Rapid response: EMS needs to anticipate, prepare for violent attacks

Violent incidents in NYC and Arkansas are grim reminders that medics are regularly threatened, attacked and harmed by the people they have been called to assist


On December 17, 2020, two Arkansas paramedics were shot on duty. Officials say one of the paramedics returned fire, killing the gunman who shot them after an argument. Arming the EMS and fire workforce has been a hot topic of debate. Please weigh in by answering the poll question: Should EMS and fire personnel be allowed to carry firearms on duty? If you would like your comments to be considered for a future EMS1 article, fill out a short form here to share your thoughts.  

What happened: Violent physical and verbal assaults against EMS providers have persisted throughout the pandemic. Three recent events highlight the ongoing danger EMTs and paramedics face every day responding to calls for service.  

  1. Two New York City hospital-based EMTs were robbed at gunpoint on December 7. They were responding to a 911 call when a man stepped into the apartment building elevator, pointed a gun at them and demanded their equipment bag, radio and tablet computer. Fortunately, neither provider was injured.  

  2. Two FDNY EMTs, just 6 days later, were responding to a false call for service in a different apartment building when a man with a gun got into the elevator with them and demanded they hand over their radios and bags. Again, neither provider was injured.  

  3. Two Arkansas paramedics were shot by a patient's boyfriend on December 17 before one of the medics returned fire, shot and killed the assailant. Initial reports are that the man began to argue with the paramedics, pushed one of them and was punched before he "pulled out a firearm and shot both medics approximately three times in the chest, pelvic and abdominal area.” The condition of the medics was reported as “serious but stable.”  

We wish all these EMS providers, especially the seriously injured Arkansas paramedics, a rapid recovery and return to service. Through the years, we’ve heard from many EMS providers who have been attacked and injured on duty. Many of them tell us that the physical injuries heal much faster than the traumatic stress that results from the attack.  

Though being shot, stabbed or held at gunpoint is relatively rare, these three incidents are a grim reminder of the constant threat to EMS providers of being kicked, punched, bitten, spat on or verbally assaulted by patients and bystanders.
Though being shot, stabbed or held at gunpoint is relatively rare, these three incidents are a grim reminder of the constant threat to EMS providers of being kicked, punched, bitten, spat on or verbally assaulted by patients and bystanders. (Photo/Getty Images)

Why it's significant: Though being shot, stabbed or held at gunpoint is relatively rare, these three incidents are a grim reminder of the constant threat to EMS providers of being kicked, punched, bitten, spat on or verbally assaulted by patients and bystanders. Unfortunately, EMS providers often have limited training to recognize violent situations, de-escalate or diffuse when possible and employ use-of-force when their lives are threatened.

Top takeaways: As is often the case, there is still much we don’t know about these incidents, especially the fatal shooting in Arkansas. Nonetheless, all three incidents should cause EMS leaders and providers everywhere to consider preparedness, training and response options for violent encounters.  

1. Move! Escape or attack! 

Mike Wood, a Police1 columnist, proposed move! escape or attack! as a better alternative to the run, hide, fight mantra for active shooter incidents. Woods’ first advice to anyone who might be in the line of fire of an active killer is to move! 

“The goal is to get the potential victim ‘off the X’ and complicate the targeting solution for the shooter, while simultaneously jump-starting the mind into problem solving mode. Even a person who is not in the immediate vicinity of the threat will benefit from the freeze-breaking nature of the ‘move" command.” 

After moving, Woods’ instructs the potential victim – civilian or first responder – to make a choice of purposeful movement. Either escape, attack or both. 

“Escape implies that the potential victim removes himself from the area of immediate danger. Actions that increase the time and distance between the shooter and victim, or decrease the shooter’s access to the victim, constitute an escape. Escape may be accomplished by finding temporary concealment (good), finding temporary cover (better), or fleeing the scene entirely (best), as the situation permits.”  

In the move! escape or attack! Model, attack isn’t a step after escape, but a choice. The circumstances and options may make attack the only viable option for the EMS provider who is facing a deadly threat.  

