WASHINGTON - Seven minutes after the authorities in Sparks, Nev., received a call one day in October that a gunman was on the loose at a local middle school, a paramedic wearing a bulletproof vest and helmet arrived at the scene.
Instead of following long-established protocols that call for medical personnel to take cover in ambulances until a threat is over, the paramedic took a riskier approach: He ran inside the school to join law enforcement officers scouring the building for the gunman and his victims.
"He met the officers right near the front door, and they said, 'Let's go. There are victims outside near the basketball court,' " said Todd Kerfoot, the emergency medical supervisor at the shooting. "He found two patients who had been shot and got them right out to ambulances."
Federal officials and medical experts who have studied the Boston Marathon bombing and mass shootings like the one in Newtown, Conn., have concluded that this kind of aggressive medical response could be critical in saving lives in future episodes.
In response to those findings, the Obama administration has formally recommended that medical personnel be sent into "warm zones" before they are secured, when gunmen are still on the loose or bombs have not yet been disarmed.
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"As we say, 'Risk a little to save a little. Risk a lot to save a lot,' " said Ernest Mitchell Jr., the Federal Emergency Management Agency's fire administrator, who released new guidelines on mass casualty events for first-responders in September.
The guidelines said that such events, which have led to more than 250 deaths in the past decade, are "a reality in modern American life" and that "these complex and demanding incidents may be well beyond the traditional training of the majority of firefighters and emergency medical technicians."
They recommended that any of those first-responders sent into "warm zones" focus on stopping victims' bleeding. The guidelines also said that first-responders should be equipped with body armor and be escorted by armed police.
"These events, like the shootings, are usually over in 10 to 15 minutes but it often takes over an hour for everyone to get there," said Dr. Lenworth Jacobs, a trauma surgeon who created the Hartford Consensus, which brought together experts in emergency medicine and officials from the military and law enforcement after the Newtown shooting to determine better ways to respond to mass casualties.
"We're seeing these events in increasing frequency and unfortunately we have to change how we approach them to keep death tolls down," Jacobs said.