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Active Killer Casualties

On Guard for Violent Intruders

Church Safety Team members provide emergency medical care to an injured man inside a church sanctuary. One responder applies a tourniquet while another assists the patient, and a third coordinates communication by radio. Bold yellow, black, and white text reads “Active Killer Casualties | Mass Trauma Response,” emphasizing church emergency preparedness, bleeding control, and lifesaving trauma response training.

An article based on the Safety Member Certification courses “Violent Intruder Response V5” and “Mass Trauma Emergency,” and the Church Security Guide article “Church Safety Teams and Active Shooter Training.” [1][2]3][4][5].

From the Bible

"For he maketh sore, and bindeth up: he woundeth, and his hands make whole" (Job 5:18).

Who forgiveth all thine iniquities; who healeth all thy diseases (Psalm 103:3).

And [the Samaritan] went to [the robbery victim], and bound up his wounds, pouring in oil and wine, and set him on his own beast, and brought him to an inn, and took care of him (Luke 10:34).

Introduction: The Uniqueness of Active Killer Casualties –

There is a reason for considering active killer casualties apart from other mass casualty incidents. Mass casualties in an active killer incident differ from other mass casualties in some ways. The three most significant distinctions are intentionality, the settings, and the kinds of injuries.

Intentionality,

Casualties in an active killer incident are intentional on the part of the killer. Even if some of the victims were not intended, the incident itself was intentional. Contrast this with severe weather or wildfires, industrial accidents, epidemics or food poisoning, non-arson fires, structural failure, etc. These, with rare exceptions, are not intentional.

Setting,

The setting of an active killer incident is unique among mass casualty events. It is not subject to outside forces, but the actions of individuals – the killer(s) and the responders. While still active, the killer or killers are a threat to the responders, including those treating the victims. Bombs are a possible exception, as long as there are no other planted explosives. However, law enforcement responders will check for other bombs before calling an all-clear.

If the incident is a fire with mass evacuation, persons that have burns or injuries from the escape, can be treated in the reunification area, safe from the fire. If people are in a storm shelter, treatment is readily available as long as qualified persons are present. But in an active killer incident, the threat continues wherever the killer or killers are. The threat with projectile weapons (such as firearms) has a larger cone of danger than threats with swords, knives, or clubs.

Kinds of injuries,

Most active killer injuries are wounds from weapons, whether firearms or edged weapons (knives, swords, spears). A bombing will cause blunt force injuries and/or burns.

In other mass casualty incidents, most injuries are blunt force, burns, gasses, water inhalation (drowning), poisoning, etc.

On the Web –

Here are reports of medical responses to a few active killer incidents:

Pittsburgh, Pennsylvania, October 27, 2018 – An antisemitic gunman entered the Tree of Life synagogue on a Saturday where three congregations were holding Sabbath services. After shooting the greeter, he went to the three rooms where congregants were meeting, shooting at least 18. Were it not for one rabbi hearing gunshots and directing his flock out a fire exit, more would have been shot. As it was, 11 persons were killed and at least 7 congregants wounded. Also wounded were two responding police officers. More would have died, but responders and congregants used their Stop the Bleed training to treat gunshot wounds. [6].

Not only this, but the city of Pittsburgh has structured its emergency services to respond to mass casualty incidents. Specially-trained EMTs were embedded with SWAT teams, equipped with IFAKs and tourniquets. Together, they practice responses to several kinds of mass casualty incidents. This arrangement is called Tactical and Law Enforcement Medicine (TLEM). A TLEM article by Keith Murray explains how they responded to the Tree of Life shooting. [7].

Sutherland Springs, Texas, November 5, 2017 – A gunman went into the First Baptist Church in Sutherland Springs, announcing, “Everyone dies.” By the time his rampage was interrupted by an armed neighbor, he had shot 46 persons: 26 killed and 20 wounded. Unlike Pittsburgh, this rural area – Sutherland Springs and Wilson County – was not prepared for an armed intruder incident. Also, besides the Pastor being in another place that morning, the few security persons were also elsewhere. The church was without a security presence, leaving them totally unprepared. The problems included inefficient communication (multiple agencies), short on supplies, no practiced coordination, etc. Most firefighters and law enforcement officers were trained in CPR and basic First Aid, but not gunshot wounds. In spite of these difficulties, the several agencies did manage to work as a team. However, one wonders how many more lives might have been saved if responders had been better prepared. [8].

Grand Blanc Township, Michigan, September 28, 2025 – On a Sunday morning, a man rammed his pickup truck into the meeting house of the Grand Blanc Stake of the Church of Jesus Christ of Latter-Day Saints, where the Grand Blanc Ward gathered to worship. He started a fire, then began to shoot parishioners fleeing into the parking lot. Four persons were killed, two by gunfire, and two in the fire. At least eight persons were injured, most by gunfire, some by smoke inhalation. Two of them were residents of the closest hospital, who notified it of incoming patients then ran into the burning building to rescue others. The two who died in the fire were not found until the fire was totally extinguished.