“The use of the word ‘attack’ instead of ‘fight’ is not accidental,” Woods writes. "‘Attack’ conjures a different emotional response than ‘fight.’ To ‘attack’ is to be proactive and aggressive. ‘Fighting’ can be defensive, but an attack is clearly offensive. In an active shooter situation, we want to encourage this spirit of aggression in a potential victim.”  

2. Body armor. Every medic. Every call.  

We’ve known for a long time that body armor should be mandatory PPE for every EMS provider. There is too much uncertainty in EMS response and the nature of call can change suddenly from “confused person” to “medic shot.”  

Unfortunately, adoption of body armor has been slow for EMS providers. Purchasing body armor that meets the National Institute of Justice standards and is appropriately sized for each provider needs to be the top purchasing priority for every EMS leader. This Police1 How to Buy Body Armor Guide is the resource you need to start the purchasing process. Also keep in mind that many departments have been able to fund a body armor purchase through grant funding and donations from local organizations.  

Body armor isn’t just for active shooter incidents. Once your agency has procured body armor, it needs to be worn on every call. Remember, the FDNY EMTs were responding to a report of a seizure and the Arkansas paramedics were responding to a woman with knee pain.  

3. Firearms policy: Develop or update  

If your agency already has a policy of allowing or not allowing EMS providers to carry a firearm on duty, you are probably ahead of most agencies. If you have a policy, use the Arkansas incident as an opportunity to review the policy and potentially make updates.  

If your department does not have a policy regarding on-duty concealed carry of a firearm, now is the time to develop a policy. Regardless of where your department lands on allowing or not allowing on-duty carry of a firearm, all personnel need training on the policy and the policy needs to be enforced by department leaders, from senior medics to field supervisors, to company officers and chief officers. A policy without enforcement is worthless.  

The department firearms policy, at a minimum, should include provisions for:  

  • On-premises firearm storage in a private vehicle, locker or sleeping quarters.  

  • Firearm storage when responding to locations, like schools, jails or federal buildings, that may not allow concealed carry because of local, state or federal law.  

  • Actions or equipment regarding firearms retention to prevent loss or discharge of the firearm by accident or in a physical struggle with a patient.  

  • Holding a valid permit, if required by state law, for a concealed carry weapon or permit.  

There is much more to consider about a department firearms policy than can be covered here. If your department has a policy you’d like to share, please email a PDF or link to editor@ems1.com

4. Discharging your weapon is the beginning of a long journey  

There is much we can learn from our law enforcement colleagues about what to expect after an officer-involved shooting. For police officers, the incident leading up to the weapon discharge is usually measured in a few minutes and the actual shooting is measured in seconds. But those minutes and seconds will be dissected, frame-by-frame, over months and years by department leaders, elected officials, community activists, local and national media, and litigators.  

If you are choosing to carry a concealed carry firearm on duty, I advise you to consider the following questions as you make that decision:  

  • Does your department allow concealed carry of a firearm on duty by written department policy?  

  • Are you able to adhere to all of the concealed carry policy requirements?  

  • Do you have an overall documented performance record of always following all department policies?  

  • Does your department provide and have you completed training in de-escalating violent encounters with verbal and less-lethal tactics? 

  • Does your department equip you and your partner with a body worn camera?  

  • Will your employer and department leadership defend your use of deadly force under the harsh scrutiny of media, legal and political accusations?  

  • Does your jurisdiction’s law enforcement officials and district attorneys have a strong record of investigating and prosecuting attacks on EMTs and paramedics?  

If you answer "No" to one or more of these questions, you may want to rethink your on-duty firearms carry, place of employment or both.  

Learn more about arming the EMS workforce 

Issuing firearms to EMTs and paramedics or allowing them to carry their own concealed carry firearm is a hot discussion on social media and likely in many stations in the aftermath of the Arkansas incident EMS1 columnists and contributors have responded to this topic previously and many resources are available to inform your discussion, as well as your consideration of body-worn cameras and firearms.  

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