Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

Tubes and Guns and Training, Oh No

This week on EMS Office Hours, Jim Hoffman, Josh Knapp, Kelly Grayson, Russell Stine, John Broyles, and I discuss the pros and cons of concealed carry in EMS.

This is not an issue of camouflage uniforms, or concealed carry of endotracheal tubes, or of RSI drugs, but concealed carry of guns.

Stethoscope, penlight, O2 Wrench, GUN…. wait a sec.

Do we need inadequate initial, and ongoing, training in another way of harming patients? This has almost no chance of benefit.

This is like homeopathy. EMS concealed carry is a placebo, but it is potentially a more directly harmful weapon than homeopathy.

We need to be better at what we are supposed to be doing (providing emergency medical care), not coming up with excuses for distracting ourselves from patient care.

Where is a gun useful?
 

 

If the attacker is 0 to 20 feet away, that is where the patient usually is. That is where I can expect to lose, if I attempt to draw a concealed weapon. If I am attacked by the patient, a concealed weapon is the wrong response. See the video at the end.

If the attacker is 20 to 60 feet away, I have time to draw and fire and I am within the expected accuracy of a concealable weapon.

Outside of 60 feet, the attacker and I might as well just taunt each other for all the accuracy of a weapon that can be concealed.
 

I don’t want to talk to you no more, you empty headed animal food trough whopper! I fart in your general direction! You mother was a hamster and your father smelt of eldeberries.[1]

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.[2]

Is there any reason to treat carrying on duty as anything other than a placebo?

When would EMS concealed carry make any difference?

Other than those times it makes things worse, when would it make a difference?
 

I’ve got this completely under control. Freeze varmint!
 

I’ve worked with plenty of people who are quite dangerous without a gun. Do I want to make them even more dangerous?

Is there a benefit to the patients?

Is there a benefit to us?

Will we start to include attack dogs on our trucks?

I have not been on any call that I see having a better outcome if my partner, or I, were to carry.

The only case I know of where EMS personnel were shot on the job was back at the station by an ex-spouse/ex-lover/ex-something. I don’t know where any lives will be saved.

We are supposed to be carrying equipment, and training with that equipment, to save lives. Few of us train enough on the equipment we have.
 

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.

When is the scene safe?

The scene is NEVER safe.

Scene safety is just another EMS myth.

Do the police have to protect citizens, or is that another myth?[3]

EMS concealed carry is a limited solution to a problem that is similar to what we face, but it isn’t the same problem and it does not appear to be the right solution.

20 feet?
 

[youtube]9igSoJHEdUo[/youtube]
 

The most important part of surviving violence in EMS is mentioned by Kelly Grayson – situational awareness.

Go listen to the podcast.

See also –

Should ambulance crews be allowed to carry weapons? – Kelly Grayson at ems1.com

Will Virginia EMT’s Be Granted Right To Carry Firearms? – A Day in the Life of an Ambulance Driver

Part I – CCW on duty… and the conversation we SHOULD be having – EduMedic

Part II – CCW on duty… and the conversation we SHOULD be having – EduMedic

Concealed Carry for EMS: 2 Questions – Everyday EMS Tips

EMS Providers Carrying Guns – A terrible idea – Life Under the Lights

Should EMS Providers Be Carrying Guns on the Job? – 510 Medic

Arming EMS? The Debate Continues – Medic Madness

Surviving the Next Shift – Standing Orders podcast

EMS Situational Awareness – EMS Office Hours

Ohio Debate Continues about EMS Providers Carrying Guns

Surviving the Next Shift – Part I – Rogue Medic

Surviving the Next Shift – Part II – Rogue Medic

Footnotes:

[1] Monty Python and the Holy Grail
Scene 8
Guard taunting Arthur, King of the Britons
Sacred Texts
Unofficial screenplay

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

[3] Warren v. District of Columbia
Wikipedia
Article
 

Warren v. District of Columbia[1] (444 A.2d. 1, D.C. Ct. of Ap. 1981) is an oft-quoted[2] District of Columbia Court of Appeals (equivalent to a state supreme court) case that held police do not have a duty to provide police services to individuals, even if a dispatcher promises help to be on the way, except when police develop a special duty to particular individuals.

.

Comments

  1. Ah, Rogue, I knew we could count on you to bring evidence and wisdom to the debate. Great post!

  2. This analysis assumes that there are only 3 people involved: you, your partner and the patient. Bystanders can come and go, and some may be quite violent. I’m fortunate that where I volunteer it’s in a suburban-like environment where the greatest violence I usually have to worry about treating is a domestic dispute well after the police have the incident in-hand. However, that doesn’t mean that there aren’t communities which have a greater propensity for violence and may be much more volatile.

