Reality Training: Shots fired during forced entry for patient welfare check

Discuss your guidelines and protocols for checking on the well-being of a patient

By Stephen Shoults

Incident Date: March 5, 2017

Department: Cincinnati Fire Department

What happened: Citizens were concerned for their friend who did not answer his phone, so they called for emergency services to check on him. Police were at the residence and the fire department was called in to assist.

While firefighters were forcing entry through the front door, the man fired a .44 Magnum in their direction, twice. The 68-year-old veteran reportedly believed that intruders were breaking into his house and feared for his life. No one was injured and no charges were filed.

Watch a body cam video of the incident

Discussion points: Legal issues, guidelines, training and best practices

A violent encounter on a patient welfare check is tragically not unusual. In April 2016, one Maryland firefighter was killed and another was injured trying to make entry into a home. In May 2017, a Dallas firefighter-paramedic was shot and critically injured while attempting to help an injured man. After reading the news article and viewing the video, ask yourself or discuss with your partner, squad or company the following questions:

  • Can fire/EMS legally force entry on implied consent without patient contact?
  • Does your service have a policy, guideline or protocol for a patient welfare check or when to force entry?
  • Have you had training on forcible entry for a medical call? What did it include?
  • How many people should be sent for a patient welfare check and where should they be positioned?
  • What would you do if you realized you were being shot at?
  • What is the difference between cover and concealment?
  • When and how should you approach a person who has just shot at you?
  • Is this similar to an "unknown medical alert activation, no further information"?

Tips for welfare checks and forcing entry

Here are tips and reminders for welfare checks and forcing entry.

1. Get more information.

On any unknown call, attempt to gain additional information from dispatch such as demographics, time last seen, prior responses to the address and any known weapons.

2. Request additional resources.

If you receive a call to perform a patient welfare check with no patient contact, the person is not expecting to see you. Consider having police officers make first contact. Consider requesting the use of a ballistic shield prior to forcing entry.

3. Announce your presence, loudly.

If the person cannot hear the phone or medical alarm company, they probably can’t hear you knocking at the door. Consider using a PA system, air horn or siren.

4. Verbally and visually identify yourself as an emergency responder.

Don’t just yell the person’s name while pounding on the door or looking in the window. This could be frightening and they could mistake you for an intruder. Announce yourself as fire department or ambulance. Be in uniform and consider high-visibility wear.

5. Prepare for the worst.

Forcing entry on a third-party medical call should not be considered a routine task. It should be considered high-risk with the probability of no reward or low reward. Often the person is either already deceased or in no distress whatsoever.

6. Constantly reassess the scene.

The scene can change rapidly and should never be considered completely safe. If something dangerous occurs, recognize it quickly and react appropriately.

7. If the scene becomes dangerous: Stay low, get away and find cover.

Know the difference between cover and concealment. If someone is shooting, being unable to see the shooter does not mean you are safe and it does not mean that the shooter cannot see you.

With all this in mind, do you think unarmed fire and EMS personnel, likely not wearing body armor, should be tasked with forcing entry into the home of an unsuspecting citizen?

In the comments below, share some of your thoughts about this call, as well as your department’s approach to the issue. As always, this is meant for us to grow and learn.

About the author
Stephen Shoults is a full-time EMT in eastern Pennsylvania. He started his EMS career in 2008 as a volunteer firefighter/EMT in Alaska. He has experience in private EMS, hospital-based EMS, and EMS via management service organization. Stephen is a certified EMS instructor and recently started his first business, a mobile CPR and EMS training service. He can be reached at, or find him on Facebook.

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