Violence has always been a concern for street medics who are taught from the beginning to “make sure the scene is safe.” If it is not, either make it safe or back out. Constantly reassess while you are on scene as circumstances can drastically change in a very short time.

Developing that “spidey sense” about what is happening and re-evaluating your scene presence is necessary. The reasons can be painfully obvious. I have gotten my butt kicked on the job over many years. Most were incidents that were not reasonable to prosecute. Now there seems to be an up-tick in these scenarios across the nation, and providers must be prepared to exit a volatile scene in the interests of crew safety. This may mean leaving a critical or compromised patient in order to save the crew. There is no shame in retreating until the operation can be secured, and the work can be performed safely. It is better to retreat and come back, rather than lose a crew to injury or worse. It totally exacerbates a single call, making it three times worse. Not only do they have to send a crew to mop-up your call, but also send a crew to save YOU!

Even veteran medics can get clipped. This year alone, multiple cases are pending against the citizenry for crimes against EMS providers. At least two have been for “involuntary restraint” in situations where a provider was taken hostage. Past years have not fared much better. Last December, a Chicago judge reduced felony charges to misdemeanors in a case where the accused battered both members of a female crew at a downtown CFD ambulance. So much for having “strict laws” protecting firefighters and paramedics performing vital services, when a discretionary judge can just ignore it.

Four firefighters were taken hostage by a lone gunman in Georgia but escaped unharmed, save for minor injuries from flash and stun grenades used by SWAT when storming the house. The fire personnel were responding to what appeared to be a routine medical call. This gives us pause in the concept of “routine” and begs us to reiterate that in our business, extinguish and rescue or EMS, that no call should be perceived as routine until evaluated.

Shootings are rare. Still, while I was on the street, one of my brother paramedics got shot through a closed door at the address to which he was dispatched. He survived and the department gave him a Kevlar vest. I did not get one.

Continued violence has recently led a county in Ohio to allow emergency providers with concealed carry permits to carry weapons while on-duty. Likening it to equipment that may never be used but is necessary, coupled with the lack of available law enforcement personnel, weapons in the hands of emergency providers may continue to proliferate. The jury is still out but I sure do not want them to come back with a manslaughter (or worse) guilty verdict for a firefighter or medic who panicked or misread a volatile scene. The liability is another consideration, so pay attention, risk managers.

We seem to have a lot of death this year, the bulk of it involving from our brothers and sisters in the sky. The 2013 tally for airmedical deaths sits in double digits with losses spread all over. Recently, we had three dead in Tennessee and another death with three injured in Oklahoma. The National Transportation and Safety Board (NTSB) published safety records for Helicopter Emergency Medical Systems (HEMS), and the number of services and the related number of fatalities has increased. This finding has raised questions and increased scrutiny over the safety of these operations. Within the last decade, more than 75 lives have been lost in the air medical transport business. This necessary component of EMS needs to evaluate every request for air transport with keen eye. This kind of thing strikes close to home all too often as well. Kathy Batterman died years ago when the bird she was flying in plunged into the Nevada desert in a freak white out storm. We lost Kalaya Jarbsunthie when her flight crashed after the rotor blades failed (not engine failure – the blades literally ‘came apart’ according to the NTSB). Three souls were lost on that one. I knew and respected both, and always grieve the loss of brothers and sisters.