Cross-Pollination of Active-Shooter Response and Critical Casualty Care

Notes From Combined Training in a Non-U.S. Jurisdiction

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Introduction

The internationalization of training and adaptability to different environments and end-users have been subjects of many operational concepts, considerations, and management opportunities. However, what happens when one attempts to take a robust and tested US active-shooter training and critical casualty care to an entirely different environment, such as Bosnia and Herzegovina, and is faced with a lack of training materials? This essay explores the necessity of tactical improvisation, offering a blueprint for synthesizing fragmented resources into a cohesive training regimen that, while forged in the unique jurisdictional landscape of Bosnia and Herzegovina, provides scalable lessons in adaptability for security professionals worldwide.1 

Background

The Western Balkans and Bosnia and Herzegovina, situated in the southeastern corner of Europe, are transitional, post-conflict societies, influenced by the Yugoslav succession wars of the 1990s. Unlike certain media portrayals, they are far from being “third-world hellholes” and do not differ much, in mentality, occupation and infrastructure, from many US Appalachian jurisdictions: Kentucky, West Virginia and North Carolina being very close parallels. 

Similar to their US counterparts, they have problems with the aging infrastructure, nepotism, social services, substance abuse, unemployment, particularly with the coal mines shutting down; however, recently, another US phenomenon – the emergence of an active shooter – has appeared. An old Appalachian adage, that “if the man was down on his luck and at the end of the bottle, the only way up is with a gun” may be applicable in the Western Balkans: generational trauma, post-war PTSD, substance abuse, domestic issues, and income inequality, coupled with various pressures, are manifesting with violent encounters. Unlike the United States, the motive of the active shooter is not the “avenger” mindset but rather a “desperado” mindset, as in, there is nothing else left to lose, so let’s go out with a bang

Within a very narrow time frame, the Western Balkan region experienced multiple active attacks: Vladislav Ribnikar Elementary School in Belgrade, Serbia (May 2023),  villages of Dubona and Malo Orasje (May 2023), Daruvar retirement home in Croatia (July 2024),  Sanski Most High School in Sanski Most, Bosnia and Herzegovina (August 2024); Precko Elementary School in Zagreb, Croatia (December 2024), Cetinje, Montenegro (2022 and January 2025). The final toll was over 50 dead and many more wounded, and law enforcement was ill-prepared and caught off-guard to react in such situations. 

DTCare is a US-based non-governmental organization (NGO) from Pittsburgh, Pennsylvania. Owing to various reasons, the organization’s principals have a close relationship with Bosnia and Herzegovina with a branch office in Sarajevo, the capital of Bosnia and Herzegovina. When the shootings began, a connection was made with the Texas State University Advanced Law Enforcement Rapid Response Training (ALERRT) Center to craft a pilot project for Bosnia and Herzegovina (and the Balkans). The ALERRT Center is the gold standard for active-shooter response in the United States, and through a variety of available courses, it trains both law enforcement officers and civilians. In November 2024 and July 2025, ALERRT/DTCare and ALERRT conducted two Level I train-the-trainer classes in the town of Kiseljak, at the local CEPS College for six law enforcement agencies in Bosnia and Herzegovina. Within this initial training, another link-up was established with Masaryk University, Department of Health Sciences in Brno, Czechia. This link was particularly interesting because it introduced another important concept, “affordable training aids,” which will be discussed later.  Thus, the training program can be described as a mix of US expertise, Czech adaptability, and Bosnian improvising to produce a successful outcome, in the adage of “adapt, adjust, and overcome.”

The ALERRT way – US expertise

The ALERRT Center at Texas State University was established in 2002 in the wake of the Columbine shooting and has since become the national standard for active shooter response training. The core methodology — avoid, deny, and defend for civilians and rapid patrol-level engagement for law enforcement — has been validated across hundreds of real incidents and delivered to millions of Americans. However, the effectiveness of ALERRT is not solely due to the tactics. Rather, it is the way the program approaches learning itself.

Most traditional training follows a familiar sequence: first, facts are taught; second, techniques are drilled; and third, scenarios are introduced. The assumption is that knowledge and skills must be in place before a trainee can meaningfully engage in realistic situations. However, this sequence produces people who perform well in controlled environments but struggle when the situation stops cooperating.

