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

- Rogue Medic

Texas bill would let firefighters, EMTs carry firearms


There is a bill in Texas to require employers to allow EMS personnel to carry guns on the job.

“I would be in favor of leaving guns in the hands of police officers,” Waco Fire Chief Bobby Tatum said. “We have a specific mission to save lives and property, and I think carrying a firearm would cross the line in that regard.” [1]


What is the possible benefit?

As I have written about this before –

When would armed EMS make any difference?

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

Below, Dara O’Briain spends a minute on the frustration of trying to explain to people, who don’t understand statistics, that crime rates are definitely going down. Following that, I provide evidence.


And they go, but the fear of crime is rising.

Well, so what? Zombies are at an all time low, but the fear of zombies could be incredibly high.


Here is the murder rate in America from 1960 to 2012 (the most recent data available from the FBI when I made the graph for Thanksgiving in 2015). The 2012 murder rate was 4.7 per 100,000. 2013 and 2014 were lower, both at 4.5 per 100,000.

US Murder Rate - 1960 - 2014

This is the murder rate in Canada compared with the murder rate in America and whether the death penalty has an effect on either. In the chart, the murder rate of Canada is on a scale that is tripled to show similar changes year to year. This chart is a decade old, but the murder rate in the US and Canada continued to drop in the newer data.

Murder rates US vs Canada 1950 - 2005 aa
Source: John J. Donohue III, Justin Wolfers, Uses and Abuses of Empirical Evidence in the Death Penalty Debate, Discussion Paper No. 1949 (January 2006) available at http://papers.ssrn.com/sol3/papers.cfm?abstract_id=870312.

What about in the Good Ol’ Days, when everything was so much better than now?

Homicide rates (per 100,000 people) 14th - 20th centuries - Millennium by Ian Mortimer a

In the Good Ol’ Days, things were not good and few people lived long enough to get old.

I regularly criticize What if . . . ? fear mongering.

This is one of the greatest harms of EMS. We need to stop this dependence on scaring people with stories of monsters in closets. We need to deal with reality.

This fear mongering is lowering ourselves to the level of alternative medicine.

What will happen the first time someone in EMS shoots someone, fires a gun, points a gun at someone, or just brandishes a gun?

Was it justified?

What will the repercussions be?

When would any outcome have been better if EMS carried guns?

How would it have been better?

Assume that only 10% of the people in EMS who will carry guns on the job are below average (yes, that means that 90% are above average). How much trouble can that 10% cause?

Assume that only 1% are below average. How much trouble can that 1% cause with below average decisions?

There is nothing in this bill to prevent that 1% from carrying on every call. The carry license is both the floor and the ceiling for qualification for armed EMS.[2]

Sometimes doing nothing is the best thing we can do, but some people need to do something, even though there is no reason to expect it to do any good. This is another case of doing something just to do something.

If we are going to change how we do things, we should insist on thorough documentation of every intervention, just as we should for any other EMS intervention. The bill does not mention any kind of tracking of the effects of this legislation.[2]

Can employers require training/skills verification? Only possession of a valid carry license is mentioned. No further skill requirement is mentioned in the bill.[2]

What will happen to the insurance rates for the employer? Insurance companies are not looking to donate money to make EMS feel good.

Will people leave EMS in order to get away from partners they don’t trust with guns? How many do that now for bad driving?

Will we end up with more people who couldn’t get onto the police force, because lights and sirens and guns is better than lights and sirens?

Will EMS providers in Texas be told that this is a replacement for the raise they were going to get?

If some people feel unsafe without their guns, because they mistakenly believe that the murder rate is increasing, when it is definitely dropping, in what other ways are they making bad decisions? Will giving the confused fear of rising crime people guns act as a security blanket, so that they will feel safer and focus on their patients? Or will the confused fear of rising crime people use the guns to act on some other confusion? It probably won’t be that simple.

PS – Is this a Constitutional issue?

Employers are permitted to limit some other important civil rights, such as speech, during work hours. We can always choose to work in jobs that permit us to be armed on the job. Security guard, police officer, corrections officer

Of course corrections officers have to carry guns. They are surrounded by inmates.

Actually, corrections officers do not carry guns when they are around inmates. It seems that introducing a gun into that environment is not considered a good idea.


[1] Texas bill would let firefighters, EMTs carry firearms – The bill would implement a statewide policy requiring jurisdictions to allow responders to carry while on duty
Feb 14, 2017
By EMS1 Staff

[2] Texas House Bill 982
Bill Text: TX HB982 | 2017-2018 | 85th Legislature | Introduced
TX State Legislature page for text of HB982


Should Universities Avoid Sensitive Topics Because of Guns in the Classroom?


