I will first discuss the applicable South Carolina law on this issue.  Next, I will discuss fire and EMS departmental concerns on this issue.  I will conclude with my personal thoughts.

N.B.:  South Carolina has a number of public-safety departments whose members are both certified law enforcement officers and firefighters/emts/paramedics.  The majority of the below will not apply to these departments and their members, as SC provides expressly for certified law enforcement offers the ability to carry openly and/or concealed just about everywhere in the State.

I.  South Carolina Law

A.  SC Authorization to Carry a Pistol

South Carolina law does not expressly provide for firefighters, EMTs, and paramedics to “carry about the person, any pistol whether concealed or not…”¹

In South Carolina your occupational status as a firefighter, EMT, or paramedic does not provide you open-carry or concealed-carry rights in the performance of your fire and EMS duties.

In other words, in order for you to carry while on duty, and in the performance of your fire and EMS duties, you must possess a valid South Carolina Concealed Weapons Permit issued from the State Law Enforcement Division.

B.  SC Prohibited Places for Concealed Carry

1. South Carolina law expressly forbids concealed weapons permit holders from carrying in the following places:  “private or public school, college, university, technical college, other post‑secondary institution, or into any publicly‑owned building”²

Your fire station or EMS station is likely a publicly owned building, therefore should you carry there, you are committing a criminal offense.

If you work for a private fire or EMS agency that is not publicly-owned, mere carry into that building may not be a crime, but South Carolina sets forth other prohibited places for concealed carry.

2. South Carolina law expressly forbids concealed weapons permit holders from carrying “into the residence or dwelling place of another person without the express permission of the owner or person in legal control or possession.”³

The majority of fire and EMS calls are to “the residence or dwelling place of another person.” In order for you to legally carry concealed into someones house, you would have to get their permission first.

Asking for permission gives away the fact that you are carrying concealed, defeating the purpose.  Additionally, since you arrive at their doorstep in an official capacity, any consent they do give would likely be determined to be invalid as being made under duress.  The consent is likely invalid because they may reasonably believe should they deny your request it would prevent you from putting out their fire or rendering them medical assistance.

If you violate this provision you are guilty of a misdemeanor and, upon conviction, must be fined not less than one thousand dollars or imprisoned for not more than one year, or both, at the discretion of the court and have [your] permit revoked for five years.⁴

3. South Carolina law expressly forbids concealed weapons permit holders from carrying into a “hospital, medical clinic, doctor’s office, or any other facility where medical services or procedures are performed unless expressly authorized by the employer.”

This covers where we transport our patients, and sometimes where we pick them up.

If you violate this provision you are guilty of a misdemeanor and, upon conviction, must be fined not less than one thousand dollars or imprisoned for not more than one year, or both, at the discretion of the court and have [your] permit revoked for five years.⁵

C.  Non-Lethal Self Defense Weapons

Self-defense weapons generally considered non-lethal, such as pepper spray, are not covered by the SC Concealed Weapons Permit law, and are not expressly forbidden for firefighters, EMTs or paramedics to carry.⁶

D.  SC Law, Conclusion

There are other prohibitions on places of carry, however I feel these are the most applicable ones to the issue at hand.  If you hold a valid South Carolina CWP, you should have been made aware of these prohibitions in your training class.  If not, or if you have forgotten them, visit the SC Code sections referenced, or visit one of the many Concealed Carry advocacy groups.

It should be rather evident that from the above that South Carolina law is quite hostile to any firefighter, EMT, or paramedic that chooses to employ their Concealed Weapons Permit to carry concealed on-duty.

Self-defense weapons generally considered non-lethal, such as pepper spray, are not covered by the SC Concealed Weapons Permit law, and are not expressly forbidden for firefighters, EMTs or paramedics to carry.

The carry of non-lethal self defense weapons will likely be determined by individual department or service policy, and is what we will discuss next.

II.  Fire and EMS Department Policy on Lethal and Non-lethal Weapons

A.  Policy on Concealed Weapons

If your fire or EMS department does not have a policy forbidding the concealed carry of weapons into the stations, and forbidding the concealed carry of weapons while on duty, it should.  Immediately.

My discussion of the applicable South Carolina law above should be all that is required to support such a policy, aside from the liability implications of an employee discharging a firearm on duty.

B.  Volunteers and Concealed Carry

Volunteers are a valuable resource to lots of departments across this State.  If your fire or EMS department utilizes volunteers who respond POV from various locations, you need to be aware that your members may be carrying concealed weapons and bringing them to your scene.