    The fact that body armor is being issued to people in some EMS services indicates that there is indeed a chance to be in a life-threatening situation or environment. Moreover, there’s no reason to believe that firearms are useless inside of 20 feet. That’s generally the range at which somebody can draw and stab you with a knife successfully before you can draw, fire, and disable them with a firearm. However, there is still a difference between stabbed once and being stabbed 19 times. Each stab wound increases the chance of death. Even at ~0 feet a firearm can be useful for self-defense or the defense of your partner.

    • Garrett,

      This analysis assumes that there are only 3 people involved: you, your partner and the patient.

      What do you base that conclusion on?

      Where do I suggest that is the case?

      OK – you, and the rest of the Jets, get called to a parking lot full of Sharks. Let the games begin.

      If the Jets have concealed handguns and the Sharks have knives and the confrontation takes place within 20 feet, the Sharks will be hiding behind each other trying to draw their concealed handguns.

      Do I really want a partner who feels it is necessary to carry concealed, but is going to have to hide behind me to be able to draw, aim, and shoot?

      That is not going to provide any protection, but is going to endanger me.

      That is assuming that Partner Quick Draw doesn’t shoot me.

      Bystanders can come and go, and some may be quite violent.

      This is clearly demonstrated by the rate of murder of EMS personnel. Zero.

      Depending on where you are, people may come and go.

      Some of them may be nice people. Some may not.

      The murder rate stays the same. Zero.

      I’m fortunate that where I volunteer it’s in a suburban-like environment where the greatest violence I usually have to worry about treating is a domestic dispute well after the police have the incident in-hand. However, that doesn’t mean that there aren’t communities which have a greater propensity for violence and may be much more volatile.

      The rate of murder of EMS personnel in the communities you do not go into is still zero.

      The fact that body armor is being issued to people in some EMS services indicates that there is indeed a chance to be in a life-threatening situation or environment.

      No.

      Body armor being issued indicates a desire for body armor.

      That is a response to perception and it is not a wise response.

      Life is full of danger. Responding to one perceived danger only indicates that the people wearing body armor think that body armor is a good idea.

      I have never been in a situation where I thought, This would be better if I were wearing body armor.

      Where is the benefit?

      Maybe in a motor vehicle collision, if you foolishly decide not to wear a seatbelt, then the body armor will provide some protection from that foolishness.

      Moreover, there’s no reason to believe that firearms are useless inside of 20 feet. That’s generally the range at which somebody can draw and stab you with a knife successfully before you can draw, fire, and disable them with a firearm.

      You are correct.

      Within 20 feet, the concealed handgun is not useless.

      Within 20 feet, the concealed handgun is dangerous to the person carrying, because the best response is something other than drawing and trying to shoot.

      Attempting to draw a concealed weapon will distract from what should be done in a violent situation.

      Within 20 feet no gun is better than a concealed gun.

      However, there is still a difference between stabbed once and being stabbed 19 times. Each stab wound increases the chance of death. Even at ~0 feet a firearm can be useful for self-defense or the defense of your partner.

      Now the idea is to be stabbed fewer times?

      This is not a video game.

      You are much better off using anything else as a weapon, or retreating (something you seem to want to avoid), than attempting to draw a concealed handgun and only getting stabbed half a dozen times before you get your magic protection shot off.

      Oh, good. Garrett won. He wouldn’t have been so cut up, and he would still be able to work, and his partner would still be alive, if only he had walked away.

      There are many possible outcomes of any encounter.

      I want to avoid a violent encounter, rather than get on the scoreboard.

      .

      • “OK – you, and the rest of the Jets, …. ” made me snort chocolate chip cookie through my nose. Incidentally that is not deadly withing 20 feet.

      • > Where do I suggest that is the case?

        Where your graphic talks about being 20 feet away from the patient. That suggests that the patient is the only person we have to worry about.

        >Attempting to draw a concealed weapon will distract from what should be done in a violent situation.

        What I find interesting about this phrase is that you’ve placed all of the conditionals (attempting, should) on your side of the estimates. If something can go wrong, it must go wrong. It implies both a lack of skill and a lack of ability to take reasonable action. Running from a knife is fun. It also isn’t always practical. It’s even worse if somebody starts shooting at you.

        > The rate of murder of EMS personnel in the communities you do not go into is still zero.

