The New England Journal of Medicine. 353:546-547.
The authors detail the medical response to the 2005 London public transportation bombing. They discuss the nature of injuries, how a treatment center was set up in a nearby hotel, and the process of handing burn patients over to a regional burn center.
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Rural Health Information Hub. (2023). Rural Emergency Medical Services (EMS) and Trauma – Models and Innovations.
This webpage highlights lessons learned in rural emergency medical services (EMS) by seven programs across the country. Examples of successful programs include providing technologically advanced training to existing EMS personnel, a rural Nevada EMS conference that provides in-person training, and training in administering trauma-informed care for the Menominee Reservation.
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Schenk, E. , Wetunge, G., Mann, C., et al. (2014). Epidemiology of Mass Casualty Incidents in the United States. Prehospital Emergency Care. 81(3).
The authors report on characteristics and frequency of mass casualty incidents in the U.S. during 2010 (as reported by emergency medical services personnel).
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Sugerman, D. and Armstrong, J. (2013). Prevention and Treatment of Injuries Following Hurricanes and Tornadoes. Centers for Disease Control and Prevention.
This one-hour webinar covers the provision of pre-hospital care; the patterns of injury seen after hurricanes and tornadoes, including appropriate initial management; appropriate emergency risk communication messages; and the importance of data collection to improve messaging and response efforts.
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U.S. Chemical Safety Board. (2016). West Fertilizer Explosion and Fire.
This report details the 2013 West (Texas) Fertilizer Company fire and explosion which resulted in 15 deaths (12 emergency responders) and more than 260 injuries. The emergency response is detailed in Section 7 of the report.
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U.S. Department of Homeland Security. (2023). Homeland Security information Network.
Registered users can access Sensitive but Unclassified information on this site that includes lessons learned, after-action reports, situational awareness tools, and other resources for emergency healthcare responders.
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Pediatric Issues 

Emergency Medical Services for Children Innovation & Improvement Center. (2020). Coronavirus (COVID-19). (Added 5/21/2020.)
This page is a compilation of COVID-19 related resources for hospital-based, pre-hospital, and community-based providers. Resources are categorized under Multisystem Inflammatory Response Syndrome in Children, pre-hospital and hospital preparedness, family readiness, school and childcare, personal protective equipment and essential skills, and mental and behavioral health. The page is updated as new resources become available.
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Fratta, K., and Fishe, J. (2022). EMS Pediatric Transport Safety and Secondary Transport.
The authors sought to fill a knowledge gap for pediatric patients being transported by emergency medical services by developing evidence-based guidelines to ensure children are transported to the most appropriate facility. Information is provided under specific “issues of concern” including life-threatening events, seizures, orthopedic injury, and asthma/respiratory distress.
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Garst, L., Gordon, J. and Peters, E. (2018). Engage – Calm – Distract: Understanding and Responding to Children in Crisis. A Resource Kit for EMS and Emergency Department Providers. Colorado Department of Public Health & Environment.
Responders report that their own emotional responses, lack of experience in working with children, and the emotions of family members can negatively affect the quality of care when responding to pediatric emergencies. This resource kit provides information, strategies, and activities to help both pre-hospital and hospital emergency providers reduce the emotional distress of children in crisis. Quickly engaging, calming, and distracting children and their caregivers can improve both immediate and long-term physical and emotional outcomes for pediatric patients.
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Health Resources & Services Administration. (2023). Emergency Medical Services for Children (EMSC). U.S. Department of Health and Human Services.
This webpage provides links to resources on the emergency medical treatment of children (both pre- and in-hospital), including data sets and analyses, a federally developed toolkit, and the Regional Pediatric Pandemic Network (https://mchb.hrsa.gov/programs-impact/pediatric-pandemic).
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Koziel, J.R., Meckler, G., Brown, L., et al. (2014). Barriers to Pediatric Disaster Triage: A Qualitative Investigation. (Abstract only.) Prehospital Emergency Care Journal. 19(2).
The authors conducted a qualitative evaluation of paramedics’ self-reported obstacles to pediatric disaster triage performance using a 10-victim, multiple-family house fire simulation. Respondents indicated difficulty with triaging multiple child disaster victims “due to emotional obstacles; unfamiliarity with pediatric physiology; and struggles with triage rationale and efficiency.”