There is paranoia over having guns on campus at state schools in Texas, but where is the evidence to support the fear that armed students will suddenly resort to violent disagreement? Professors are being encouraged to avoid sensitive topics if there are armed students in the classroom. Has discussion of sensitive topics previously resulted in attacks on professors with knives, clubs, chairs, or fists?

With students potentially carrying weapons after Aug. 1, University of Houston faculty members may want to avoid sensitive subjects or drop certain topics from their curriculum altogether, a forum of professors suggested recently.

A slide shown at a recent discussion of a new state law, which will allow licensed individuals to carry concealed handguns on campus, says faculty may want to “not ‘go there’ ” to avoid creating a tense situation. This echoes concerns voiced by professors across the state that allowing guns into the classroom will limit academic freedoms and inhibit discussion of sometimes touchy subjects.[1]


We do need to know more about the causes of shootings, but Congress has prohibited studying this because the research often reflect the biases of the researchers, whether pro-gun or anti-gun. Researchers on the topic have not done a great job, but that is a reason to improve the research, not to prohibit research.

While there have been a lot of school shootings, is there anything to suggest that these shootings have had anything to do with discussions of sensitive topics?


Will this change if students are allowed to carry firearms on campus?

Probably not.

Research would be nice, but Wayne LaPierre (executive vice president of the National Rifle Association) appears to be convinced that guns are the cause of all of the problems in America. He is the main opponent of research, which he seems to expect to uncover his secret. LaPierre is also the person who seems to profit the most from every mass shooting that makes the news.

News coverage of a mass shooting is a fund raiser for Wayne LaPierre and the NRA. While LaPierre fights to keep guns in the hands of criminals, most NRA members are more reasonable.

Pew - guns - background checks
Section 2: Opinions of Gun Owners, Non-Gun Owners[2]

Gun ownership is a topic that many people approach emotionally, rather than logically. People want guns for protection, even though there is no valid reason for the average person to feel safer with a gun. There are plenty of reasons to feel less safe with a gun.

The best way to protect yourself is to stay away from violent people, such as gangsters, but that is not always possible.

What is a gun supposed to protect you from? Being killed –

All homicides
Number of deaths: 16,121
Deaths per 100,000 population: 5.1

Firearm homicides
Number of deaths: 11,208
Deaths per 100,000 population: 3.5


What is the greatest risk of owning a gun?

All suicides
Number of deaths: 41,149
Deaths per 100,000 population: 13.0
Cause of death rank: 10

Firearm suicides
Number of deaths: 21,175
Deaths per 100,000 population: 6.7

Suffocation suicides
Number of deaths: 10,062
Deaths per 100,000 population: 3.2

Poisoning suicides
Number of deaths: 6,637
Deaths per 100,000 population: 2.1


People with guns are almost twice as likely to intentionally kill themselves as they are to intentionally kill someone else, so why the fear?

Then there are 505 unintentional firearms deaths, 281 firearms deaths in the undetermined category, and 467 firearms deaths in legal intervention/war category. Even the accidental (unintentional) deaths outnumber the appropriate deaths.

This does not mean that there is no good reason to own a gun. There are many, but just for the feeling of protection in a low crime area, like some who are prepared for a home invasion, is like buying a lottery ticket. Your odds of winning do not change, regardless of how many tickets you buy. Estimating the home invasion rate, since it is not usually a specific part of crime statistics, is a guess at what is just a tiny part of the violent crime rate, which has been decreasing for a quarter of a century.

Perhaps a gun is not just supposed to protect you from being killed, but from being attacked, or just from being anxious about being attacked. The suicide statistics do not suggest that guns provide an effective psychological benefit.

The NNT (Number Needed to Treat to produce a benefit) is almost impossible to measure, because of the prohibition on research and the difficulty in identifying cases where a gun might have prevented something vs. when having a gun may have contributed to a bad outcome, vs. the many other difficult to measure possible outcomes. Outcomes of even positive reports might have been better without a gun, since we generally have no way of knowing what the outcome would be if a person did not have a gun.

The NNH (Number Needed to Harm) is easier to measure. Add the accidental injuries, the accidental deaths, and the suicides and divide by the number of guns. Even this will have some difficult to measure possibilities. The difference is that the majority of this number is unambiguous, while the benefit is almost entirely speculative.

The bad outcomes are only going to be a fraction of one percent. They are like dealing with terrorism, which is like mass shootings – rare, dramatic, and emotional. We are not good at making these decisions rationally.

But how dangerous are guns?

Actual causes of death in US in 2000 - a
Actual Causes of Death[4]

Some of the death rates, such as due to motor vehicles and firearms, have decreased since 2000, while others, such as illicit drug use have increased.

