Equal Opportunity Threat

     This issue's close call comes to us from Jonathan Reese, a firefighter/EMT-Cardiac from Middletown, RI. It is the quintessential close call and an excellent safety reminder for us all.

     Jonathan writes:

     "About three years ago, I was working as an EMT in southwestern RI, and we provided EMS services to our neighboring town in Connecticut. One night, at about 9 p.m., we were dispatched to a reported moped accident on a moderately busy main road. When we arrived, we found police already on scene, and the female patient was up and walking around. The police informed us that she had been involved in a domestic dispute earlier in the day and had rolled her car over that afternoon. They also told us she was under arrest for DUI. The patient had no complaints, but because of the police department's protocols, we had to transport her for evaluation. Since she was under arrest, we were followed to the hospital, which was approximately 15 minutes away, by a cruiser. Standard evaluations were performed, and the patient again had no complaints. She was belted into the stretcher and was not otherwise restrained. She expressed no distress at her situation. Once we arrived at the ED, the patient was transferred to their care while I gave a report. While I was speaking to the nurse, another nurse asked the patient to remove her jacket so they could get her undressed and into hospital garb. It was at this point that the patient said, "Be careful; I have a gun in there," referring to her jacket. The officer who had followed us to the hospital immediately stepped in and checked her jacket pocket, where he found a loaded handgun. There was no problem, no threats or other weapons involved. It was later determined that she had likely been planning to attempt to either kill herself, her husband, or both, as a result of their fight earlier in the day."

     Few have been on the street for any amount of time without ending a shift saying, "Wow. We were lucky." Luck is nice—but something we should try not to count on. Let's look at a few parts of this call for some potential warning signs and opportunities to prevent issues like this in the future.

     While we see unusual people in some unusual situations, this patient seems to have been the trifecta of trouble for that Connecticut town, having been involved in a domestic, a rollover crash and now a moped crash/DUI in the span of a single day. While nothing known by the EMTs on this call directly indicated weapons were present, the domestic violence incident and pattern of self-destructive behavior should raise a certain level of caution.

     Should you find yourself in a situation like this in the future, these tips may help you stay safe:

• Don't let your guard down because it is a woman.
• Be sure the police have cleared the patient for weapons before treatment and transport. If the patient is in custody, there are no legal obstacles for doing so. Even during an investigatory phase of a call, any person who may pose a threat can be given a perfunctory pat-down for weapons. Occasionally, you will have to insist or prod the police to do this. It is usually worth the effort.
• Your patient assessment can act as a secondary pat-down. By removing outer clothing, we take items in the pocket out of the patient's reach. Our head-to-toe exam should detect all but the most carefully concealed weapons. When it's done well, patients won't know the difference.
• As long as you are prepared for the answer, it is also OK to ask patients if they have weapons. You'll be surprised at how truthful patients can be. This also works for hypodermic needles with drug-shooters. Most are pretty straightforward in telling you whether they are carrying needles.
• Knives and guns aren't the only weapons that can harm you. In the hands of a determined violent person, anything can be a weapon.
• Some sources report that up to 10% of single-occupant motor-vehicle collisions may be suicide attempts. While these cases are relatively rare, if your patient's behavior is off or you have other reason to suspect a suicide attempt, a search of the patient for "plan B" weapons is reasonable.

     Jonathan concluded his letter with some very appropriate thoughts: "The biggest lesson I took away from this incident was to make sure that any person I will be transporting under arrest has been checked by police prior to entering our vehicle. This was a situation that had never even crossed my mind. Had she decided to pull the gun during our transport, my partner and I would have been completely taken by surprise. I am very thankful that nothing worse happened, and this is something that I will do my best to never let happen again."

     Jonathan, thank you for sharing so others can learn. We're glad you and your partner are OK.

     Until next time…stay safe!

Daniel D. Limmer, AS, EMT-P, is a paramedic with Kennebunk Fire-Rescue in Kennebunk, ME. He is the author of several EMS textbooks and a nationally recognized lecturer.

     To submit a case for review, e-mail nancy.perry@cygnusb2b.com.

Note: It is not the intent or policy of the Close Calls column, the author or EMS Magazine to determine or imply fault in any situation. By writing to discuss potential issues and contributing factors, those who share their stories do so to help others.