ALERRT hosts a national integrated response conference each fall. The ALERRT Active Shooter Integrated Response Conference is the only national conference bridging the law enforcement, Fire and EMS responses to active shooter / attack events. The 2018 conference merged the four disciplines (Police, Fire, EMS, and Emergency Management), and for the first time, included emergency room physicians to build integration and coordinated command centers, creating stronger local, regional, state and national active shooter response preparedness. Based on recent active shooter / intentional mass injury events in the United States, the reality is that saving victims’ lives does not end in an ambulance or at the doors of the emergency department.