Wednesday, January 24, 2018

By Barbara Miller

It was the knife attack on a EMT in Harrisburg, PA, that convinced Jason Campbell, chief of Dauphin County's SouthCentral EMS, that his people needed bulletproof vests.

For Yellow Breeches EMS Chief Robert Weidner, it was the increasing number of opioid calls and the mass shooting in Las Vegas last year.

Other first responders point to a situation last year when Dani Kamenar, an EMT with Dauphin County's Community LifeTeam, was assaulted by a patient when she was 32 weeks pregnant. The vest she was wearing absorbed a blow to her abdomen, although she was still suffered a partial placenta abruption, leading to her baby being born four weeks early.

The threat of increasing assaults as EMTs respond to calls to aid the sick and injured has prompted more and more ambulance units in central Pennsylvania to equip them with body armor.

Yellow Breeches, based in Mount Holly Springs, recently became the first in Cumberland County to buy vests for its providers to wear voluntarily, Weidner said.

“Most of our calls are medical, but some are assaults, overdoses, suicide attempts,” Weidner said. “You don't know what's going to happen. I want my crew to be safe rather than sorry.”

The importance of the vests was graphically illustrated when Community LifeTeam EMT Zachary Myers was saved by his vest during a slashing attack in November 2015. A woman with an alcohol abuse problem tried to stab him in the chest during a domestic violence call in Harrisburg. The vest he was wearing, which he'd purchased on his own, prevented the knife from harming him.

Most of the 102 to 103 EMTs at LifeTeam now wear vests, which were purchased starting in late 2016 with help from a grant from the Pinnacle Foundation, said Barry Albertson, LifeTeam director. They aren't mandated to wear them, but some EMTs had already been wearing vests of their own.

Yellow Breeches recently bought 15 bulletproof vests—three for each of its five rigs—for $3,000, with help from a $1,000 Walmart grant, Weidner said. Yellow Breeches has 20 to 25 EMTs.

EMTs are asked to wear them on any high-risk calls, such as active shooter or assault incidents, Weidner said.

Even overdose calls can become violent, Weidner said. “When we administer Narcan, they come out swinging,” he said. “I've been doing this for 40 years. In my day you didn't have this. Things are changing drastically.”

Violent attacks on EMTs “seem to have increased exponentially the last few years,” said Albertson at Community LifeTime.

He said he's not sure if opioids and other drugs are to blame—the use of Naloxone on someone who overdosed often triggers a violent reaction when the person is revived— or just the increasing violence in society.

In Cumberland County, Holy Spirit EMS does not issue or mandate that EMTs wear ballistic or bulletproof vests, said spokeswoman Lori Moran.

South Central EMS in Dauphin County purchases vests for its employees who want them but requires a 25 percent contribution from them.

Chief Jason Campbell estimates about 30 percent of its 97 responders are now wearing one, including himself.

After LifeTeam's knife incident in Harrisburg, Campbell said, “I decided it was time.”

The latest injury was Jan. 6, when a South Central EMT was punched and kicked by a patient, Campbell said.

“We get one or two a month. This happens a lot—people don't realize how often it occurs,” Campbell said. “We've had guns, knives pulled on us,” he said, but so far no one has been shot at.

“I've been assaulted numerous times, having blood drawn, over my 23 years,” Campbell said. “I would not go out without one,” he said of a bulletproof vest.

He doesn't believe it's connected to the opioid epidemic but is due to society becoming more violent.

Calls to 911 for an ambulance may not appear to have a violent component. Yet last year, a chest pain call escalated into a gun being pulled on an EMT, Campbell said.

“You can't tell from the dispatch. That's why you need to wear them all the time,” Campbell said.

Before South Central decided to buy vests starting in January 2016, Campbell said one or two providers wore them occasionally.

South Central wears vests under their shirts, similar to police, rather than on the outside. “We don't want to be like the army coming into your home,” he said.

They are fitted to each person, and a level 2 vest similar to what police wear costs about $698, with South Central paying 75 percent.

“Those who wear them wear them every day,” he said.

“I foresee in the next year or two it will be a requirement for all EMS and possibly firefighters to wear them,” Campbell believes.

South Central could afford the purchases, but Campbell said he knows a lot of EMS companies aren't as fortunate.

“We are financially stable enough we can do it,” he said.

If EMTs leave, the vests go with them. “If they're going somewhere else that doesn't provide them, at least they'll have something,” Campbell said.

Susquehanna EMS in Dauphin County leaves it up to its providers whether to wear a vest.

Chief Matt Baily estimates about 12 of his 49 providers wear their own vests.

His family purchased one for him to wear about two years ago, due to increasing violence toward EMS providers, he said.

“It became a bigger topic when a provider at Lifeteam was attacked with an edged weapon,” Baily said, referring to the 2015 incident in Harrisburg.

Cost is one of the reasons Susquehanna EMS doesn't buy them for all, Baily said. They have to be properly fitted for each person, and with frequent turnover of providers, it can be “a cost-prohibitive issue,” he said.

