Severe pain + 2mg of Morphine = severe pain.

- Rogue Medic

Why are We So Afraid of Our Patients

WANTYNU asks –

We all know EMS can be dangerous, so if you could carry a weapon, would you and which would it be?[1]

Better to be judged by 12 than carried by 6.

This is the kind of reasoning used by the people who think they need to have a weapon to provide patient care.

This is not a valid choice this is just paranoia.

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?[2]

The armed and dangerous EMS people would have us believe that the number is large.

In how many years is the number not zero?

Are we more likely to be shot or stabbed by our paranoid coworkers, by our family members, by our patients, or never to be shot or stabbed?


In the Standing Orders podcast on armed EMS,[3] the only real defense of EMS carrying weapons was as tactical medics. That is appropriate. You do not go on a raid without a weapon, but what does that have to do with going into someone’s home to provide medical treatment and carrying a weapon?

Not a thing.

How bad do our communication skills have to be for us to make people want to shoot, or stab, us?

I annoy a lot of people, some of whom carry weapons, but I do not feel any imminent threat.

Why are so many people in EMS so afraid?

Better to be judged by 12 than carried by 6.

The reasoning behind this seems to parallel the reasoning behind a lot of other bad decisions in EMS.

I am afraid of responsibility. I need extreme protection.

Flying everyone who might be seriously injured. Learning to assess patients competently is too much to ask.

Immobilizing everyone because they might sue us.

We need our endotracheal tube to save lives. We need to be able to pretend that we know more than nurses, just because of this one little used part of our scope of practice – something that we do very poorly, but why bring reality into this?[4] [5]

Maybe, if we want to be viewed as a profession, we should start thinking, rather than panicking.

Footnotes:

[1] We all know EMS can be dangerous, so if you could carry a weapon, would you and which would it be?
WANTYNU
02/09/2012
FaceBook page

[2] Surviving the Next Shift – Part I
Rogue Medic
Fri, 16 Dec 2011
Article

[3] Surviving the Next Shift
Standing Orders
Dec 13, 2011
Podcast page

[4] Prehospital intubations and mortality: a level 1 trauma center perspective.
Cobas MA, De la Peña MA, Manning R, Candiotti K, Varon AJ.
Anesth Analg. 2009 Aug;109(2):489-93.
PMID: 19608824 [PubMed - indexed for MEDLINE]

Of the 88 patients who were transported by ground, 46 (52%) were successfully intubated in the prehospital setting and 42 (48%) had a failed PHI (PreHospital Intubation)

Of the 203 patients, 115 (57%) were transported by air, and within that group, 94 (82%) were properly intubated in the field, and 21(18%) were not. Of the 88 patients who were transported by ground, 46 (52%) were successfully intubated in the prehospital setting and 42 (48%) had a failed PHI (P < 0.001 compared with patients transported by air).

Even though the flight crew success rate was dramatically better than the ground EMS intubation success rate, it is still unacceptably low. What is the difference between the flight crews with 82% intubation success and the ground crews with 95+% intubation success or the flight crews with 95+% intubation success?

[5] Misplaced endotracheal tubes by paramedics in an urban emergency medical services system.
Katz SH, Falk JL.
Ann Emerg Med. 2001 Jan;37(1):32-7.
PMID: 11145768 [PubMed - indexed for MEDLINE]

Free Full Text PDF

Trauma patients were significantly more likely to have misplaced ETTs than medical patients (37% versus 14%, P<.01). With one exception, all the patients found to have esophageal tube placement exhibited the absence of ETCO2 on patient arrival. In the exception, the patient was found to be breathing spontaneously despite a nasotracheal tube placed in the esophagus.

In spite of these studies, and others, few medics will admit that they are poor at intubation. We are all above average. At least, more of us do seem to be above average in deceiving ourselves. It seems to be an EMS job requirement.

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Comments

  1. Arming EMS totally transforms our perceived role, IMO. I need to be able to say, “I’m only here to help you,” full stop — and mean it. A gun makes that a very hard sell.

  2. But why would the patient even have to know the you are armed? The best way to carry a weapon is concealed. That way should it ever be needed the surprise factor when it is revealed might be enough to de-escalate a situation. Police are armed, firearm are armed why not EMS. Some services issue EMS with vests…, that should tell you something. But you are on point with you professional skills statements.

