The only reason we get away with giving such large doses of epinephrine to these patients is that they are already dead.

- Rogue Medic

Surviving the Next Shift – Part I

The most recent Standing Orders podcast, the discussion is about what we need to do to go home safely at the end of our shifts.

Should EMS carry firearms?

Brad Buck, Matt Fults, and Dr. Chris Russi D.O. are joined by Eric Dickinson (author, police officer, EMT, and author of the article Tactics to Survive Your Next Shift) and Art Hsieh (of EMS1.com and author of the article On self defense and being a medic).

Of course, I don’t have an opinion on this, but if I did –

There are several things to consider.

How many EMS personnel are shot on calls each year?

How many EMS personnel are stabbed on calls each year?

How many EMS personnel are attacked with any other lethal force on calls each year?

We do not have good data on these.

Do we include brandishing a weapon in the same category as being in danger of being killed?

No. If the armed person is allowing us to leave and not chasing after us, we leave, contact the police, and there is no reason to believe that we are any less likely to go home safely.

If EMS refuses to leave, that is a problem, but not one that justifies arming EMS. We need to be smarter than the paper target at the firing range and smarter than the stab mannequin. If someone in EMS does not leave, that is not someone I want to have any access to any weapons. The person is dangerous. And that person should not have any access to any drugs.

Do we train at drawing a gun while starting an IV?

Do we train at drawing a gun while carrying a patient in a stair chair?

Do we train at drawing a gun while carrying a monitor, drug bag, and oxygen bag?

Are we good enough at drawing and firing a weapon in a confined space with coworkers, family members, and maybe a gunman in hiding to ambush us, but a gunman who is stupid enough to let us come in, put down our gear, draw our weapons and shoot before he shoots?

Are we more likely to shoot our coworkers than whatever original threat might have been there?

How much training on clearing a room do we need before we can secure the room so that it is safe for police to enter?

Can we provide patient care and follow Four Rules of Gun Safety?

RULE I: All guns are always loaded.

RULE II: Never let the muzzle cover anything you’re not willing to destroy.

RULE III: Keep your finger off the trigger until your sights are on the target.

RULE IV: Be sure of your target, and what’s beyond it.[1]

In EMS can we be sure of our target and what is beyond our target?

Are we working with the partner who insists that he does not need to practice intubation, because he is that good?

Is this partner really that good at intubation?

Would you let him intubate you?

Is his aim any better with something designed to be more deadly than a laryngoscope and an endotracheal tube?

Where would you feel safest while he is firing?

Behind him?

Beside him?

In front of him (you’ve seen him shoot)?

In the next state?

Behind a bullet proof barrier?

If you answer is Behind him, will you have the opportunity to get behind him before people start shooting?


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Which brings us back to my original questions.

How many EMS personnel are shot on calls each year?

How many EMS personnel are stabbed on calls each year?

How many EMS personnel are attacked with any other lethal force on calls each year?

EMS is a dangerous job.[2]

 

As dangerous as EMS can be, the danger of being shot, or stabbed, or clubbed by a stranger is probably much less than the danger of being shot by your partner.

 

Are we making the environment safer or are we making the environment more dangerous?

Just call in an air strike with high explosives, followed by napalm. A winning combination.

Then there is always the wisdom of the ages – Better to be raped in prison by a dead guy’s friends, than to back away and leave the room to go home at the end of the day, or something like that.

When is the scene safe?

The scene is NEVER safe.

Scene safety is just another EMS myth.

Go listen to the podcast.

Continued in Part II.


Original cartoon credit.

Footnotes:

[1] maybe some people shouldn’t own guns.
the munchkin wrangler.
Article

[2] Studies Show Dangers of Working in EMS
Providers should raise awareness about the many hazards of EMS

David Page, MS, NREMT-P
From the November 2011 Issue
Tuesday, November 1, 2011
JEMS.com
Article

.

Comments

  1. To be honest, I wouldn’t trust most police officers to hit what they are shooting at, let alone the unknown sums I work with. I can vouch for my own level of proficiency with a firearm and that’s about it. There are very few people I would trust to be shooting at a dynamic target with me down range, and that’s really what we have to expect in the real world where there isn’t a deliniated firing line and “down range” is just the direction someone is sending bullets.

    That all being said, I think most of the advice we receive as EMS professionals about matters of self defense is developed by actuaries and lawyers as opposed to anyone who has a clue about preventing and stopping violence.

  2. If you want to come home safe, put your gun away and

    1) Wear your seat belt
    2) Drive cautiously
    3) Watch behind you on roadways
    4) Be ready to flee the moment a scene goes bad
    5) As a habit – watch peoples hands

    These things will actually help you come home safely. A gun will not.

    • Steve,

      If you want to come home safe, put your gun away and

      1) Wear your seat belt

      But wearing a seat belt is not cool.

      2) Drive cautiously

      But driving cautiously is not cool.

      3) Watch behind you on roadways

      But watching behind us is not cool.

      4) Be ready to flee the moment a scene goes bad

      But fleeing a scene is not cool.

      5) As a habit – watch peoples hands

      But watching peoples’ hands is not cool.

      These things will actually help you come home safely. A gun will not.

      Amen.

      And understanding what we are doing – scene safety, treating patients well, knowing the risks of the treatments we use, et cetera is not as cool as carrying a gun.

      .

  3. Seriously? Arming EMS personnel should be so far down the list as to not even be up for discussion. If we want to make EMS safer, stop RLS!

