What can you say? What can you do? Are there solutions? These are all questions we ask ourselves.

Just a few days before the Umpqua Community College shooting, I was hanging out with a couple of fellow firefighters/paramedics from different agencies in Oregon. Little did we know that one of us would be the first paramedic and medical responder on scene.

During a mass casualty incident (MCI), the first EMS personnel on scene aren’t running around placing tourniquets, administering fluids, or saving lives at a record rates. They are performing one of the most difficult jobs in the world of emergency medicine: triage. From start to finish, the first on scene are there, categorizing every victim and deciding who is and who isn’t a priority. Whether young or old, a mass shooting is the worst day of your career as a medic.

Patients have a card attached that states their level of need, order of treatment, or if resources are better used elsewhere. The individuals working triage must make these decisions. There is no re-do, instant replay, or second-guessing and time-wasting. Not every decision will be perfect, but decisive action is necessary.