  3. I carry a gun on my full time job. At times I carry off duty. I will never carry a gun either as a paid or volunteer EMT. The possibility of someone seeing my concealed firearm and going for it as I provide patient care is to much. I know that it is a remote possibility, and yes I do provide patient care at the job which requires me to carry a gun. But the need to constantly be aware of my firearm and my entire duty rig, can detract from patient care. I try to always be aware of my surrounding. I used to work in a urban (ghetto) environment and have had my (new) stethescope stolen as well as other supplies and equipment, on scene, in a residence. Even now that I am more rural, I have been in situations in which I was glad for a police presence.
    My firearm is not necessary and it is a potential threat to myself and others.
    I was once on an attempted suicide in which the patient went for the cops gun. we walked in on a wrestling match. I was carrying that day, I responded on my way home from work, I drove. had I been in the back and the patient went for my gun,………..????? A pancake holster is not way as secure as the level 3 I use at work. That incident was 20 years ago and I have never carried on an ambulance since.

  4. I think Joe puts it best. Carrying a firearm especially requires a change in mindset, to where the focus is on awareness of the weapon and maintaining control of it. This change in focus would take away from the our role as primary caregivers to the patient.

    While there are places where the lethal threats to EMS are very real, arming EMS is not the solution.

  5. Seriously? We have enough problems with low education standards, voodoo medicine, and piss poor performance in skills that should be done near perfect every time and yet people are worrying about guns in our jump bags?

  6. Agree wholeheartedly Rogue. If I feel threatened, I want police on scene. If someone threatens me, I walk away. If someone attacks me, I run away.
    But proper preparation, risk assessment and communication should be able to diffuse nearly all those situations, so violence won’t even happen in the first place.
    We’re here to treat and help, not cause further damage.

  7. I’ve worked in different ‘hoods for a long time. According to one survey, now I work in the 9th most dangerous city in the US. Never once have I wished I had a gun. Many times I am glad people I was on scene with did not have one. How about we get better at driving before we add more deadly weapons to our arsenal.

    Some of the scariest EMS people are the ones who can not get hired as cops. And they’re the ones who want to carry at work most.

    http://emspatientperspective.com/2011/12/19/keeping-scenes-safe-from-flea/

  8. I’d be curious to hear what people have to say about the “rescue knife” deal. I don’t carry one, I’ve got a leatherman on my radio strap, but thats primarily for the fire stuffs (fire-medic here)

    Myself, I take the same stance as most of you on the “rescue knife” deals. They’re bogus and I have never seen one used in 5 years other than to show off.

  9. Addendum:

    A rescue knife is still a weapon, it’s a blade, usually kept concealed, and for what purpose other than to cause harm?

    Again, I feel the same way about carrying knives as one does about arming anyone but law enforcement with firearms or other conventional weaponry.

    • I carry a knife and use it often, but “weaponizing” it is the furthest thing from my mind. It’s a tool for fixing equipment and managing problems on scene.

    • I used to carry a “rescue knife” because it had a window punch and seat belt cutter. After I discovered that I used my shears for everything and generally didn’t need the knife, I stopped carrying it except on camping trips. All of the EMS people I know who carry such knives consider them tools ONLY. You’re the first I’ve heard mention a “rescue knife” as a weapon for medics.

      The most common defensive weapons I’ve heard mentioned are a big metal clipboard and “oxygen therapy” (aka a D tank upside the head).

  10. I work full time as a paramedic in a mid-western city. Unfortunately, the police department in the city that I cover does not have enough staff to send an officer on every medical runs, so I’ve been in places that I would have felt more comfortable knowing that I have a weapon. But maybe that’s because of other realizations that I’ve made in life.

    Bad shit happens to good people, even to good people who never get placed in bad situations. I carry a firearm on a regular basis because I accepted the truth to the above statement. I’m not looking for trouble, and I’ll go out of my way to avoid trouble, but if I’m ever placed into a situation where I need to defend myself, I’d much rather have the tools necessary to do it, than not have those tools.

    Working EMS, I enter situations on a regular basis that I’d never think to enter of my own accord, does it really make sense that I leave tools that could save my life at home when I walk into those situations?

    I’m all in favor of allowing EMS professionals to carry firearms, concealed or open, provided they have qualified with them, and can demonstrate proficiency, and that includes proficiency in making sure that people cannot “grab” your gun…

    A properly carried firearm, in a secure holster, holds absolutely no threat to anybody.

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