Preparing for the Worst

Posted on September 3rd, 2025
Vincent Torres Gordon Center

Preparing for the Worst – Training First Responders for Active Shooter Events

An interview with Vincent Jesus Torres, Executive Director, Emergency Management; Associate Director of Disaster Management with the UM Global Institute for Community Health and Development; and Adjunct Instructor at the Gordon Center for Simulation and Innovation in Medical Education.

Vincent, can you briefly introduce yourself and explain your role at the Gordon Center?
I wear a couple of hats. My primary title is Executive Director of Emergency Management for the health system and the medical school. I also hold a secondary appointment as Associate Director for Disaster Management at the Global Institute for Community Health and Development. Outside the university, I’m also an active-duty law enforcement officer. And here at the Gordon Center, I serve as an adjunct instructor, teaching first responder courses like the Active Shooter Hostile Event Response program, among others.

Can you tell us a bit about how the Gordon Center’s regional hub in Tallahassee came to be, especially in collaboration with the Florida Public Safety Institute?
We had previously delivered a program up there, and there was strong interest from the Florida Public Safety Institute (FPSI) in Tallahassee to expand the partnership. It was a great opportunity to extend our reach and bring the training more frequently to first responders in the northern region of the state. We trained instructors from Tallahassee State College’s Florida Public Safety Institute (FPSI)– some of whom are active-duty law enforcement officers from local agencies – so they could teach our program themselves. It’s been a really effective way to broaden our instructor base and bring the training to more areas.

What does the work at the hub entail? What happens on the ground there?
Essentially, the hub delivers the program on our behalf. When we’re there, we co-teach or audit the program to ensure it aligns with our standards. We recently taught classes together (May 20-22) in Tampa and Pensacola (July 14-16) – our team from Miami and theirs from Tallahassee. The goal is for FPSI to teach police and fire academy cadets and provide training for local police departments and fire rescue agencies through the Institute.

The program you’re referring to – can you summarize it briefly? And is this something entirely new or an evolution of previous efforts?
It’s called the active shooter hostile event (ASHE) response program. It’s been around for some years now. While other programs focus on tactics and stopping the bad guy, our program focuses on integrating law enforcement and emergency medical services in the response.

Historically, as with the school shooting in Columbine in 1999, law enforcement would secure the perimeter and wait for the SWAT team. Tactics have evolved to bring medical teams – EMS, paramedics, fire – into what’s referred to as the “warm zone,” just behind the “hot zone,” where the threat is currently not present but isn’t active at the moment. Law enforcement escorts these responders in so they can start immediate care. If that’s not possible, officers themselves are trained in medical management such as Tactical Emergency Casualty Care, which is “Stop the Bleed” for responders – things like applying tourniquets, chest seals, and wound packing – to begin lifesaving interventions right away.

Let’s talk about the FSU shooting in April of this year. I know it’s hard to be definitive, but how might this training have helped?
We know for a fact that several of the responding agencies that day – FSU Police, Tallahassee Police, and others – had individuals we trained in the response. While I can’t share specifics because the investigation is ongoing and the case is pending trial, we’ve heard, officers did exactly what they were trained to do and neutralized the threat quickly. Then officers on the scene began administering medical interventions before victims ever reached ambulances. The timeline from the first call to the final shot was under three minutes. 11:58 a.m. – first call to police; 12:00 p.m. – subject down. And remember, this wasn’t the first shooting at FSU. There was also the library shooting in 2014.

That’s incredibly fast.
It is. These events tend to be over in minutes, even seconds, from first shot to last, but the aftermath – recovery, support – can last for years. Institutions must be prepared not only to stop the bad guy quickly and treat the injured, what we refer to as “stop the killing” and “stop the dying.” They must be prepared to manage the consequences of the incident. This is accomplished through good command, control, communications, and coordination via the incident command structure, which must be stood up as fast as possible to manage the scene and scale as necessary. That’s also a core component of the course.

It seems like those who were wounded in this latest incident survived, which might suggest that early intervention worked.
That is our understanding of the incident. We’ll need more data, but early medical intervention is the cornerstone of this program. An adult can bleed out in 2 to 3 minutes; a child even faster. So, the faster we stop the bleed, the more likely the patient is to survive. Every second counts. What also sets our program apart is the simulation component. At the end of each training day, we conduct a number of realistic exercises that escalate in size and complexity, using the crawl-walk-run method.

Can you walk me through what those scenarios look like?
The simulations are done with role players and moulage – makeup that simulates real wounds – to create as much realism as possible. We run through three main scenarios.

The first scenario is relatively small and simple, testing the core components of what they learned. The idea is to get participants comfortable.

