In the wake of a violent crime with injuries…or highway crash or structural collapse or fire…paramedics and police alike must deal with the fall-out. Each response is an unknown. Perhaps workers are called to a gunshot wound in an alleyway at night. Who’s to say the suspect is not still at large? Or family members are there seeking immediate care for their loved one—or even revenge? EMTs have always been part of the cast of characters for incidents that have been “cleared but not secured.” And as such, much like their law enforcement brothers and sisters, their jobs are not without risk.
Danger statistics
It turns out a great number of paramedics are worried about personal safety, even though these concerns are not always adequately addressed by employers, researchers and fellow care providers. Many times abuse is just considered to be “part of the job.” Skip Kirkwood, director and chief paramedic for Durham County, North Carolina, points out this mentality lies in stark contrast to the ‘zero tolerance’ atmosphere prevalent in law enforcement—the common attitude that “everybody goes home in tact at the end of the night”.
In fact, studies show that violence against EMS workers is quite common, though not widely reported. Care providers are routinely punched, kicked and spit upon. A study cited within ‘Occupational fatalities in emergency medical services: a hidden crisis’ (Maguire BJ, Hunting KL, et. al.) found the relative risk of non-fatal assault for EMS workers is roughly 30 times higher than the national average.
So if assault is common in the EMS world (although perhaps not widely acknowledged) it doesn’t take a leap of the imagination to think that these workers could come under fire too, given the rash of shootings within the U.S. (and the methodology of response to those events). This is something paramedic must consider more and more. Typically in a mass shooting incident, EMTs and paramedics will arrive well before law enforcement gets there, or before the threat has cleared. When this happens these men and women risk injury from criminals who are still on the scene.
Kirkwood says the “Lesson of Columbine” was if law enforcement waits for SWAT and does not contain or suppress the threat quickly, lives will be lost. He adds, “The more recent lesson is that if EMS waits until law enforcement declares the scene ‘secure’” then potentially lifesaving treatment will be unacceptably delayed”.
Thus EMS have even more reason beyond the everyday to suit-up. While it used to be very rare for fire and EMS workers to be provided with (or select their own) body armor, more are choosing to do so.
Old threat, new threat
“The Number 1 risk/threat [of EMS] is NOT being shot or stabbed,” says Robert Kaiser, CEO of PPSS Group, a company that develops and manufactures personal protection equipment. “The most typical situation is where a paramedic finds himself in someone’s house, aiming to help reduce pain levels or prevent death…but is blamed for ‘not doing enough’ or for ‘arriving too late’. It is an emotional response [by the family] that often results in injuries.” Kaiser established his company following a lengthy career in government security and executive protection in some of the world’s most hostile regions.
Although an active shooter scene is an unlikely worse-case scenario, it is something that needs to be planned for nonetheless. Kirkwood says, “We train every day for things that, in a perfect world, will never occur. We need to train as a team with our co-responders so that we can function effectively as a team at the time of an incident.” A growing number of EMS workers are not only wearing protective gear on the job, but are also making a point to train more with local law enforcement since the “active threat response” methodology that was ushered in post-Columbine.
“Before that time (Columbine), fire and EMS staged far from harm’s way until law enforcement declared the scene secure,” says Kirkwood. “Since the inception of the ‘rescue task force’ movement and the movement towards performing life-saving interventions and rescue in the ‘warm zone’, the use [of body armor] has increased”.
The thing is, paramedics never know exactly what level of danger they will be performing under.
Does one size fit most?
New body armor models geared towards EMS works are lightweight, and sometimes have a place to store medical equipment. Kirkwood says most professionals he know wearing PPE are using Level 3A vests (the same as local police). These vests provide a measure of physical protection from principle threats like common handgun rounds, but also psychological reassurance to workers in harm’s way.
The company Phalanx also makes a Level IIIA body armor—the Tactical Responder MKII—that offers specific benefits to EMT paramedics. The armor’s dual strike face panels mean the armor can face threats from either side and still stop all handgun rounds. The design allows for hanging storage behind the seats of most existing emergency vehicles, and one size fits most.
Eric Johnson, Phalanx Defense Systems’ executive vice president of sales and marketing says he, too, has noticed more paramedics purchasing body armor in recent years, and adds some features they should look for specifically include: simple design, maximum coverage, plate acceptance, maximum use of MOLLE to attach gear, side armor availability with pockets, low cost, easy maintenance, shift deployable and NIJ certification.
Kirkwood’s agency provides standard-issued body armor to all its members for personal protection. Something is better than nothing. However, Kirkwood is concerned that “communal” might not always be the best bet. “This body armor will not fit the users properly, and might just provide an illusion of protection that does not exist.”
PPSS Group’s Kaiser adds paramedics should consider the weight and thickness of body armor so they are comfortable and more apt to don the gear. He places particular emphasis on stab- and blunt-force resistance. “I don’t believe the focus should be on ballistic protection at all. It should be considered…but not the main focus. The majority of paramedics not attending work following an assault will not do so because they have been shot or stabbed, but because they have been punched, kicked or someone has hit them,” says Kaiser. His UK-based company supplies armor that protects against blunt force trauma, edged weapons, hypodermic needles (all common threats) and firearms, too.
On training together
“Armor use must be factored into mission and protocols. The use of armor should not and does not turn Fire and EMS into active shooter responders. Training and education is critical,” says Johnson with Phalanx Defense.
Kirkwood agrees it is crucial for EMS crews to train with local police for situations in which they will surely work together. “The force protection role is not one that officers practice frequently, and for many it is a new one. And paramedics are not accustomed to working in a for-protection environment where tactical movement and tactical casualty care are required. It is too much to learn when lives are at stake.” In its own multi-disciplinary training Kirkwood’s team has learned that law enforcement supervisors are not necessarily fully versed in incident command systems and the unified command that will be required for a mass violence incident.
“We have also learned that the standard paramedic ‘call practice’ presents some obstacles,” he says, such as loading a stretcher up with equipment and rolling it to the patient. This won’t work in a ‘rescue task force’ environment. He found it was easier instead for his team to employ small, backpack-style ‘Shooting and Stabbing Bags’.
“We’re really on the same team, and we share the common goal of saving lives of innocents caught in the line of fire,” says Kirkwood. His TEMS medics provided self-aid, buddy-aid and tourniquet training to all of its local LE agencies, including Durham PD and Durham Co. Sheriff’s Office, as well as Duke University Police Department and the NC Central University Police and Durham Technical Community College Police. “If we can get our trainers and exercise planners together, it is not difficult to plan scenarios where everybody is able to hone their skills,” he says.
Planning and protection are paramount to a successful response when lives are in danger. Should paramedics, then, be provided with a means of protecting themselves in preparation for the unknown, including worse-case scenarios?
Kaiser says the UK’s Association of Professional Ambulance Personnel (APAP) has been campaigning for the issue of body armor for more than a decade, and it is time that it finally happened. “Based on dozens of constructive and personal comments I have received in…discussions, as well as some almost emotional emails addressed to me personally, I can clearly state that the majority of paramedics seem to be in strong support of…making body armor available to paramedics—not making them compulsory—but making them available to those who clearly want or even need them.”