Three Selected Causes of Injury†— National Vital Statistics System, United States
The full image shows more dramatic changes since 1979, but I edited it to show only the changes since 1999.[5]

Guns are much less dangerous than tobacco, obesity/inactivity, or alcohol, but more dangerous than terrorism. We don’t worry much about tobacco, obesity/inactivity, or alcohol, but we panic about terrorism. Risk management is not something we do well. We evolved a fight, flight, or freeze response to threats. These are reflexive and emotional responses. Universities are supposed to promote reasonable discussion of diverse and sensitive topics, but they have encouraged political groups to shout down the ideas they do not want to hear.

Professors are supposed to think clearly about things, and educate students to think clearly. Avoiding sensitive topics, because students might not be reasonable, is not reasonable.


[1] UH faculty suggest steering clear of some topics if students armed
By Benjamin Wermund
Updated 8:30 am, Wednesday, February 24, 2016
Houston Chronicle

[2] Section 2: Opinions of Gun Owners, Non-Gun Owners
March 12, 2013
Why Own a Gun? Protection Is Now Top Reason
Perspectives of Gun Owners, Non-Owners
Pew Research Center

[3] Deaths-Final Data for 2013
Jiaquan Xu, M.D.; Sherry L. Murphy, B.S.; Kenneth D. Kochanek, M.A.; and
Brigham A. Bastian, B.S., Division of Vital Statistics
National Vital Statistics Reports
Volume 64, Number 2
February 16, 2016
Free Full Text in PDF format

[4] Actual causes of death in the United States, 2000.
Mokdad AH, Marks JS, Stroup DF, Gerberding JL.
JAMA. 2004 Mar 10;291(10):1238-45. Review. Erratum in: JAMA. 2005 Jan 19;293(3):298. JAMA. 2005 Jan 19;293(3):293-4.
PMID: 15010446

[5] QuickStats: Death Rates* for Three Selected Causes of Injury†— National Vital Statistics System, United States, 1979–2012
Morbidity and Mortality Weekly Report (MMWR)
November 21, 2014 / 63(46);1095
Edited to show only the changes since 1999
Free Full Image with footnotes from CDC.


Tubes and Guns and Training, Oh No – Part II


EMS concealed carry of firearms has become a topic of discussion, again.[1]

One of the comparisons made was that firearms are like condoms. I don’t think that person understands the proper use of a condom.

A condoms is an effective tool for problems that might arise from something that is pretty common (sexual activity). There is no judgment about how to use the condom, while how to use a firearm during an EMS call is the most important part of carrying a weapon on the job in EMS.

Weapons are not effective tools for EMS to use, since too few of us seem to be capable of providing competent basic EMS care.

The most important weapon we have is our judgement. We regularly demonstrate that we do not have good judgment.

One example is needle decompression, which is used appropriately much more often than any weapon would be (if the weapon were used appropriately).

However, when needle decompression is used, the use appears to be almost always inappropriate.

Needle decompression does save lives when used appropriately.

Click on the image to make it larger.[2]

The chart is for all patients treated with needle decompression for suspected tension pneumothorax.

Many patients never had any kind of pneumothorax.

Was needle decompression used appropriately on any of these patients?

We do not know.

It is the responsibility of the EMT to make sure that his shooting skills – and decisions – are up to par better than par. Right?

Is it the responsibility of the EMT to make sure that his intubation skills are better than par?

No. It is the responsibility of everyone – the medical director, the employer, the supervisors, and the EMT. The life threatening skills we use on the job (intubation, needle decompression, cricothyrotomy, . . . ) affect much more than the individual, the individual’s reputation, and the individual’s income.

When I am at work, my First Amendment rights are limited.

Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the Government for a redress of grievances.[3]


The rights described above do change at work. The same is true for many of our other rights.

Tell your employer that you wish to participate in a public assembly on the job in uniform.

Tell your employer your unsolicited opinion of exactly what you think of the way things are run.

Tell your employer that you will share this unsolicited opinion with the press.

Our rights as citizens and our rights as employees are not the same.

This is not about protecting the Second Amendment.


[1] Facebook discussion
Chance Gearheart
Web page

After reading some of the EMS Forums and groups, I can safely say that I want to be nowhere near some of these people if they’re allowed to carry a handgun on the unit. They’ll be more of a danger to themselves than anyone else around them.

Barney Fife with a bullet in their pocket. Christ man.

[2] Inadequate needle thoracostomy rate in the prehospital setting for presumed pneumothorax: an ultrasound study.
Blaivas M.
J Ultrasound Med. 2010 Sep;29(9):1285-9.
PMID: 20733183 [PubMed – in process]

Free Full Text from J Ultrasound Med.