  4. There are a lot of safety concerns that may be more important to EMS, particularly when it comes to driving, but that doesn’t mean that this is a pointless debate. Unfortunately, if you search for “EMS” and “self-defense” you pretty much find the same old condescending and often dangerous advice to “use run-fu” or “should EMS carry firearms”. The two extremes pretty much stifle any real conversation about defensive tactics for EMS providers, which is an important topic for discussion.

    A real discussion about the soft skills we can use to avoid, diffuse and deter violence against us as healthcare providers and the hard skills that are practical should that fail is sadly missing.

    • Marc,

      I agree that we should address other aspects of scene safety. I think that it is important to first cover the topic of guns = safety, because some people will be thinking, All I have to do is draw and shoot and I will fix everything.

      .

      • I’ve been teaching firearms and defensive tactics for years. Outside of work on the ambulance, there is a high probability I have a firearm on my person. I think a lot of people in EMS (and in general) have just enough knowledge about armed self defense to be dangerous (see: dunning-kruger effect). No one with any experiece thinks guns are magic force fields against violence. The trick is conveying that to the delusional masses.

        • Marc,

          I’ve been teaching firearms and defensive tactics for years. Outside of work on the ambulance, there is a high probability I have a firearm on my person. I think a lot of people in EMS (and in general) have just enough knowledge about armed self defense to be dangerous (see: dunning-kruger effect).

          The problem with the Dunning–Kruger effect is that we seem to think that it only applies to other people. At some point, we all exhibit the overestimation of our abilities, as described by the Dunning–Kruger effect.

          No one with any experiece thinks guns are magic force fields against violence. The trick is conveying that to the delusional masses.

          I keep trying to explain reality to people with many kinds of delusions.

          I don’t have any expectation of running out of delusional people in EMS to try to explain reality to.

          .

  5. I’ve carried at work for years. I have never had the need to pull my weapon, and don’t plan on it either. But I would much rather explain to my employer why I had a gun against their policies, than have them tell my wife I won’t be coming home.

    • CCC,

      I’ve carried at work for years. I have never had the need to pull my weapon, and don’t plan on it either. But I would much rather explain to my employer why I had a gun against their policies, than have them tell my wife I won’t be coming home.

      Why assume that the two are connected?

      What if the reason you don’t come home is that the violent patient took your gun away from you and shot you with it?

      What if the reason you don’t come home is that you shot someone because your bullet traveled through the wall, rather than into your intended target, and hit some neighbor?

      What if the reason you don’t come home is that your partner was carrying and shot you by mistake?

      What if the reason you don’t come home is that you shot the patient while trying to draw your gun while also treating the patient?

      When we are on their home ground and we have not chosen the time, the place, the lighting, the surroundings, or anything else about what happens, why should we assume that the outcome will be the one thing we control?

      .

      • You raise a lot of “what ifs.” Good points, though.

        I make sure to make sure that my safety comes first on any scene. I was taught by a very experienced medic a long time ago to walk into a room knowing where the exit was, and to never allow anyone between me and that exit. I’m also always trying to be hyperaware of my surroundings. It’s worked well for me.

        I’m all for EMS carrying concealed, as long as they are willing to obtain the necessary education in how to handle and use their firearm, and they are willing to assume the responsibility that comes with the gun.

        • CCC,

          You raise a lot of “what ifs.” Good points, though.

          Thank you.

          While I often criticize those who catastrophize with “What if . . . ?” We do need to examine the possible consequences of our actions. Looking at just the possible positives or just the possible negatives are both wrong.

          I make sure to make sure that my safety comes first on any scene. I was taught by a very experienced medic a long time ago to walk into a room knowing where the exit was, and to never allow anyone between me and that exit. I’m also always trying to be hyperaware of my surroundings. It’s worked well for me.

          We do need to be aware of our surroundings, which can frequently change. We also need to be aware of what is going on medically with our patients. Sometimes these conflict.

          How many different things can we pay full attention to at once?

          I’m all for EMS carrying concealed, as long as they are willing to obtain the necessary education in how to handle and use their firearm, and they are willing to assume the responsibility that comes with the gun.

          But what are the odds of that?

          As I wrote in the most obvious analogy –

          Are we working with the partner who insists that he does not need to practice intubation, because he is that good?

          Is this partner really that good at intubation?

          Would you let him intubate you?

          Is his aim any better with something designed to be more deadly than a laryngoscope and an endotracheal tube?

          If medics do not practice intubation well enough to maintain a success rate above 95% and an unrecognized esophageal intubation rate no higher than zero, how do we expect them to develop/maintain any kind of proficiency with firearms and combat shooting skills.

          Then there is the problem of paramedic judgment, when the most common cause of unrecognized esophageal intubation appears to be a refusal to use waveform capnography.

          Should we really be giving medics, with such poor judgment, more ways to kill people?

          .

  6. The people I’ve worked with who most wanted to be able to carry are the last people who should be allowed to. A few people seem to consistently request the police for unruly family members than anyone else. I’ve watched safe scenes turn into dangerous ones because of things they said or how they conducted themselves on calls.

    • Bob,

      The people I’ve worked with who most wanted to be able to carry are the last people who should be allowed to. A few people seem to consistently request the police for unruly family members than anyone else. I’ve watched safe scenes turn into dangerous ones because of things they said or how they conducted themselves on calls.

      Exactly.

      The same people who seem to think that the way to deal with a language barrier is to say the same thing slower and louder. If that doesn’t work, turn up the volume even more.

      This is not communication, but if they understood communication – in any of the many ways they screw it up – they might not have so many people trying to kill them.

      Or are they paranoid and just assume that everyone wants to kill them?

      .

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