‘Should Paramedics Carry Guns? The EMS-Firearms Debate’ with Dan Gerard, EMS Coordinator at Alameda City Fire Department

Picture of Dan Gerard during should paramedics carry guns interview

Dan Gerard is the EMS Coordinator at the Alameda City Fire Department, an expert on whether paramedics should carry guns, as well as the Vice President of the International Association of EMS Chiefs.

Interview with Dan Gerard

Dan Gerard is the EMS Coordinator at the Alameda City Fire Department, an expert on whether paramedics should carry guns, as well as the Vice President of the International Association of EMS Chiefs.



CBD: Camilla Barker-DeStefano
DG: Dan Gerard

CBD:   Okay. So, today we are talking about the debate as to whether professionals in the EMS and fire services should carry weapons, specifically firearms. And we are joined by one such professional today. So Dan, thank you so much for joining us.

DG:     Oh, it’s my pleasure to be here. Thank you for having me.

CBD:   Yeah, absolutely. So, I’d really like to start things by just kind of figuring out a bit about who you are. So, would you mind to tell us your background, your kind of current position, what do you do now and how did you get there?

DG:     So, currently I am the EMS Coordinator for the City of Alameda Fire Department. I oversee the clinical education for the paramedics, the quality assurance. I ride along with them in the field to make sure that they’re up to snuff and they’re able to perform appropriately to county standards, obviously, the necessary paperwork and reports that go with that. A lot of training and a lot of preparedness to make sure that we’re ready to respond.

            My story is kind of funny. I started in 1981 as a basic EMT in north New Jersey. I earned my paramedic card in 1985 and I had about 20 years in that system. I want to say that it was a very violent time, probably, in the United States. The term car jacking was invented in Newark, New Jersey by the FBI. We saw a lot of violent crime and we saw a lot of penetrating trauma.

            After about 20 years there, I said, you know, it’s time for me to slow down a little bit. I became a professor. I was at George Washington University for a period of time. I did some international work. I worked for the Pan-American Health Organization in The Bahamas. I did the ambulance service redesign for Hong Kong Fire Services Department. I was there in 2001. I got invited back in 2012. I came out to California as the trauma educator at San Francisco General, and then I transitioned over to Alameda Fire Department as the EMS coordinator.

            And for some reason, I got a little crazy. I went to Oakland for a little bit and I was the EMS coordinator there and the acting EMS director there for a short period of time. I did that for about six years. And then I came back to Alameda Fire and I don’t want to bore you with all my other certifications, but I’m also a registered nurse and I have time working on the trauma team, and the burn center, and pretty much anybody can Google me for the rest of the information.

CBD:   That’s fantastic. I was not actually aware of just the sheer diversity of your background when we first got in touch. That’s really, really impressive. I like the fact that you have the kind of academic background, as well. I think, increasingly, we’re kind of seeing academics transition into practice and vice versa. There’s a lot of really good learning that comes out of that.

            So, with that kind of background in mind, and the years that you’ve spent in these various services, could you just kind of give us a bit of an explanation or tell us how you’ve experienced the debate on the use of firearms or the carrying of firearms kind of evolve over the years?

DG:     It was funny, when I first came into the field, there was probably some very beginning discussions about whether we should carry guns or not. And by and large, I would say that the vast overwhelming majority of people were against carrying firearms. As opposed to today, I would say it’s almost a 50/50 split between people that think that we should carry firearms and people that are opposed to it.

            I understand the rationale why more people want to come to the point of carrying firearms, is because we’re seeing more attacks against emergency medical providers in the field. It’s just ramped up across the United States and around the world. I’m horrified by some of the stories that I see that occur in the UK or Australia. Here in the United States, just recently, there was a young gal in Boston that was stabbed and had to go to the trauma center. I’m so overwhelmed by hearing these stories of units that respond for medical emergencies and somebody lies in wait and shoots at them. We can find these stories on our RSS news feeds. They abound all over and it’s just very disconcerting. But, I don’t know if firearms are the answer to that problem.

CBD:   Yeah, I’m thinking too, of the new stories that I’ve seen around this, and I’d never really thought about putting a number on it before, like the kind of 50/50 split that you mentioned. I think it’s really difficult to pinpoint what the general sort of idea, there’s definitely not a consensus on it, which is why there’s this debate in the first place. But, in my experience and my view of keeping up with this debate, I can’t really put a number on how many people are in favor of this and how many people are against.

            But, I would agree with you that there’s a good kind of rationale on both sides of it. And just to hop back, as well, to the point that you said about the UK. Massive, massive problems, especially in the big cities like London, Birmingham, and Manchester. The use of, it’s usually knives and machetes, in the UK.

