The topic of arming EMS providers, open or concealed carry, is neither a new discussion nor an easily resolved controversy. Our columnists have written about arming EMS providers and the potential cost of pulling the trigger. The Inside EMS podcast has explored weapons for EMS providers and equipping personnel with less lethal tools.

A Kansas law, which became effective on July 1, 2016, makes it legal for firefighters and EMS personnel to have a concealed carry weapon while on duty. The only exception is for school zones or private buildings specifically marked or designated as 'gun free.' Public employers, such as city and county governments, cannot prohibit their employees from carrying on duty.

We asked EMS1 columnists to react to the legislative change in Kansas and to answer this question, "As an EMS leader, educator and advocate what is the one thing EMS providers should consider before carrying a concealed weapon in the ambulance?"

A Kansas law, which became effective on July 1, 2016, makes it legal for firefighters and EMS personnel to have a concealed carry weapon while on duty. (Photo/USAF by Airman 1st Class Justin Armstron)

Many of them discussed the need for weapons qualification, additional training on weapons use, weapon retention and regular shooting practice. Those recommendations sound reasonable, but it seems to be the case that in Kansas, as long as the employee meets the state requirements for concealed carry, there can be no restriction or requirements placed on the employee who chooses to carry a concealed weapon while on duty.

Here are the replies from EMS1 columnists. Read what they have to say and add your response to the question in the comments.

Art Hsieh: Array of force options

Like any other complex piece of technology, used in a low-frequency, high-criticality environment, any public safety provider who elects to have a gun in the unit must be qualified, equipped and well trained to deploy it.

Policies and procedures must be developed to employ the use of deadly force. Moreover, departments must ensure that the employee qualifies on the firearm routinely. I would also imagine that the liability profile for the agency must rise as well, although I don’t know that for a fact.

Since we are talking weapons — which to me seems counterintuitive in an EMS vehicle — what about less lethal options? Chemical restraints? TASER? Batons? Why resort to the one most lethal option?

If the discussion is about self-defense, then a full debate should be had about the array of force options available. Otherwise, the risk of being boxed into an unmitigated risk scenario is simply too high.

Dan Limmer: EMS isn’t like television

People believe they can carry a firearm to instantly and heroically save lives. The truth is that someone will carry a firearm for decades and most likely will not use it — even when providing EMS in tough neighborhoods.

Pistols are heavy and awkward to carry. Quite frankly, it can be quite a pain. The responsibility and liability involved is staggering. The potential to shoot an innocent bystander or to draw fire into a crowd, to have the weapon taken away from you or even to have it accidentally discharge are rarely considered.

Training should be required at least two to three times per year (and we complain about our required CE already).

The beginning of this answer might cause some to believe I am not in favor of EMS personnel carrying firearms. Not true. The world today can be a dangerous place.

If someone accepts the responsibility to add a firearm to their daily toolbox and is as familiar with it as they are their cardiac monitor, I support them carrying a weapon. You shouldn’t be using any equipment in EMS without being competent and qualified. Firearms are no different.

Kelly Grayson: Much ado about nothing

Are you ready to kill someone who initially called you for help? That's the number one question every EMT needs to ask himself before carrying a concealed weapon on the ambulance.

As someone who is a strong Second Amendment advocate and who regularly carries a concealed weapon off-duty, that's a question every concealed carry permit holder has to answer for themselves. There is a stark difference between the caregiver mindset and the combat mindset, and make no mistake, the mindset is the weapon. The firearm is just the tool you employ.

I'm not sure most EMTs I know can shift between those two mindsets without compromising one or the other, but as a matter of principle, I will never speak against another human being employing a legal means of armed self-defense. That is a personal choice.

I have no issues with a partner going armed. To my thinking, if I can't trust the partner sitting next to me with a concealed weapon, I can't trust him, period. He has no business on an ambulance otherwise.

Carrying on duty is considerably more problematic. When I'm carrying off-duty, I can simply avoid those places where I am legally prohibited from carrying a weapon, or disarm and leave my firearm secured in my vehicle before I go inside.

EMT's, on the other hand, don't have that luxury. We routinely go into jails, schools, hospitals, bars, banks, and public buildings. We can't opt to stay outside, and disarming ourselves may prove cumbersome and time-wasting. There is no way around this short of commissioning every EMT as a law enforcement officer, which will never happen.

Another factor is that in the confined space of an ambulance patient module, when I'm wrestling with a combative patient, I don't have a gun. We have a gun. Most concealed carry permit courses do not cover weapons retention techniques. I have that training, but I'm reasonably certain that the vast majority of non-LEO concealed handgun carriers do not.

