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Handling Patients with Concealed Weapons
Speaking of safety, what should EMS providers do when patients have a concealed firearm, and there is nowhere safe to secure it before going to the hospital? Suppose the firearm has nothing to do with why we were called, there's no reason to suspect that the patient may become violent, and law enforcement is tied up and won't be available for a while?
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Replies to This Discussion
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Permalink Reply by Skip Kirkwood on -
I'm thinking (a) leave it alone, and (b) notify the hospital when you arrive. They will have a procedure for dealing with patients (lawful, legitimate) property.
If you learn of the concealed weapon before loading the patient, you might want to ask that he (or she) leave it at home. In some states, a hospital is one of those places where a concealed weapon may not be brought except by LEOs, and you might actually be saving the patient some aggravation.
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Permalink Reply by Chris Scherzer on
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If it can't be secured at the home, there are a couple ideas depending on the situation. I live in a county that has one of the highest number of concealed weapon holders in Michigan.
1. Like Skip said, leave it alone and let the hospital know. They should have protocols in place.
2. Contact law enforcement to take it, either there at the scene or at your destination.
3. If it is a car accident, and for some reason LE is not there for some odd reason, most towing services have a secure locker for valuables and may be willing to secure it. You could possibly secure it in the trunk of a car, but most people probably don't want their expensive handgun just sitting in a trunk in a wrecker lot. Just make sure you can safely clear the weapon. This would be a last resort thing for me.
4. If you need to secure it in your bus and you are ALS, secure it in your drug cabinet. Again let the hospital know and they can secure it.
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Permalink Reply by Skip Kirkwood on
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There are precious few EMSers who have the training and experience to safely clear every conceivable model of handgun likely to be encountered in the legal CCW population.
Please DO NOT attempt to clear a weapon with which you are not familiar!!!
As for placing it in your drug locker - please consult with your service management AND state EMS authorities before you do that. Some may have objection......
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Permalink Reply by Neil White on -
If there was a patient and a concealed weapon the last thing I would do is open the controlled drugs locker. Everyone gets everso twitchy even when we take a morphine vial out of the safe and transport it to the patients side via our shirt pocket.
I guess it's a cultural thing tighter gun laws and we don't have this sort of thing in the UK but then assaulting EMS staff is an Olympic sport...
It would make sense to me regardless of whether it is registered or what have you that it is given to the police officers for safe keeping. Many officers issue a receipt and the person collects their belongings for the station thereafter. Although my experience with this is laptops ect...
Perhaps someone can clarify this a bit more. Naturally if it was a call to a residence the first thing wouldn't be to think of a concealed gun. And to be honest it wouldn't be a question that would be obvious in the medical sense. Is it better to leave alone, if say you spot it doing a bp or exam rather than trying to coax it away from the patient...
The last thing for me would be to have raising temperatures coupled with a concealed weapon. Are we getting to the stage where issues like these are becoming common place to smoking, turning off the tv and moving the dog to another room
Interesting!
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Permalink Reply by Skip Kirkwood on
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In the US, there are plenty of concealed handguns (legal) that don't involve any raised temperature, or any illegality - it is just like having a wallet or a pair of fingernail clippers. Should not be a problem, unless somebody (a medic) tries to make it an issue. Law abiding folks are very aware of their responsibility for the security of their weapon (both on their person and at home); if in the house a simple "Sir would you mind securing your weapon here at home before we transport you?" would probably take care of it.
Found on the street, it's a bit more of a challenge. Again, not a police matter - nothing illegal here. Could be a problem, though, if the person is or becomes demented for some reason. And most often there are no police in attendance on our calls (unless a traffic crash or something). And yes, it is as common as smoking, turning off the TV, and moving the dog to another room. Next it will be RPGs for home protection!!!!
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Permalink Reply by Kevin Stansbury on -
We are dealing with more and more violent patients as well as gang violence in our ED. In fact we have had several threats and assults on our nurses and now CMS is stating that we must find a different way to contain these types of patients. I wish one of the folks would come and handle these types of patients themselves before making such decisions.
We now have law enforcement making 90% of their drunk and unruly patients a 5150 so we must take responsibility and they pass the buck to us. The only problem with this issue is that the mental Facilities in our area have either closed or we have extremely lack of support.
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Permalink Reply by Neil White on
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We now have law enforcement making 90% of their drunk and unruly patients a 5150 so we must take responsibility and they pass the buck to us.
That's a very interesting point, we see this here also where intoxication has now suddenly become an emergency. If you are drunk to the state you are incapable it is a criminal offence not a medical emergency. I have had many a "discussion" with police on this matter. They don't want to take the risk of placing them in custody and having to do 15 minute checks. I do point out neither does a short staffed ER that has maybe 2 MI's an RTA and a several mental health cases.Its common place that EMS fails to advocate for itself on these issues, everyone gets an ambulance regardless of what they call for, because no one has the balls or the insurance policies to say no....
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Permalink Reply by John Shady on -
Amen!
I have a fairly good background in weapons and own or have owned most of what you will see out there that people carry. My deal is I will ask them if it I can clear and unload it. I will then hand it to them with the slide locked back or cylindar open, with the rounds in my pocket, and then have the ER secure it for them, most hospital security has procedures for this.
I have had one person who years ago would not allow me to clear and unload their weapon. They were told that they would not be riding with me with that weapon in their control. They relented at that point and all was good. There is no need to get LE involved in those situations, they have better things to do.
A more important issue is what to do with the LEO that is armed, on or off duty. If they become altered and feel threatened they are trained to act and it will become a deadly situation. If you try to disarm them they can react to that also. Depending on their problem it would be imperative to have them disarmed, this is for the same reason a lot of agencies do not allow real, functioning firearms in hands on training. Their responses have been drilled into them with repetative training that they can act without thinking in the heat of a moment. Someone can be shot by accident based on second nature. May not be you but, your friendly ER nurse later. It may be a medical problem while they are off duty at the grocery store and you have no LEO's on the call. What do you do then?