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Lowe, C.G. (2009). Pediatric and Neonatal Interfacility Transport Medicine After Mass Casualty Incidents. (Abstract only.) The Journal of Trauma. 67(2 Suppl): S168-71.
A mass casualty incident can present major challenges for a critical care transport team, which is essential for the safe interfacility movement of critically ill patients. The author reviews the capabilities and limitations of pediatric and neonatal critical care transport teams and factors that hindered the evacuation of pediatric and neonatal patients after Hurricane Katrina to provide recommendations to improve the efficiency and efficacy of interfacility transport of pediatric patients.
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* Michigan Department of Health and Human Services. (2019). MI-MEDIC. Michigan Medication Emergency Dosing and Intervention Cards.
These color-coded cards were designed to help emergency healthcare practitioners provide care for patients based on weight and age. Instructions for each age/weight group are provided on two cards: Conditions/Medications and Cardiac Resuscitation. The cards can be saved and/or printed for future use.
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Moore, B., Shah, M., Owusu-Ansah, S., et al. (2020). Pediatric Readiness in Emergency Medical Services Systems. Annals of Emergency Medicine. 75(1):e1-e6.
This joint policy statement highlights 16 recommendations specific to pre-hospital care of the unique needs of children and their families.
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Mountain Plains Regional Disaster Health Response System. (2024). Pediatric EMS Considerations. Rural EMS Education Series.
Speakers discuss the unique characteristics of and how to treat pediatric patients in various pre-hospital scenarios (e.g., diabetic ketoacidosis, febrile seizure, altered mental state, and burn).
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National Association of State EMS Officials. (2020). Pediatric Transport Products for Ground Ambulances.
This document contains information on products available to support pediatric transport in ground ambulances, such as restraints for children of different sizes, weights, or ages. Information is provided by situation (e.g,, not sick/uninjured, sick and injured [newborn with mother], and child requiring intensive care). Each product listed is accompanied by information on product weight, child weight, installation capability and method of cleaning.
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National Association of State EMS Officials. (2023). EMS Education Toolkit for Pediatrics.
The toolkit can help emergency medical services (EMS) professionals better understand their state's EMS license renewal process with a focus on pediatric education.
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National Association of State EMS Officials. (2023). Safe Transport of Children.
This webpage links to educational resources and documents organized by the Safe Transport of Children Committee to ensure children are safely transported in ambulances. The page contains information on proper restraints for children in emergency vehicles and pre-hospital transport of critically ill pediatric patients.
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Steve, S., Rebecca, L., Rhonda, D., et al. (2007). Prehospital Preparedness for Pediatric Mass-Casualty Events. (Abstract only.) Pediatrics. 120(4).
The authors examined the preparedness levels of U.S. emergency medical services agencies specific to the care of children who are involved in mass-casualty events. Less than 15% reported pediatric-specific mass casualty plans, and while almost 70% reported participating in local disaster drills within the past year, fewer than half of those drills included pediatric victims.
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Plans, Tools, and Templates

* ASPR TRACIE. (2023). EMS Infectious Disease Playbook.
This playbook (updated in 2023) synthesizes multiple sources of information in a single planning document addressing the full spectrum of infectious agents to create a concise reference resource for emergency medical services (EMS) agencies developing their service policies. The information can be incorporated into agency standard operating procedures and reviewed by the EMS medical director.
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  • Bridget Kanawati Thank you for your interest in this resource. Unfortunately, funding restrictions preclude our being able to provide printed versions of our resources so all of our products, including this one, are only available electronically. ASPR TRACIE Team
    3/26/2020 2:12:41 PM
  • Frances Thorpe I agree with Tracy, is there a way to order this publication in hard copy format? The information contained in this publication highlights agency infection control policies and is a great resource to have in the department library.
    3/26/2020 12:21:36 PM
  • Tracy Miller Is there any way to order a printed and bound version?
    8/9/2018 5:16:09 PM
California Emergency Medical Services Authority. (2023). Disaster Medical Services Division — Ambulance Strike Team.
This webpage defines Ambulance Strike Teams and how they are used in California and includes links to related resources (e.g., the Ambulance Strike Team [AST]/Medical Task Force [MTF] System Manual and a reimbursement schedule).
