Jon Jui, MD, from Portland, reported that his regional EMS system has decided that fire fighters will enter Mall and other confined, but police-secured, areas and extract injured parties at active shooter incidents that are declared under control by law enforcement, and leave the ambulance/transport personnel/vehicle outside, positioned/staged to transport rapidly. 1. Do we go in? 2. Under what circumstances do we go in? 3. Who do we go in with? In Philadelphia, Crawford Mechem, MD, reported that the police are using some of their EMTs and paramedics as advanced team responders. Chris Cowell, MD, medical director of Denver Health, reported that the major issue at incidents are communications (inundated and multiple frequencies) complicate and confuse when and where EMS vehicles and personnel should move, position and transport from. Brent Myers, MD, reported that Wake County (N.C.) developed an active shooter EMS/police protocol in close cooperation with their law enforcement agencies and will continue to drill with and test it. James Augustine, MD, reported that the Atlanta Police Department found it beneficial to pair firefighters with police officers as they “cleared” an entire Courthouse because of the expertise of firefighters in performing rapid room searches–with proper police protection provided. It was agreed by the medical directors that this is the key area. They agreed that clear-cut communications, as well as command, control, response, activation and positioning parameters need to be addressed and resolved between EMS/fire department prior to an active shooter iIncident. At the end of the article, you can download the following: “¢ The Wake County EMS Protocol on Active Shooting Incident Response; and “¢ Informative slide show and notes from the North County Department of Justice/Attorney General’s Office. EMS systems and media outlets represented at Eagle Creek include: Acadian Ambulance Service Albuquerque, N.M. American Medical Response Anchorage, Alaska Grady EMS in Atlanta Austin, Texas Boston Chicago Cincinnati, Ohio Columbus, Ohio Dallas Denver, Colo. El Paso, Texas Federal Bureau of Investigations Ft. Worth, Texas Greenville, S.C. Honolulu, HI Houston Indianapolis Journal of Emergency Medical Services Kansas City, Mo. London Louisville. Ky. Memphis, Tenn. Miami Milwaukee, Wis. Minneapolis, Minn. Nashville, Tenn. New Orleans Fire Department of New York (New York City) Oklahoma City, OklaOrange Cty, Fla.PhiladelphiaPhoenixPortland, Ore.Raleigh/Wake County, N.C.Salt Lake CitySan Antonio, TexasSan FranciscoSt. LouisSt. Paul, Minn.TucsonTulsa, Okla.Washington, D.C.Wichita, Kan. How should we in EMS handle active-shooter event responses? Those are some of the key questions the Eagles/EMS medical directors addressed at the Eagles conference in an intense discussion of active shooter incidents with which their agencies have been involved.