We place them in a single room with a small number of victims. The assumption is that the active shooter has already been neutralized, and the responders are entering a “warm zone.” This is about forming the rescue taskforce, getting in, starting triage, and providing care under pressure.

The second scenario increases the complexity. There are more victims, more space to cover – multiple rooms, maybe a hallway – and the teams begin to manage the scene more actively. They set up a casualty collection point (CCP), begin coordinating the movement of victims, and secure the space. It introduces more decision-making and coordination. This scenario is typically repeated three to four times with different groups.

Then we move to the third scenario, which is the most complex. We combine all the groups into a single large-scale operation. Now you have a contact team and multiple rescue taskforce units working simultaneously. They’re navigating stairwells, handling a range of wound types, coordinating through an incident command system, and working with a simulated dispatcher to manage rescue truck staging and movement from the CCP to the hospital. It’s a full-blown, high-pressure simulation that brings everything together.

Are there any plans to create more regional hubs like the one in Tallahassee, either statewide or nationally?
I’m not sure about expansion plans, but the current setup works well. With Miami in the south and Tallahassee in the north, we can teach together across the state of Florida. Tampa and Pensacola, which I already mentioned, are great examples of collaborative training, with the Tallahassee team taking more of a lead over time. Pensacola is scheduled for the week of July 14 with the Miami and Tallahassee teams training a group of responders together.

To learn more about the Active Shooter Hostile Event Response program, visit:
Gordon Center Emergency Training


University of Miami Miller School of Medicine’s Standardized Patient Program Featured in Miami Today

Posted on March 6th, 2024

The use of standardized patients allows students to practice taking medical history on patients, doing physical exams and talking to patients. Read the Miami Today’s story featuring Dr. Gauri Agarwal, associate dean for curriculum at the University of Miami Miller School of Medicine and Gordon Center’s Samantha Syms, director of the Standardized Patient Program. Read Article


One Million Lives: A Laerdal Podcast

Posted on February 21st, 2024

Dr. Barry Issenberg, recently shared profound insights on the future of patient simulation in One Million Lives, a Laerdal Podcast. In this podcast episode, Dr. Issenberg delves into the evolving landscape of patient simulation and its critical role in healthcare. For healthcare professionals eager to explore the transformative potential of patient simulation, this podcast is a must-listen.


NAVRA Presentation – Point of Care Ultrasound – Monday, November 13, 2023

Posted on November 9th, 2023

Come join us at the 2023 NAVRA, for an in-person event showcasing the power of Point of Care Ultrasound in Trauma by the University of Miami Gordon Center.
In recent years, the use of point of care emergency ultrasound (POCUS) has become a rapidly growing field. In emergency medicine, US has been integrated for rapid diagnostic and procedural capabilities. There is increasing evidence that US has a role in out-of-hospital emergency care and with the advent of lower cost portable devices, the use of US in EMS is growing. Prehospital Ultrasound may be beneficial in the diagnosis and management of trauma and critically ill patients. EMS providers, with the appropriate training, can acquire and interpret ultrasound images and address prehospital diagnosis in real-time.


Metaverse Medicine and the Doctor, Patient Avatars Ahead

Posted on August 25th, 2023

In what some are calling the next iteration of the internet, the metaverse is an unfamiliar digital world where you could be an avatar navigating computer-generated places and interacting with others in real time. In this space, the constraints of our physical, bricks and mortar world and travel habits fade. And new opportunities and challenges emerge.

At the University of Connecticut Health in Farmington, doctors in training got a first taste of what life could be like in a futuristic place like this when residents were given virtual reality headsets for the first time.

In a historic moment, orthopedic surgeries were largely put on hold because of the COVID-19 pandemic, says Olga Solovyova, MD, assistant professor of orthopedic surgery at UConn Health.

Now, residents put on goggles and see their avatars (digital representations of themselves) in a virtual operating room with a table, instruments and a virtual patient. They manipulate the instruments with controllers and feel the resistance when they saw or drill a bone and they feel the pressure drop when they cut through completely.

In VR, they can also peel away virtual layers of skin and muscle to better view the bone underneath. Training modules give feedback on how well students complete procedures and track their progress.

Headset Ready

“Classically it was always the ‘see one; do one; teach one,’ mentality, watching first and then practicing then teaching others,” Solovyova says. Now residents can practice on their own repeatedly in a safe environment with professional feedback.

It also allows practicing rare surgeries that might not come up in real-life patients, Solovyova says.

Such training in digital environments like the metaverse is starting to become more common at other surgical residency programs in the U.S., she says.

