EMS Insider, Expert Advice

It’s a Mad World

12 and 2015.

On a regular basis, sometimes daily, we read or hear about an EMS or fire responder being injured or killed in the line of duty. Some of these incidents are due to motor vehicle crashes, being struck while operating in a roadway, getting caught in a building collapse or operating in a hazardous environment. Truthfully though, every time we respond to a call, we are operating in a potentially hazardous environment. We can no longer consider any call routine, especially when it comes to responder safety.

One area that greatly concerns me is responding to incidents with known or potential violence. Whether it is a mass killing situation, a domestic violence call or a behavioral health evaluation, it seems the number of assaults against citizens and responders is increasing. Maybe this is due to the ever-present news media bombarding us with round-the-clock coverage, or maybe it’s just that it has always been this way but now we are keeping better track of this data. Regardless, it’s a mad world, and it doesn’t appear to be getting any better.

From the mid and late 1980s to the early 1990s, Denver General Hospital (now known as Denver Health) and its paramedic division, DG Paramedics, referred to working in the city and county of Denver as the “knife and gun club.” A book was even published under the same name about the experiences of paramedics, nurses, doctors and others who worked the streets and attended to patients suffering from acts of violence. Paramedics knew the dangers associated with responding to these calls, and most wore ballistic body armor while on duty. This was not uncommon in many large, metropolitan systems across the U.S., and was generally understood to be part of the job.

As a paramedic working for a large private ambulance company at the time, I too wore a vest whenever I was assigned to an ambulance either downtown or in close proximity to known dangerous areas of the city and county. As a backup to DG, my agency had the potential to be exposed to the same types of calls they were running, as well as the same risks. However, if I was working in the more suburban areas, I rarely wore my body armor because I thought those neighborhoods were considered safe.

Ballistic vests were not considered essential PPE, and if you wanted to wear one you had to purchase one at your own expense. A number of EMTs and paramedics could not afford the cost, so they did not wear vests. My vest was hot, uncomfortable and not designed for EMS personnel, but I looked at it as a necessary evil.

Flash forward 25 years later to today, and we still don’t see ballistic vests being issued to EMS and fire responders. We are responding to more calls of potential violence on a more frequent basis, and we know that assaults against our personnel are occurring. EMS and fire agencies regularly respond to calls of domestic violence, assaults, behavioral health evaluations, intoxicated patients and, unfortunately, we now have to add in terrorist events, active killer incidents and mass killings. It’s not just in the metro areas where we experience these types of calls.

Some agencies have started down the path to provide ballistic vests and helmets to certain personnel, and others are obtaining PPE for each riding position, or seat, on the unit. Technology has improved over the years and many vests now offer some level of stab protection in addition to ballistic protection.

While this is all a good start, it needs to be taken further. Every single person in your agency should be issued their own ballistic vest. It should be issued the day they start and should be considered part of their uniform. Yes, there is a cost associated with this, but there always is with PPE. The cost of PPE will be far less than the costs your agency would incur for an on-the-job injury or loss of life. Our people are our most valuable asset and we owe it to them to provide the necessary equipment to do their job effectively and safely. Will this PPE prevent all injuries or deaths? No, but it gives our personnel a fighting chance.

We know that violence, some of great magnitude, can occur anywhere. As public safety consultant Gordon Graham preaches, “predictable is preventable” and the time is now to step up and give our EMS and fire responders the PPE they need to operate more safely while providing service in this mad world.