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Contra Costa Health Services. (2018). Emergency Medical Services Multi-Casualty Incident Plan.
This county mass casualty plan lists responsibilities for a variety of roles (e.g., helicopter providers, law enforcement, and communications centers) and includes checklists and a CHEMPACK mobilization plan as appendices. Additional resources are available on this webpage.
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County of Santa Clara, Emergency Medical Services. (2014). EOA Emergency Ambulance Staffing Contingency Plan.
The plan was designed for managers of the Santa Clara County Emergency Medical Service System to help them manage staffing shortages of any cause within the county's 911 Exclusive Operation Area. It is separated into phases and includes sections on public information and messaging and a variety of checklists.
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Duncan, E. Colver, K., Dougall, N., et al. (2014). Consensus on Items and Quantities of Clinical Equipment Required to Deal with Mass Casualties Big Bang Incident: A National Delphi Study. BMC Emergency Medicine. 14: 5.
British researchers developed an expert consensus regarding the essential items and minimum quantities of clinical equipment necessary to care for 100 patients on the scene of a mass casualty explosion event.
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Federal Emergency Management Agency. (2012). Operational Templates and Guidance for EMS Mass Incident Deployment.
The goal of this detailed report is to share model policies and practices across a variety of disciplines and provider types and help the emergency medical services (EMS) field deploy more effectively to planned and spontaneous mass care incidents. Case studies and event templates are included that can help EMS planners develop related policies and templates.
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Illinois Department of Public Health. (2018). Catastrophic Incident Response Annex.
This annex describes and guides Illinois' state-level response and care of patients, including crisis care and resource allocation, during a catastrophic incident that incapacitates the local, regional, and/or state health care system and prevents the ability to provide conventional and/or contingency care. It includes a concept of operations and sections on roles, responsibilities, resource requirements, and recovery. Attachment 6 has specific recommendations for EMS adaptations during catastrophic incidents.
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Metropolitan Emergency Services Board (MN). (2012). Mass Casualty Incident Response Plan.
This fact sheet (developed for agencies in Minnesota) lists considerations and steps for emergency medical services (EMS) to take during a mass casualty incident. Information is provided for ambulance operators (focused on loading patients and leaving the scene), EMS command, EMS operations, and transportation supervisors.
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* Michigan Department of Health and Human Services. (2019). MI-MEDIC. Michigan Medication Emergency Dosing and Intervention Cards.
These color-coded cards were designed to help emergency healthcare practitioners provide care for patients based on weight and age. Instructions for each age/weight group are provided on two cards: Conditions/Medications and Cardiac Resuscitation. The cards can be saved and/or printed for future use.
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National EMS Information System. (2023). Heat-Related EMS Activation Surveillance Dashboard.
Local, state, and federal public health, emergency management and health care workers can use this dashboard to better understand trends in emergency medical services responses to people experiencing heat-related emergencies in the pre-hospital setting.
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Paramedic Protocol Provider. (n.d.). EMS Protocols. (Accessed 10/2/2023.)
This webpage includes links to many state and county emergency medical services protocols including incident response and mass casualty incident plans.
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Rappahannock EMS Council. (2018). Regional Mass Casualty Incident (MCI) Plan.
This plan was developed to help emergency medical services providers in a specific region in Virginia provide a patient care via a unified, coordinated and immediate mutual aid response to any type of mass casualty incident including activation of regional / coalition coordinating entities. Two unique feature of this plan are its sections on training and exercise and air operations.
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Shartar, S., Moore, B., and Wood, L. (2017). Developing a Mass Casualty Surge Capacity Protocol for Emergency Medical Services to Use for Patient Distribution. (Abstract only.) Southern Medical Journal. 110(12):792-795.
The authors developed a prepopulated tool based on research, hospital capacities, and resource availability for emergency medical services providers “to distribute higher-acuity casualties to trauma centers and lower-acuity casualties to non-trauma hospitals.” They note that the tool was tested and validated in a series of tabletop and functional drills.
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State of Florida, Department of Health. (2018). Florida Ambulance Deployment Standard Operating Procedure.
This document outlines steps for marshalling and deploying ground and air emergency medical services during a disaster. The Concept of Operations section includes considerations for notice and no-notice events, communications, and resource management. Duties and responsibilities for select roles are also specified.
