Gunfire could still be heard from the Pulse nightclub when the first paramedic-firefighters arrived — but they never got inside, instead treating wounded patrons across the street in a bagel shop parking lot.

That approach hasn't caught up with the latest federal guidelines. Those call for paramedics to integrate their response with police, perhaps even wearing body armor and going into buildings alongside officers.

But paramedics Josh Granada and Carlos Tavarez didn't have armor or vests. They made five trips with 13 victims to a hospital. They say it's too tough to tell whether they could have saved more lives if they had equipment and went inside Pulse.

Since the Columbine High School massacre in 1999, paramedics have struggled with how close to get to active-shooter scenes when they know wounded victims need help. The guidelines suggest that victims' chances improve when paramedics go into "the warm zone."