Response was rapid. Police officers neutralized the threat in less than four minutes. Ambulances were there to transport injured and wounded to a hospital ready to treat them. Without the quick response, more would have been injured, even killed. [9].

San Jose, California, November 22, 2020 – This incident happened during the Pandemic of 2020. Grace Baptist Church in San Jose has a shelter for homeless people. It is full during cold weather. A homeless man, who also had a long history of domestic violence, was helping serve during Sunday evening dinner. Something inflamed his anger. He grabbed a knife in the kitchen and began stabbing people. Five were stabbed before others took the knife away and held him for the police. One victim died on the scene and another at the hospital. Quick response by law enforcement and medics is credited with saving the lives of the survivors. [10].

Frederick County, Maryland, July 25, 2015 – On a Sunday afternoon at the Anna Prayer Center in a rural area, a Korean American man with a history of mental illness and domestic violence who was staying there for counseling and help took a knife from the kitchen and stabbed a husband and wife, missionaries from South Korea, because he felt disrespected. The male missionary died and the wife survived serious stab wounds. Authorities first heard of the attack when the assailant, who had fled, called them while still on the campus and told them he needed an ambulance because he had just stabbed some people. News stories did not say how the victims were treated. This also calls into question why 911 was not called sooner. [11].

Medical Response to an Active Killer Incident –

A Church Safety Ministry needs to be ready to respond to mass casualty incidents. If this is an active killer incident, it requires special planning, training, and equipping. Since, as we already know, any church may be the target of an active killer, then every church should take this into consideration in its preparations.

Preparation for an active killer casualty response includes considering the setting of such an incident in that church, organization of the response, preparing and equipping for the kinds of injuries that may be involved, and recruiting and training for the response.

Consider the Local Setting;

What would be the setting of an active killer incident in your church? Actually, this is a number of potential locations in the church as well as the kind of attack.

There may be other questions to ask when considering the locations and the method of attack. One is how we can fulfill the first responsibility, getting victims to safety, even while the attack is still going on. That partly depends on who is injured and where the rescuers are. Can they retrieve a patient without becoming victims themselves? The answer to this question may be in the sections below.

Organization;

This is where it can pay to already have a Church Safety Team. Attacks are planned by the attackers, not by the responders, so you cannot be certain when an attack will start. At the New Life Community Church in Colorado Springs, the security team was waiting, but only because they had been warned. There’s no guarantee you will be warned an assailant is on his way. [12].

Here are a few questions to ask and answer:

Preparing and Equipping;

Make your church’s plans for response and share them with church leadership. They can give you their views and help in refining the plans. That way, everyone is in.

Ensure that the church has enough supplies for treating wounds to limbs, bodies, and heads. There are special bandages and presses for each of those: Tourniquets are essential.

You should have enough, because during an event some might not be accessible at that time. Remember to consider the safety of the responders. Place these supplies in enough locations so that some will always be accessible, no matter where the active killers are.

An Individual First Aid Kit (IFAK) is essential equipment for a member of the Safety Team or the Medical Response Team. There should be enough that a team member can pick one up when picking up the radio. This is in addition to the mass casualty kits.

Know where to get the supplies and what to get. Sheepdog Church Security’s Amazon store, Recommended Equipment for Safety Ministries, has the Ergodyne Arsenal 5215 Large Medic First Responder Trauma Duffel Bag with Shoulder Strap. It has three compartments. The middle one has removeable dividers for easy organization of the contents. There’s plenty of room for covering a mass casualty incident. It does not come with supplies, so you can choose what to put into it. [13].

Sheepdog Church Security Academy is an affiliate of Mountain Man Medical. SDCA has its IFAK in the online store, the Sheepdog Belt IFAK. It contains 1 SOF-T, 1 4″ Israeli Bandage, 1 Pair of Gloves, 1 Pair of Shears, and 1 CPR Face Shield in a Prairie Molle Pouch. It was configured by Kris Moloney. [14].

Kris also coordinated with Mountain Man Medical (M3) in configuring the Mountain Man Medical Mass Trauma Kit. It is in a back-pack style, not too big. The reason is that it is better to have several kits rather than just one. First, if kits are well-placed, a kit will be available where needed. Also, more responders will have kits in a mass casualty incident. M3 has a guide to how many kits are needed according to the size of the congregation.

A Mountain Man Medical Mass Trauma Kit has the following items (list copied from the M3 page):

Note: these are chosen to keep victims alive until medics arrive.

M3 also has replacement supplies, so as items are used, the bag can be refilled. Since stopping bleeding is a key procedure in treating active killer victims, M3 has products for combatting mass hemorrhage:

It pays to have what you need when you need it.