When Should EMS Use Needle Decompression
Rogue Medic
Thu, 10 Nov 2011

Inadequate needle thoracostomy rate in the prehospital setting for presumed pneumothorax: an ultrasound study – Full paper
Rogue Medic
Mon, 14 Feb 2011

Inadequate needle thoracostomy rate in the prehospital setting for presumed pneumothorax: an ultrasound study – abstract
Rogue Medic
Tue, 07 Sep 2010

[3] Bill of Rights to the US Constitution
National Archives
Web site.


The Wars on Gays, Guns, Drugs, Speech, and Everything Else Not Politically Correct


If you are easily offended, you are in the wrong place.

This has not much to do with EMS, except that there is the contrast between those who try to avoid responsibility for their actions (and try to make sure anyone who acts differently is punished) and those who try to do what is right (because it is about taking care of the patient, regardless of what the rules state). The Supreme Court will soon be deciding if anti-gay marriage laws violate any civil protections from discrimination. Since the Justices are known for decisions based on their ability to find precedents for their ideological political preferences, this is not necessarily just a secular legal decision, but it should be. In that vein –

What is the definition of marriage and when did a bunch of politically correct whiners start caring about the poor defenseless dictionary?

The dictionary is not really of interest to the opponents of gay marriage. A Gallup poll shows what reasons were given by people. Maybe being a dictionary Nazi was not a choice.

Image credit. Click on images to make them larger.

What does the Bible state?

21 And they asked him, saying, Master, we know that thou sayest and teachest rightly, neither acceptest thou the person of any, but teachest the way of God truly:

22 Is it lawful for us to give tribute unto Caesar, or no?

23 But he perceived their craftiness, and said unto them, Why tempt ye me?

24 Shew me a penny. Whose image and superscription hath it? They answered and said, Caesar’s.

25 And he said unto them, Render therefore unto Caesar the things which be Caesar’s, and unto God the things which be God’s.[1]


There is God’s law and there is government law and they are different and should not be confused.

Is Jesus the source of our wall of separation between Church & State?[2]

If gay marriage required priests, ministers, rabbis, imams, or other religious leaders to perform gay marriages, then that would be a problem, according to what Jesus said.

Only people who take exaggeration to sinful levels make that ridiculous claim. Where is there any suggestion that this would be anything other than a legal elimination of discrimination?

As with teaching Creationism in publicly funded schools, this is a religious dispute, not a legal dispute.

If the religious cannot agree, the government should not be adopting one particular religious interpretation.

But how does the Bible define marriage?

Image credit. Click on the image to see all of the forms of marriage that are acceptable to God and should be legalized if we are to be consistent.

But that is the Old Testament. We just use that to make the Book look bigger and the tradition seem older. We ignore everything in it, unless it suits us.

True. The most vocal critics of the behavior of others are the ones who use this excuse, but those include the opponents of gay marriage. Maybe they should have this tattooed on their foreheads to warn others of their hypocrisy. Except that tattoos are forbidden in the Old Testament.[3]

3 And why beholdest thou the mote that is in thy brother’s eye, but considerest not the beam that is in thine own eye?

4 Or how wilt thou say to thy brother, Let me pull out the mote out of thine eye; and, behold, a beam is in thine own eye?

5 Thou hypocrite, first cast out the beam out of thine own eye; and then shalt thou see clearly to cast out the mote out of thy brother’s eye.[4]


What does Jesus say about banning any kind of marriage?

When given the opportunity, Jesus does not criticize an example of Old Testament marriage.

27 Then came to him certain of the Sadducees, which deny that there is any resurrection; and they asked him,

28 Saying, Master, Moses wrote unto us, If any man’s brother die, having a wife, and he die without children, that his brother should take his wife, and raise up seed unto his brother.

29 There were therefore seven brethren: and the first took a wife, and died without children.

30 And the second took her to wife, and he died childless.

31 And the third took her; and in like manner the seven also: and they left no children, and died.

32 Last of all the woman died also.

33 Therefore in the resurrection whose wife of them is she? for seven had her to wife.

34 And Jesus answering said unto them, The children of this world marry, and are given in marriage:

35 But they which shall be accounted worthy to obtain that world, and the resurrection from the dead, neither marry, nor are given in marriage:

36 Neither can they die any more: for they are equal unto the angels; and are the children of God, being the children of the resurrection.

37 Now that the dead are raised, even Moses shewed at the bush, when he calleth the Lord the God of Abraham, and the God of Isaac, and the God of Jacob.

38 For he is not a God of the dead, but of the living: for all live unto him.

39 Then certain of the scribes answering said, Master, thou hast well said.

40 And after that they durst not ask him any question at all.[5]


In other words, for those who want to use the use the words of Jesus to discriminate against others, Jesus appears to be saying, Get off my lawn, Punk.

What about guns, drugs, speech, and everything else not politically correct?

We are fond of demanding freedom for ourselves, but prohibiting our neighbors from having freedom.

Gay marriage prohibitions are just more of the same.

