Call to Arms

In January 2009, EMT Melissa Greenhagen was shot in the back by a sniper in a hospital parking lot. Two weeks later, EMT Mark Davis was gunned down on a residential call by a patient with a high-powered rifle. Those events respectively happened in Glasgow, MT, and Cape Vincent, NY—not exactly hotbeds of American violence and danger.

All sorts of threats lurk out there for EMS providers. These are the most extreme examples, and prehospital caregivers murdered on duty thankfully remain rare. But lesser incidents of violence can be pretty common. In an unscientific sampling by EMS World, more than three-quarters of those surveyed had been assaulted on calls. Other investigations have produced rates over 60%.

A lot of Tim Holman’s crowd at EMS World Expo had been too. Holman, BA, EMT-P, CFO, chief of German Township Fire and EMS in Clark County, OH, spoke to a large and receptive audience on the provocative question “Is it time to arm our EMTs?” The topic triggered vigorous debate, if not a clear answer, which was fine with Holman.

“My goal was to stimulate discussion and get people to look at both sides of it,” he says. “I’m not 100% convinced it’s something we should do. But I think [dangers] are going to get worse out there, and one of the biggest problems we have is denial that there’s a problem. Some people still seem to think we’re not going to have any more attacks, and I’m a firm believer we will. So ultimately my challenge to the class was to keep the discussion going, and let’s figure out what we can do about this.”

EMS World conducted a follow-up chat to further explore the arguments for arming our EMS providers.

What led you to want to talk about this subject?             

Well, statistics show that one of the most common injury causes for EMTs today is assault. Labor Department statistics show that 52% of EMTs in the field have been assaulted. We see people who have been shot and killed, people who have been ambushed. It seems like it’s increasing, and we need to do something about it.

On average, every law enforcement officer in this country has to protect 1,813 people. It’s an overwhelming job. And when you look at court cases, most of the courts have concluded that police do not have an obligation to protect individuals—there’s only a duty to protect the public at large, not any person in particular. That’s concerning.

So are there circumstances where EMTs and paramedic should be allowed to carry on duty?

I think they should be able to. I’m not against it. I’m not totally sold on it. There are several things that have to be done first. I’d require a minimum of 40 hours of tactical training—situational awareness, clearing the scene, things like that. It wouldn’t be the extensive training police officers have, but providers carrying would need to know tactics and be proficient with a handgun. They’d need to know safety regulations, and they’d have to qualify. There are a lot of stipulations that would have to be put on it.

How does that argument tend to go over with people?

One of the things I hear is that people with concealed-carry permits commit more crimes. That’s not true. The true statistic is, just 0.02% of concealed-carry people commit violent crimes. The figure among law enforcement officers is 5%!

A lot of people argue, ‘Well, I know a lot of EMTs who shouldn’t be carrying a gun.’ And I say, ‘I agree with you. And I also know some cops who shouldn’t be carrying guns.’ It’s something we’d have to monitor and be very strict about. But I say, if I can teach a person to intubate a patient or start an IV or put an IO in, I can teach them how to handle a gun safely.

My motive is to keep EMTs safe. These are people who are out there trying to deliver care to the public, and they ought to be able to feel safe, and not have to wait 20 minutes for a deputy or police officer to secure every scene.

You suggested a benefit to passive deterrence, as well as direct self-defense. Is there evidence of that working?

There’s a small city out west where I go every year to teach, and this subject keeps coming up. So I asked people’s opinions: ‘What do you guys think about EMTs carrying?’ The chief was in my class, and he said, ‘We won’t let our EMS unit go out the door without an armed person on it.’ And the reason is, during the day, their primary EMS is all women, and they had four different cases where people without actual emergencies called for the ambulance to try to lure the women into their homes. They were fortunate that nothing really bad happened, but after the fourth time, they said, ‘That’s it.’ They haven’t publicized it; they just carry. But he said, ‘The word is getting out, and we’ve had no more problems since they found out we’re carrying.’”

My thinking is, people who want to do harm look for soft targets. EMS is a soft target. Just knowing we have a firearm, in many cases, will shut an incident down. In 2009, it was estimated that 2 million crimes were prevented by concealed-carry people. Out of that 2 million, there were fewer than 100 shots fired. Just the nature of people knowing somebody had a gun deterred the violence.

Theoretically, we’d have a safer environment, because we wouldn’t be soft targets. In many cases we wouldn’t have to wait for police to clear scenes, and we could get to patients quicker. We had a run one morning for a patient who overdosed, and we got there at the same time the police did. She wasn’t breathing when we got there. We intubated her and got her back, and she did fine. But what if we’d had to stage and wait 20 minutes for the police, which is not unusual for us at that time of day? She would have died!

What I’m afraid of is, at some point in time, somebody’s going to say, ‘She died, and you didn’t even come in.’ We’ll say, ‘Well, we didn’t come in because the scene wasn’t safe.’ And their argument in front of a courtroom is going to be, ‘She was no problem. She was unresponsive. You didn’t even know she was unresponsive; you didn’t even check. You failed to respond to her, and in relationship to that, she died.’

In a case like that, I think you’d be hard-pressed to get a jury not to say you were negligent.

What are some of the cons you see to carrying?

One, I think our image would change. There are people who just resent authority, and they may come to see us just like police officers. In fact, I had one of the people in the class say they stopped wearing their badge for that reason.

Another con is, there would have to be very tight controls over this. It will require more training, and there’s going to be increased liability. Unfortunately, there will be some who abuse the privilege. Those are the things that worry me, but at the same time, we’ve had to overcome a lot of other obstacles in EMS; I don’t see why we can’t overcome this as well.

How would you characterize your EMS World Expo group’s debate on the idea?

A majority of the people were very positive about it. I had a lot of military people. One individual was kind of outspoken against it; he was both an EMT and a police officer. His position, in response to some of the cases I cited, was ‘How do you know a gun would have prevented that?’ I said, ‘I don’t know. How do you know it wouldn’t have?’

I told him, ‘You, as a cop carrying a gun, are no longer a soft target. It’s been shown that people who want large head counts are going to pick the softest targets they can find, because they want their names going down in history. They’re going to pick people who are vulnerable. We see it in restaurants and workplaces and all over. As an EMT, you’re a soft target. As a cop, you’re not. And I can guarantee you, as a cop, you have stopped crimes just because they knew you were a cop with a gun.’ I think a majority of the time, an EMT will never have to pull their gun, because just people knowing they have a gun is going to stop things.

What are the take-home points you’d like people to keep from this discussion?

Make no mistake: There are some people out there who want to do harm to you, and that’s the bottom line. There are some people who, either because of mental illness or desperation or because they just want to produce a body count, are looking to do harm, and they’re going to find the softest target they can find to do it. Unfortunately, we fall into that category.