Photo courtesy of Jorge Intriago.
By Steven C. Hamilton
There has been a lot of conversation of late on social media, from news outlets, in opinion columns, and so on about firefighters and paramedics responding to scenes of violence and what their roles should be. Many have called for personnel to don body armor and enter the scene. Some have suggested that waiting for law enforcement to clear the scene is at the cost of survivable victims. Even more have called for a change in how we do business and respond to these types of incidents. Although this change may or may not be warranted, I can ensure you that either option cannot be applied universally.
I have great concern when I read these posts, articles, and columns because of their broad nature. The author is calling for a servicewide change that we must adopt and follow ALL suggestions or be stricken with guilt or civil liability. The truth is that no procedure can be applied across all services when dealing with these types of responses. I caution all of you not to blanket the entire fire service or emergency medical services (EMS) career field with a single procedure or policy. Some agencies are more than capable of outfitting firefighters and paramedics with body armor and training, while others simply are not. Many jurisdictions can support such a policy, while others cannot possibly. Simply stating that paramedics and firefighters need to risk their lives to save a life is a fairly reckless statement to apply to the entire country and beyond. Agency personnel read these articles and use their content to drive policies and procedures. Recently, an opinion editorial published in the Washington Post essentially called for paramedics to risk their lives because they should; it’s part of the job.
Risk in our business is everywhere and is part of the job, I agree. But we are trained to manage that risk. We take a risk every time we drive to an emergency scene. That risk is calculated and comes with rules, regulations, and laws. The training required for personnel to assume the responsibility for that risk is quite extensive. Skill, experience, education, and training allow personnel to assess a structure fire and determine the risks associated with the various strategies and tactics available to combat that fire. Paramedics use their knowledge and protocols to identify and treat injuries and illnesses. The knowledge that firefighters and paramedics possess is not universal across the entire realm of emergency services. Jurisdiction location, staffing, distance from additional resources, and response times are just a few of the many factors that affect the decision making of responders who have been called to an incident location. Scenes of violence are no different. It may be a completely acceptable and viable option to put responders in body armor and send them into a scene of violence—or it may not be. It may very well be the best option to stage and await the arrival of law enforcement—or it may not be. Every situation is different, and each one requires an assessment just as any other emergency response which we go to.
The way ahead is to send the clear message that each agency needs to empower its personnel with the knowledge, experience, education, and training to respond to these types of incidents. The path down that road will be different for many. Some will contact experts to review the department and make recommendations. Others will engage their brother and sister agencies to develop a plan together. Some will buy body armor, while others will not. Violent scene response is a growing problem, and the solution is dynamic and will change from place to place as well as over time. Recently, I was contacted by Chief Brad Pinsky of the Manlius (NY) Fire Department. Chief Pinsky was seeking advice on how to move his department forward and provide the best possible to service to his community while providing protection for his personnel. Manlius, New York, has some rural areas, and response times can be long for fire and EMS as well as law enforcement. Chief Pinsky thought that it was time to provide body armor for his personnel. We had extensive conversations over a few months about how best to incorporate that idea.
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Today, his personnel have body armor. Their program is a little more than two months old, and it has already made some adjustments. They took a problem and conducted their own risk assessment. Further, they recognized certain factors that made body armor a viable and acceptable solution. They sought training, and they are still tweaking their policies and procedures. I played devil’s advocate with Chief Pinsky and made him articulate the need, which he was able to do fairly successfully. In short, it works for them because of their unique circumstances, but that does not mean that every agency should go buy and outfit personnel with body armor. As Chief Pinsky will tell you, it is not a simple process by any means.
As Mike McEvoy stated in his recent blog post, it is a horrible state of affairs that medical personnel stage on a 13-year-old child experiencing an overdose. But did they know the child was a 13 years old? Did they ask? If they knew they were staging on a very young teenager, would they still have staged? These are all unanswered questions, but they are important questions. I do not believe that an incident such as this should drive us to not stage on an overdose, but I also believe that it should affect policy. If your department has a firm stage policy on overdoses, this incident may warrant a policy review. An overdose at a known drug house that has an extensive history of violent calls (and dispatch can access that information if you ask) may absolutely justify staging
Further, I have written articles, given presentations, and authored a training DVD on violent scene response; I have been in the fire service for more than 20 years, six of which was as a sheriff deputy. My efforts in doing so have been to educate responders on how to incorporate response protocols to keep responders safer, recognize threats, and react to those threats. I truly believe that this is the way ahead—to educate responders on what to look for and how to respond when they see it. Give your personnel the tools to identify a risk, the ability to determine the risk vs. victim survivability, the skills to address the unanticipated risk, and the power to seek more information. We should encourage personnel to engage dispatchers for more information. It can make a lot of sense to stage when law enforcement is reported to be two minutes as opposed to staging when law enforcement is 20 minutes away. You won’t know the answer if you don’t ask the question.
What is the next step? Issuing firefighters and paramedics firearms? Although that may seem extreme or downright crazy, there are departments that have considered it. Or, they allow personnel to carry their personal firearm while on duty. There is no universal answer except to say that an answer is needed. It is up to each agency to seek that answer for themselves. Some may seem very similar, while others may be night and day different. Neither is wrong or right. As a collective, it is important to stop pointing fingers and assigning blame or demanding standardization. Our service is dynamic and requires dynamic thinking to reach a safe mitigation. Training and coordination between agencies is absolutely essential for success. Departments cannot institute policy that does not incorporate conversations and agreements that include law enforcement and EMS. The statement, “Well, that’s not my department or responsibility,” does not cut the mustard. It is a multiagency response. On large-scale incidents, we preach unified command for the control and successful mitigation of an incident, but on small-scale, single-unit, multiagency responses, we are mute. This needs to change. Engage your brother and sister agencies and see how, collectively, everyone can provide the best possible service to the person who called 911, regardless of why or how big of a problem he has. From this, we will discover the agency’s way, and that way will look different for everyone.
STEVEN C. HAMILTON, a career lieutenant with the Fort Jackson Fire Department in Columbia, South Carolina, is a 20-year veteran of the fire service and a certified EMT-B, fire instructor II, and fire officer III. He is also a reserve deputy with the Richland County Sheriff’s Department. He also produced the DVD “Responding to Scenes of Violence” for Fire Engineering Books and Video.