Ultimately, I think what will happen is ... nothing. Just because carrying a handgun on an ambulance becomes legal does not mean EMTs will rush to the gun store to buy a Blastomatic 2000 to carry on the boo boo bus. What will happen is that existing concealed handgun permit holders ― already one of the most law-abiding demographics in all of society ― will simply carry their weapons in one more place.

And plenty of them, like myself, will choose not to.

Mike Rubin: Willing to take responsibility

Assuming it's legal to carry, I think the first question should be, "Am I willing to take responsibility for my bullets?"

In Tennessee, as a concealed-carry permit holder, you're responsible for whatever damage your bullets do. If you shoot at a gunman and strike a bystander, you're responsible. If you aim for a tree and hit someone's pet, you're responsible. If you fire a warning shot into the air and the bullet lands on some kid's head, you're responsible.

If your gun goes off as you're defending yourself in the back of an ambulance and the bullet exits through the windshield, ricochets off the driveway, breaks a window next door and puts a hole in the neighbor, you're responsible.

Yes, I carry.

Michael Morse: Corruption of the sacred philosophy of healers

Consider the effects of an armed fire and EMS force on the public’s perception of us. Our strength is our neutrality. Our safety is directly attributed to the goodwill generated by our willingness to let our street smarts, faith in humanity, awareness of potential threats and our ability to transcend the current us-against-them mentality.

Introducing a firearm into the patient-provider relationship corrupts the sacred philosophy of all healers to "First, do no harm." Arming the nation’s firefighters and EMTs will attract a different kind of provider into our ranks: one that needs the power of intimidation rather than persuasion while treating the people who need us.

Doug Wolfberg: Know the risks and your state's laws

In my view, the most important thing to consider is the risk to the EMS providers themselves and to the patients they serve. The risk of an EMS provider’s weapon being used against them by a disturbed or combative patient is probably just as pronounced as the risk of deadly force being used against the EMS provider in the first place.

Even highly-trained law enforcement officers have their guns taken from them and used against them; EMS providers with even less firearm training or experience than LEOs would likely face a higher risk, particularly since they are also supposed to be focused on other duties like patient care and therefore less attentive to their firearm. Patients who are making threats or who express suicidal ideations would have yet one more option to inflict harm on themselves or others if a firearm was within reach.

Some states expressly prohibit the carrying of firearms by EMS personnel. Pennsylvania EMS regulations, for example, state that "weapons and explosives may not be worn by EMS providers or EMS vehicle operators or carried aboard an EMS vehicle." And even in states where there is no such prohibition, employers are generally within their rights to prohibit concealed carry of firearms by employees on the job (Wisconsin law says this, as one example).

So legal and employment prohibitions also must be considered before any EMS provider decides to carry a weapon on the job. No EMS provider should carry a weapon on the job without the prior knowledge and permission of their employer; it would not be a Second Amendment violation for an employer to discipline or terminate an EMS provider who carries a weapon on the job without the permission of his employer.

Mike McEvoy: Leave well enough alone

Let's not be silly. Unless you've had your head in the sand, you know full well that medics have always carried weapons. What percentage and what weapons vary from place to place and is probably cultural as well as related to the work environment.

Should we condone this behavior by explicitly authorizing it? I think not; primarily because doing so tends to put weapons in the hands of people who probably would be better off without them.

Yet, I also believe we should not overtly prohibit such behavior. Responsible medics and EMTs have been carrying guns and knives for as long as I can remember (and this is a long time). I can't recall a situation where it became an issue.

But I can almost certainly guarantee that weapons, of one sort or another, helped deescalate many a situation and protected the lives of many providers over the years.

We need no rules authorizing providers to carry nor do we need rules prohibiting weapons on the job. Let's leave well enough alone. Meddling is likely to cause problems where none currently exist.

Gustavo Flores: With concealment and effective use

Any law-abiding citizen that is legally allowed to carry a concealed firearm should be allowed to do so provided that the handgun is concealed.

In my humble opinion, the first thing that a provider (and employer) should do before allowing a handgun to enter the workplace is to verify the user's ability to use it safely and effectively.

Sean Caffrey: EMS is part of public health

I do not have the expertise in the firearm area comparable to those that have already commented. My opinion, however, is likely somewhat contrarian.

Overall, I think it is clear our society has a serious gun violence problem compared to other first world nations and a big piece of that is the proliferation of firearms. In public health terms it would qualify as an epidemic.