        Not according to this news article.
        http://www.firehouse.com/news/10495630/new-york-emt-shot-and-killed-by-patient

        Or this research article which suggests about 2/year:

        http://www.emsedsem.org/Prior Articles/EMS_Fatalities from JEMS.pdf

        Granted, I had to wade through a few pages of Google search results to find that. I found a number of other cases where providers had been shot, but survived. It is a small number of deaths, but it is non-zero.

        > Within 20 feet, the concealed handgun is dangerous to the person carrying, because the best response is something other than drawing and trying to shoot.

        Always? Every single time. Care to write the Universally Correct course of action down? Hell, we could make this part of the protocols. 🙂

        > Now the idea is to be stabbed fewer times?

        No. The idea is to take action which results in the best possible outcome for me, my partner and my patient. All things being equal, being stabbed fewer times is better than being stabbed more times. Being shot fewer times is better than being shot more times. Not getting into a dangerous situation is better than getting into a dangerous situation. Diffusing a situation is better than having to engage in a fight. And shooting somebody who presents a clear and present danger to my life and well-being is better than being severely wounded or killed.

        > I want to avoid a violent encounter, rather than get on the scoreboard.

        So the only options are to either magically avoid violent encounters or view life as a video game? Please! Given the two options that you present, I would prefer a magic aura which prevented all violent encounters around (or especially involving) me. However, that isn’t realistic. If you want to argue in favor of the continued prohibition against EMTs carrying weapons to defend themselves, please do so. But let’s not go over into magic thinking land where a tool of defense is *never* useful and cannot *ever* be the best course of action.

    • They had better get stab protection in those vests then.

      I am sick of these what ifs driving the argument that we need to be armed in EMS. You have a greater chance of being killed by a drunk driver at 2am responding to the call you are afraid of getting stabbed or assaulted at. With the line of thinking being applied by all you what if types you should refuse to respond if there are drunks out there. There are so many more aspects of are job that are far deadlier and frequently cause EMTs and Paramedics to be injured. Those are what we should be focusing on since we can mitigate those risks. Random violence against EMS cannot be predicted or really prevented. Thankfully it is more rare than what we can prevent.

      There is no reason to have concealed carry in EMS and it would add another element to it that we do not want. Police are there to do that job. We do ours and they do theirs. I remember a story last year of a councilman named Kenneth Stokes wanting EMS to go into dangerous situations and everyone was up in arms. Now everyone wants to be armed instead of allowing law enforcement to do their jobs. Y’all need to make up your minds.

  3. What Combat Doc says.

    The comments on Kelly’s blog post about this are alarming.

    Like I’ve stated before, there are to few medics that I trust with IVs, ETTs, and meds; there is no way I want to be anywhere near any of them with a weapon.

    And we wonder why other medical professions don’t take us seriously. This simply ridiculous.

  4. People talking about needing this for work in bad areas have no idea. I work in a very high crime area, with lots of violence. I even a had a few attempted and successful assaults. I cannot think of a single one that would have turned out better if i had a gun. In most of them the pt was on the cot a foot away , it happened so fast that reaching for gun would have prevented me from actually protecting myself and getting the pt under control.

    Even the body armor argument is bunk. First I have never been shot at, and i know none of my co-workers have ever mentioned being shot at. One of my partners who had spent a long time working the hood explained it to me when i asked about a vest, they told me that vests are uncomfortable on a long shift, and that if there is a situation where i would be safer with a vest, then I shouldn’t be there. They also pointed out that vests just gave people the nerve to go into situations they shouldn’t since they are “bullet-proof”

    The fact is 99% of the time we are called by people who want our help. Even the most blood thirsty thug gives us pass when we are there to help them or their family . The only really dangerous ones i have come across are drunks and EDPs, and as I said above when those situations go bad, a cravat was more useful to me than a gun.

    Just as a final note I am strong 2nd amendment supporter, guns are tools and they have a legit use. I just don’t think that they are tactically correct for the EMS operating environment

  5. To approach this from a different angle, what about the possibility of deterrence from carrying firearms? If you’ll remember the basis of the Cold War; not to engage the enemy but to make the enemy think you’d promptly defeat him should he chose to engage you. Thus, you avoid the war altogether. Apply the Cold War to a smaller scale. If EMS is carrying firearms and it is known, could we reduce the assaults on EMS providers?
    Studies have shown states with concealed carry laws have lower crime rates than states with tighter gun control laws. Is this because criminals are less likely to strike in these areas knowing they stand a chance of getting killed?

    I agree, the research posted has shown a pistol is ineffective under 20 feet, and that’s by an officer that’s supposed to be proficient in his weapon. However, how many criminals stop to consider that fact? How many would-be assailants would be too scared to act knowing a firearm was available to the EMS crew?

