Rapid Assessment Medical Support (RAMS) for active shooter incidents.

This country has witnessed a steady increase in the number of active shooter incidents in recent years. The traditional emergency medical services (EMS) response to such incidents has been to stage at a safe distance until the scene has been secured by law enforcement. Such an approach may lead to unnecessary delays in medical care and potentially needless loss of life. To address this issue locally, the Philadelphia Fire Department (PFD) and the Philadelphia Police Department (PPD) collaborated to develop the Rapid Assessment Medical Support (RAMS) program. All PFD paramedics have been equipped and trained to move with PPD officers into a scene that has been cleared by police but not yet secured in order to initiate emergency care, with an emphasis on hemorrhage control. Patients are then extracted to awaiting EMS resources in the cold zone. The history behind the program and the challenges and obstacles that had to be addressed in its development are described. These included initial and ongoing training and funding sources; buy-in from risk management, labor, and the individual providers; whether only paramedics should be included in the RAMS program or if the PFD's firefighter-EMTs should be included as well; the potential for mission creep as police recognized the value of this asset and its potential application to other scenarios; and how to involve the many nonmunicipal ambulance services that are not involved in the routine operation of Philadelphia's 9-1-1 system. To date, RAMS teams have been activated on multiple occasions, but fortunately the incidents were resolved without injury or loss of life. However, the program provides another valuable tool with which the City of Philadelphia can respond should another active shooter incident occur.