Many paramedics and other front-line professionals are still opposed to wearing stab vests or other forms of body protection, due to simple misperception. There is still the myth that body armour is exceptionally heavy, thick and bulky.
After conducting a survey questioning paramedics across the country, the author came to the conclusion that protection is indeed still desired, but that body armour manufacturers need to gain a better understanding of what paramedics really want (PPSS, 2011).
What are the real operational risks when dealing with potentially intoxicated members of the public? What kind, and what level of protection, is required? This article has been written to clear some myth, and offer solutions to those professionals who serve and care, risking their own lives.
Misconceptions of body armour
There is no doubt that too many paramedics and other front-line professionals are still opposed to wearing stab vests or other forms of body protection, only due to simple misperceptions, often based on previous experiences.
Many internal surveys, conducted by the UK's NHS Ambulance Trusts and other organizations, have incorrectly concluded that stab vests or body armour are not wanted by their front-line staff. In fact, I have personally attended a number of meetings with these authorities in which I could sense a clear technical and design misperception of body armour.
If we ask a paramedic, for example, what he or she believes is the average weight of protective armour, today the answer would vary from anywhere between 5 and 8 kg. Why may they think this? Some paramedics may have previously been employed by the armed forces, police or other homeland security agencies. Based on their operational risk and duties, these professionals are required to wear body armour that also offer protection from a number of different handguns or rifles. Protection from high velocity bullets and similar threats is only achievable by incorporating materials that will lead to a body armour weight of approximately 5-7 kg. The question in reference to paramedics is, however, would such high level of protection be required in order to protect paramedics? The answer is a solid no. In fact, it would be simple overkill.
‘Many paramedics and other frontline professionals are still opposed to wearing stab vests or other forms of body protection’
This matter of fact means that thousands of paramedics reject to wear any form of body protection as the thought of having to wear heavy, bulky and movement restrictive body armour is unbearable.
Survey
Via a number of ambulance, paramedic and other emergency service forums, and also our own website, we invited paramedics to complete a fairly basic, but nevertheless very informative, survey (PPSS, 2011). After nine months, we concluded the survey, and the results mirrored exactly what I had expected:
Our responsibilities
Paramedics are not expected to be experts in body armour, stab vests or bullet-proof vests. It is certainly not their job to learn and research the latest developments within the world of personal protective equipment (PPE).
However, it is the responsibility of line managers, health and safety managers and procurement managers to educate the paramedic profession that the risk of workplace violence related injuries can be reduced and that we can increase their chance of coming home safely. They can be offered PPE in the form of body protection that allows them to get on with their operational duties, without making them appear like ‘Rambo’ or ‘Robocop’. Making them look confrontational, authoritative, or even aggressive, must, and can be, avoided.
It must be the body armour manufacturers' responsibility to develop and manufacture armour, which are user friendly, lightweight and not movement restrictive in order to ensure the body armour is worn at all times when issued by the employer. It must also be their responsibility to provide clear fitting guides in order to ensure paramedics wear the correct size body armour to reduce the level of stress while wearing such equipment.
We must accept the simple fact that professionals who deal with potentially intoxicated or hostile members of the public are working within a higher risk environment—especially when operating at night times, when the risk of alcohol or drug related violence increases. People who might be under the influence of drugs, alcohol or other substances can overreact to anything a paramedics says or does at any time. Dealing with people who might be disappointed in your service, or facing others who might feel you are not arriving at their premises fast enough or you are not doing your very best to assist their family member or friend during a time of distress, represents again a higher risk work environment.
‘We must accept the simple fact that professionals who deal with potentially intoxicated or hostile members of the public are working within a higher risk environment’
Many other professionals working within such a level of risk are equipped with body armour or seek some form of protection. This includes police, border control, immigration, private security, environmental protection, customs or local authority's enforcement teams. There is nothing wrong with wanting to be protected, or wanting to increase the chance of being safe during a potential assault.
The priority must be the protection and personal safety of paramedics. In this context, understanding their operational risks and duties is crucial. I would create the following list in order of risk:
Risk: blunt trauma injuries
It is a matter of fact that an incident involving a punch, kick or blow is a more likely incident than the risk of being faced by a firearm or edged weapon. Not many aggressors leave home with an edged weapon or even firearm. Most confrontations escalate from one second to another. A paramedic might attend the scene of an incident and might later be confronted by a hostile member of the patient's family or one of his aggressive friends who express their anger or bad feelings. They might be unhappy with the time it took you to arrive or they make you responsible for the slow recovery of an injured person in distress.
In the worst case scenario, they might make you hold responsible for the patient's death in case you were unable to save his or her live following a heart attack. This does not mean they will grab a knife or firearm.
It is much more likely they will express their anger or frustration with a punch, push or kick. However, such attacks can cause serious injuries, and often long lasting injuries. Body armour should offer excellent protection from this type of threat.
Risk: edged weapons
Knives, broken bottles, glass and similar weapons are widely available and they have become the preferred weapon of choice for many aggressors during or after a long night of alcohol and drug consumption. Protection from this type of threat should be offered to a reasonable level. The UK Home Office offers their seal of approval to such body armour and certifies them to stab protection level KR1 or KR2. KR1 is absolutely sufficient, KR1 stab vests can be very lightweight and should not weigh more than 2.5 kg.
Risk: hypodermic needles
Paramedics can of course be subject to the treatment of drug addicts and the potential worst possible outcome of a hypodermic needle related incident could include death. Protection from this type of threat should be a part of all body armour.
Acknowledging danger
Recommending body armour offering protection from the above threats does certainly not mean we suggest all paramedics are in danger. It is simply to say that someone will have a higher chance of remaining unharmed in the unlikely, but possible, case of something going wrong. Wearing personal protective equipment can be compared to wearing a seat belt when driving a car. We do not put the seat belt on because we believe we are going to have an accident. We are simply acknowledging the fact that there is an exceptionally small chance that we might crash. Yet, if this chance becomes reality, you have increased the chance of survival by wearing a seat belt.
If we would know at the beginning of a car journey that we will have an accident we would not get into the car in the first place. The fact is that we do not know what is around the corner or what will happen next, and a seat belt acts as a safety net just like body armour do.
Legal obligation to protect those who serve
The Corporate Manslaughter and Corporate Homicide Act 2007 puts clear pressure on all employers to ensure the personal safety of their personnel, and I believe that user friendly body armour, which offer protection from obvious and realistic threats, must be a part of the available measures that must be taken to ensure our front-line professionals have a higher chance to return home safely at the end of the working day.
We should also note the cost of facing potential legal action and the cost of injured employees taking time off after a fatal or non-fatal incident. Assaults on personnel who are not wearing body armour or other types of protective clothing also create bad publicity for the authority concerned, not to mention the welfare of the person involved and operational problems resulting from the injured staff being unable to work. All of this should make us think twice when looking into the potential use of body armour within emergency services.
Conclusion
Figures published by the NHS Security Management Service (SMS) confirm 1262 physical assaults against ambulance staff in England during 2009/10. (NHS SMS, 2010).
Latest statistics also show the number of physical assaults against East Midlands Ambulance Service staff alone, including North Lincolnshire personnel, surged by 21% last year. There were 58 recorded assaults between April 2007 and March 2008 which rose to 69 in 2008/09 and 84 last year, according to figures obtained by the Telegraph under the Freedom of Information Act.
Those professionals working for the ambulance services do so because they want to help and care for people, and violence and abuse should not be a part of their job, nor should it be accepted. However, the reality unfortunately is that dealing with potentially intoxicated and hostile members of the public provides a higher risk, and user friendly body armour will help to protect paramedics from these risks.