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Arming the EMS workforce

What recent legislative changes mean for equipping, arming and tactically training SWAT and TEMS medics


A SWAT Team paramedic treats a suspect that was brought down after taking his wife hostage in the middle of a busy roadway in Florida.

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Back in 2012, having only been a U.S. permanent resident for a couple of years, I wrote one of my regular “Letters from America” for the UK’s Ambulance Life newspaper. The title of that piece was “Guns on the Truck.” The article was born out of changes in Virginia’s EMS regulations that removed the prohibition of firearm carriage by EMS employees on duty. The blanket ban was lifted by the state, transferring the onus to individual agencies and squads to rule on open carry, concealed carry or no carry within their organizations.

At the time, I argued that “Armed individuals may also develop a false sense of bravado that may place them even further in harm’s way in the patient’s home or close confines of the ambulance.” I also contended that as we work hand-in-glove with our police partners, a protective ring exists around us when lethal use of defensive force would be warranted.

When and where EMS providers are carrying guns

That was then; this is now. The arming of medics has once again become a headline. In the city of Green, Ohio, following a change in state law, tactical paramedics are now permitted to carry handguns when called out to assist the sheriff’s SWAT team. This move was reviewed by Green’s City council, who gave tactical paramedics unanimous approval to be armed. This came after residents were assured that the weapons wouldn’t be present during non-SWAT incidents at homes or businesses.

In Florida, legislative changes, signed into law by Gov. Ron DeSantis in July 2019, gave sheriffs and police chiefs authority to equip medical personnel with weapons when they respond with SWAT teams to high-risk encounters. The impetus came from the Marjory Stoneman Douglas High School Public Safety Commission recommendations that SWAT medics carry weapons. Again, the Florida changes do not cover the carriage of weapons for routine calls.

So, the call to arms is not for a wholesale issuing of weapons for street medics but for special purpose teams operating in close proximity with law enforcement agencies. It is still not a done deal in areas where legislation has changed, as some agencies are not allowing directly employed staff to bear arms even on SWAT teams due to liability issues.

By way of example, PatientCare Logistic Solutions, the parent company of Sunstar Paramedics, which provides ambulance services across much of Pinellas County, Florida, declined to let medics carry weapons – although they have worked and trained on the SWAT team for years. The way around this has seen agencies such as the Tampa Police Department and Hillsborough County Sheriff’s office put SWAT medics through a reserve officer or deputy training program, which then allows them to carry weapons.

Firearms require training and certification

So is anything new? Equipping, arming and tactically training SWAT and TEMS medics has been going on, above or below the radar for many years. So should we have that serious discussion to arm everyone?

My take still reflects my 2012 view, in that a provider in the back of a truck is too close to an unrestrained subject for comfort. It could well be the case that your Glock is closer to their hand than it is to yours. To get a second opinion, I spoke with Dr. Alex Eastman, a trauma surgeon in Dallas, Texas. Importantly, Dr. Eastman is also a Dallas Police Department (DPD) sworn lieutenant, the lead medical officer for DPD SWAT and the chief medical officer of the department. Dr. Eastman, a veteran of many SWAT operations and also the aftermath in the OR is very clear; “If you are a medic on a SWAT team and operating with a tactical team in a large chaotic environment, with a limited number of operators where you might lose your cover, I might see the rationale, but other than that I don’t see it,” he told me.

To carry and – if necessary – use firearms requires training, more training and certification, a view Eastman notes with passion, “Part of the larger American gun fallacy that just having a weapon makes you a gunfighter is not the case. It takes an incredible amount of training and practice to be an effective tactical asset in a gunfight.” Eastman agrees that rolling this (armed medics) out to everyone is probably a step too far. “We are setting people up for a really bad outcome when we put people in the wrong bucket.”

I firmly believe that to tidy up legislation to allow the arming, training, tactics, techniques, procedures and employment of tactical medics (to include coverage in the event of a LODD) is no bad thing. Despite the EMS1 reader poll on this subject which is swinging towards guns for all paramedics, I believe the debate on the wider deployment of sidearms close to those we treat needs to be holstered. That’s my view, I would love to hear yours in the comments section below.

Listen: Arming medics – EMS One-Stop With Rob Lawrence

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Rob Lawrence has been a leader in civilian and military EMS for over a quarter of a century. He is currently the director of strategic implementation for PRO EMS and its educational arm, Prodigy EMS, in Cambridge, Massachusetts, and part-time executive director of the California Ambulance Association.

He previously served as the chief operating officer of the Richmond Ambulance Authority (Virginia), which won both state and national EMS Agency of the Year awards during his 10-year tenure. Additionally, he served as COO for Paramedics Plus in Alameda County, California.

Prior to emigrating to the U.S. in 2008, Rob served as the COO for the East of England Ambulance Service in Suffolk County, England, and as the executive director of operations and service development for the East Anglian Ambulance NHS Trust. Rob is a former Army officer and graduate of the UK’s Royal Military Academy Sandhurst and served worldwide in a 20-year military career encompassing many prehospital and evacuation leadership roles.

Rob is a board member of the Academy of International Mobile Healthcare Integration (AIMHI) as well as chair of the American Ambulance Association’s State Association Forum. He writes and podcasts for EMS1 and is a member of the EMS1 Editorial Advisory Board. Connect with him on Twitter.