Making the Most of Street Medics

Many of the jurisdictions touched by America’s 2020 summer of protest saw the presence of street medics—volunteers with a range of clinical training, immersed among and usually of a mind with demonstrators, treating their injuries and offering other basic assistance at scenes too volatile or restricted for formal EMS providers to reach.

Though occasionally in conflict with law enforcement, street medics typically aren’t adversarial to EMS—in fact, they may make its job easier. Handling lesser problems keeps EMS resources free for bigger ones, and in raucous crowds they often deliver the first assistance and stabilization injured protesters can get.

With numerous protests in Texas’ capital over the summer, Austin-Travis County EMS took the initiative to reach out to its local street medics and establish some basic communication and a general framework for cooperation. This paid off in faster evacuations of serious casualties from crowds, as well as other benefits.

Wes Hopkins, LP, ATCEMS’ division chief for operations and special events, reviewed the experience for a forthcoming EMS World feature on street medics and street medicine. Look for that in the January 2021 issue. Until then here are some ideas for making the most of your local street medics when protests occur.

Persona Non Grata

Demonstrations after the deaths of George Floyd and others in 2020 called for police reform. And while EMS isn’t police, it is an official entity, often governmental, that represents authority and works closely with them. So even a third service like ATCEMS encountered some hostility at protests.

“We learned very quickly,” says Hopkins. “If I go into the crowd, I can have EMS as big and bold and loud as I can, and there are still times I’m viewed as the government or law enforcement or the city of Austin. We’ve had objects thrown at us, people yelling horrible things at us. Sometimes we were like putting fuel on the fire, unfortunately.”

Conversely, street medics live among the protesters and share their perspectives; thus they may be more trusted and accepted in rendering care.

While street medic groups often have medical professionals—Street Medics Austin, for example, was founded by a firefighter and includes firefighters, nurses, and paramedics—their care is generally limited to basic first aid and stabilization. Groups are typically content to hand off more serious cases to official help, at least when police aren’t involved.

Spurred by an invitation from an Austin street medic, Hopkins took a quieter moment during the summer protests to meet some of them and start interfacing.

“There were a few times when the crowd was having a calm day that I was able to go down to their camp and just shake a few hands and talk with them,” he says. “What we said was, ‘These are unprecedented protests, and it’s going to take a village. So if you’re down here, we want to collaborate with you.’”

The idea wasn’t as outside-the-box as it seemed. ATCEMS has worked regularly with medical teams at local special events (e.g., the South by Southwest and Austin City Limits festivals, the Formula 1 U.S. Grand Prix), and this didn’t seem that different. So Hopkins passed on his cell number and invited them to contact him directly with major problems. Even off duty, he could relay casualty information to the current command.

The connection paid off most in crowd extractions. If a protester needed definitive care but was able to be moved, the direct link to ATCEMS facilitated the handoff.

“If they’d pinpoint the patient and then crowd-extract and tell us where they were going to go, then we’d rendezvous with them there,” Hopkins says. “It expedited patient access and made the process more seamless overall.” He estimates street medics evacuated 2–3 dozen casualties from crowds for ATCEMS over the course of the protests.

For those too badly hurt to be moved by the street medics, local authorities continued performing extractions using rescue task forces consisting of two police officers, a firefighter, and a medic on a Polaris Ranger. Street medics facilitated locating those by wearing high-visibility pink shirts easily identified in crowds.

Besides the faster care, Hopkins notes, the arrangement represented a safety benefit for Austin-Travis County and its providers.

“These protests were not something we’d encountered to this scale, scope, and magnitude before,” he says. “I don’t believe that in the middle of those protests, where you can have bad actors and different groups, is probably the best place for a city medic or governmental employee. So if the street medics want to be in that situation and want to help, utilizing them is very helpful.”

Future Problems

The relationships, once established, can pay dividends beyond immediate trauma care. Once ATCEMS and Austin street medics had established their rapport, they cooperated to shield at least one vulnerable citizen from trouble in advance.

A street medic texted Hopkins about 5 one night, before the protest ramped up. He had an agitated homeless woman in a zone soon to fill with angry demonstrators and anticipated conflict.

“I was able to tell him, ‘We have a community health paramedic on duty, and I’ll send them right to you,’” says Hopkins. “That community health medic was able to talk to that individual, and while they didn’t necessarily want go anywhere to get help, we did convince them to leave the area. So we think we prevented a homeless person from getting into a bad situation where a protest was about to happen. For them to just go somewhere else was very beneficial that night. So they identified a future problem for us, which was really helpful.”  

John Erich is the senior editor of EMS World.