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

- Rogue Medic

Too Old To Work Gets Cantankerous

Too Old To Work, Too Young To Retire does not appear to like what I wrote about EMS being armed and dangerous.[1]

This post is well below your usual standards regarding data and analysis. You certainly wouldn’t use statements such as,

The police have psychological screening, but for EMS the only screening seems to be to have failed the police psych exam.

in any other context regarding EMS, but you feel free to use such gratuitous insults regarding EMS providers when it comes to something that you don’t favor.

When did TOTWTYTR become a stranger to sarcasm?

If TOTWTYTR wishes to contradict me, he can provide his own sarcasm.

Another job that EMS often considers as an alternative to EMS is nursing. If I made a comment about intubation not making EMS better than nurses, would that also be offensive?

It certainly undermines your credibility when it comes to your other declarative statements about EMS, providers, physicians, and medical control.

Certainly?

Please explain how sarcasm undermines credibility. After all, TOTWTYTR never uses sarcasm to make a point./

Statistically civilian gun owners are safer at handling their firearms than are police officers. Most police officers are not “gun people” and many that I know view having a firearm as a liability. On the other hand, civilian gun owners spend a lot of time practicing and especially practicing safe handling of their firearms.

People in EMS are not civilians any more than police are civilians.

We are uniformed emergency personnel. The uniform is a bit of a clue.

Why do we think we won’t be donating our weapons to the people we want to protect ourselves from?

There is no data to support the long spoken lie that civilians will always have guns taken away from them by criminals. Another myth you are perpetuating with this post.

I did not mistakenly call EMS civilians, TOTWTYTR did.

I did not state that this would always, or even frequently, happen.

The fear of being shot/stabbed appears to be due to a lack of understanding.

Better to be judged by 12 than carried by 6.

Where are the shot/stabbed LODDs (Line Of Duty Deaths)?

This is just another example of the thinking that comes up with –

If it saves just one life . . . .

We ignore unintended consequences in our focus on potential murders.


Image credit.

I do not know of any evidence that EMS is any more likely to use a weapon on an attacker than have their own weapons used on them.

Please provide some of the facts you claim contradict the question I asked.

Of course, TOTWTYTR‘s partner will be able to conceal a firearm and still have ready access to it in a confined environment.

Of course, TOTWTYTR‘s partner will be able to shoot only the bad people and would never fire a round through a wall, or a door, or a window.

All of the sharpshooters in EMS are above average shots.

If nothing else, we always choose the best places to draw our weapons.

I guess facts are only important when it’s something you believe in. Noted for future reference.

Show me some research on EMS being shot at.

I made a sarcastic comment and I asked a question. I did not present them as facts.

In TOTWTYTR‘s eyes, that reflects on the research I cite and the commentary I provide on that research?

Please provide some evidence of EMS (not tactical EMS) preventing murders by carrying weapons.

Please provide some evidence of EMS firing shots safely when attacked by people presenting a genuine threat. Tactical EMS does not count, because I have not suggested that they not carry weapons.

Complaining that I do not provide citations for sarcasm is just plain silly. However, I did not notice TOTWTYTR providing any facts.

Go listen to the discussion on the EMS Office Hours podcast – Arming EMS – Defensive or Simply Offensive.

Footnotes:

[1] Arming EMS – Defensive or Simply Offensive
Rogue Medic
Thu, 16 Feb 2012
Article

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Arming EMS – Defensive or Simply Offensive

On EMS Office Hours most recent show, Jim Hoffman, Josh Knapp, and I discussed a topic I have written about several times – particularly my recent post Why are We So Afraid of Our Patients.

Arming EMS – Defensive or Simply Offensive


Original cartoon credit.

How well prepared are we to use lethal force on the job? Not medications, endotracheal tubes, and other potentially lethal interventions, but guns, knives, clubs, and other weapons.

Randy called in and made some good points.

Why do we think we won’t be donating our weapons to the people we want to protect ourselves from?

If we carry weapons that are concealed well enough that nobody notices, how long will it take to draw the weapon in a confined space while being attacked?

The police have psychological screening, but for EMS the only screening seems to be to have failed the police psych exam.

Is is better to fight back or to run away?

We are not there to fight. We should not stay to fight.

How many EMS providers are murdered in any year?

How many of them are murdered on a call?

Will any of this be improved by putting a weapon in your partners’ hands?

This is not about whether you are safe with a weapon.

This is about whether your partner is safe with a weapon.

I have worked with a few people who would be safe with a weapon, but most of the partners I have had would only be dangerous with weapons.

[youtube]XcxKIJTb3Hg[/youtube]

We are not there to win arguments.

 

We are there to treat patients.

 

Go listen to the podcast.

