Being Shot is the Top of a Deep Iceberg of Safety Pitfalls

If you are living in a cave, you may have missed the reports today that an EMS crew was shot, ambush-style, while sitting in their ambulance in Tucson, Arizona Sunday.

It's difficult to express fully the spectrum of emotions that I experienced upon learning of this incident. I am outraged that two people - I'll call them colleagues because they do what I and my teammates at our company here do each day - have been subjected to this violence while on duty. EMS is there only to help others and serve the community, and now two young members of our extended family are fighting to remain alive because of a random attack.

I am saddened that EMS providers have increasingly become the target of violence both from those with psychological issues and those with political agendas. My brothers and sisters in EMS exist, again, to serve the community. We're not out there trying to cause problems for people. 

Most of all, however, I am fearful. I am afraid that it will happen to someone I work with; perhaps it could even happen to me. We spend hours in the ambulance, often parked at some public location awaiting our next run. It's not at all difficult to picture ourselves in the exact situation that this crew from AMR in Tucson faced yesterday. Two partners, sitting in the parked rig, discussing the last call or the weekend's goings on when some clown approaches with a firearm and starts lighting up the cabin.

Yet every tragedy is also an opportunity to learn, and there are some definite lessons we can learn from this incident - and they aren't all about guns.

Lesson 1: Store-bought "Safety" is no guarantee. We hear much about body armor these days from EMS providers. Many agencies, mine among them, allow providers to wear body armor on duty. We actually encourage it. Body armor provides a layer of safety from certain firearms and from blunt force trauma. It's an excellent investment. But armor itself does not make us safe. Both in the practice of wearing it, and in structural limitations of armor, there are multiple points where it can fall short. 

Some people use external carriers with the idea that "I'll don my armor if we are going to a scene where I might need it." That mentality fails the logic test - if you're EMS and going someplace where you think you might be shot, you probably shouldn't be going there. The Tucson situation is a perfect example of this failure as neither provider likely thought they'd "need it" sitting in a parking lot. If you're buying and wearing armor, it should go on when you punch in and stay on until you punch out. Period. I don't know if either Tucson providers had armor, but one was shot in the head. Armor doesn't help with that. Lastly, if the firearm used was a rifle, there's little in the way of practical and economical armor that would have stopped a high-velocity round. In short, body armor would not have prevented what occurred yesterday. 

Other EMS providers and leaders have recently begun advocating for on-duty carry. Again, the purchase of the best concealed carry handgun in the universe would not have prevented the tragedy that transpired in Arizona. Ambush is ambush. By definition it's an attack that is not expected, usually designed to inhibit any defensive response from the target of the attack. We must speculate that there was no indication of trouble, and therefore no time for either person in that rig to draw a firearm and put it on target even if they'd had one. Nothing short of a bullet-proof ambulance would have made a difference Sunday - and even then the providers may have been outside of the vehicle enjoying the day or stretching or having a cigarette... Bottom line: you cannot simply purchase safety.

Lesson 2: Our job is inherently dangerous. Random shootings aside, EMS is subjected to motor vehicle accidents, back injuries, physical assaults, stress and mental health issues, heart disease, weight gain, and exposure to communicable diseases. We risk much every day to do our jobs and, until very recently, our industry has failed to prepare our people for those risks. How do you psychologically deal with the death of a child? How do you operate an ambulance as safely as possible? Where do you turn when depression and anxiety develop over time, or when your marriage suffers because of shift work? How do you eat healthy and get exercise when you spend so many hours each week in the truck? How do you anticipate and/or defend yourself against a physical assault? We've chosen an honorable career, but one that can bring considerable risk to our well-being. It's time we and the world start speaking very openly about it.

Lesson 3: Training and preparation may be our best "armor." We train on IV placement, pharmacology, and airway control - but are we really embracing training for the well-being of our providers? Every agency and, more importantly, every individual EMS provider needs to assess his or her level of commitment to remain physically and mentally healthy. While no body armor or firearm in the front of that ambulance would have provided much defense against this cowardly ambush, some situational awareness just might have. Are we training our providers how to routinely assess the area around them for potential threats? 

Please be clear: I was not there and I am in no way blaming these two victims for what happened to them, but the event brings up some rhetorical questions. Are you aware of your surroundings while on duty? Would you notice an individual approaching your ambulance while you were sitting in a public area?  Do you know what pre-attack indicators are? Would you park your ambulance in a dark alley-way behind a business to nap out of sight and, if so, would you and your partner trade off "watches" to remain vigilant? Do you have the physical fitness level to run from a threat, or to fight off an attacker until help arrives? Have you taken self-defense training of any kind, and do you practice it? Do you carry a tactical tourniquet on your person for self-treatment if you are seriously injured? Do you stretch during your shift? Do you prepare and bring a healthy lunch to work? Do you make time to mentally recover from stress?

There are many questions there but I pose them because, at the end of the day, they are questions that need to be considered when we talk about "provider safety." Have flexible rifle armor? Good on you. Is that armor covering a guy with high blood pressure, chronic depression, a resting heart rate of 95, who's carrying 75 extra pounds and is fast asleep in a parking lot? If so, you’re not nearly as safe as you fancy yourself.

It's our responsibility to protect ourselves and there are many ways in which we can do this. Exercise, diet, spiritual practice, martial arts, meditation, and even psychotherapy are good places to begin the journey to wellness. We need to be proactive in taking care of ourselves - to stay well and extend our careers. We're our own stewards, and we can't buy well-being. I recommend to all of my EMS brothers and sisters... no. I beg of you: seek out ways to stay safe. From assaults. From illness. From injury. From mental health issues. Stay in the field with us. Continue to do honorable, compassionate work as long as you are willing. Be safe out there!

** I send my sincerest thoughts and prayers to the two providers shot in Tucson, to their teammates at AMR, and my well-wishes for everyone who works on the rigs around the country and around the world. I hope for the best outcomes for all of you.