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January 15, 2016
Body armor for EMS: Is it time for every medic to wear a ballistic vest?
EMS agencies across the United States are adding or considering body armor as required personal protective equipment for their EMTs and paramedics. Recent news of ballistic vests, secured through budget allocation, grants or donation, has come from Cleveland, Wisconsin, Pennsylvania, New Jersey, Michigan, Ohio, and Colorado.
The purchasing decisions are driven by a combination of both actual incidents of violence against EMS providers and a perceived increase in the day-to-day threat of violence to medics. The implementation of the rescue task force model, which puts EMS providers into the warm zone of an active shooter incident, is also certainly playing a role. A Pennsylvania EMS agency is purchasing body armor for all of their responders after some personnel began purchasing it on their own.
Paramedic chiefs and EMS leaders, rather than simply following the purchasing decisions of neighboring departments, should understand the functionality of body armor, the potential functional complications for medics wearing vests, and the long-term impact of maintaining and replacing another piece of department-issued PPE. Here are questions your department should ask before purchasing body armor or seeking an EMS grant to purchase body armor.
Is the need for body armor supported by evidence?
Since the scope of the problem is not understood nationally, what is the local data? How often do medics in your service or region come under fire, engage in hand-to-hand combat, or face an attacker with a knife?
What does body armor protect against?
Two Detroit medics, attacked by a patient's friend, were slashed in the face, neck and hands. Body armor, even if slash resistant, would have done little to prevent those injuries. Two San Diego firefighter/paramedics were stabbed in the back and flank by a bystander. Body armor, generally not designed to stop a penetrating knife, might not have changed the severity of their injuries.
What is the department policy for body armor use?
The sometimes usage approach creates a problem of policy enforcement and adds an extra step to the response phase. When responding from a station, the PPE selection and donning, based on the dispatch information, seems sensible. Much like firefighters choose wildland, hazmat or structural turnout gear based on the incident type.
Medics, responding from a posting location, are less likely to be able to easily incorporate the donning of PPE, like a vest, into the response phase. They are almost certainly most likely to don the vest once they arrive at the scene — creating a moment of vulnerability when the scene tension is at its highest and there has been no medic action to stabilize the scene.
Opposite of a department mandate to wear body armor on ever call is a policy which puts the decision to wear a ballistics vest up to the medic. These discretional policies result in a wide variability of usage, the likelihood that some providers are wearing a vest while others, at the same incident, are not.
Are there EMS-functional body armor products?
Are the vest colors and labels specific to EMS?
Red, yellow or green helps the caregivers standout, but does that create an easy to see and identify target? Each department should discuss what's more effective in their community — looking like a cop or standing out from the cops.
A concealable vest, worn under a uniform shirt, is another option to consider. A concealable vest though likely causes a secondary expenditure for the department or personnel to replace uniform shirts with a larger size to accommodate the vest. A Chicago medic was ordered to wear a ballistic vest he purchased under his uniform.
How many vests need to be purchased?
How will the department sustain its body armor inventory?
During the purchasing process investigate the durability of the body armor, what components are easily repaired and which components require replacement. The condition of body armor, worn as an outer uniform layer, should have the same shine and polish as the department's vehicles and other uniform components.
Develop a replacement schedule so each year the department can be removing some vests and adding new vests to the inventory. Having to replace the total inventory every five years, especially if funds are not set aside annually for that purchase, is difficult and unlikely for many agencies.
What other questions need to be asked and answered before an EMS agency purchases body armor? Share your experiences with and best practices for purchasing body armor in the comments.