ALERRT has always emphasized scenario-based training, but the program is increasingly grounding that emphasis in current learning science. This direction is well captured by a framework developed by philosopher John Vervaeke and colleagues, which describes four interconnected forms of knowing: knowing facts (propositional), knowing how to execute skills (procedural), knowing what a situation feels like from the inside (perspectival), and knowing by being fully present and engaged in a role (participatory). Traditional training treats these as a staircase to be climbed from facts up to full participation. However, research suggests that the staircase is upside down. Effective learning begins with participation, placing trainees in representative situations from the start, acting in the role, making real decisions under realistic pressure, and the other forms of “knowing” develop from that base.

In Bosnia and Herzegovina, this was not a theoretical proposition. Stripped of familiar training aids, working across language and cultural barriers, the training team had to place trainees in the situation and build outward from there. These constraints forced adaptation at every level and demonstrated that the model holds even when the conditions are nothing like what the curriculum was designed for.

Critical Casualty Care – Czech adaptability

When we teach the management of high-casualty incidents, such as ongoing floods, fires, or active attackers, there is often a simple rule: “First, stop the killing; second, stop the dying.” Therefore, crisis-response training is incomplete without a medical component focused on hands-on critical care for the casualty (CCT). The most common skills taught are managing life-threatening bleeding and making quick, practical decisions about who needs to be moved first and how.

In our training, we try to maintain a high quality by focusing on retention, which is people ’s ability to perform tasks weeks and months later, not just during the course. The challenge is that this is not always easy in remote locations or in places with limited resources. Sometimes, you simply cannot have all the equipment and the newest simulation tools. In such situations, we remind our instructors and colleagues that they do not have to “play by the book,” as long as they still meet the learning objectives. In underserved environments, this means being adaptable and able to do a lot with very little.

In Bosnia and Herzegovina, we used simple, low-cost props that were easy to obtain and quick to reset. One example is wound packing, using citrus fruit. First, we created a simple “wound” opening in the peel of an orange (for example, by striking the orange against the ground or making a short slit/puncture), so there was an opening to pack. When the orange was squeezed, juice leaked out like active bleeding, providing trainees with immediate performance feedback. The trainees practiced packing finger-over-finger until the “bleeding” stopped; we then added direct pressure and reassessment. The same idea could be applied under clothing and placed at the groin or armpit (junctional areas) to force harder decisions: pack vs. direct pressure, or tourniquet when the bleed is on an extremity.

A second example is triage using plush (stuffed) toys as “casualties.” We could set up many patients in seconds, apply simple tags, and have learners sort and resort priorities as new information appeared. Although it was not realistic in appearance, it was realistic in testing decision speed, team communication, and coordination, exactly what the learning objectives required.

This simple and resourceefficient approach kept medical actions tightly connected to the tactical decision cycle and supported the scenariobased methodology described below, while also being cost-effective.

Training Challenges – Bosnian improvising

Implementing an American-designed active attack response program in Bosnia and Herzegovina brought both expected and unexpected challenges. Of course, there is the language barrier that must be addressed with any course developed in one language and presented in another. Written course materials were translated into the local language. During the oral presentation portions of training, the trainer would speak in English and pause to allow for translation. This slowed the rate at which the material could be communicated; however, it also ensured that the students understood the material. Culturally, there were many differences regarding what is expected of police officers. The concept of patrol-level officers engaging a shooter without waiting for orders or a SWAT team runs counter to deeply ingrained norms in many European police organizations, including those in Bosnia. The more hierarchical structure of command in Bosnian agencies initially created hesitation among participants when exposed to the ALERRT model’s emphasis on rapid engagement. Through discussion, we were able to adjust training to address these issues.

Legally, the use-of-force framework in Bosnia differs significantly from that in the United States. Bosnian officers operate under stricter legal parameters and public expectations regarding firearm use. As a result, training scenarios that in the US context are seen as straightforward justifications for lethal force often require extended discussion and adaptation to fit Bosnian legal standards. The presented challenges were strategic in nature and could mostly be addressed with ease; however, when it came to execution, real operational challenges emerged.

