When asked about his personal belief on firearms in the emergency department, Dr. Coppola said, “I firmly believe that it is every person’s right to defend themselves. If you’re in a remote part of the ED where there is very little security or security is all on the other side and a patient becomes violent and you have no way to protect yourself, how do you do that? You could call for help, but you might be dead by the time they come.”

Rural Considerations

At its 2021 meeting, the ACEP Council passed Resolution 32: Firearm Ban in EDs Excluding Active Duty Law Enforcement, after extensive discussion. The majority of the debate on the Council floor was surrounding the first Resolved clause: “That ACEP promote and endorse that Emergency Departments become “Firearm Free” Zones, with the exception of active duty law enforcement officers, hospital security, military police and federal agents.”

     (Did you know you can check on the status of recent Council resolutions? Visit acep.org/actions-on-council-resolutions to do a deeper dive. The archive goes back to 1993.)

Unlike many urban emergency departments, many rural emergency departments do not have armed security guards. “Do I carry when I’m not at work? Yes, I do,” says Edwin Leap, MD, who works in small and medium-sized emergency departments in southern Appalachia. “I believe that concealed carry is a reasonable thing, but I don’t do it in the hospital. Now, having said that, I’ve worked in lots of places that had little to no security. In fact, I worked once in a small town in Kentucky. There was a critical access hospital and after 5 p.m., the city police closed up, they weren’t available, and the only person available was the highway patrolman who had responsibility for that area. And that person might have three or four counties. So, when emergency physicians feel like they’d like to carry at work, I’m sympathetic. I understand.”

Dr. Marco, who personally does not feel that physicians should be armed while on duty, cites the violent confrontation in her own ED as one that demonstrates how complicated the issue can be. “[Ours was] a situation though, where any amount of gun control or weapon screening would not have helped because it was a security officer’s weapon.” Evidence shows that 23 percent of firearm attacks in the ED occur after the assailant takes a weapon from a law enforcement officer.¹⁰ “I think we all agree that security officers should be armed,” Dr. Marco said.