I am safe with a gun, but he is not.

I can consume alcohol safely, but that marijuana is dangerous.

I can speak without restriction, but he should not.

Freedom means tolerating what we perceive as the excesses of others with the freedoms we want for ourselves, or with freedoms we have no interest in.

Freedom is not about only allowing us freedom.

If we cannot trust our neighbors with the same freedom, we should not have that freedom – or should we just grow up and stop trying to control others?

What is the opposite of freedom?

Not slavery, but prohibition.

Guns are dangerous.

If we pass a law banning guns, we will create safety.

Drugs are dangerous.

If we pass a law banning drugs, we will create safety.

Speech is dangerous.

If we pass a law banning speech, we will create safety.

Many have attempted to ban speech. They have been unsuccessful.

Is flag burning wrong?


Flag burning is a way of getting attention for the speech that is protected by the Constitution that Americans have fought, and some have died, to uphold.

The flag is just a symbol. The flag is a symbol of our republic that protects the minority from the abuses of powerful anti-American majorities, even when all of those trying to harm the US Constitution are American citizens.

If you think that you know someone who died to oppose the US Constitution and defend a symbol against being burned, then you deserve ridicule.

We have attempted to ban drugs. We have been unsuccessful.

Is consuming intoxicants wrong?


There are many ways that we might harm ourselves, but drugs are not always harmful.

Claiming that drugs are always harmful is absurd.

What if we legalize drugs? Then everyone will take drugs!

Half of American adults already have tried marijuana, including Presidents Clinton, Bush, and Obama.

Portugal decriminalized everything, including heroin.

Their crime rate decreased. Obviously, the drug crime rate would decrease if it is eliminated. Other crimes decreased – the ones that we claim the drug laws are supposed to protect us from.[6]

We have a history of abandoning prohibition. The only Amendment to the US Constitution to be repealed was the 18th.

The police, courts and prisons were overwhelmed with new cases; organized crime increased in power, and corruption extended among law enforcement officials. The amendment was repealed in 1933[7]


Why do we keep trying to stop others from doing things we do not like?

Why don’t we recognize that we are harming ourselves and we are harming them?

Are we really that illogical?

The number one killer is tobacco.

In the United States, smoking is responsible for about one in five deaths annually (i.e., about 443,000 deaths per year, and an estimated 49,000 of these smoking-related deaths are the result of secondhand smoke exposure).1 [8]


We do not ban them, although we seem to be trying. If we did ban cigarettes, would we do anything other than encourage a lot of otherwise law abiding Americans to break the law?

The next biggest killer is alcohol.

Number of alcohol-induced deaths, excluding accidents and homicides: 25,692[9]


If we include accidents, the number might double, but it is still a tiny fraction of tobacco-related deaths. Should we ban tobacco and alcohol?

Only is we want to encourage criminal behavior among people who would not otherwise engage in criminal behavior.

Someone will whine that there will be drug-related driving fatalities.

This is not about legalizing driving while impaired/intoxicated. That would remain illegal.

We have attempted to ban guns. We have been unsuccessful.

Is owning a gun wrong?


There are many ways that we might harm ourselves, but guns are not always harmful.

If we are interested in limiting the traffic in illegal guns, we should make the gun laws national. Wherever you go, the rules on gun ownership should be the same. Why should Virginia be the source of illegal guns used by gangsters in neighboring states?

These different laws only make it easy for criminals to buy guns, but they do nothing to protect the rights of legal gun owners.

Banning guns is no different from banning drugs. Many otherwise law abiding Americans will break the law, diverting a significant portion of the US GDP (Gross Domestic Product – the measure of financial income of a country) to criminal organizations.

What will a ban on large capacity magazines (more than 10 rounds per clip) do to the millions of large capacity magazines already owned by Americans?

It will make an insignificant dent in the supply. The large capacity magazines turned over to law enforcement will be from the people least dangerous with them – least dangerous to law abiding Americans.

The law will not do anything to discourage criminals from obtaining large capacity magazines. A prohibition will do just the opposite.

A prohibition will create a lucrative criminal market in these magazines, but it will not save any lives.

This is not a spoof video. The full CSPAN link is in the footnotes.[10]

Sen. Dianne Feinstein is just as ridiculous as the people who claim that the marriage of someone else will destroy the sanctity of their marriage.

And the designated hitter rule in the American League destroyed the sanctity of baseball in the National League. Riiiight.

Is it really legal to hunt humans with any capacity magazine?


There are plenty of laws that would be available to police to charge someone who is hunting humans. If you doubt me, go try to hunt Sen. Feinstein and explain to the police that Sen. Feinstein says hunting humans is legal.

What about assault weapons?

Shouldn’t we use rules about cosmetic accessories, that do not affect function, to be paramount?