            People are always saying about the UK, oh, they don’t have violence problems, no guns in the UK. For one, there is. And two, or there are, sorry. And two, is it’s mostly knife and machete, which you can’t get to the same number of people as you can with a semiautomatic weapon. But, it’s still a huge problem.

            And yeah, ambulance personnel, fire personnel, police, they are regularly, either targeted or they’re involved in some kind of brawl, especially with the binge drinking culture that there is in the UK. It is kind of scary and I think the jump to then saying, well, maybe we should just arm people, that’d be a great idea. That is also kind of scary. So, I mean do you have a stance on this? Do you have a firm stance on this, one way or the other? Or are you kind of in the middle somewhere?

DG:     Well, I’m actually against providing firearms to paramedics and EMS personnel, as a whole, for a variety of different reasons. The first thing is that number one, it automatically changes our perception, how people view us in the community.

            So, if I’m walking around and I have a gun on my hip, and I am in Starbucks getting a coffee, or I am in the emergency department, or out in the field taking care of a patient, people’s perceptions of me change. They may make that mental transition, whether conscious or subconsciously, that maybe I’m not a medical person anymore. Maybe I’m the law enforcement. Regardless of what I’ve been called for, regardless of what my duties and responsibilities are, regardless of what I’m authorized to do by law as a paramedic, I’m not going to be authorized to pull people over and write them tickets or stop a bank robbery, but it’s just that visual perception that they have.

            Another issue has to do with patient care. One of the things, as a profession, we struggle with is our medical competencies, intubation, a variety of different skills that we perform and we really struggle with this to be successful. Handing someone a firearm and the training, and the continued competencies that need to go into carrying that firearm, using it responsibly, storing it, et cetera, that is a whole subset that we have no experience with.

            And while we may be able to tap into law enforcement, we haven’t mastered the competencies for intubation in our profession. Now, we want to add something as complex as firearms. Don’t get me wrong, with the advent of more attacks against EMS providers, we need to teach and it needs to become part of the basic education. We need to teach deescalation techniques. We need to teach techniques how to recognize potentially violent situations when we’re walking into them or, hopefully, before we enter the building or before we enter the scene.

            And then the other thing that we need to do, is that we need to teach people how to defend themselves. Because when you have a firearm, you not only become a target for people who want to do harm to you, but that gun becomes a target to anybody who wants to take it. And if you can’t defend yourself, then all you’ve done now is given somebody the opportunity to take your weapon from you and use it to do greater harm.

            So, there are a whole host of things that we could do on the backend before we start giving firearms to people. Then the other thing, too, is that there’s a tremendous financial burden, because now we have to speak about how are we going to insure people?

            People are not perfect, firearms are not perfect. What if, heaven forbid, someone discharges a firearm and they hit an innocent person? How do we make that person whole? How do we make that family whole again? Is this something that we want to assume? We haven’t figured out the mechanism for financing our EMS systems. Now, we’re going to add an element of danger to this and who pays for that at the end of the day? Do I add more money onto your bill? If you’re paying out of pocket, is that fair to you?

            So, adding firearms doesn’t really address the problem at hand. It just really complicates the picture, overall. And for many organizations, even smaller organizations, they would just really be overwhelmed with trying to meet those abilities and capabilities in order to have firearms for their EMS providers out in the field.

CBD:   I think you’ve raised some really important points there and if I may just touch upon three of them pretty quickly. One is, you mentioned the perception changes. If you give, say an ambulance service personnel, a firearm, you look at that individual differently. And we’ve seen this debate before and I’m sure you’re well aware of this, in the military context. There’s been talk of arming medics in the army. To someone who’s either in the army or in the military, or in any kind of humanitarian service the mere idea of that is horrifying almost because, traditionally medics, of course, have not been armed. And there’s questions as to whether that would actually violate a series of principles, some of the relating to the legal protection of people who work in a medical capacity and in the armed forces.

            So, we’ve seen it there before and we’ve also seen it when military units are used in disaster response. And there are some really complex, but very useful guidelines on this that were produced in Norway, I believe it was, on the use of military personnel and military assets in peace time disaster response. Because people see the army come in or they see one of the other branches of the force come in and they panic because they’re like, this is really bad because the army is here or this is really bad because the air force is flying things in.

            So, there’s that same kind of concern that we have. Now, we’re just asking it in the context of say, ambulance or fire. So, I think that’s a really interesting point that you raised. The second point is you mentioned training. Now, we’re going to come back to training. So, I’m going to just point out that that is something that I want to ask you about and then we’ll come back to it in the next question.

            But the last thing, and this is something that I kind of think about quite a bit. I really need to sit down and do some research on this, is the legal aspects of this. Now, you asked the question or posed the question, what do we do if an innocent bystander gets injured from a firearm? Then, we’ve got negligence claims, we’ve got insurance claims, and we’ve got everything else.

