Safety First or Saving Lives? How Medical Responders Would Decide when Facing an Active Violent Incident. Results from an Explorative Cross-National Survey

Ellebrecht Nils (), Joval Anna, Kaplan Tomer, Wacht Oren and Weinstein Eric S.
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Ellebrecht Nils: Centre for Security and Society, 9174 University of Freiburg , Werthmannstr. 15, 79098 Freiburg im Breisgau, Germany
Joval Anna: (Security Management), Norwegian Red Cross, Oslo, Norway
Kaplan Tomer: 251222 Magen David Adom , Or-Yehuda, Israel
Wacht Oren: Department of Emergency Medicine, Ben-Gurion University of the Negev, Beer-Sheba, Israel
Weinstein Eric S.: Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, Novara, Italy

Journal of Homeland Security and Emergency Management, 2025, vol. 22, issue 1, 1-25

Abstract: In recent years, public authorities and rescue services have been discussing how Medical First Responders (MFRs) should behave in an Active Violent Incident (AVI) where it is necessary to weigh up self-protection and the rescuing of others. The aim of this exploratory study is to generate a preliminary picture of how European MFRs position themselves on this and related questions. With the help of a network of experts, an AVI scenario and accompanying questionnaire were developed and pretested. A refined version was then distributed among MFRs in eight European countries and Israel. We performed descriptive statistics and tested for significant differences among the participating countries. 1164 MFRs completed the survey. In the absence of police protection, a majority of respondents opted against providing immediate casualty care (56.6 %). Under certain circumstances, however, the rest decided in favour. More than 65.5 % did not fear disciplinary or legal consequences for not providing assistance immediately. Even with police protection, one in ten respondents would still not enter a “yellow zone”, one in four would leave this to Emergency Medical Services (EMS) units specifically trained for such operations. While there are very few strong contrasts between MFRs with different work experience, roles (supervisor/instructor) or additional qualifications (e.g., firefighting, military service), there are significant differences between MFRs from participating countries. Most notably, (1) only Norwegian participants identified, on average, a clear paradigm shift from “safety first” to “controlled risk taking”; (2) while 69.8 % of the Austrian cohort were unwilling to enter without being escorted by the police, among Norwegians MFRs the figure was 42.7 %; (3) the question whether “weapons” are “useful” equipment in such a scenario is particularly divisive (ranging from 14.3 % of German to 58.9 % of Israeli respondents). Although most of the questions were answered in the same way by a large majority, significant differences can be observed, especially between countries. We offer various explanations for these and discuss whether MFRs can actually remain passive given the situational normative forces inherent to an AVI.

Keywords: emergency medical services; risk assessment; self-protection; ethical dilemma; weapons; tactical casualty care (search for similar items in EconPapers)
Date: 2025
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DOI: 10.1515/jhsem-2022-0051

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