Some aspects of the metaverse – a term just beginning to make its way into conversations – are already here like VR training, telemedicine and 3D printing.

Facebook’s announcement last year that it would be rebranded as Meta set off ripples of curiosity about the concept. Definitions differ, but at its core the metaverse is the space where VR, augmented reality, artificial intelligence, the Internet of Things (where unrelated devices communicate with each other), quantum computing and several other technologies come together to bridge the physical and digital worlds.

The Meta-What?

A report by industry trends analyst Gartner predicts that 25% of people in the world will spend at least an hour a day in the metaverse by 2026, whether for work, shopping, education or entertainment.

And with the wearable technology today, people can monitor their vitals and update their doctor with real-time data. Barry Issenberg, MD, director of the Gordon Center for Simulation and Innovation in Medical Education at the University of Miami, says electronic health records in the metaverse will likely become living documents updated from sensors in clothing or furniture, on phone apps or wearable devices.

Instead of people coming into a doctor’s office to be examined and have lab values interpreted, doctors will already have much of the picture in uploaded data.

That, he says, will help address a common complaint that with electronic health records medical visits have become strained with doctors distracted by typing information into templates.

Doctors can also set parameters for abnormalities so that if a patient’s blood pressure gets too high or walking abnormalities are detected, the doctor will be notified, enabling more proactive, preventative care.

Because people will also get the information in real time, they can become more engaged in their own care, Issenberg says.

Virtual Tools

In Miami, clinicians are working with emergency responders in the community using virtual tools. They can show a learner using a stethoscope, for instance, the anatomy that lies underneath the chest so the responders don’t have to imagine a hea

rt pumping — they can see it on a screen while hearing the sounds.

At Miami’s Bascom-Palmer Eye Institute, Issenberg says, a doctor developed personal goggles that can detect the visual response of patients. The goggles are sent to patients with vision problems so doctors can conduct exams without the patient having to come into the center.

A major stumbling block for ushering in the metaverse is a problem that has thwarted progress in the use of electronic health records, too. Health systems use different technologies that often don’t talk to each other.

The metaverse will find more seamless connectivity in large, contained systems such as the Veterans Administration, Kaiser Permanente and the Mayo Clinic, Issenberg says.

And clinical trial recruitment, patient engagement and monitoring could also look different in the metaverse, says Nimita Limaye, PhD, research vice president of Life Sciences R&D Strategy at International Data Corp., headquartered in Needham, MA.

Clinical Trial Digital Access

Many of the challenges associated with clinical trials include a big burden on patients, which can result in people not following directions or dropping out of trials. Questionnaires can be long and difficult to fill out.

Virtual assistants could issue reminders on medications, ask patients how they are feeling each day, read questions to people and record the answers for investigators.

“I don’t think that’s very far away,” Limaye says, noting that voice commands are much more convenient than downloading and using apps, especially for older people who may have poor eyesight.

Amazon Web Services is already working with its voice and Chatbot solutions, Alexa and Amazon Lex, to improve clinical trial participation, reduce dropout rates and improve the quality of the data recorded.

One day, Limaye says, people with a particular disease or condition could ask a virtual assistant such as Alexa what clinical trials are available for them.

Exclusion and inclusion criteria could be built into the technology and the virtual assistant could answer with a list of trials and directions on how to sign up.

COVID-19 Limaye says, already changed clinical trials and made it more common for people to participate from home through telehealth, home health nurses, wearables and the direct-to-patient shipment of drugs and devices.

“The life sciences industry saw the proof of concept that technology can work with clinical trials,” she says.

As technologies advance, Limaye adds, equitable access will be critical.

While few can afford a sophisticated virtual reality headset yet, she points out, other solutions may be more widely accessible.


Gordon Center Annual Report 2021

Posted on February 19th, 2022

Our 2021 Annual Report is now available! Join us in looking back and learning about our plans going forward.


Virtual/Remote Simulation to Complement Face-to-Face Learning in the COVID Era and Beyond

Posted on February 1st, 2021
The Gordon Center will be hosting a virtual learning lab during this year’s IMSH conference. On January 20th from 2-3PM EST, we will discuss:
  • Hybrid Courses: Dr. Ross Scalese
  • Tele/Virtual Objective Structured Clinical Examinations: Ms. Samantha Syms, MS, CHSE
  • Transitioning Courses from In-Person to Other Formats: 
    Dr. Ivette Motola & Mr. Al Brotons, EMT-P
For more information or to register for the live session, CLICK HERE.

Please also join us at our exhibit in the IMSH Delivers Virtual Industry Hall that will be open every Wednesday from January 20th through March 31st.
View full schedule.