The Role of Emergency Medical Services (EMS) Providers in Firearm Injury Prevention
A colleague recently responded to a call for a medical complaint that could have escalated to something much worse. After talking with officers, the patient decided to go to the hospital by ambulance and gathered his backpack and other belongings before entering. At that point, the patient was cooperative. However, shortly after departing the scene, he became violent with the EMS crew. The crew immediately called for help and the responding officer was fortunately still nearby. Officers and paramedics subdued the patient, who was then transported to the hospital for further evaluation. Upon searching the patient’s backpack, officers found a loaded firearm.
Being locked inside the back of a moving ambulance with a violent patient, secluded from their partner and other resources, can be dangerous for paramedics. Unfortunately, this situation is not uncommon in EMS work today. As a paramedic at a private EMS agency, I have witnessed similar events in the field and shared various stories in which crews were in unsafe situations with firearms present. In addition to being the ones at potential risk, EMS providers constantly find themselves at the “downstream” end of firearm-related injury and violence, treating gunshot wounds, responding to active assailant events, or observing the devastating long-term effects that these injuries can bring.
EMS providers have an advantage of being at the scene, something that other healthcare providers may never see.
EMS providers may respond to a residence in which children have unrestricted access to firearms, presenting a unique opportunity for education and discussion of preventative strategies. They may recognize indicators of intimate partner violence or suicidal ideation in which firearms are present and find themselves providing advice, instructions, or referrals for resources. EMS providers may be the highest-level medical personnel that a patient sees in their course of care, or if patients seek further care, EMS providers may communicate information about patients to authorities or hospital personnel, presenting a window of opportunity for intervention.
EMS providers’ level of responsibility significantly outweighs the amount of training they receive. An average paramedic program is one year long and split across didactic, clinical, and field internship phases. In our practice, EMS providers often rely on support from physicians, co-responders, and law enforcement, and take comfort in knowing that the hospital is a short transport away. Ideally, we will always have such support, but what happens when we don’t? What happens when patients presenting with behavioral emergencies do not wish to go to the hospital? Are EMS providers able to effectively provide counseling and education to patients, including about firearm injury prevention? What if a patient at risk for firearm-related violence has access to guns and law enforcement is unavailable to respond? These are all scenarios that can occur on any given shift and EMS must be prepared for these interactions and aspire to be more than just “ambulance drivers.”
It’s in the best interest of first responders and our larger community for EMS providers to also take part in preventative strategies. Providing training on firearm-related injury prevention to EMS providers could help keep them safe while responding to calls, reduce firearm-related injuries in their patients, and provide valuable insight to receiving hospitals.
EMS providers’ unique role and perspectives, together with their training, enables them to make important contributions.
It’s very difficult to witness continuous firearm-related injury and acts of violence within the community I serve. The situation in the opening scenario could have ended much differently, resulting in the patient, officers, EMS providers, or hospital personnel being killed or seriously injured. I believe that with appropriate education and training, EMS providers could be an untapped resource in the prevention of such issues.
MPH Candidate at the University of Nevada, Reno
Clinical tools for preventing firearm injury