Hypothetical Situation for the LEOs and EMTs

< />< />the only reason for leaving teh gun in place is that you (the dude ON SCENE) have a good reason to believe you cannot get the gun safely (which is apparantly the conclusion AD reached, especially given the long police response time), and the risk of trying outweighs the real risk that Mr. Disoriented will get paranoid because someone moved too fast in his field of view or tried to start an IV and the patient isn't tracking real well.

Ray,< />< />Combat is a whole different kind of disorientation. You know what training the guys around you have had. You know whom to stay away from. This guy is a complete cypher. You choose to view him as harmless, apparently just because he has a gun and is disoriented. That is a mistake.< />< />When the person is disoriented, he should not be armed any more than hey should drive. With a report of becoming rowdy after seizures, that is a good reason for him not to be armed.< />< />Evacuate an area because a guy, who is too big to wrestle with, is reported to become rowdy after his seizures and is currently disoriented? Absolutely. < />< />I don't have any problem with guns. I do have a problem with disoriented people with guns. The two do not mix well. Those who advocate for disoriented people to have guns, give responsible gun owners a bad name. They also give plenty of ammunition to the 2nd Amendment opponents.

Rogue Medic,< />< />I disagree with about everything you said except for where you quoted me. Disoriented people with guns do not bother me. If you have ever been in combat you will see an entire squad of disoriented people with guns. < />< />The man wasn't doing anything wrong. The weapon was holstered and not a threat. If you choose to disarm people before you treat them then that is up to you. I think you are wrong for doing so.< />< />Evacute the entire area because a guy has a siezure and is armed? I can't believe people would do that but hey, i live in Texas where everyone is carrying a weapon. < />< />Ray

The weapon has to be secured. Until it is, you're dealing with a confused, armed patient WITH A KNOWN HISTORY OF VIOLENCE.< />< />This guy doesn't get to have a firearm on my scene. He also doesn't get to have a taser, asp, knife, or pointy stick. < />< />Hell, when I treat perfectly alert and calm LEOs/armed citizens/soldiers/sailors/airmen/marines I still make sure their weapons are secured.< />< />In a perfect world, PD will disarm the patient before it becomes my problem. < />< />If not, hopefully he's alert enough to cooperate and willingly relinquish his sidearm once I've explained things in my Calm Reassuring Voice.< />< />If that doesn't happen, I'll look for him to seize again and secure the weapon while he's seizing (remember, scene safety comes before airway), then deal with the seizure.< />< />If he doesn't seize again, I'll explain to him that we need to start an IV, then take his gun arm (the left in this case) to start the line. While I have the arm distracted, the most gun-savvy person on my team secures the weapon. Before this move is made everyone on the team gets assigned roles in case things go pear-shaped.< />< />If I really think things are likely to go south, and I have a few seconds to work with, some nasal Versed might be a good idea. The risks of benzo overdose/adverse reaction here could be outweighed by the benefits of a calmer patient who isn't shooting anyone. Of course, local practice guidelines would have to be considered.< />< />Lastly, short of clearing the scene, is the brute force approach. For this I'd like at least 4 team members: strongest/heaviest on the gun arm, next strongest/heaviest on the pelvis, most gun savvy secures the weapon, last guy on the non-gun arm. If I can get two more guys for the legs and another one for the chest, so much the better. If I had to go this route I'd restrain the patient afterwards for his safety and that of my team.< />< />We had an EMS Fellow who would occasionally RSI severely combative patients, and may have done the same for this guy. I don't know if that's a great idea.< />< />Thanks AD for the great case. What did you do, did it work, and what would you do differently next time?

Superglue. Follow w/ spray mist of water to set it up.< />< />Seriously, I prefer Ray's suggestion. It isn't a problem till it's a problem. < />< />Administrative firearm handling causes negligent discharges. You, the AD handling someone elses firearm is negligent. You have a responsibility to protect the patient, so allowing the PD or FD to endanger him is also a less than optimal solution. Administering drugs not directly related to treating the seizure is also reckless and negligent, as you don't know what he is sensitized or allergic to. < />< />I like solutions that keep the firearm secured in the holster.< />Communication if possible. If not, then. . . superglue, duct tape, will secure in the holster. Jaws of life / electric sheep shears, etc will make two short duty belts out of one long one.< />< />And of course, what ever you decide to do, you do it calmly and confidently. Cause you're the Ambulance Driver. :)