    • TexasMedicJMB,

      To approach this from a different angle, what about the possibility of deterrence from carrying firearms? If you’ll remember the basis of the Cold War; not to engage the enemy but to make the enemy think you’d promptly defeat him should he chose to engage you. Thus, you avoid the war altogether. Apply the Cold War to a smaller scale. If EMS is carrying firearms and it is known, could we reduce the assaults on EMS providers?

      A deterrent works, if there is a reasonable expectation that it will be used.

      Reagan and Kruschov needed to convince each other that they are crazy enough to use a weapon that would guarantee massive destruction to both countries.

      How is that relevant to EMS?

      Studies have shown states with concealed carry laws have lower crime rates than states with tighter gun control laws. Is this because criminals are less likely to strike in these areas knowing they stand a chance of getting killed?

      There are many studies of differences in behaviors in different geographic regions, but they do not demonstrate cause and effect.

      The homicide rate is higher in the US than in many countries that prohibit firearms. Does that mean that guns are the reason?

      The research is not at all clear on the effects of different gun laws, but politically motivated people will present whatever supports their side as if it is definitive.

      I agree, the research posted has shown a pistol is ineffective under 20 feet, and that’s by an officer that’s supposed to be proficient in his weapon. However, how many criminals stop to consider that fact? How many would-be assailants would be too scared to act knowing a firearm was available to the EMS crew?

      You have presented arguments both for and against a deterrent in this paragraph. Which would you like me to address?

      .

  6. I’m sorry you’ve only heard of EMT’s being shot by ex-lovers at their stations. Take a few minutes to do a simple search on the web of line of duty injuries and deaths due to medics beings being shot. In less than five minutes of searching, I came up with about a dozen on-duty shootings, including three LODD’s within the last decade. What statistic is justifiable for us to then be allowed to carry? I’m NOT saying it is the right thing, but I’m also not saying it isn’t. Your own articles continually show us the follies of doing what it is we do in EMS because of proof of danger and harm, but you usually offer statistical and quantifiable evidence, but this time, your answers appear to be as circumstantial about being against as anyone else’s is for. All you appear to have proven this time is that the police don’t have to be there for anyone. Why do we mess around with procedure X when statistically, we’re unlikely to even see a full 1% usage of procedure X in our career lifespan, and then cannot unequivocally prove procedure X had any impact on survivability? Because it has the POTENTIAL to improve survivability, and we’re held accountable to that potential in a court by our peers. The same could be said of firearms carry. The jury should be out until there’s more proof one way or the other, otherwise, it’s all conjecture and opinion. To my previous comments on various forums, I add, maybe until this is sorted out, there becomes a standard of ballistics vests with trauma panels, and all providers must undergo immediate training in close-quarters combat martial arts, such as JuJitsu, Aikido, Tae Kwon Do, Karate, etc., to a black belt proficiency level, and a mandatory course on situational awareness, and another on advanced therapeutic interventions (non-physical interventions to de-escalate a crisis), while we accumulate statistics for an educated decision. Now, who wants to be in the control group?

  7. I have a couple of things to add here. I don’t strongly disagree with your position. For the most part, you make good points. But, I will quibble:

    1. Condescension does not make your argument stronger. It just makes you look condescending, in this and the followup to this post where you respond to Garrett and Unwired Medic.

    2. Your “20 feet” graphic does not work. If you wish it to strengthen your argument, it does not. For a man who rails about drawing unsupported conclusions from dubious evidence, this is a perfect example of an unsupported conclusion, drawn for dubious evidence… and this time you’re the one doing it.

    First of all, the vast majority of defensive handgun uses are at bad-breath distances. Contact range, in other words. Since you are a strong advocate of evidence, I would like you to provide evidence to support this little gem of hyperbole:

    “Within 20 feet, the concealed handgun is dangerous to the person carrying, because the best response is something other than drawing and trying to shoot.”

    You impose a set of conditions on a situation where you cannot know or predict the conditions.

    What is the best response, and how can you claim to know it beforehand? Is it retreat? What if retreat is not possible? And what about carrying a concealed handgun automatically makes someone less likely to retreat?

    Is disarming your attacker the best defense? How many people are sufficiently skilled at hand-to-hand combat to accomplish that? How difficult are those skills to acquire versus skill with a handgun?

    The bottom line is, carrying a handgun is for those times when retreat is not possible and the disparity of size and/or force makes unarmed self-defense unfeasible. This is a fundamental tenet in most defensive handgun classes.

