Pistol-Packin' Patients

What to know about legally armed patients and handling handguns safely.

     You are dispatched to a person "not awake but breathing" at the local park. Upon arrival your crew, including an EMT student, finds an adult female unresponsive, with classic signs of anaphylaxis. After initiating treatment, you decide to conduct the rest of your physical assessment en route. As transport begins, your student starts an exam, and the patient begins to respond. Suddenly the student exclaims, "Hey, she's got a gun!"

     EMS providers may encounter patients who are armed. Awareness of a patient's handgun may come through the patient's admission or by discovery during the physical exam. This article deals primarily with patients who are armed legally and not behaving aggressively toward EMS.

     Absent other factors, the mere presence of a legally carried handgun should not indicate a threat to provider safety. Concealed-carry permit holders have a criminal conviction rate much lower than that of the general population.1–3 Illegally carried handguns obviously present a different set of concerns. As a rule of thumb, the vast majority of off-duty law enforcement officers (LEOs) and legally armed citizens use holsters, while illegally carried handguns are usually found tucked in the waistband or pocketed without a holster. Many LEOs are required to wear badges next to their weapons. Only government-issued badges and documents are official.

     Citizens in 48 states can carry concealed weapons with a permit (the exceptions being Illinois and Wisconsin, plus Washington, DC). Permit holders account for more than 1.3% of the population.4 This means more than one in every 100 patients can be assumed to have a permit, although not all permit holders will be in possession of a firearm when seen by EMS. Usually citizens are required to attend firearms training and pass a background check before they're issued a permit to carry a concealed weapon. The prerequisites vary by state. Vermont and Alaska allow concealed weapons without permits, and unconcealed carry of handguns without a permit is legal in many states.5 Nebraska recently enacted legislation requiring permit holders to disclose and surrender their handguns to EMS personnel.6 However, most states have no such legislation, and patients with altered levels of consciousness may be unable to comply with such a law.

     EMS agencies should have protocols in place for dealing with legally carried firearms. Providers have a duty to themselves and their coworkers to make handguns safe until they can be secured or turned over to law enforcement. It is dangerous to leave firearms with ill or injured patients such as the one in our opening scenario—she may require immediate treatment, have an altered level of consciousness or be physically impaired by injury. The handgun may impede application of a backboard. Narcotic treatment may be indicated, such as for pain management.

     There is no cause for alarm when taking custody of a firearm. Handguns do not "go off" by themselves. A handgun will only discharge if the trigger is depressed or if there is a mechanical malfunction. Such malfunctions are extremely rare. There have been isolated cases of discharge when a firearm is dropped, usually involving old guns. Fortunately, there is an established set of rules to govern the safe handling of firearms (see Table 1).

     To maximize safety, EMS providers are encouraged to seek professional instruction prior to attempting to manipulate any handgun. Gun shops and trainers in your area may be willing to offer brief tutorials.

     The information in this article is meant only as a general reference to augment, not replace, hands-on instruction. The variety of handguns, especially pistols, available on the market and the steps required to unload and/or make them safe cannot be adequately addressed without hands-on instruction.

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