While it may have been legal for them to carry where they were prior to their response, it may not be legal for them to carry into your scene, your station, and the hospital.

Your department should have a policy in place that deals specifically with volunteers responding with concealed weapons.  An easy solution would be to have your members secure their weapons in a locked glove box or console within their vehicle prior to exiting and performing their duties.

C.  Sign Requirements for Prohibiting Concealed Carry

Even though SC law expressly forbids carry into publicly-owned buildings, your department needs to reference SC Code Section 23-31-235, on the proper signage requirements required by law designating the station or other facilities as a prohibited place for concealed carry.

If you are a private fire or EMS agency, then you definitely need to reference this code section.  The stickers you buy at Staples to stick on the door likely fail to meet the legal signage requirements for legally prohibiting concealed carry.

D.  Policy on Carry of Non-Lethal Self-Defense Weapons

If your fire or EMS department does not have a policy on the  carry of non-lethal self defense weapons you may need to consider one.  You need to be aware that your personnel may already be carrying a variety of such weapons on-duty without your knowledge.

If you lack any policy and your personnel carry non-lethal self defense weapons, you should know that your department is liable for any injury that results from their use of such weapons.  Non-lethal does not mean non-injurious.

If your personnel are carrying non-lethal self defense weapons with your permission, hopefully you have considered the following:

1. Does your department have a continuum of force protocol?
2. Does your Medical Director approve of a Non-Lethal Self Defense protocol?
3. Does your department train your personnel in the proper use of non-lethal self defense weapons?
4. Does your department issue non-lethal self defense weapons?

These are just some basic questions, but you should get the idea.  A plaintiff’s lawyer could have a field day with you on the stand over just these questions, and this is just the tip of the iceberg of considerations.

III.  Personal Opinions on the Arming of Firefighters and EMTs

First off, I hunt, I shoot, and I own firearms, including firearms for self-defense.  I am a firm believer in the Second Amendment imparting an individual right.

I cannot, however, support arming firefighters, EMTs or paramedics with lethal weapons.  Ambulance Driver has a previous post on this as well.  Further, I cannot imagine a department knowingly permitting their members to carry concealed weapons on duty.  The potential liability and public relations implications are huge.

If the scene is not safe, stage and wait for law enforcement.  Wait however long it takes.

If the scene deteriorates, retreat to a position of safety.  If law enforcement is not already on scene, get them.  Do not re-enter the scene until law enforcement has secured it and made it safe to re-enter.

If a patient attacks you or is uncontrollably combatative in the back of the ambulance, stop the ambulance in a safe place and retreat.  Use only what force is required to retreat and get to a position of safety.  It is not patient abandonment if you retreat for your own safety.  Get law enforcement on scene and allow them to use their tools and training to handle the combatative patient.

Further, if you were assaulted then you will need them anyway to file charges on the patient.  It is a crime in SC to assault a firefighter, EMT or paramedic in the performance of their duties.

Some may argue that pepper spray or other non-lethal weapons are needed to ensure that you can escape a situation.  That may be true.   It is a crazy and violent world.  I have worked in Savannah with medics wearing body armor and carrying pepper spray.  (Although I had neither!)  I understand that fire and EMS departments are issuing body armor to their members.

However, I consider the carry and use of  non-lethal weapons anathema to our mission and in violation of our hard earned status as non-combatants.  We are not the police, and that affords us a level of patient trust and interaction that our LEO friends don’t receive.

In my opinion carrying weapons and deploying weapons on our patients (or bystanders) revokes our non-combatant status and places us in greater danger.

These are just my personal thoughts on the matter.

Each jurisdiction is different, and may determine that their members need these tools.  I just hope that those of us in the streets and those in administration take the time to answer the tough questions and perform the proper risk-benefit analysis in making a decision on this topic.

I would enjoy hearing why you agree or disagree.

1. SC Code of Laws, Section 16-23-20.  See also, SC Code of Laws, Section 23-31-240.
2. SC Code of Laws, Section 16-23-420.
3. SC Code of Laws, Section 23-31-225
4. Id.
5. SC Code of Laws, Section 23-31-215.
6. Id.

This post was generated from an email I received from Mark over at Medic999. One of Mark’s readers posted the details of a call he ran wherein the patient had a valid DNR order, and he was uncomfortable with the way the the DNR limited the available treatment options. You can visit Mark’s blog for a full run down of the opinions there.