Fortunately, Susquehanna EMS providers have not had to withstand an attack by gun or knife in the 13 years Baily's been there.

Still, he said, “We come into situation where providers are assaulted on a pretty regular basis—combative patients hit and kick.”

At Goodwill EMS in Carlisle, spokesman Nathan Harig said they've been debating the vest issue for about six months.

“Some of the most dangerous situations are not the traditional active shooter,” Harig said.

For example, he cited a case in Maryland in which an EMT was shot by a person who unknowingly set off his medical alarm during the night and, surprised by the responding EMT, shot him.

Vests leaves heads and armpits exposed, he said, and could lead to a feeling of invincibility. And some don't feel EMTs should walk into places like nursing homes wearing bulletproof vests.

Harig said the opioid epidemic isn't driving the debate.

“It's the proliferation of violence that seems to be rising in our society,” he said, with more mass shootings.

Still, the number-one killer of EMTs are vehicle accidents, followed by medical issues like heart attacks.

Some feel the money would be better spent on safety and ensuring EMTs are physically fit, Harig said.

Penn State Life Lion EMS does not require its staff to wear body armor on calls, said spokesman Scott Gilbert. However, individuals can provide their own vest to wear should they want to do so.

Susquehannna Valley EMS in Lancaster County has a goal of finding money to buy vests this year, said Terri Givens, business development manager. it has  70 providers.

While the agency hasn't had injuries, she said, mass casualty incidents across the U.S.—as well as recent incidents in the area—have raised concern.

In November in Manheim Township, a man who threatened to kill his wife fired several shots into the ground as EMTs were responding to a domestic incident.

At Northwest EMS, based in Elizabethtown, about a dozen of 25 to 30 providers wear their own vests, and more are on order, said Edna Kline, operations supervisor.

They've become more common in the last six to eight months, she said.

“Just with the changes in how folks are responding to calls,” and sometime mixing up EMTs and police, it gives responders a feeling of safety, Kline said.

Wearing a vest is optional. “Some didn't feel the need to wear a vest at this point,” she said.

The opioid epidemic, along with mental health issues, play into the danger EMTs face, Kline said.

“Sometimes people aren't sure who's coming, and may be aggressive toward them. It gives a better sense of security when they go out on calls.”

Darryl Mitchell, director at Manheim Township Ambulance, said wearing vests is a personal decision at his agency.

Three or four of the 30 providers are wearing them, he said, starting in the last year. He said he doesn't believe the reason they are being worn is linked to the opioid epidemic but said some feel that way.

At Lancaster EMS, about 20 to 25 percent of 150 clinicians have begun wearing bulletproof vests, said Jerry Schramm, director of operations.

Some purchased their own through their uniform allowance and other money, and several were purchased with a grant.

But at a cost of at least $500 each, Schramm said, they can't afford to buy vests for all.

Most were purchased in the last two or three years, he said.

“It's certainly the environment... mass shootings, active shooters—those events have certainly raised the awareness levels,” Schramm said.

Some EMTs have suffered minor injuries, but so far there have not been any shootings or serious injuries.

“By all means, we want to provide a high level of protection for our crews, but trying to maintain that safety and be fiscally responsible is difficult,” Schramm said, when 150 vests are needed at a cost of $500 and up.

“When funding becomes available, we will see more of a move toward that,” he said.

West York EMS has purchased about 10 vests for each shift to wear in the last seven or eight months, said president Dennis Reigart. The cost was about $5,000.

The 27 EMTs are required to don a vest if they're responding to a domestic incident or shooting, Reigart said.

“They don't like wearing them—they weigh about 25 pounds—but they know the reality of certain calls, they better be wearing them. But that doesn't mean on other calls something couldn't happen,” he adds.

“It's more of the situation in the country today. You have the violence—it's not necessarily all opioid,” he said.

York Regional EMS also doesn't have vests for its 48 providers, and cost is the major factor, said director Joe Stevens.

A properly fitting vest can cost several thousand dollars, Stevens said.

He said he has concerns that less expensive, one-size-fits all vests may not offer the appropriate level of protection, which could increase liability.

Stevens also said he believes if vests are provided, they should be worn all the time.

“They are just as vulnerable in every call,” he said.

Stevens said he hasn't seen an increase in injuries among his EMTs. “It's always been there. It's the luck of the draw if you happen to be there when that goes down. That's why we always encourage safety.”

At First Aid & Safety Patrol in Lebanon, vests are not purchased for staff, but they are allowed to wear their own, said director Brian Smith. The main reason the EMS agency doesn't buy them is cost, with more than 100 staff working there.

He said vests have become more affordable in the last five years and are more comfortable and easier to take on and off.

Smith said he wore one as long as 20 years ago. While his EMTs have had some “uncomfortable situations,” he said none have been shot at.

“There's more opportunity to be physically abused—kicked or punched,” he said.