< />< />Some people play with their genitals when they are post-ictal. This does not indicate that they like you. The guy is not oriented. You do not know what he will do. You have jumped to the conclusion that he is behaving responsibly, even though he is disoriented and that is all we know about his current level of consciousness. If he agrees to have someone relieve him of the weapon, then you may be right about him being aware of it at all times, but jumping to that conclusion is not a safe thing to do. Not for you. Not for coworkers. Not for bystanders. Not for the patient. < />< />If you do not want to disarm him, the only responsible way to handle this is to evacuate the area. If this is in a busy area, that may involve shutting down streets and emptying buildings.

AD,< />we had a policeman in our city who was diabetic. We would get called on him fairly often, usually he called himself and dispatch sent us and a couple other squads. < />< />Our rule was to get the gun. We assisted the cops, and let them take the gun. They knew how to work the holster, and it was just better that way. Sometimes the officer could talk to him as he was doing it, sometimes our assistance was to hold him while it was taken.< />< />He was a real nice guy, when he wasn't low in sugar. When he was, sometimes it got rodeo.

Pheonixtoashes,< />< />Dood you do not need to be scared of armed citizens. You asked why i don't want to disarm him. Let me explain:< />< />Lets review the facts, he was not lucid, history of siezures and percieved as violent when he comes out of the siezure. He is 6'5" and 400 pounds. He is an armed security guard.< />< />I am 6'5" and 320 pounds. When i raise my voice people percieve me as violent. When you're our size, it doesn't take much to make people think we are violent. His employeer may just be reacting to something that scared him.< />< />He is an armed guard. If he has a history of discharging his firearm when recovering from a siezure, then he wouldn't be an armed security guard any more would he? All he is doing is what he was trained to do. He is aware of his weapon at all times!!< />< />He hasn't broken any law or given any reason why there is a problem and he needs to be disarmed. AD is well versed in dealing with people and guns as well. < />< />Just because he is big and armed has your tail between your legs and running scared. It is WRONG for people to want to disarm others because they are uncomfortable especially when no law has been broken. < />< />Your Quote (By the time it "becomes an issue," he's either going to have drawn and shot someone or something already, or he's going to be trying to shoot someone or something)< />< />< />I can't even believe you said this. Your assumptions and fear is what is driving you in this situation. < />< />Ray

My original thought for the suggestion to the cops/supervisor would be for something along the lines of dislodging the magazine, with the hope that the gun's of a model that doesn't shoot with the magazine dislodged. But if it did, hey, at least there'd only be one shot right ;)

Get him in the ambulance and go as fast as you can to the closest border. Then, while your shopping at the duty free shop, the gentlemen from the canadian, or mexican, homeland security dept will disarm him. < />< />By doing so, you avoid yourself a complaint of unuseful use of strengh.< />< />But don't forget your passport...

I say: bob and weave,unsnap and run. < />How many comments are you waiting for until you tell us how you resolved it? Tell us already!

I forgot to mention DO NOT TOUCH HIS BELT!!!! This will feel to him like an all out assault. Just remove the weapon, keep talking in a calm b=voice, do not acknowledge what you have done, just talk about treating hime and making him well again.< />Capt. Tom

A lot of whooosies out there. It's a weapon, not an atom bomb. He is a siezure patient, not a homicidal manic. You speak to him clearly and concisely in a direct, calm, professional tone. "Sir I need to treat you, but as before I can do that I need to make sure your weapon is secured. Do you understand what I am saying?" and with that you use your left hand (he is a lefty) and slide it down his slide and remove the weapon and hand it to his supervisor. No big deal.< /> Much easier than walking into a strangers house and finding a loaded handgun on the nightstand next to an altered mental status patient and trying to figure out how to get the gun out of the room. Now that is tricky.< />Capt. Tom

to hold him down and remove the gun; they're paid to do that, and they do it on a regular basis - let them handle it.< />< />Later, though, you might want to submit a query to Dood's employer on the matter of why they're employing, in this particular line of work, a guy who seizes and gets violent right afterwards; doesn't sound like a safe guy to be handing a gun to, in my opinion.

If he's showing signs on what the supervisor has told you, where I work we have an agitated patient protocol which amongst other things, allows us to sedate a patient if there actions are going to harm themselves or others. Not ususally used for post ictal patients, but I don't think I'd have any problem justifying it in this case. Of course, you still have to give him enough midazolam IM for it to work, and there is a time delay.