    Police academies teach that an armed attacker within 21 feet is an imminent and lethal threat. A determined man with a knife can reach you and inflict harm before you can draw a firearm from a retention holster on your belt.

    But you assume that a concealed draw is appreciably slower than an unconcealed draw from a retention holster. That may be true for some, but you have no evidence that it is true for all.

    In addition, you assume that the use of the weapon is to protect you from harm. In the ideal case, I suppose that may be true, but in practice the weapon is to protect you from death. It is unreasonable to presume that you will not be harmed in a gunfight. Your knife-wielding attacker can still cut or stab you. Your club-wielding attacker can still bash you. A sufficiently large and skilled person can beat you to death with their fists. An attacker with a handgun can send bullets your way, and possibly more accurately than you can.

    None of those things are the point.

    The point is, carrying a weapon might stop any of those things from killing you. Not carrying a weapon means that you must rely on the restraint and good graces of your attacker to stop before he kills you.

    Personally, I trust myself a lot more.

    Any one of your arguments can also be used against civilians carrying handguns in general. Do you oppose that, as well? If you do not, please tell me why EMS should be any different. What about working in an ambulance or wearing a uniform abrogates a right we have when we are not working?

    I have not been on any call that I see having a better outcome if my partner, or I, were to carry.”

    Your N=1, Research Boy. 😉 Anecdote does not equal evidence.

    At the end of the day, my position on concealed carry of firearms is a philosophical one, and not in response to any perceived threat. I, too, have never felt the need to carry a firearm on duty. (Hey, I just doubled your sample size! A few thousand more and your conclusion might be supportable!)

    I wrote my column and blog post on the subject in response to couple of news articles. In those posts, I stated my belief that allowing concealed carry of firearms by EMT’s would have the same detrimental effect on overall safety that allowing concealed carry in bars and concealed carry on college campuses had: none. That is because when these restrictions are eased, the people that take advantage of it are, by and large, some of the safest and most law-abiding people you will ever meet. I fail to see why EMS would be so different from the general population in that regard.

    I do not wish to be the poster boy from the EMS pro-gun movement. I think there are more pressing issues for our profession. But, I strongly believe in my right to armed self-defense, and it is absolute. Whether I choose to exercise that right is my choice. Millions of other Americans feel the same way.

    If the laws prohibit me from carrying my firearms in certain places, I avoid those places, or if I find the restriction silly and onerous, I lobby against it. I have not actively lobbied against laws prohibiting concealed carry of firearms by on-duty EMT’s because I personally do not consider those restrictions silly and onerous.

    That does not mean that I am going to actively oppose an EMT who does feel that way, however, just like I’m not going to tell a woman what she can or cannot do with her unborn fetus, despite the fact that abortion is repugnant to me.

    • Ambulance Driver,

      I have a couple of things to add here. I don’t strongly disagree with your position. For the most part, you make good points. But, I will quibble:

      Quibble away.

      1. Condescension does not make your argument stronger. It just makes you look condescending, in this and the followup to this post where you respond to Garrett and Unwired Medic.

      If I point out that misleading and/or dishonest arguments are misleading and/or dishonest. That is just pointing out what should be obvious.

      2. Your “20 feet” graphic does not work. If you wish it to strengthen your argument, it does not. For a man who rails about drawing unsupported conclusions from dubious evidence, this is a perfect example of an unsupported conclusion, drawn for dubious evidence… and this time you’re the one doing it.

      First of all, the vast majority of defensive handgun uses are at bad-breath distances. Contact range, in other words.

      Please provide some evidence to support your claim.

      Since you are a strong advocate of evidence, I would like you to provide evidence to support this little gem of hyperbole:

      “Within 20 feet, the concealed handgun is dangerous to the person carrying, because the best response is something other than drawing and trying to shoot.”

      You impose a set of conditions on a situation where you cannot know or predict the conditions.

      That is from the video of the police officers being the tomato to the attacker’s Ginsu at less than 20 feet.

      People who get tunnel vision are not going to do well in any kind of competition, and this is an example of a competition we really do not want to lose.

      From the video –

      “At close distances, your only realistic option for controlling the suspect is empty hand tactics.”

      “Keep in mind drawing from a concealed holster is even slower.”

      What is the best response, and how can you claim to know it beforehand? Is it retreat? What if retreat is not possible? And what about carrying a concealed handgun automatically makes someone less likely to retreat?

      Is disarming your attacker the best defense? How many people are sufficiently skilled at hand-to-hand combat to accomplish that? How difficult are those skills to acquire versus skill with a handgun?

      Fentanyl is the best prehospital pain medicine, but that does not mean that fentanyl is the only pain medicine EMS should use.