Ask any fashion maven and they will tell you that accessories make the wardrobe, but are we trying to prevent people from being scared to death by guns, or are we trying to prevent people from being shot with guns?

We do need to have some limitations on weapons. Even the President cannot arbitrarily decide to launch nuclear missiles.

We need to have those laws made by people who understand more about guns than That looks scary!

Are guns dangerous in the hands of well trained, law abiding citizens?


Are guns dangerous in the hands of criminals?


why don’t we focus on the dangerous people, rather than the people who are not shooting up schools, and not shooting out of car windows to protect the illegal drug business we created for them?


The problem is not the gays, or the drugs, or the guns, or the language, but the ways we act like tyrants to protect our egos.

In the immortal words of Sgt. Hulka, Lighten up, Francis.


We need to stop listening to those who claim that they are better than everyone else and that all we have to do is keep other people from having rights, then everything will be perfect.

We are responsible for our actions.


[1] Luke 20:21-25
King James Version

[2] Jefferson’s Wall of Separation Letter

To messers Nehemiah Dodge, Ephraim Robbins, & Stephen S. Nelson, a committee of the Danbury Baptist association in the state of Connecticut.


The affectionate sentiments of esteem & approbation which you are so good as to express towards me, on behalf of the Danbury Baptist association, give me the highest satisfaction. my duties dictate a faithful & zealous pursuit of the interests of my constituents, and in proportion as they are persuaded of my fidelity to those duties, the discharge of them becomes more & more pleasing.

Believing with you that religion is a matter which lies solely between man & his god, that he owes account to none other for his faith or his worship, that the legitimate powers of government reach actions only, and not opinions, I contemplate with sovereign reverence that act of the whole American people which declared that their legislature should make no law respecting an establishment of religion, or prohibiting the free exercise thereof, thus building a wall of separation between church and state. [Congress thus inhibited from acts respecting religion, and the Executive authorised only to execute their acts, I have refrained from presenting even occasional performances of devotion presented indeed legally where an Executive is the legal head of a national church, but subject here, as religious exercises only to the voluntary regulations and discipline of each respective sect.] Adhering to this expression of the supreme will of the nation in behalf of the rights of conscience, I shall see with sincere satisfaction the progress of those sentiments which tend to restore to man all his natural rights, convinced he has no natural right in opposition to his social duties.

I reciprocate your kind prayers for the protection and blessing of the common Father and creator of man, and tender you for yourselves and your religious association, assurances of my high respect & esteem.

Th Jefferson


[3] Leviticus 19:28
King James Version

28 Ye shall not make any cuttings in your flesh for the dead, nor print any marks upon you: I am the Lord.


[4] Matthew 7:3-5
King James Version

[5] Luke 20:27-40
King James Version

[6] 5 Years After: Portugal’s Drug Decriminalization Policy Shows Positive Results – Street drug–related deaths from overdoses drop and the rate of HIV cases crashes
By Brian Vastag
Scientific American

“Drug decriminalization did reach its primary goal in Portugal,” of reducing the health consequences of drug use, he says, “and did not lead to Lisbon becoming a drug tourist destination.”


[7] Eighteenth Amendment to the United States Constitution

[8] Smoking & Tobacco Use
CDC (US Centers for Disease Control and Prevention)
Fact Sheet

[9] Alcohol Use
CDC (US Centers for Disease Control and Prevention)
Fact Sheet

[10] Gun Control legislation Markup
Senate Committee Judiciary
March 7, 2013
Forward to 50:30 of the video.


Two Ridiculous Comments on Tubes and Guns and Training, Oh No

This is long, but some unusually bad arguments were made in the comments. I need to make examples of them.

Both The Unwired Medic and Garrett responded to Tubes and Guns and Training, Oh No. First, let’s look at what Garrett wrote –

> 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.

If you add more people with weapons, it only gets worse for you. I did not limit the possible attackers to the patient. Look again.



That does not mean that the attacker is not someone else within 20 feet. Outside of 20 feet, I did not even mention the patient.

>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.


Your concealed carry argument assumes that everything will go just right for the person carrying concealed.

We can’t get medics to practice with equipment that is much more likely to make a difference between life and death, so if I imply that you do not get much practice drawing from concealed while being shot at, or stabbed, am I implying too much?

Please share video of your skill at drawing from concealed, while being shot at or stabbed. We can use that as a basis for training, so that we do not endanger patients, family, bystanders, and partners by having unskilled concealed carry drawing and firing of handgunson scene.

Other weapons (chair drug bag/drug box, monitor, oxygen cylinder, . . . ) are more practical and do not need to be concealed. You prefer to attempt to draw a properly concealed handgun, while avoiding shooting the people who are not attacking you, such as your partner and the patient and the neighbors.