If he is to out to be talked into turning over the weapon and is instinctively guarding the weapon. Removing the whole belt would be a better option than just the weapon. If that's out, what about letting him keep the weapon but not control it. If you try to tape or zip tie it in place, your hands near his weapon is going to cause a problem, what about sliding a heavy article of material (smith cot, sweat shirt, sheet, triangle bandage) between the holster and hand covering the weapon and tie it off on the opposite side of the body make sure it covers the entire weapon. That way he still knows its there, but he is unable to draw the weapon because of the lack of control. Of course that's assuming that the situation delegates that EMS personal have to assume this responsibility.

If PD isn't there yet, it's on his dipshit boss who hired dude with a medical condition. Lord knows I can't carry a gun if I'm seizing all the time. < />< />If PD is there and he's lucid, I'd suggest the easy route. "Sir, these nice medical type guys and/or gals are going to treat you, but they're terrified of getting shot since they don't have these lightweight, comfortable, breathable, not-at-all stifling vest on. Would you mind if I secure your weapon?"< />< />If he's out and PD isn't there, refer to first answer. If he's out and PD is present...well I'd just have them do it. < />< />But ask them to put down the coffee first. Anything else is just plain rude.

The only thing I can think of (if he is not lucid and cannot respond to reasonable requests) absent having the police do it is to get him onto a gurney, then get five or six really big guys to pin him down and get him into medical restraints, then remove the weapon.< />< />But I am not an EMT, police officer or firefighter, nor do I play one on TV...

Been in this spot with Police and trauma but never this tough spot.< />I can only rely on PD to secure the weapon for me.< />If he awakes and gets defensive, I'm toast.< />< />Or I can have my EMT attend...hmmm< />< />Good thinking situation, thanks AD.< />< />HM

I have a couple thoughts as I read the comments. Modern holsters designed for carrying a handgun for law enforcement and security have internal mechanisms to defeat gun takeaways. They tend to be a lot more complicated than unsnap and pull. If you try and take the gun out and the patient is not lucid you will probably have a pretty good fight on your hands. Somebody trying to take my gun is going to get shot by me. Especially if I'm not lucid and don't realize I'm a patient in an ambulance. Getting the police means you will have enough muscle to restrain the patient and the knowledge of how to draw the gun properly. You will probably have similar results trying take and apply handcuffs. Again, a couple cops restraining the patient and removing their gun belt, I think, is your best option. < />< />The several times I've been around seriously injured cops being transported, we've taken their whole duty belt off. Then we either had a police escort in the ambulance or following it.

my course of action would definitely be based on my perception of how he is acting (with some weight given to what his supervisor is saying).< />< />As far as disarming him, it would largely have to do with what kind of holster the gun is sitting in (as the retention devices on many modern holsters are meant to be actuated by the person carrying the gun, and are designed to prevent a gun grab (which is actually what we're attempting to do here.)< />< />In many cases, it may be best to try and secure the gun in the holster. I'm not certain that could be accomplished either.< />< />Removing the belt is probably out, because either he's got belt keepers hold it in place that need to be removed (all the way around his waist) or the belt is threaded through the loops on his pants (which means that all the gear has to come off to remove his belt anyway).< />< />I think having someone he knows and trusts is probably the best way to go. Short of that, talking him into giving up the gun is probably the best option, but I wouldn't really want to be there.< />< />What did you do AD?

I'm with Donnathedead and several others. And it's the same if if "wonky security guy" or "decorated 20 year police vet had an unknown seizure", or "armed civilian fall down go boom".< />< />Gently tell him you need to secure his stuff. Preferrably, the whole bloody belt as a unit -- nobody handling any guns, no discussions about taking away guns if we can at all avoid it.< />< />If he's tracking well enough to comply, great. < />< />If not, time for Plan B -- which does NOT involve a bunch of EMTs trying out the takedown and secure moves they've seen cops use. It should involve other cops handling it like they are trained to -- and in many cases, have done in real life with other armed good duys who were temporarily a bit whacky (officer after a car accident, colleague had a few too many at teh FOP, etc.)

I think I would try restraining the gun. Zip tie to the holster if possible. The other choice it to restrain the hand.