      The bottom line is, carrying a handgun is for those times when retreat is not possible and the disparity of size and/or force makes unarmed self-defense unfeasible. This is a fundamental tenet in most defensive handgun classes.

      Prehospital thoracotomy is for those times when nothing else will work, but we do not have EMS doing that, either.

      Police academies teach that an armed attacker within 21 feet is an imminent and lethal threat. A determined man with a knife can reach you and inflict harm before you can draw a firearm from a retention holster on your belt.

      But you assume that a concealed draw is appreciably slower than an unconcealed draw from a retention holster. That may be true for some, but you have no evidence that it is true for all.

      I never stated that anything is absolutely true in every single situation. I regularly state the opposite.

      Again, from the video –

      “Keep in mind drawing from a concealed holster is even slower.”

      In addition, you assume that the use of the weapon is to protect you from harm. In the ideal case, I suppose that may be true, but in practice the weapon is to protect you from death. It is unreasonable to presume that you will not be harmed in a gunfight. Your knife-wielding attacker can still cut or stab you. Your club-wielding attacker can still bash you. A sufficiently large and skilled person can beat you to death with their fists. An attacker with a handgun can send bullets your way, and possibly more accurately than you can.

      The first stab may completely disable you.

      The first punch, or strike with a club, may do the same. There is no reason to assume that the person being stabbed, clubbed, punched, or even tickled will be able to fire their weapon with any degree of accuracy.

      None of those things are the point.

      The point is, carrying a weapon might stop any of those things from killing you. Not carrying a weapon means that you must rely on the restraint and good graces of your attacker to stop before he kills you.

      Personally, I trust myself a lot more.

      Now who is assuming too much?

      These are the only options?

      Any one of your arguments can also be used against civilians carrying handguns in general. Do you oppose that, as well? If you do not, please tell me why EMS should be any different. What about working in an ambulance or wearing a uniform abrogates a right we have when we are not working?

      EMS is not about exercising our right to bear arms any more than working in a hospital is.

      I do not oppose civilians carrying, but civilians and EMS are not the same.

      I have not been on any call that I see having a better outcome if my partner, or I, were to carry.”

      Your N=1, Research Boy. Anecdote does not equal evidence.

      I have been on more than one call. Why assume that the N equals the number of calls? 😉

      I only presented it as anecdote, but I did present the video as evidence. You did not contradict the video.

      The burden of evidence is on those attempting to introduce a treatment, not on those claiming that the treatment is ineffective, or even that the treatment is harmful.

      Where is the evidence that concealed carry would improve outcomes more than it would lead to harm?

      At the end of the day, my position on concealed carry of firearms is a philosophical one, and not in response to any perceived threat. I, too, have never felt the need to carry a firearm on duty. (Hey, I just doubled your sample size! A few thousand more and your conclusion might be supportable!)

      A more relevant response and your conclusion might be supportable.

      I wrote my column and blog post on the subject in response to couple of news articles. In those posts, I stated my belief that allowing concealed carry of firearms by EMT’s would have the same detrimental effect on overall safety that allowing concealed carry in bars and concealed carry on college campuses had: none. That is because when these restrictions are eased, the people that take advantage of it are, by and large, some of the safest and most law-abiding people you will ever meet. I fail to see why EMS would be so different from the general population in that regard.

      EMS has some extremely conscientious people, who practice airway management enough that they can manage a complicated airway.

      EMS has some much less conscientious people, who do not practice airway management enough, and demonstrate this in many intubation studies.

      The same is true of doctors.

      I don’t see why you assume that the people who will take advantage of this in EMS, where there is no apparent need.

      Carrying in response to the microscopic threat is a demonstration of not understanding risk management.

      That lack of understanding of risk, demonstrated by plenty of comments on plenty of posts on this topic, is a good reason to not want EMS to carry concealed.

      I do not wish to be the poster boy from the EMS pro-gun movement. I think there are more pressing issues for our profession. But, I strongly believe in my right to armed self-defense, and it is absolute. Whether I choose to exercise that right is my choice. Millions of other Americans feel the same way.

      There are no absolutes.

      Try to carry on a call in a courtroom. In EMS, we do get called to patients in courtrooms. We even occasionally get subpoenas.

      Try to carry on a call in a prison.

      Try to carry on a call involving anyone receiving Secret Service protection.

      Try explaining absolutes to the people who will tell you that you may exercise your rights somewhere else.