            I know in the UK, for example, that there’s been a lot of debates around the liability of police officers when they are in that kind of situation. If a police officer accidentally shoots somebody as an innocent bystander, are they liable? For years, the answer would be no. And there are a lot of public policy concerns around that because you’re saying, you can’t reasonably expect an officer to be able to preempt all of the issues and all of the people. If you’re trying to stop somebody running through a crowd with, let’s go back to machetes, that’s a very realistic threat nowadays. If you’re trying to stop that, there are going to be innocent bystanders who are going to get in the way.

            And so, I think there’s some really serious legal questions that we need to ask in addition to all of the policy and operational questions that you pointed out. So, thank you, for those points. They’re really interesting. Let’s talk about training. You mentioned training already. You mentioned the difficulties in just merely keeping up with the existing sort of medical competencies. What kind of training do you think would be necessary for the States that already allow professionals in these services to carry firearms and the States that are looking into this, what kind of training do they need to be thinking about?

DG:     Well, the first thing, as I said before, is the deescalation techniques. Recognizing the dangers that they may be stepping into and the deescalation techniques to prevent incidents from ramping up and becoming more serious than they generally are. The next would be, again, the ability to physically defend themselves from someone who may try to take their firearm off of them.

            I can’t speak to what police officers can do and what they can’t do. But, if somebody tried to grab an officer’s gun, I would think that there was a bit of danger that would be involved there. I don’t think that he would necessarily immediately draw his weapon in an attempt to disable the person. But, I do know that they would protect themselves and protect their weapon. And so, not having those very basic capabilities.

            We didn’t get to the point in the world where one day, we had tribes and then the next day, one tribe said, we need a nuclear weapon. Let’s go with this nuclear weapon. Let’s take care of this, right off the bat, we’ll just wipe this other tribe. It started with slingshots, and bows and arrows, and then eventually, we got to that point.

            And so, it has to be the same sort of measured response and capabilities that we have to have on the provider level before we hand somebody a firearm. And then, it’s what are the situations and the scenarios that we need moving forward in order to make sure that somebody is safe and competent in the use of the firearm. I know that the police department has some very robust training mechanisms, computer generated scenarios, live fire exercises, et cetera, that they utilize.

            And how many times a year do we need to bring people in to train them? Is it quarterly? Is it every six months? Is it a year? I have friends of mine that are in the Secret Service and they train every month, and they’re highly competent. I hear of other departments that they bring people in every six months. So, if the Secret Service does every month and other departments do every six months, how did you come to that decision? What was the rationale for that? So, the training piece really can’t be underestimated and it’s not only that initial competence that you achieve, it’s the ongoing competency that you have moving forward.

            There’s one thing that I wanted to bring up that I neglected to mention before, and then it would only probably be one area where EMS providers would need to be armed. It’s a very narrow function that we perform and it would be for those medics that are part of a tactical police team. We saw this in Ruby Ridge and we saw this in Waco, where the FBI had to call a timeout, essentially, they had to call a truce with the combatants so that they could remove their injured and dead off the field.

            It was unheard of in law enforcement before. And I don’t know if you would get that same response if ISIS decided to have an asymmetric attack in the United States. I don’t know if you would get that same response with a street gang or a bank robbery suspect. So, in that instance, if paramedics were embedded with a tactical police unit, they probably should be armed just to protect themselves. But, that would be the only exception that I have.

CBD:   Okay. Yeah, that brings me nicely actually to the next question which I was going to ask you is, let’s just assume that across the whole of the United States it becomes legal, and in some cases mandated, for EMS, firefighters, for example, to to carry firearms. What kind of restrictions need to be in place so that their role can still be conducted effectively? So, fire and paramedics respond to very different scenarios, from hour to hour, let alone day to day and week to week. So, where would you see the restrictions coming in? What kinds of situations can or should EMS, fire professionals be using weapons, assuming it was made legal everywhere?

DG:     Well, my biggest concern would be responding to patients with mental health issues. Generally, when law enforcement responds to those incidents, the officers will secure their weapons before engaging the person. If they’re going to travel in the back of the ambulance, the officer will not bring his weapon into the back of the ambulance. He will generally hand it to his partner or put it in a lock box until after the transport is over.

            And so, in that circumstance, if that’s what law enforcement is doing, maybe we should do the same thing. I would have to think about when we respond to correctional facilities, obviously we can’t carry a weapon inside a correctional facility. Maybe you limit use of firearms if you’re dispatched to a violent crime scene, and you have your gun secured until you’re dispatched to this certain type of call, you remove your weapon, you place it on your hip and you respond to the call.