I'm not a professional, but I'd immediately take the weapon. Reach, unsnap and pull the weapon. By the time it registers, it's out and gone. I'd think he'd be as weak and uncoordinated as a kitten.

What would I do? I'd hit him over the head to knock him unconcious then remove his weapon. But I'm sure that's not the correct route. I'm also pretty sure you would lose your license. So, enough about me, what did YOU do?< />< />BTW, did I mention I'm not an EMT? Or, did you guess that on your own?

Donnathedead said:< />Just tell him you need to remove his belt. Gun goes with belt. Don't say gun. < />And then do it. He's not going to fight you if it is phrased in those terms. < />If you wear a badge, and he can see you, make sure he sees the badge. < />Which is, I'm sure, what you did. < />Failing that, or if he can't track, throw a couple loops of tape or wrap around the holster so that it can't be drawn. Living in NM, we are the wild wild west too, and that's what I've done.

I have not read the other comments yet. I would talk to him. Plain and simple. I'd rather talk to someone for five minutes than wrestle with them for one minute. There are many ways to approach this. Having PD or other personnel crowding the scene does not help it escalates the situation. You cannot and should not pass the buck off to PD. Sure have them standing by you never know but if you're pressed for time and don't want violence talking is the best way I see. Besides if PD walks up that's at least one other gun on scene. The chances of weapon discharge goes up even only a little bit. Nothing against law enforcement but it's a typical EMS perspective that once PD is on scene that the scene is safe and things are kosher. Sometimes very rarely this escalates the situation. I'd take the tactic of having the guy sit down explain that we have to make sure he's ok and don't want to take a chance of him seizing again and having the weapon go off. It can be done nonchalant like. "Hey let's make you more comfortable and get that weapon secured." Yup we could drug him but again it's a physical altercation (wrastlin' match) that I'm trying to avoid when firearms are involved. Besides in a pre-hospital setting we just might not have enough meds to put this huge person down. Be cool and collected and in the words of Dalton (Road House) Be nice...Be nice until it's time NOT to be nice.

Get someone strong to gently take and hold his hand, then inform him you need to secure his weapon for him, then get someone else to take the weapon or the whole belt.< />< />Ideally you should be giving instructions via radio from another building. At least, that's where I'd be. I'm 150 lbs soaking wet and not hugely strong with it.

I am not a LEO, but will soon be playing one on T.V. I watched four officers frog march a man out of my bank office lobby once after a) having a seizure, and b) suffering a mental break at the same time. One had a firm grip on the guy's belt/pants, another had a Tazer lodged against the guy's neck, the other two had grips on the guy's upper arms. He was on tiptoes as they walked out the door. Paramedics were walking close behind with gurney and gear. He wasn't security, but he was a big boy. Coulda taken some whoopin' before going down IMO. < />< />If it were me, I'd secure the scene of extraneous persons, handcuff said patient, and remove his entire duty belt. Pat down to be sure he doesn't have a BUG stashed somewhere, too.

So is he at a client site, or at his employer? If at the employer, with other presumably armed security officers, why can't they secure the weapon?< />< />I agree with everything else said here though: let someone else secure the weapon.< />< />Then again, do you know the guy? Have you treated him before? Any chance you can use your Calm Professional Voice and coax it away from him, or at least keep him calm enough to avoid having the weapon come out?

I see no reason to remove the weapon. He hasn't done anything and how his boss feels is totally subjective. If he has been trained to be aware of gun safety in his state, then more than likely he will be ok. I would just talk to him when he came too and keep him calm. Don't make it an issue just because, wait until there is an issue.< />< />Ray

Please don't keep us hanging. < />< />What did you do?

*raising eyebrows at last comment*< />< />I don't carry a gun, just a feckin' great pair of shears/hammer - I ain't handing it over to anyone but a colleague or partner!< />< />S'mine - getcha own! ;)

OK, just a thought. Keep in mind, I don't know squat about guns.< />< />"Hey, I see you've got a (insert gun type here)! I saw one at the gun shop last weekend, and was thinking about buying one. Can I have a look at yours?"

