As mass shootings become more common in the United States, hospitals have increasingly faced the challenge of treating many patients with life-threatening injuries simultaneously. Wednesday's shootings in San Bernardino, California put those protocols into action. Initial reports indicated that at least 14 people had been killed and that 14 others were injured. At least eight victims were reportedly rushed to Arrowhead Regional Medical Center—which was put on lockdown— and four others were sent to Loma Linda University Medical Center. A photo showed tents were set up outside of Loma Linda University Medical Center, with medical personnel standing nearby to treat victims as they arrived.

Neither of those hospitals released details of their actions on Wednesday afternoon. But Ken Bouvier, a New Orleans fire chief and paramedic who specializes in responses to mass shootings, outlined several tactics for handling such incidents, according to, a website for paramedics.

Bouvier recommended waiting for law enforcement to secure the scene and said medics should not draw attention to themselves if there is an active shooter on the scene. Bouvier also advised EMS to call for disaster supplies early, including blood and tactical EMS resources, as well as activate the hospital disaster plan quickly by calling and saying, "We're on scene with at least X number of casualties, many of which are coming your way." 


"It's better to call in too much medical aid than too little," Bouvier said, adding that in mass shooting situations, people must react to what might happen in a worst case scenario.

In October, during a campus shooting at Umpqua Community College in Roseburg, Oregon, a hospital about five miles from campus had roughly 15 minutes to prepare before the first victims arrived. When word got out about the shooting, Mercy Medical Center immediately prompted an all-hands-on-deck scenario. Surgeons reportedly canceled office appointments to be available to treat gunshot victims. Pediatricians, obstetricians, retired orthopedic and vascular surgeons called the hospital to offer their services. Non-clinical staff were also critical to the hospital's emergency response, including pastoral care staffers who comforted distressed families. Public relations staff managed the influx of national media attention while protecting patient privacy as well, according to the Catholic Health Association of the United States.

In Paris last month, after gunmen opened fire in restaurants, bars and a concert venue, the French followed protocols adapted from the military and sent physicians to the field, setting up triage centers close to the site of attacks. Patients were dispatched to a hospital where specialists were on hand to treat particular injuries. Patients wore colored signs around their necks representing different levels of injury: red for those critically wounded and admitted directly to resuscitation units or surgery,  yellow for those who needed immediate treatment in the ER, and green for patients who could be released with instructions to check in at an ER within 24 hours.