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U.N. Office for Disaster Risk Reduction. (n.d.). Prehospital and Disaster Medicine Disaster Terminology. (Accessed 10/2/2023)
This webpage includes an alphabetized list of terms and detailed definitions relevant to prehospital disaster preparedness and response.
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U.S. Department of Health and Human Services, Health Resources and Services Administration, Office of Rural Health Policy. (2012). Community Paramedicine Evaluation Tool.
This document addresses the need for each community paramedicine program to define its system-specific health status benchmarks and performance indicators and to use a variety of community health and public health interventions to improve the community’s health status. It also addresses reducing the burden of illness, chronic disease, and injury as a community-wide public health problem, not strictly as a patient care issue.
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Agencies and Organizations

American College of Emergency Physicians. EMS and Disaster Preparedness.
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American Trauma Center. Trauma Information Exchange Program (TIEP).
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Committee for Tactical Emergency Casualty Care.
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Emergency Nurses Association.
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International Academies of Emergency Dispatch.
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National Association of Emergency Medical Technicians.
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National Association of EMS Physicians.
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National Association of State EMS Officials.
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National EMS Information System.
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National Highway Traffic Safety Administration, Office of EMS. EMS.gov.
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Paramedic Protocol Provider. EMS Protocols.
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U.S. Department of Health and Human Services, Health Resources and Services Administration Emergency Medical Services for Children Program.
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U.S. Fire Administration. Emergency Medical Services.
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This ASPR TRACIE Topic Collection was updated in September 2023 and reviewed by the following subject matter experts (listed alphabetically): Raphael M. Barishansky, DrPH, Principal, RMB Consulting Services, LLC; Carol A. Cunningham, MD, State Medical Director, Ohio Department of Public Safety, Division of Emergency Medical Services and Professor of Emergency Medicine, Northeast Ohio Medical University; Ryan M. Hay, MSN, RN, PHRN, CEM Administrator, Public Safety & Emergency Operations, Lehigh Valley Health Network; John Hick, MD, Hennepin Healthcare; Richard C. Hunt, MD, FACEP, Senior Medical Advisor, Office of Health Care Readiness, Office of Preparedness, Administration for Strategic Preparedness & Response, U.S. Department of Health & Human Services; Jake Johnson, M.S, CEM, NRP, CHEP, Protective Services Emergency Management, Bon Secours Mercy Health; Jodi Keller, RN, Director of Healthcare System Emergency Preparedness and Response, COTS; Mary Massey, BSN, MA, PHN, Vice President Emergency Management, California Hospital Association, Hospital Preparedness Program; Amber L. Pitts, B.S., M.A., Healthcare Preparedness Program Section Manager, Division of Emergency Preparedness and Response, Bureau of Emergency Preparedness, EMS and Systems of Care, Michigan Department of Health and Human Services; Mary Russell, EdD MSN, Healthcare Emergency Response Coalition, Palm Beach County, FL; L. Corey Sloan, PhD(c), EdD, MPH, MS, MA, EMT-Paramedic, CEO, Managing Member, Principal Consultant, Viking Emergency Preparedness Consultants, LLC; and Meghan Treber, MS, Senior Director, Preparedness and Incident Management, University of Maryland Medical System.    

It was comprehensively reviewed in March and April 2016 by Eric Alberts, BS, FPEM, CHS-V, CDP-1, CHPP, CHEP, SEM, CFRP, FABCHS, Manager, Emergency Preparedness, Orlando Health, Inc. (Hospital System); Jim Bolen, MS, Planning Section Chief (T), Butler County / State of Ohio AHIMT; Julie Bulson, MPA, BSN, RN, Director, Emergency Preparedness, Spectrum Health Hospital Group; Patricia Frost, RN, MS, PNP, Director Emergency Medical Services, Contra Costa Health Services; John Hick, MD, HHS ASPR and Hennepin County Medical Center; Mark P. Jarrett, MD, MBA, MS, SVP & Chief Quality Officer, Associate Chief Medical Officer, Northwell Health, and Professor of Medicine, Hofstra Northwell School of Medicine; Brad Learn, Regional Healthcare Preparedness Coordinator, Kentucky Department for Public Health; and Joseph W. Schmider, State EMS Director, Texas Department of State Health Services, Office of EMS/Trauma System Coordination.

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