Skip Kirkwood said:There are precious few EMSers who have the training and experience to safely clear every conceivable model of handgun likely to be encountered in the legal CCW population.
Please DO NOT attempt to clear a weapon with which you are not familiar!!!
As for placing it in your drug locker - please consult with your service management AND state EMS authorities before you do that. Some may have objection......
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Permalink Reply by Skip Kirkwood on
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Extremely difficult situation.
If you can't talk the patient/officer in to clearing the weapon and letting you secure it, you MUST get another LEO, ASAP. Kind of like the K9 officer in the wreck, who will defend his handler, but will allow himself to be leashed or muzzled by another officer that he is familiar with.
If that isn't possible, it's a tough spot. Medics may have to stay back, even while the officer/patient deteriorates - because you're right, weapons retention training is done to make it instinctive, and it involves hurting the person "trying to take" your weapon. You probably won't get shot, but you are likely to have a fractured arm or wrist and take several elbows, punches, and knees - whatever that officer is capable of delivering.
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Permalink Reply by John Shady on
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That is actually a simple problem. The last one I had at the intake of the jail I asked the appropiate questions to determine if they were capable of making an informed decision. They were and after they vomited on my Danners, I asked them if they wanted to go to the hospital by ambulance. They did said no and I informed the officer that I could transport only if they were in custody but, I could not treat them without a court order. The officer said they were in custody and I should take them to the hospital and it came to a head when I had them sign the consent and accept the charges for the run. All of a sudden it was not bad enough to need an ambulance for the medical clearance. As long as you are not abandoning them on the street corner after officers have left they still have to act for the safety of the subject. It is no different than any other refusal of any other patient that can make an informed decision.
I do not abuse law enforcement and I will not be abused by them because they are too inconvienced by the situation when they have to take them for clearance before jail. Being drunk is not a crime in itself and EMS and hospitals are not the babysitters. If they are so drunk that they could be dangerous to themselves then LE needs to do their jobs, they are the ones with the authority to take someone into custody to protect them from themselves. One day one of these subjects are going to sue a Paramedic for criminal confinement because they were forced to go to the hospital when they were capable of making an informed decision.
Kevin Stansbury said:We now have law enforcement making 90% of their drunk and unruly patients a 5150 so we must take responsibility and they pass the buck to us. The only problem with this issue is that the mental Facilities in our area have either closed or we have extremely lack of support.
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Permalink Reply by Skip Kirkwood on
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There is a real question about the obligation of ambulance personnel to maintain a 5150 in custody - by what authority? If the guy wants to leave, stop the truck!
One of the (many) things that EMS agencies often neglect is self-advocacy at the highest levels. These issues should not be left for medics on the streets to sort out - EMS executives should have relationships with chiefs of police and (elected) sheriffs to work these issues out at the policy level.
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Permalink Reply by Joe Paczkowski on -
Skip Kirkwood said:There is a real question about the obligation of ambulance personnel to maintain a 5150 in custody - by what authority? If the guy wants to leave, stop the truck!
Over the past 5 or so years there has been a court case working its ways through the courts asking that very question (Desert Ambulance v Inland Counties Emergency Medical Agency). The trial court sided with Desert Ambulance saying that because no authority is granted to EMS providers to maintain 5150 holds (either as a hospital or as a party authorized to write holds (i.e. mobile evaluation teams, police officers, or physicians), Desert Ambulance can't be required to transport patients on a 5150 hold without the person who wrote the order. An appeals court recently threw out that opinion basically saying, 'Well, no one has ever argued about it, and it's a wide spread practice as seen by numerous counties requiring said transports, therefore it's improper to issue an injunction against ICEMA.' For better or worse, the opinion isn't published.
http://www.leagle.com/xmlResult.aspx?xmldoc=In%20CACO%2020110622043...
While it isn't published, in California I'd argue that that gives the ambulance crew the power to take reasonable means to restrain and control patients on 5150 holds. Additionally, since patients on 5150 holds lack the capacity to make all but very limited treatment decisions (i.e. psychosurgery), they similarly lack the capacity to refuse care. As such, they are treated under implied consent (i.e. someone without an uncontrolled psychiatric disorder would consent to treatment) and a request to refuse treatment against medical advice cannot be processed in any fashion. The question then moves to not "can EMS providers take reasonable means to ensure transport," but "what are reasonable means." Certainly no one should expect an EMS crew to go Kelly Thomas on a patient with schizophrenia (granted, no one expects the police to either, hence criminal charges in that case), but some level of force should be acceptable.
Furthermore, if EMS providers lack the authority to maintain a 5150 hold, then I would similarly argue that EMS providers lack the authority to compel treatment at any time a patient maintains the ability to communicate his or her wishes (in contrast to the more ambiguous standard of capacity). If a patient can communicate wishes, even if those wishes are suspect due to intoxication or other disease or disorder, then wouldn't we lack similar authority to compel treatment under the concept of implied consent? Furthermore, if we lack the authority to maintain a 5150 hold and just let the patient subject to such a hold leave, don't we similarly lack the authority to maintain any sort of physical or medication restraints not directly tied to a medical procedure (i.e. sedation and paralytics to maintain intubation)?
Summary: If the statutory language of a 5150 hold (or what ever the local statute is for non-CA people) does not grant power to EMS to maintain it, then the doctrine of implied consent does since patients subject to such holds lack, by statute, the capacity to make treatment decisions.
I'll let those with a JD tear my argument apart now.
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