When Your Patient Has a Gun

Here is a short primer on how to deal with a patient who happens to have a handgun. This is a surprise that can make you uncomfortable, but if you have a plan, the threat can be reduced.

1.  Be Proactive!

You are called to a scene for a patient who has fallen or was in an MVC and is going to need transport. As part of your scene survey, look to see any of the tell-tale signs that your patient (or others) are carrying a concealed firearm. Don't neglect the obvious. It may be very visible if you look for the signs.

Here are some indicators differing between men and women that you should watch for:

a. Men: Shirt is untucked. The firearm may be inside the waistband or outside the waistband but covered by the shirt. Wearing a holster inside the waistband with the shirt tucked in actually indicates the person may be well-trained. Look for the "print" of the pistol grip on the right side since most people are right-handed, and the left side if left-handed. The gun can also be carried in the front of the waist, the small of the back, or under the left (non-dominant) arm pit. Shoulder holsters are not very common.

b. Men: Ankle holsters show frequently when the person is not in a standing position. There may be a bulge.

c. Men: Frequent touching with their dominant hand to where the firearm is located—sub-consciously checking its placement. People touch and frequently adjust the firearm when carrying.

d.Men: Holding their hand on the firearm with one hand as they try to run.  They don't want it to drop or allow it to become loose.

e. Men: Clothes sag on one side. There is something heavy in there!  People who conceal carry will more likely wear loose fitting clothes.

f. Men: Pocket Holster. These are tougher to spot but you can spot them if you look. They are most likely in the cargo pocket on the right side or the right front pocket. If it is in a rear pocket, it will be on the dominant side. 

g. Women: Purse. This is by far the most common location for a woman with a firearm.  It can be in the main compartment, but there are many purpose-built purses with quick-access Velcro compartments.

h.Women: Bra. There are some bras designed specifically to carry a fire arm but these are not common.  A small pocket gun can be hidden inside a bra and is most likely on the left side for a right handed person.

2. Ask!

You are following your protocol and now it is time to do a quick head-to-toe check on your patient. Ask, "Do you have any firearms or weapons on you?"  Don't just ask "Any weapons?" Instead, be specific and say the word "firearm." Patients may misinterpret the question and say yes if they own a gun. Owning a gun is okay, we just don't want you to bring it to the hospital with us. If they have a firearm, they will need to leave it with a responsible person or have it secured somehow. A firearm that is not in the back of an ambulance is not a problem. 

Here is an important point: A handgun in a holster is a wonderful thing! There are two mandatory things to happen for a handgun to go bang.  These two things must happen:  There must be a bullet in the chamber of the gun and the trigger has to be moved. Holsters are designed to cover the trigger so that it prevents an accidental discharge. 

If there are law enforcement officers present, you can ask them to assist you. 

Leave a handgun in the holster. Holsters have different levels of how they retain a pistol. Some are very secure and you will be thwarted in trying to remove the gun. Many holsters allow the firearm to just slide in or out with no other retention devices. Simply take the holster off with the firearm still inside. Holsters are held in place by either the belt going through a loop,  snaps, Velcro flap or a clip. If a patient is wearing a holster and they are competent (also read this as not under the influence), ask them to carefully remove their holster and leave the gun in the holster. There is no sense in asking if it is loaded. You should assume it is loaded with a bullet in the chamber every time!

You find a pistol located in the front waistband or small of the back and it is not in a holster. In my experience, 100% of these scenarious indicate that the individual is not supposed to be carrying a firearm, does not want law enforcement to know, and it is basically a "throw-away." Ask them to carefully remove it so you can store it in a cabinet out of reach.  More on this in a moment.

How do you handle a gun that is not in a holster? Actually, there are a few “don'ts” to avoid. Do not point a gun at any part of any person.  Don't point it at yourself, your patient or your partner. Hold the gun by the grip, which is the handle of the gun. All fingers need to be on the grip. This may feel a bit unnatural, but it ensures that your "trigger finger" is not on the trigger (a big no-no), the slide or the frame.

Do not examine the firearm to see if it has a safety—this is not the time or the place. Rack the slide or check the magazine to see if it is loaded. Simply secure it. This includes everyone at the scene: EMS, police, firefighters and family.

A gun being in a purse or bag is likely the highest risk of an accidental (or negligent) discharge. The pistol could be pointed in any direction and it may not be in a holster. You must automatically assume it is loaded with a round in the chamber. The best option is to just leave the purse at the scene or secure it in a cabinet of the ambulance. If your only option is to remove the gun from the bag, take a moment to plan it out! Use a flashlight if needed to look before you reach. Plan the direction of removal BEFORE you start to remove the firearm.

Work with your partner. Let them know you have a firearm secured in a cabinet, for example. Do not surprise them when they are straightening up after a call.

How do you handle the situation when arriving at the hospital? Concealed carry is legal in many locations. Your patient hasn't broken any laws, but you should not bring your patient into the Emergency Department with a handgun. When they find it (and they likely will) and you have not told them about it, that will not go over well.

Here's what I suggest. Take the patient inside without the firearm. Tell security you have the patient's firearm and need to transfer it to them.  I don't suggest you tell the hospital on the patient radio or phone report that you need security to meet the ambulance. It raises questions and tension higher than needed. Advise the patient that you will transfer the weapon to security for safekeeping. Neither the back of an ambulance or inside the ED is an appropriate location for security to examine the gun or determine if it is loaded.  Record in your documentation who took responsibility for it. Talk to your supervisor to see if you have a defined company procedure. Talk to your medical director for guidance.  Ask an armed law enforcement officer (LEO) how they would handle the situation. Go to a gun store and ask to see holsters and how to remove them while the handgun is in the holster.

Wrap it up! The likelihood of having a patient with a concealed firearm will increase in the future. Look for them as part of your scene survey. Ask the patient. It's better to find out before you leave the scene than while transporting or at the hospital. Assume firearms are always loaded—never try to unload the firearm or engage a "safety." Never allow the barrel to point at anyone as it is secured. This has to be thought-out in advance! Be safe, but there is no need to be afraid if your patient has a handgun.

Captain Dick Blanchet (retired), BS, MBA, worked as a paramedic for Abbott EMS in St. Louis, MO and Illinois for more than 22 years and served as an armed federal law enforcement officer for over 11 years.  He was also a captain with Atlas Air for 22 years on the Boeing 747 and served as a USAF pilot with more than 21,000 flight hours over 22 years.