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

Not according to this news article.

I had not read about that. I have asked for information about any on-duty homicides in previous discussions about this and nobody has ever produced anything except for the lovers’ quarrel at the station.

Or this research article which suggests about 2/year:

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

I had not seen that, either.

That is a link to a JEMS description of a paper that used the Census of Fatal Occupational Injuries to produce the 10 apparent homicides over 6 years, but none of them appear in the National EMS Memorial Service records.

Would any of these homicides have been prevented if anyone had been carrying concealed? There is not even enough information provided in the paper to determine if they were actually EMS providers, so we do not know. Were some of them struck by drunk drivers, reckless drivers, or intentionally struck by vehicles?

Those could be listed as homicides if the people were charged with vehicular homicides.

The JEMS article includes information not in the original paper –

10 from homicides, most of them shootings;[1]

The JEMS article was an interview with the primary author of the paper, so he may be the source, but the article does not mention where this extra information comes from.

Image source.[2]

You assume that concealed carry would somehow improve things, but I do not see any reason to believe in your Goldilocks scenario.

However, I do admit that the rate of murder is slightly above zero.

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.


I was wrong.

The number is tiny, but it is not zero.

With all of the attention that the attack on Brian Stow received off duty, I figured an attack on someone actually on duty would receive much more attention.

> 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.

I did not write best every time, did I?

> 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.

And winning a million dollars in the lottery is better than not winning a million dollars, but you make it seem as if you have the ability to choose a winning ticket. Buying a lottery ticket changes your odds of winning the lottery by such a minuscule amount, that your odds of winning essentially do not change.

Why do you assume that carrying concealed is making things safer for you, or for anyone else?

You appear to be just making the scene less safe.

If you knew that the attack would happen, you would not be there.

Since the attack is happening, things are already out of your control, but you think that attempting to draw a concealed handgun will make things better.

> 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.

Why do you need to misrepresent what I write? My point is to make fun of your attitude.

Your approach seems to be to get on the scoreboard with the magical thinking of the protective aura of your concealed handgun.

I do not view your approach as reasonable.

Now let’s look at what The Unwired Medic wrote –

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.

I have asked for data before, but this is the first time anybody has ever provided any.

What statistic is justifiable for us to then be allowed to carry?

There are far more factors than that to consider, but with millions of EMS calls each year, that is a very low incidence to address. Defensive driving, exercise, and a massage would probably be much more effective at prolonging your life than attempting to draw a concealed handgun on an EMS call during an attack.

I’m NOT saying it is the right thing, but I’m also not saying it isn’t.


You are saying that you are not saying anything.

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.

I do try to show the folly of introducing unnecessary risk into patient care.

The potential benefits are so small that they cannot be measured – and that is assuming that the dangers are not much greater than the potential benefits.

Why do you ignore that risk, and exaggerate the potential benefits, even though you claim that you have no opinion?

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.

I don’t see any accountability.

I regularly criticize that What if . . . ? fear mongering.

That is one of the greatest harms of EMS. We need to stop this dependence on scaring people with stories of monsters in closets and deal with reality.

This is lowering ourselves to the level of alternative medicine.

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.

What a load of nonsense.

Picture credit.

Maybe you have not read what I have written, or you have not understood what you have read. I apologize if I have been unclear.

If I have at any time suggested that we should use something until the danger can no longer be hidden, I was completely wrong.

That kind of thinking is reckless and irresponsible.

We should not be encouraging reckless and irresponsible EMS.

Why do we like to assault patients with dangerous, untested treatments?

Why do we demand evidence of harm before removing them?

Why are we so dangerous to patients?

Some of the following treatments have been deadly. None have been shown to be beneficial. How much evidence of harm did we need to get rid of these What if . . . ? treatments.

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

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.

And on and on and on . . .

When we assume safety and demand evidence of harm, we should be prevented from treating patients.

Assuming safety and claiming that a lack of evidence of harm is the same as evidence of safety is dangerously incompetent.

We need to stop being dangerous.

We need to stop making excuses for being dangerous.

We need to stop worrying about What if . . . and start dealing with reality.

For a reasonable approach to protecting ourselves, read what CombatDoc wrote –


[1] Fatality Study: EMS Is a Dangerous Profession
By Kim Oriole, JEMS InfoMail Reporter
Link to Download in PDF format

[2] Occupational fatalities in emergency medical services: a hidden crisis.
Maguire BJ, Hunting KL, Smith GS, Levick NR.
Ann Emerg Med. 2002 Dec;40(6):625-32.
PMID: 12447340 [PubMed – indexed for MEDLINE]

Free Full Text Download in PDF format from paramedicduquebec.org


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?


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


[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.

[3] Warren v. District of Columbia

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.