            There are a lot of difficulties, again, that we have to consider in regards to firearms and safety. I would think that grammar schools, if you’re responding to a school, parents may be up in arms about that, that paramedics or EMTs are in response to the school carrying firearms. You bring them into churches. What is the cutoff? Where do we need to be?

            If it became the law of the land, then I would see limitations placed on perhaps only carrying weapons to violent crime scenes or active shooter scenarios. As a whole, again, if it’s policy then it becomes difficult. The issue is always going to come up, well, I’m putting the gun in the case, I’m taking the gun out of the case, I’m putting the gun in the case, I’m taking it back out, so I should just carry it all the time. So, you’re going to run into issues relevant to labor and management, and perceived dangers and threats.

CBD:   Again, I think you’re raising some really important points there and they are ones that actually I would like to see in this debate a bit more. I think we kind of go straight to the, okay, well, what if it’s a major terrorist incident or what if it is an active shooter, which actually here is the same thing. What if it is a self-defense kind of case? We kind of go to these polarizing extremes, but we don’t think too much about what’s in the middle of that spectrum.

            Okay. So, let’s get back to the reality of it. And that is that some states in the U.S. do permit these professionals to carry weapons and some don’t. So, my question for you now, is what would happen if there was a multi-state response to say a major disaster, an emergency and you’ve got paramedics from one state that are armed and paramedics from another state that are not armed, do you foresee any kind of issues with that? Do you think there would be any kind of coordination or other issues with that?

DG:     Oh, absolutely. There are major issues with that. Just look at what happens when we have major disaster responses and we send law enforcement officers from one state to another state to assist local law enforcement. So, there are a whole host of MOUs that have been developed on the federal and state level to allow those officers to go to other states and function as law enforcement officers. And essentially, what they do is they federalize them for the period of time that they’re deployed, but now, this is an entirely different animal.

            If a state balks at having armed paramedics in their state, does that mean that they don’t get the help when they need it? So, all of this has to obviously be worked out and dealt with ahead of time and addressed. I could see some states, I could see some locales drawing a line in the sand, and how do you address that?

CBD:   Yeah, I think that is definitely something that at the federal and the state level, we need to be thinking about a hell of a lot more because you know, none of us are immune. The fact that I was telling you earlier off camera that we had a big lightning strike here yesterday and the building started burning down just across the street from me, and there was a multi-town response and a multi-city response to that.

            But if we had been, say on the border, I’m in central Connecticut, but if we were on the border of Massachusetts, we would have teams from Massachusetts coming in probably, and similarly with New York, we’d probably have both teams coming in. Just the very thought of those teams being differently trained, differently armed, and yet they’re responding to the same incident. The coordination for that, in the heat of the moment, I think, would be, I didn’t mean to pun that, heat of the moment, but you know, in the heat of the moment, that would be very difficult.

            Okay. So, last question that I want to ask you, and this is sort of a provocative kind of question. It’s a little bit kind of tongue-in-cheek in a way, but is this a slippery slope? If we allow ambulance personnel, firefighters to carry firearms, does that mean we can then start arming teachers? Arming people who work in sports stadiums? Who are we going to arm next, if we do end up arming pretty much all of our paramedics and firefighters?

DG:     Well, every time that we lower the bar, we make it easier for that parallel group to point the finger over and say, well, the EMT paramedics carry guns. And the argument for teachers is that we’ve poorly prepared them for dealing with these mass shooter incidents that occur at schools. Now, I understand what they’re saying because they want to harden the target and make it harder for people to have firearms, but they also make the comparable argument that we should arm the teachers, as well, so that they’re able to defend their class and defend their students.

            But again, we come back to the whole issue of competency. And what do we do when mistakes happen? So, it is absolutely a slippery slope. And it’s not some place that we want to be as a country.

CBD:   That’s really interesting to me that you would say yes, categorically is this a slippery slope, because I don’t tend to like the slippery slope arguments as a general rule, just because I think that, it’s almost like we’re just jumping between these different kind of areas at different kind of poles, or whatever. So often, we hear of these slippery slope arguments that are actually just completely different things, but they just happen to concern the same part of the subject matter.

            So guns, should police have them? Yes. Should the army have them? Yes. Should I have one? Probably not. Right? And it’s kind of where we draw the line as to how long that slope goes down, I think is an important question.

            But yeah, you’ve given me and I’m sure the people watching this, an awful lot to think about right now. So, I just want to say thank you again for sparing the time to speak to us. I think your insights are fantastic and I’m going to be thinking about this for the rest of the day, I think. So, thank you so much.

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Camilla Barker-DeStefano

Camilla Barker-DeStefano

Dr. Camilla Barker-DeStefano (Oxon) is a disaster lawyer, author, and founder of the Crisis Academy.

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