      If the laws prohibit me from carrying my firearms in certain places, I avoid those places, or if I find the restriction silly and onerous, I lobby against it. I have not actively lobbied against laws prohibiting concealed carry of firearms by on-duty EMT’s because I personally do not consider those restrictions silly and onerous.

      That does not mean that I am going to actively oppose an EMT who does feel that way, however, just like I’m not going to tell a woman what she can or cannot do with her unborn fetus, despite the fact that abortion is repugnant to me.

      We have enough distractions from good patient care.

      We carry too many medications and give them in unreasonable combinations, with little understanding of their complex interaction.

      Our job is patient care, not being an all hazards response.

      .

      • First of all, we were talking about firearms. Pointing out everything else EMS sucks at is a poor straw man, and even less relevant than you seem to think my points were.

        Basing your conclusions about the speed of a concealed draw or the preferability of open hand combat when am attacker is within 20 feet based on one video is not evidence. It is anecdote.

        But since we’re calling anecdotes evidence as long as the subject is guns, I will counter with an anecdote of my own:

        http://m.youtube.com/#/watch?v=hA-xIssgT-o&desktop_uri=%2Fwatch%3Fv%3DhA-xIssgT-o

        Your video says you can’t beat an armed attacker within 20 feet and should fight him unarmed, my video says not only that you can, but you can execute a Mozambique drill in under 1.38 seconds.

        Now, is Jim Zubiena a representative sample of the average CCW holder? No, but since we’re both calling one video “evidence,” we can say whatever the hell we want, can’t we?

        Keep in mind that I am not disagreeing with your stance that concealed carry of firearms by EMT’s is an overreaction to a perceived threat. I am calling you out over your supposed evidence in making your argument. You’re an evidence guy, Tim. You of all people should be above such mistakes.

        And ridiculing someone else’s position is what people do when they don’t have facts on their side. That is especially true when the evidence is as weak as what you provided here.

        I’ll see if I can dig up the research on the average range of gunfights.

        • Ambulance Driver,

          First of all, we were talking about firearms. Pointing out everything else EMS sucks at is a poor straw man, and even less relevant than you seem to think my points were.

          The competence of the person attempting to draw a concealed handgun in a residence, in an ambulance, or in any other place EMS might be called – is irrelevant.

          We may suck at a lot of other things, but it is unfair to suggest that anyone who has a concealed carry permit is like that, because they are excluded from the research that shows EMS in a poor light.

          Basing your conclusions about the speed of a concealed draw or the preferability of open hand combat when am attacker is within 20 feet based on one video is not evidence. It is anecdote.

          No.

          They had an expert with knives up against average policemen.

          They tested responses over a variety of distances.

          They showed that for various distances, from bad breath distance out to about 20 feet, the open carry police officer did worse when he tried to draw and shoot.

          That seems to have been accepted by the police and used in their training.

          But since we’re calling anecdotes evidence as long as the subject is guns, I will counter with an anecdote of my own:

          http://m.youtube.com/#/watch?v=hA-xIssgT-o&desktop_uri=%2Fwatch%3Fv%3DhA-xIssgT-o

          How many takes were required for that?

          How many takes do we get in real life?

          How well would that have worked if the guy had just shot him, rather than trying to hold him at gun point?

          You are preparing for someone to draw, not shoot, and then wait for them to look away, so you can draw a concealed handgun? I don’t see you advocating that kind of approach.

          Your video says you can’t beat an armed attacker within 20 feet and should fight him unarmed, my video says not only that you can, but you can execute a Mozambique drill in under 1.38 seconds.

          Now, is Jim Zubiena a representative sample of the average CCW holder? No, but since we’re both calling one video “evidence,” we can say whatever the hell we want, can’t we?

          The video I presented shows average officers being presented with someone not clearly armed, who attacks them before they can draw.

          The video seems to have been the result of a series of tests to present an outcome that can be expected for the average police officer.

          Your counterpoint is a best case scenario by a quick draw specialist.

          Keep in mind that I am not disagreeing with your stance that concealed carry of firearms by EMT’s is an overreaction to a perceived threat. I am calling you out over your supposed evidence in making your argument. You’re an evidence guy, Tim. You of all people should be above such mistakes.

          I would like to have better evidence, but I don’t see any reason for expecting that others would come to different results from the video I presented, do you?

          And ridiculing someone else’s position is what people do when they don’t have facts on their side. That is especially true when the evidence is as weak as what you provided here.

          We should accept anything without evidence, but we should demand evidence of harm?

          That argument is ridiculous.

          There is plenty of evidence that we have killed people by making that mistake.

          Do you really want me to provide the evidence for all of the examples I gave to demonstrate how ridiculous his suggestion was? I have written about most of them.