Also listen to –

EMS Situational Awareness at EMS Office Hours.

Surviving the Next Shift the Standing Orders podcast.

Other sites mentioned on the podcast –

DT4EMS.com

EMS Museum post at Rescuing Providence

Copy & Paste post on Federal EMS agency at EMS Patient Perspective

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A Brilliant Design 1

This looks OK, at least from this angle.

When viewed from a slightly different angle, this is a poor design.

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]

Now look at the problem with the design.

If you have a gun that runs on compressed air, it would be nice to know how much air you have left wouldn’t it? I’m not sure the design was fully thought through.[2]

Should anyone look at the end of the barrel to find out how much pressure is left? No.

Even though the barrel doesn’t have to be directly pointed at my head, I am teaching myself a bad habit by pointing it near my head. If I become comfortable with that, how uncomfortable will I be in pointing the gun near anyone else? This is not the way to learn to use any weapon safely.

The gas cylinder can be removed to check the level, but why put the gauge where it is? This is just tempting people to misbehave – almost as if it were designed for EMS.

Footnotes:

[1] maybe some people shouldn’t own guns.
the munchkin wrangler
March 26, 2008
Article

[2] Why You Need Domain Knowledge
by Mark Shead
February 9, 2012
Mark W. Shead
Article

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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?

[youtube]Mzcgyk62cHU[/youtube]

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

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Handguns, Health, and the Second Amendment

Today’s New England Journal of Medicine has an interesting editorial that is not in the editorial section. Handguns, Health, and the Second Amendment. It is also surprising that it is not part of their free content. The NEJM tends to make articles, that they feel are important, available for free.

What did a couple of medical ethicists, From the Department of Health Law, Bioethics, and Human Rights, Boston University School of Public Health, Boston, have to write about the District of Columbia v. Heller decision? Well, they spent most of the 6 pages giving their legal opinions.

What did these non-Constitutional scholars not address, or just barely address? Tangentially, they did mention that we have a problem with violence in the United States. What they did not address at all, is the way that gun control might have the effect of decreasing that violence.

Is the problem with handgun crime one of otherwise law abiding people obtaining guns for their personal protection?

Is the problem with handgun crime one of criminals obtaining guns illegally for the purpose of committing even more crimes?

The article seemed to take the approach that is common with gun control efforts. It assumes that by aggressively prosecuting the first individual, there will be a decrease in handgun crime.

This is like the drunk looking for his keys under a streetlight. Where did he lose his keys? Nowhere near the streetlight, but he knows that the light is better under the streetlight, so that is where he will look.

Guns do not have the ability to posses the soul of the gun owner and cause the person to become violent. This is silly. No more than RSI (Rapid Sequence Induction/Intubation) causes people to ignore the use of waveform capnography to confirm placement of the endotracheal tube. No more than any tool will control the will of the person using the tool.

What is never explained is the way that disarming law abiding citizens has any effect on the violent criminals. True, there will be fewer guns available to be stolen and sold/bartered to the violent criminals. Anybody who thinks this will seriously decrease the crime rate is clearly not grasping the concept that these are criminals. They do not need to obtain guns legally. Except for the amateur criminal, they are already well armed. It will only cause the law abiding citizens to not have protection against violent criminals.

OK, there will be some protection, but how many criminal attacks with a handgun are interrupted by the police before the gun wielding criminal has a chance to fire some shots into the unarmed victim?

Ah, but what about crimes of passion? Otherwise law abiding citizens become so irate that they use a handgun to attack the person they are not happy with. While the hand gun is the most expeditious way of accomplishing this, it is far from the only way. In England, where you practically have to be James Bond to get a handgun, there have been a lot of knife laws put into effect. The gun laws do not seem to make people any more agreeable. Knives also kill, so we have to ban those evil knives.

If this didn’t work with guns, why will it work with knives?

As with anything else – the problem is not the tool. The problem is the person misusing the tool. Handgun, laryngoscope blade, medication, automobile, knife, legislative power, . . . . Attacking the tool is not going to fix the problem of misuse. This will only cause the dangerous people to be dangerous with other tools.

The problem of violence is a significant problem. Mistaking it for a problem of guns, is not the way to solve the problem. When the legal guns are all gone, the problem will be knives, then baseball bats, or tire irons, or rocks, or automobiles, or something else. It doesn’t really matter what the tool is. The problem is the hand behind the tool. The hand is following the direction of a faulty brain. That does not mean that the brain will not be resourceful in finding other ways to be violent.

These passionately violent morons just help the Lawmakers of Unintended Consequences to make laws that continue to ignore the violent criminals.

Late entry – 10:40 5/28/09 – for a different take on this NEJM piece, read:

Ah, Yes, the “Guns as Disease Vector” Meme!

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