Is Arming EMS Defensive – Comment

In response to Is Arming EMS Defensive, there is this comment from Another medic from Texas

Many of us are sensible, level-headed, patient people. We’re not easily angered & we tolerate abuse from our patients without believing our lives to be in danger.

What is logical about assuming that having a gun, or knife, is going to improve the outcome of an EMS call?.

we’re logical people who wouldn’t want that on our conscience unless it’s perfectly clear that the other option was face death ourselves.

How does having a gun, or knife, hidden somewhere on your body change the life or death option for the better?

How does having your partner draw a gun and start shooting, or draw a knife and start swinging it around, improve anyone’s safety?

I’ve never had to use my weapon, though it is on my person at all times when not specifically forbidden by law.

That must make for interesting showers.

Why should my right to protect my LIFE be restricted while on-duty?

I don’t think that having EMS carry weapons improves anyone’s safety. Not even your safety.

I’m no LESS likely to be assaulted/murdered/witness a Columbine/Virginia Tech/Ft. Hood incident while on duty than off…

Based on what?

If that were the case, I would expect the rate of EMS personnel murdered on duty to be similar to the rate of murder for the general public.

Our death rate from motor vehicle collisions is high, but our rate of being murdered is so low that it is almost always zero.

Please provide some evidence that EMS personnel are being murdered.

so why not have a few concealed handguns within reach of calm, responsible, alert folks who know how to use them?

To defend against what?

If we are calm, responsible, alert folks then why do we need guns or knives?

Why should I have to be a helpless, defenseless victim?


Without a gun, you are a helpless, defenseless victim?


I am not a psychiatrist, but I do not see this as any kind of healthy attitude.

I do not own any guns, but I do not consider myself a helpless, defenseless victim.

Too often, I see an EMS call going from nice and calm to a confrontation because someone wants to assert authority. I expect that you work with some of the same people.

Image credit.

These are not people I want to see carrying any weapon when they are trying to assert the authority that they should not be asserting. I definitely do not want to be between them and any patient, or family member, or bystander, when they decide that they want to fumble around in their clothing and try to retrieve their gun, or knife.

I do not see that there is any danger to EMS that justifies having EMS carry weapons.


Is Arming EMS Defensive

What are the threats to EMS?

Earlier, I wrote Arming EMS – Defensive or Simply Offensive about EMS feeling the need for guns to deal with violence.

Clearly EMS needs guns.


Paramedics arrived and the boy was again verbally abusive, and they restrained him before taking him to Huntington Memorial Hospital. As they loosened the restraints at the emergency room, the boy punched a paramedic in the face before he was again restrained.[1]

A gun would have stopped this punch.

During this portion of the transport, Lovern managed to pull out the IV and blood spurted forth. Crager grabbed Lovern’s arm to stem the flow of blood. Lovern scratched Crager’s wrists and spit at her while Crager was attempting to stop the bleeding.[2]

A gun would have stopped this spit.

A MAN drunk after a night out spat in a paramedic’s mouth because she disagreed that he was having an asthma attack.[3]

A gun would have stopped this spitting.

Acting operations manager Simon Cooper says an ambulance was called to an address in Elliot Street and the paramedic was punched in the face when he got out of the vehicle.[4]

A gun would have stopped this punch.

A Cottonwood man who authorities say intentionally rammed his pickup into an occupied ambulance parked at Mercy Medical Center in Redding on Saturday night has been arrested, Redding authorities said today.[5]

A gun would have stopped this pickup truck.

A mother-of-two has been convicted of an alcohol-fuelled attack on two paramedics – sinking her nails into one and pushing over the other as they tried to help her.[6]

A gun would have stopped the nails and stopped the push.

Then there is this –

An Osceola County Fire Rescue paramedic has been arrested on charges of attacking a Polk County deputy sheriff who was protecting a psychiatric patient patient from the outraged firefighter,[7]

Is this a medic who is endangered by a lack of firepower?


[1] Drunk student punched paramedic at school, police say
March 8, 2012 | 11:19 am

[2] State v. Lovern
No. 66018-7-I.
Court of Appeals of Washington, Division I.
Filed: March 5, 2012.

[3] Drunk man spat at paramedic
1:10pm Thursday 1st March 2012
By Matthew Hobbs
This Is Cheshire

[4] Ambulance officers angered by attack on paramedic
By Gail Liston
Posted February 22, 2012 16:34:40
ABC News

[5] Suspect in assault on Redding medical personnel arrested
February 12, 2012
Sacramento Bee
by Loretta Kalb

[6] Woman clawed arm of paramedic in attack after drinking session
by Gareth Mcpherson
Published: 20/02/2012 08:14 – Updated: 20/02/2012 14:23

[7] Paramedic Accused Of Flipping Out On Patient, Deputy
March 5, 2012
FireFighting News