Body armor for EMS personnel

EMS personnel are becoming receptive to the idea that body armor is now the accepted level of all-hazard personal protective equipment. Much like the cultural shift to the routine wearing of gloves and eye protection for protection against infectious disease exposure, the appropriate use of body armor must become an organizational norm for incident response, even incidents that are not obviously violent or likely to become so.

The need for EMS body armor is in part from the changing role and operations of EMS personnel during and after an active shooter/multiple casualty incident has been changing for several years. The "Fire/Emergency Medical Services Department Operational Considerations and Guide for Active Shooter and Mass Casualty Incidents" describes incorporating tactical medicine into active shooter events. The FEMA information comes with other lectures during the Special Operations Medical Association conference which talked about ways to get EMS and fire department personnel into the warm or hot zone [1].

The National Fire Protection Association (NFPA) Chiefs support the Rescue Task Force concept. This medical response method equips fire and EMS personnel with body armor and sends them into the warm and hot zones, which has been almost unheard of up until recently [1].

Considerations, planning and interagency training should occur around the concept of properly trained, armored medical personnel who are escorted into areas of mitigated risk, which are clear but not secure areas, to execute triage, medical stabilization at the point of wounding, and provide for evacuation or sheltering-in-place. Some jurisdictions accomplish this through the deployment of Rescue Task Forces[1].

In addition to active shooter response EMS agencies are also considering body armor to protect personnel from the daily risk of violent patient encounters. A volunteer firefighter was shot and killed by an Arkansas man when the firefighter responder for a medical emergency call at the man's home. Ambulances have been shot at and EMS personal in Detroit and San Diego were stabbed by bystanders

Types of body armor
Before purchasing body armor paramedic chiefs and EMS leaders need to understand its construction to make an informed decision about the level of protection EMS providers need.

Soft armor
Soft armor panels are typically constructed of multiple layers of ballistic-resistant materials which are sometimes called aramid fibers. The number of layers within the panel and the order in which these layers are placed influence its overall performance. Additional energy from the projectile is absorbed by each successive layer of material.

A soft armor panel works much like a baseball catcher's mitt. When a handgun bullet strikes the panel, it is caught in a web of strong fibers. These fibers absorb and disperse the impact energy that is transmitted to the panel from the bullet. This process causes the bullet to deform or mushroom [2].

Hard armor
Hard armor plates may be constructed from ceramics, compressed laminate sheets, metallic plates or composites that incorporate more than one material.

Generally speaking, hard armor plates work in one of two ways: They can either capture and deform the bullet, or they can break up the bullet. In both instances, the armor then absorbs and distributes the force of the impact [2].

What level of protection do EMS providers need"
Do EMS providers need protection from pistol threats or rifle threats" Soft aramid fiber ballistic vests stop pistol and fragmentation threats, but it takes a rigid rifle plate to stop a rifle bullet.

For handgun protection it is important to know that Level II-A, Level II and Level III-A all stop the overwhelming majority of pistol projectiles an EMS provider will ever likely encounter (plus 12 gauge, OO buckshot), and also to know that NO vest is ever 100 percent bulletproof under ALL conceivable circumstances [3].

There is always a tradeoff between more protection and wear-ability or concealability — so the level of protection chosen is a personal choice. It is better to purchase a lower protection level that personnel will wear consistently, than the highest protection that isn't regularly worn by personnel. The best vest for you is the one you are actually wearing when shot [3].

• Level II-A generally ~4 mm thick
• Level II generally ~5 mm thick

The biggest difference between those two levels is the amount of blunt trauma impact protection. Ballistic Protection Levels are:

• Level II-A has become quite rare, but could actually be the best choice if thinness, comfort and concealability are the most important factors over blunt trauma protection. Average Cost: $400-500 (New).
• Level II is often worn by police officers and provides a good balance between blunt trauma protection, versus cost, and thickness/comfort. Average Cost: $500-700 (New).
• Stab-Resistant vests are available, but are generally not recommended, due to the added cost, unless there is a significant knife threat. Stab-resistance makes the vest a little heavier and thicker and significantly stiffer, and therefore less comfortable and concealable. Secondly a regular ballistic vest does offer some knife protection from a slashing knife attack [3].

How to buy body armor for EMS personnel
EMS agencies looking to acquire body armor for their personnel should look at products that have undergone testing following the test procedures contained in the National Institute of Justice (NIJ) document, "Ballistic Resistance of Body Armor, NIJ Standard–0101.06."

This is a minimum performance standard developed in collaboration with the Office of Law Enforcement Standards of the National Institute of Standards and Technology. It is produced as part of the Standards and Testing Program of the National Institute of Justice, Office of Justice Programs, U.S. Department of Justice Programs, U.S. Department of Justice [4].

The National Institute of Justice companion document, "Selection and Application Guide to Ballistic-Resistant Body Armor: For Law Enforcement, Corrections and Public Safety" (NIJ Selection and Application Guide-0101.06) that provides a wealth of information for any EMS agency looking to purchase body armor for its personnel.

What is the least expensive and good protection"
Level II-A is adequate and may be the best choice if lightweight and/or comfort is the first priority over more blunt trauma protection. A cost-effective solution for EMS agencies on a tight budget may be a Police surplus Level II ballistic vest.

In ballistic tests, used body armor performed as well as new according to the NIJ research. The aramid fiber used in the construction of ballistic vests is good for many years as demonstrated in the NIJ research. Surplus vests can be purchased for approximately $200 and up.

Before you buy:

• Choose a reliable and licensed supplier when making a purchase. This will make sure that you are getting the best quality possible.
• Do not forget to check the background and number of years of experience of the manufacturer before you would actually make a deal.
• Choose a manufacturer that is NIJ accredited for guaranteed safety use.
• If you are going to buy a used vest, make sure it was taken care of properly.

Wearing your armor
Regardless of your level of protection choice, it is paramount that the armor fit correctly. Most carriers or vests are designed to fit slightly below or at your collarbones and end an inch or two above the waist. The armor you wear should enable you to reach your portable radio and other equipment. The wrong time to find out that your trauma scissors hang up on your vest is when you need them.

References

1. Imminent Threat Solutions. Is Body Armor Truly Coming for EMS and Fire" TCCC and C-TECC Updates from SOMA 2013. [Available online] http://ift.tt/1eHjy38

2. National Institute of Justice. Selection and Application Guide to Ballistic-Resistant Body Armor for Law Enforcement, Corrections and Public Safety. NIJ Selection and Application Guide-0101.06. p. 6. [Available online] http://ift.tt/1PXPX9A

3. BulletProofME. What PROTECTION LEVEL should I get" [Available online] http://ift.tt/1mE7kQV

4. National Institute of Justice. Ballistic Resistance of Body Armor, NIJ Standard–0101.06. p. V. [Available online] http://ift.tt/1PXPX9E

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