          Here is a link to evidence of harm for the first one.

          I can give more if you remain unconvinced of the ridiculousness of the assertion that we should assume safety until there is evidence of harm.

          Thalidomide – over 10,000 children with major birth defects.

          It should be emphasized that the teratogenic nature of thalidomide was recognized only because it produced a rare and rather specific combination unusual syndrome led Lenz2 to search for its cause. If thalidomide (or aspirin, for that matter) produced a more common type of defect such as cleft lip and palate or spina bffida in, say, 5% of cases where it was taken in the first trimester, it would probably not have been suspected.

          In any case. it is clear that medications should not be given to pregnant women without a definite medical indication and a reasonable expectation of benefit to the mother.

          Drug-induced teratogenesis.
          FRASER FC.
          Can Med Assoc J. 1962 Sep 29;87:683-4.
          PMID: 13894748 [PubMed – indexed for MEDLINE]

          Free Full Text from PubMed Central

          Bleeding to remove bad humors – how many thousands died for this?

          Removing children’s tonsils to prevent infection – how many children died from this unnecessary surgery?

          X-rays of our feet in shoes to get a good fit – how many cancers from old, high-dose radiation?

          Trendelenburg position – no benefit, but it impairs respirations and increases the risk of vomiting and aspiration.

          Furosemide for CHF – how many unnecessary intubations to be able to treat the fluid in the bladder, rather than the fluid in the lungs?

          High-dose epinephrine for cardiac arrest – more ROSC, but less survival.

          Lidocaine for cardiac arrest – more ROSC, but less survival.

          Amiodarone for cardiac arrest – more ROSC, but less survival.

          Standard-dose epinephrine for cardiac arrest – more ROSC, but less survival.

          Antiarrhythmics for patients with PVCs after having a heart attack – how many tens of thousands died due to this dangerous treatment?

          Steroids for spinal cord injury – still unproven, but still being pushed by one doctor.

          We should accept anything without evidence, but we should demand evidence of harm?

          That argument is ridiculous.

          I’ll see if I can dig up the research on the average range of gunfights.

          That would be the average range of EMS gunfights?

          Excellent.

          We wouldn’t want to be discussing something that is not relevant to the use of concealed handguns by EMS.

          .

          • “We should accept anything without evidence, but we should demand evidence of harm?

            That argument is ridiculous.

            There is plenty of evidence that we have killed people by making that mistake.”

            Don’t put words in my mouth. That is not what I said. What I said was, and allow me to make it plainer, is that you tend to behave like a condescending horse’s ass with people who disagree with you.

            You and I have known each other for years. I know you’re not a horse’s ass. You’re a smart enough guy to advance your argument without such tactics.

            You had people disagree with you. Their arguments weren’t as strong as yours. Or perhaps they simply weren’t as well stated. Calling someone’s comments idiotic is unnecessary, especially when their comments did not attack you directly.

            On the range of EMS gunfights,I’ll take your sarcasm in stride since we both know such data does not exist (and why), and merely point out the similarities in distance to the confines of an ambulance module. You can then figure out whatever reasons you need to declare it irrelevant.

            • Ambulance Driver,

              “We should accept anything without evidence, but we should demand evidence of harm?

              That argument is ridiculous.

              There is plenty of evidence that we have killed people by making that mistake.”

              Don’t put words in my mouth. That is not what I said. What I said was, and allow me to make it plainer, is that you tend to behave like a condescending horse’s ass with people who disagree with you.

              But that is the argument I am describing as ridiculous.

              This is possibly the most dangerous concept in medicine and should be ridiculed any time it is proposed.

              You and I have known each other for years. I know you’re not a horse’s ass. You’re a smart enough guy to advance your argument without such tactics.

              You had people disagree with you. Their arguments weren’t as strong as yours. Or perhaps they simply weren’t as well stated. Calling someone’s comments idiotic is unnecessary, especially when their comments did not attack you directly.

              If someone attacks me directly, I don’t have any reason to call them idiotic.

              If someone makes idiotic statements, that is fair game.

              On the range of EMS gunfights,I’ll take your sarcasm in stride since we both know such data does not exist (and why), and merely point out the similarities in distance to the confines of an ambulance module. You can then figure out whatever reasons you need to declare it irrelevant.

              I think that the situation is much different on an EMS call from going about our not so normal lives.

              I would expect that the variatities in quality of intubation in EMS reflect the varieties in quality of use of any concealed weapon.

              Is the average concealed carry EMS person more like the average police officer or Jim Zubiena (the expert quick draw shooter from your video)?

              .

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