The first challenge in the Balkans was to separate the police officers from their firearms during training. ALERRT is very strict in this regard, and for an excellent safety reason – fatal mistakes have occurred in the past. However, in the Balkans, disarming the officers, searching them (repeatedly), and requiring that all firearms (and other weaponry) be safely secured for the duration of the training was tantamount to ensuring safety. By demonstrating that the trainers as well as the trainees were searched and that everyone was the same, unarmed and dedicated to safety during training, the disarmament process gradually became routine.

An additional challenge came with the training aids required for scenario-based training. Given the complex jurisdictions and often numerous legal codes at various levels of governance (in Bosnia and Herzegovina, there are 13), most of the items used for training simulations but accessed with ease in the United States (e.g., non-firing prop, or “blue,” guns) are heavily regulated in other countries. Hence, any medical device (e.g., tourniquet), blank-firing guns, blue (non-firing) prop guns, airsoft guns, and so on, had their own regulative framework, licensing, and such in Bosnia and Herzegovina. The import of training, non-firing pistols required almost comparable levels of licensing as for real firearms. To overcome these challenges, we opted to 3D print most of the required training aids (guns, holsters, knives, radios), and are also now working on developing training tourniquets, because to import even the training tourniquets one needs to have a license for the importation of “medical devices,” issued by a ministry, approved by the agency, and granted by the commission, even for the training of law enforcement agencies. No licensing is required (yet) for the 3D printing of props; the printers and raw materials are inexpensive and readily available. 

Concluding remarks

The supervised growth model that emerged from this work represents one of the most important long-term investments in the program. Simply certifying trainers to deliver existing curricula is insufficient, particularly in contexts where conditions differ every time and where trainers will face challenges that no script can anticipate.

The model asks a more challenging question: how do you develop instructors who can adapt? The answer draws on the same principles that underpin the training itself. The required shift is from the instructor as the authority, the expert who holds the correct answers and delivers them, to the instructor as an experienced guide. Not a teacher who has all the answers, but a practitioner who knows the terrain, has seen where trainees get lost, and designs situations that force them to find their own way through.

This transition is more difficult than it appears. Most instructors were trained using the traditional model and default to it under pressure. The supervised growth pathway creates structured checkpoints: trainees first complete the course as students, then assist as junior instructors under observation, then lead scenarios with mentorship, and then certify as independent trainers. At each stage, the scaffolding is withdrawn. By the time a trainer is fully certified, they have navigated these challenges themselves, which is the only reliable way to know where they are.

The participants in Bosnia and Herzegovina reported high levels of engagement, satisfaction with the course structure, and appreciation for the scenario-based learning design. Many emphasized that this approach was a significant departure from their prior training experiences, which tended to rely heavily on classroom lectures, theoretical discussions, and static drills. Participants noted that being placed in dynamic, uncertain scenarios forced them to think and act in real-time, bridging the gap between abstract principles and operational reality. Several commented that while classroom instruction had provided knowledge, this type of scenario work built confidence and readiness.

The successful delivery of the initial courses at CEPS College in Kiseljak, Bosnia and Herzegovina, has set the foundation for deeper collaborations in Bosnia and Herzegovina and potentially the wider Balkans and Europe. An immediate priority is to support newly certified instructors as they lead independent classes. 

Integrating these lessons back into the ALERRT framework in Texas, the focus should shift from curriculum fidelity to adaptive capacity: whilst ALERRT is the gold standard for standardized active-shooter response in the United States, the Bosnian experience suggests that the next evolution of the program lies in institutionalizing the “Supervised Growth Model.” Ultimately, the integration of Bosnian lessons into the Texas ALERRT framework transforms the program from a research-based training into an adaptive process of developing elite, adaptable thinkers and doers. By adopting the supervised growth model, ALERRT ensures that its instructors are not just teaching a course, but are building a sustainable, global culture of tactical self-reliance.

References

1)  For additional information, including images – see: https://www.dtcare.org/active-attack and https://ceps.edu.ba/alerrt

Dr. Amer Smailbegovic is a coordinator of special programs for DTCare NGO in Sarajevo and lecturer at the CEPS College in Bosnia and Herzegovina.

Mr. Michal Pospisil is a paramedic practitioner and instructor at the Department of Health Sciences, Faculty of Medicine, Masaryk University, Czechia.

Dr. J. Pete Blair is the executive director of the ALERRT Center and professor at the Faculty of Criminal Justice at Texas State University, San Marcos, Texas, USA.

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