Okay, I’ll play your game. I’m writing this off-line, without having read the (currently) 7 pithy observations.< />< />Given that patient is at least partly lucid - - I’d try to get a uniformed cop to tell him, or at least be present while I informed patient that THE LAW requires that all OFFICERS being medically evaluated or transported must have their weapons - - Taser, gas, and/or firearms - - TEMPORARILY attended by another authorized person. And, so as to minimize anyone else handling their sidearm, let’s just remove the entire duty belt, shall we? Let the security guy know his position of author-ah-tie is properly respected, and that the rule applies to all OFFICERS. And, certainly, he’ll be given a written receipt for his gear.< />< />I’ll be interested to read other replies.< />JPG

To quote my instructor "Officer, go get that gun! Cause I'm not touching him till you do!" < />< />As well, my own personal opinion is I am not going near anyone with a gun on them that I can obviously see, especially one who is not in their right mind- and for those I can't see- I hope to high heaven that my own personal radar is working well and goes off before I get involved!

I agree, you ask us knuckle draggers to get it for you. If he's alert enough to talk to I'd ask for it. If he's out of it and a couple of us can temporarily restrain him and remove it that works too.

Take off and nuke it from orbit. It's the only way to be sure...< />< />Don't suppose you have those horse tranquilizers in the 'bolance...

um.............you ask him for his weapon? "Sir, we're going to treat you, but we need to secure your weapon and belt first."

Glad that's something I don't have to deal with...< />< />(I remember spending one Christmas wrestling with a 6'6" security guard who'd gone hypoglycaemic - I always wonder where they get their energy from when their blood sugar is so low).< />< />I'd clear the scene (as it's unlikely that anything bad is going to happen even if he fits again) and ask the experts, the police, to throw in any ideas.< />< />If he's pretty chilled then I can't see any reason to start wrestling with him. Depending on how chilled out he is, I might just ask him if I can take his gun from him - all depends on the state of the punter I guess.< />< />But yeah, otherwise I take the cowards way out and hide behind a nice big engine-block.

Pray?< />< />Seriously though, I'm interested in what you actually did.

The problem is that any dose of sedative you're likely to give is going to take several minutes to take effect so he would still have time to pull his weapon and fire. I'm with RM on trying to find a way to control his gun hand. I'm an EMT-P going through the police academy here in Ga and they have been teaching us to always keep our gun hand free. If you could try and talk to him while being covered with a Taser, maybe you could get him to hold something with his gun hand. The question is how much retention training he's had? If you can get enough people there, you could try wrestling with him to get his gun away and sedation with some IM Versed.

My pithy LEO opinion would be to have someone try to establish a rapport with him and ask him nicely for his gun whilst someone out of his sight is covering him with a Taser, and if there are enough officers there, a pistol as well.< />< />I would think trying to snatch it would be a bad idea. Handcuffing would go in the same category, cuffs can be tricky to get on quickly with a fairly large person, let alone an extremely large one.< />< />Sneaking in a knockout dose of a tranquilizer by the medic sounds good to me too, if the medic is up to the task.< />< />I also like the idea of having his boss do it, since they knew about the problem and continued to arm the guy anyways.

Sounds exactly like a chap we had the other day - except ours wasn't armed!< />< />I'm definitely not big enough or experienced enough in firearms to risk wrestling with that guy, so I'd go with TDB - cops get paid to deal with that sort of thing, we don't.< />< />So glad I don't come across armed patients on a daily (or weekly, monthly or even yearly) basis... :D

I think TDB has it spot on. If police are available, and in my suburbia they are, then thats their problem. < />Buuuut.. if you're stuck on your own with everyone else's safety in mind, then I think it'd be best to see if you can't coax his hands close enough together to lock with his own handcuffs, and have plenty of people ready to subdue him. < />< />Failing that, everyone leave the area, lock the doors, leave a note, tell the cops.< />< />If he's that antsy about his firearm, then i wouldn't expect him to stay still (and unagitated) enough to try and slip an IV in. Something IM maybe, but you still gotta hope you're not setting him off. Quickly restrain or leave.

Isn't that why you confirm the scene is safe... and get the police to remove his gun. That is what they get paid for right...?

guy. My bigger concern would be that I might not carry enough. Some people are resistant to even toxic doses of benzo's (at least what would be beyond the dosage in the protocols - not that we're really working inside the protocols for most places).< />< />Maybe the best choice would be succinylcholine IM, stand back until he gets jiggy, then secure the weapon and the airway.< />< />PS The company knows that he has seizures, becomes violent, and still hires him to be the armed protection for the employees? Did you ask the boss if he has a resume printed up for his job search?