For the readers outside of the United States, you should be aware that each State sets its own laws and regulations regarding DNR orders; there is no nationwide standard. Each State’s law may be different.

First a bit of a disclaimer: I am educated in United States common law and most specifically educated in the law of South Carolina, the State of my bar admission. I am also registered as a NREMT-P in South Carolina so I am most familiar with South Carolina’s laws on DNR orders.

I will focus first on the law within the jurisdiction I practice law and ride an ALS truck. I will then discuss my thoughts as to the call posted by Matt, and will end with a sampling of DNR regulations from other States for comparison.

Here in South Carolina we have the Emergency Medical Services Do Not Resuscitate Order Act. To establish a DNR order in South Carolina, the patient must: (1) have a terminal condition; and (2) the terminal condition must have been diagnosed by a health care provider and the health care provider’s record establishes the time, date, and medical condition which gives rise to the diagnosis of a terminal condition. Thus, it is a pre-requisite to have a physician established terminal condition.

When EMS personnel are presented with a valid DNR order EMS personnel must not use any resuscitative treatment. EMS personnel must provide that degree of palliative care called for under the circumstances which exist at the time treatment is rendered.

Okay, that is some great lawyer-speak, but what constitutes the “resuscitative treatment” we can’t give, and what does “that degree of palliative care called for under the circumstances which exist at the time treatment is rendered” mean for those of us in the street?

For that guidance we must consult South Carolina Department of Health and Environmental Control Regulation 61-7, Sections 1406 and 1407. In the event that the patient has a valid DNR order, the following procedures shall be withheld or withdrawn: (1) CPR; (2) Endotracheal intubation and other advanced airway management; (3) Artificial ventilation; (4) Defibrillation; (5) Cardiac resuscitation medication; and (6) Cardiac diagnostic monitoring. These 6 items are defined as prohibitive resuscitative treatment in the presence of a valid DNR order.

The following treatments may be provided as appropriate to patients who have executed a valid DNR order: (1) Suction; (2) Oxygen; (3) Pain medication; (4) Non-cardiac resuscitation medication; (5) Assistance in the maintenance of an open airway as long as such assistance does not include intubation or advanced airway management; (6) Control of bleeding; and (7) Comfort care. These 7 items are defined as the permissible palliative measures that can be given in the presence of a valid DNR order.

Okay, so that is what I can do and can’t do in the presence of a valid DNR order. But wait, there is more. When presented with a valid DNR order, I must honor it, regardless of the circumstances. If I can’t or won’t honor it, then I must immediately transfer patient care to another EMS provider or other health care provider who will honor it.

That is the law in the State I work.

Let’s restate Matt’s patient presentation: Elderly male, lungs full of fluid, SpO2 mid to high 60s on a nasal cannula, improved to about 69-70% with a non rebreather, respirations about 24, mental status , about a GCS 5. Nursing home staff states aspiration of vomitus, suction attempted with no relief. Valid DNR presented to EMS on arrival.

If I was presented with the above in my jurisdiction, right off the bat there are several things that I cannot do for this patient in the presence of the valid DNR order. I cannot drop an ET tube, King Airway or LMA. I cannot use a BVM to artificially ventilate. I cannot attach my LifePak 12 for cardiac monitoring.

My patient revoked my ability to use these tools, and I will respect their decision, but I won’t just watch them circle the drain. There are things I can do that may really help this patient. First, I will do my own assessment, as I do not trust NH assessments. I can still suction, so I would try to clear the airway as best I can. Here, an OPA is a basic skill, so dropping an OPA to maintain an open airway would be permitted. I can administer oxygen via non-rebreather over the OPA. (A tougher question would be whether CPAP or BiPAP is considered artificial respiration. I’ll punt on that one for now.)

I can also establish an IV and check a BGL. Who knows, maybe his blood glucose is 20 and an amp of D50 perks him up. I can…well, you get the idea. There are things we can do and should do to care for our patients.

I encourage you to become familiar with your State’s laws and regulations regarding DNR orders and your local protocols on DNR orders so that when presented with a valid DNR order you know what you can and can’t do to care for your patient.

These are tough situations for us because we are used to doing all we can with all we got. But we must remember that our primary purpose is quality patient care, and sometimes that means respecting our patient’s wishes regarding the end of life too.

Other State DNR order regulations for comparison:

State of California

State of North Carolina

State of Texas