Recruiting and Training;

Your church needs trained persons to respond to any mass casualty event, especially if it’s an active killer incident. This means you need to get the people, then be sure they’re all trained in the skills and practiced in coordination as a team.

Recruiting: look for persons who are already trained in trauma response, such as medics, nurses, and physicians, or who are willing and can be trained.

Training: The SCSA course Mass Trauma Emergency is as much about teamwork and organization as it is about skills. Basic skills in medical response can be learned through various organizations, such as the Red Cross, the American Heart Association, the military, medical school, etc. The goal is to get all the responders – Safety Team members, Medical Response Team members, and other trained volunteers – to work as one team during an active killer event. This means drills. Who does triage? Who directs? Who is the runner getting what each responder needs? Who communicates with agencies? And so on.

They all should also be trained in Violent Intruder Response. Frankly, this is not a storm or an accident. This is an intentional killer coming into the church.

Conclusion –

If a violent intruder begins killing people in the church or on its premises, we need to be ready to treat several wounded persons.

References –

  1. Kris Moloney, Safety Member Certification, Sheepdog Church Security Academy, 2025 [https://sheepdog-church-security.thinkific.com/courses/safety-member-certification-v5-2025]
  2. Kris Moloney, “Violent Intruder Response V5,” Safety Member Certification, Sheepdog Church Security Academy, 2025 [https://sheepdog-church-security.thinkific.com/courses/church-safety-violent-intruder-response].
  3. Kris Moloney, “Mass Trauma Emergency,” Safety Member Certification, Sheepdog Church Security Academy, 2022 [https://sheepdog-church-security.thinkific.com/courses/mass-trauma-emergency].
  4. Kris Moloney, Church Security Guide, Sheepdog Church Security Academy, 2023 [https://sheepdog-church-security.thinkific.com/pages/security-articles?c=church-security-guide].
  5. Kris Moloney, “Church Safety Teams and Active Shooter Training,” Church Security Guide, Sheepdog Church Security Academy, June 9, 2023 [https://sheepdog-church-security.thinkific.com/pages/security-articles?p=church-safety-active-killer-response-strategies].
  6. Staff, “Get Trained,” American College of Surgeons, Copyright © 1996-2026 [https://www.stopthebleed.org/get-trained/].
  7. Keith Murray, “After Action Report and Lessons Learned – Tree of Life Synagogue - Pittsburgh, PA,” Tactical and Law Enforcement Medicine, May 22, 2019 [https://www.acep.org/talem/newsroom/may2019/after-action-report-and-lessons-learned--tree-of-life-synagogue---pittsburgh-pa/].
  8. Person Interviewed: Chris Thompson (Fire Chief), “A Mass Shooting in a Small Texas Town Shows the Importance of a Coordinated, Team-Based Response,” Rural Health Information Hub, date of article unstated [https://www.ruralhealthinfo.org/toolkits/emergency-preparedness/case-studies/mass-casualty-incidents/district-1-fire-and-rescue].
  9. Carol Thompson, “'Wounds you never see in Grand Blanc': Doctors share trials of treating attack victims,” The Detroit News, October 1, 2025 [https://www.detroitnews.com/story/news/local/michigan/2025/10/01/wounds-you-never-see-in-grand-blanc-doctors-share-trials-treating-mormon-church-attack-victims/86458719007/].
  10. News Saff, “'Horrific' San Jose Church Stabbing; Suspect Arrested; Two Dead, Three Seriously Injured,” CBS San Francisco, November 23, 2020 [https://www.cbsnews.com/sanfrancisco/news/update-suspect-arrested-two-dead-others-seriously-injured-in-stabbing-at-san-joses-grace-baptist-church/].
  11. Roz Plater, Sam Sweeney, Diane ChoSun, “Song Su Kim charged in deadly church stabbing in Urbana, Md.,” ABC 7 (WJLA), July 26, 2015 [https://wjla.com/news/local/one-dead-one-in-critical-condition-after-church-stabbing-in-maryland-115940].
  12. WGV, “The 2007 New Life Church Shooting,” Sheepdog Church Security, December 6, 2021 [https://sheepdogchurchsecurity.net/articles/2007-new-life-church-shooting/].
  13. Kris Moloney, Instructor, Recommended Equipment for Safety Ministries | Church Safety and Security Aids and Equipment Ideas, Amazon, 2025 [https://www.amazon.com/shop/instructor_moloney/list/].
  14. Kris Moloney, Sheepdog Belt IFAK, Mountain Man Medical [https://www.mountainmanmedical.com/product/sheepdog-belt-ifak/?aid=18].
  15. Mountain Man Medical Staff and Kris Moloney, Mountain Man Medical Mass Trauma Kit, Mountain Man Medical [http://www.mountainmanmedical.com/product/the-mass-casualty-trauma-kit/?aid=18].
  16. Staff, Massive-Hemorrhage, Products, Mountain Man Medical [https://www.mountainmanmedical.com/product-category/march/massive-hemorrhage/].