EMS Kevlar is Silly

I spent the first half of my career wearing a bulletproof vest while at work.  Most paramedics in my system did, so I just kind of followed along.  Plus, I was in the Big City EMS department.  Big cities are dangerous, right?  And the vest looked cool – made me feel like a cop or something.

People in olden days were insane!  Polish inventor Jan Szczepaik invented the bulletproof vest in 1901.  Here is the first (successful) test of the invention with a shot at his (egregiously underpaid) servant done with a 7mm revolver at three paces.  (Author unknown. Public domain via Wikimedia Commons)

I never had need of it.  Wait – once I didn’t have it on when my right nipple almost got bit off while wrestling a dude on PCP.  I wish I had the vest on at that moment, but that wasn’t a vest thing.  The nipple-biting incident was the culmination of a string of bad choices on my part.  Improving my choices that night could have resulted in me not needing a vest, and not getting my nipple almost bit off.

For those of you smart enough to forego bulletproof vests, they are hot.  They cost a few hundred dollars.  They are uncomfortable in that they ride up in front and cause your shirt to come untucked.  They make you look 40 pounds fatter.  They don’t breathe at all.  The torso sweat throughout your shift goes right into the vest and never leaves – after a week a vest smells like my 8^th grade gym locker did (the year I never took my gym clothes home).  Of course, you can expend a lot of effort and expense getting defunkifying sprays and cleaners. 

I’ve been at my agency for 15 years.  In that time we’ve gone from about 70,000 calls per year to close to 100,000 calls per year.  So some back-of-the-envelope math says that I’ve been employed while my agency ran more than one million EMS calls.  Do you know how many times I’ve heard of a medic being saved by their bulletproof vest?

None.

What troubles me about the vests is that they are outward signs of inappropriate risk estimation.  When one researches EMS injuries, such as these 2011 data, one finds that EMS providers dodging gunfire at work is an exceedingly rare event.  Which is consistent with what I have seen in the last 15 years.  The 2001 data show that the most common event that results in injury is “Bodily reaction and exertion.”  That classification includes lifting heavy stuff and performing repetitive microtasks.  Second is “Harmful exposures” (not necessarily hazmat spills – this includes noisy environments and emotionally stressful events) and third is “Contact with objects and equipment” (needlesticks, rough surfaces, etc).  “Falls” comes fourth and “Transportation incidents” comes fifth.  You have to go to the sixth most common event to find “Assaults and violent acts.”  Most of the 2,100 assaults in 2011 are unchanged by wearing a vest or not.  Violent acts include animal and insect attacks, face punching, finger biting, shoves, cutting/stabbing, and other non-ballistic torso injuries.  You knew a bulletproof vest isn't knife proof, right?

So if we alter our behavior and equipment to match the risks inherent in our jobs, we should focus on lifting mechanics and moving in the back of an ambulance.  I don’t know about you, but standing in a hunched position in the back of the bus ends up hurting my low back.  I do much better if I just sit on the bench or captain’s chair.  Consider hearing protection when you have the siren on.  Watch out when you are handling needles.  Watch your step on icy or uneven ground.  Wear safety goggles.  Consider some kind of grip-enhancing overshoes on icy days.

Traffic accidents are pretty common for EMS providers.  When was the last time you put a seatbelt on yourself in the back of an ambulance?  Maybe not when you are moving around and getting equipment, but there are calls when your work is mostly done and you are typing a PCR and chatting with the patient.  Is your seatbelt on then?  Do you wear a high visibility vest or uniform when working in roadways?  Honestly, you are more likely to be run over working on the side of the road than you are to be shot in the torso.

Those are the things we would do if we were concerned about safety.  Until you are doing those simple things to improve your safety, I don’t believe you when you say you just want to be safe.  Deep down, you know the Kevlar vest is mostly a fashion statement.

I have been injured many times in my career.  I have three or four needlesticks under my belt.  I have a few falls where I had enough hang time to realize that having my feet over my head in midair was not a good position.  Those hurt.  I may have missed a few days of work here and there due to back pain after ill-advised lifts.  Once I wedged myself between the floor and ceiling of the ambulance in order to use both hands to treat a patient.  My partner hit a speedbump, my neck crunched, and my arms went numb for three days (I was embarrassed, so didn’t even report that one).  There was the nipple biting incident (again, poor choices on my part) and I once got punched in the mouth by a girl wearing a big-assed diamond ring.  I donate a chunk of scalp on the infernal oxygen christmas tree almost every day.  I’ve been in a bunch of wrecks but have gotten off lucky and never been hurt in one.

Most of those were due to my own decisions.  Most of those were avoidable.  And every single one of them didn’t require a hot, sweaty, smelly, expensive Kevlar vest to save me.  What I needed to do is slow down, watch my step, duck lower in the back of the ambulance, wait for more help when dealing with angry people wearing big-assed rings, and wear my seatbelt. 

I don’t wear the vest anymore.  But I do wear goggles, the reflective vest, and put on my seatbelt in back when I can.

Seriously, old people are nuts!  Check the look on dude's face!  And what's with the friggin' bicycle? Who rode that to the scene of the experiment?  (National Photo Company (1923), Public domain, via Wikimedia Commons)