The old "Superman" TV series always made me chuckle. Why was it Superman would stand there with his hands on his hips and his jaw thrust forward as bullets bounced off his chest - then duck when the bad guy threw the gun at him?
Generally, we are seen as the "good guys." People turn to us for help on the worst days of their entire lives. Unfortunately, sometimes people view us as the enemy. I took particular interest in two recent news stories. A firefighter/ paramedic in Ocala, FL, was shot in the chest by an elderly man after being mistaken for an intruder.
About a week later, a paramedic working in Indianapolis was shot in the abdomen by a mentally unstable patient who had just been transported to the hospital. In both cases, these seemed like "routine calls." But they turned out to be anything but "routine." Suffice it to say, no calls should be "routine."
These, however, are only the latest incidents of violence against paramedics. In December 1996, a Washington, D.C., Fire Department ambulance carrying a shooting victim pulled over enroute to the hospital so that an intravenous line could be started. Suddenly, a man approached the ambulance, asking the crew, "How's my cousin?" He then pulled the ambulance doors open and started shooting. The gunman fired as many as eight shots into the ambulance before the paramedics wrestled the gun away from him. The gunman fled, but not before shooting the injured victim, who died, and a firefighter, who was struck in the leg.
In September 1997, Lieutenant Jeff Cook of the Toledo, OH, Fire Department was wounded by a shotgun blast from an assailant who had stabbed a woman and an 11-year-old boy. As the two ambulances transporting the two seriously injured patients to the hospital approached an intersection, the assailant - who was apparently waiting to ambush them - stepped from a gas station lot and fired through the windshield into the cab of the first ambulance. Thankfully, Firefighter David Bilis, who was driving the ambulance, ducked down into the cab and his only injuries came from shattered glass. After shooting at the first ambulance, the assailant took off. Cook, who was following in the second ambulance, stopped to check on the status of the personnel in the first ambulance. Unfortunately, the assailant circled the block in his vehicle and returned once again, making Cook his next target. Cook took a shotgun blast to the right upper arm and the chest. The suspect was later cornered in a shopping mall and killed in a shootout with police.
Violence against fire personnel performing medical duties is not uncommon and appears to be rising. In 1994, Don Walsh, a district commander of the Chicago Fire Department's Bureau of EMS, made a study of violence against paramedics as a part of his master's thesis. His study, "An Analysis of the Application of Body Armor for Paramedics," addressed violence in the 25 largest U.S. cities. It involved 251 paramedics and took nearly two years to complete.
Fire personnel can find themselves right in the middle of a crime scene - sometimes with the assailant still on the scene. Fire departments that do not respond to staging areas for violent calls often find themselves arriving at crime scenes several minutes before the police.
Ask yourself this question: How often have you been physically or verbally assaulted at an EMS scene? Odds are, there is a good chance it has happened at least once in your career.
The Walsh study found that 92% of the 251 paramedics who participated had been the victims of assaults (hit with fists, hands or feet, cut, stabbed or shot). Sixty-four percent of those paramedics reported being injured during the assaults; of those, 96% had to receive treatment for their injuries.
What was alarming in the Walsh study was that 24% of the surveyed cities reported EMS personnel had been shot while on duty and 80% of the cities reported paramedics being shot at, but not hit, while on duty.
How can you safeguard yourself? First, you need to have a "staging" policy in place. In essence, any fire personnel dispatched to a violent-crime scene involving any form of assault need to stage away from the incident until the police have secured the scene. Please note - police being "on the scene" and "securing the scene" are two different things. It is possible to have the police on the scene and the situation is still fluid. A secure scene means the assailant is gone or has been arrested.
Second, fire agencies need to consider issuing body armor to personnel, preferably to be donned prior to going into a violent-crime scene. The general connotation is that body armor is only for gunshots. Not true! Body armor also can protect personnel from kicking, punching or objects causing blunt trauma.
In the Walsh study, 88% of the paramedics surveyed said they believe body armor is an essential part of their personal protective equipment. Thirty-eight percent of the surveyed paramedics said they wear body armor and 92% said the employer should provide body armor.
Interestingly, paramedics in England - a country that experiences very little gun violence - are renewing a call for the government to issue protective jackets as standards to protect them from a rising tide of violence. The Association of Professional Ambulance Personnel made the issue of body armor a highlight at its conference in November 1999.
Another precaution is to be wary of any suspicious vehicle following the ambulance to the hospital. Also be aware that the arrival in an emergency room driveway is a period of vulnerability when the patient and you are exposed to anyone wanting to "finish the job."
Remember, the first priority for everyone in our profession is to go home to our families the same way we came to work. That means physically and mentally intact.
Gary Ludwig, MS, EMT-P, a Firehouse® contributing editor, is the chief paramedic for the St. Louis Fire Department and is the vice chairman of the EMS Executive Board for the International Association of Fire Chiefs. He has lectured nationally and internationally on fire-based EMS topics and operates The Ludwig Group, a consulting firm specializing in EMS and fire issues. He can be reached at [email protected].