We have also developed a cultural and political idealization of firearms based on a very permissive view of the Second Amendment that, in my opinion, is both unrealistic and unhealthy. That being said, I support the responsible private ownership of firearms and certainly support the carrying and use of firearms by well-trained law enforcement officers.

The mission of EMS is to provide medical care and save lives. I do not see where arming EMS professionals would do anything other than create a massive liability and distraction from this core mission. Maintaining proficiency in medical care is hard enough.

We must do a better job of training our people to recognize, deescalate and escape violent encounters when necessary. The only times in my career as an EMS leader where I have supported the carrying of firearms by EMS providers for defensive purposes was when those individuals were also fully-qualified law enforcement officers. I would not support, and have not supported the carrying of weapons by EMS providers in any other context and would be very comfortable prohibiting them on EMS vehicles or in EMS stations except for use by qualified law enforcement officers.

I would also agree the risks of EMS providers carrying a firearm far exceed any potential benefits by many orders of magnitude. I would rather see EMS providers be part of the solution to gun violence as opposed to adding to the problem. We are after all, concerned with and part of public health.

Robert Avsec: Same training as law enforcement officers

First off, let me say that in my opinion it’s a sad day that in the U.S.A we’ve come to the point where EMS personnel and firefighters feel the need to carry firearms while on duty.

Now that I’ve got that off my chest, I think it’s imperative for any EMS personnel who carry a firearm to have good, solid, tactical training in the use of that firearm. I’m not talking about a basic gun safety class and some practice time on the shooting range. I’m speaking of the same kind of training that a law enforcement officer must engage in that includes threat assessment and the shoot/no-shoot decision-making process.

We all know that EMS responses can be high-stress situations to begin with, and that’s before the situation goes south. Any armed EMS provider must be as comfortable with the use of that firearm and how and when to use it as a law enforcement officer.

Nathan Stanaway: Firearm will change perception of caregivers

Weapon retention alone consists of an exhausting and very intense training regimen. Close-quarters firearm use — the back of an ambulance, a bedroom or someone's living room — these are all very dangerous situations in which a reactionary gap is nearly impossible to maintain.

All the logistics and added danger of EMS carried firearms aside EMS can, should and in many cases does enjoy a marginal safety provided by our role of caregiver and patient advocate. Adding a firearm, strapped to the side of this EMS provider, will change how we are perceived.

Rommie Duckworth: Is the purpose limited to self-defense?

Concealed carry by non-law enforcement EMS providers would be presumably for self-defense rather than expanded role public safety professionals and would have to be supported by state and local law pertaining to non-law enforcement emergency responders, as well as employers.

Assuming that is the case, providers and their employers need to ask, "What role/purpose does this tool serve?" If the answer is for prevention and protection in an increasingly threatening world for responders, then we have to ask what other tools are available so that we can compare costs, risks and implications.

Like any other tool that has the potential to save (or take) a life, the training that must be demanded of EMS providers seeking to carry firearms must include more than just how to use it, but how to safely carry while on duty (weapon retention, limitations of EMS use for self-defense), how to avoid needing to use it (situational awareness, escape, threat de-escalation) and how to make the decision that its use is needed (threat assessment, use of force continuum). To encourage or even allow non-law enforcement responders to carry a weapon in a professional capacity with only rudimentary firearms training can only increase the possibility of an unfortunate headline.

Armed EMS may be appropriate, possibly (sadly) inevitable, but it is definitely neither a quick fix nor a simple answer.

Dave Konig: Tradition or progress?

Ambulances have traditionally been imbued with a sort of amnesty as non-combatants on both military and social battlefields. While it is important to honor tradition, both FEMA's recommendations and the raised expectations of the public for EMS to be more forward during a crisis, there comes a point and time when tradition needs to be laid aside in the name of progress.

Whether concealed carry is the answer or perhaps a more transparent open carry policy, I believe that providers need to be able to protect themselves adequately in line with the expectations of their job. If we're going to insist that EMS personnel remain unarmed for the sake of tradition, then let's put the backboards back into spinal immobilization while we're at it.

EMS providers need to be properly trained in all of the equipment on the ambulance, and that would include any armament they bring with them. This includes didactic lessons as well as hands on practical use at a gun range that focuses on safety.

Catherine R. Counts: Bull in a china shop?

I’ve been shooting guns since the rifle barrels were taller than I was, but I agree with responsible ownership and training. There is a time and place for concealed carry, but the back of an ambulance is one of the last places a gun belongs.

This law feels like ploy on the emotions and allegiance of first responders posing as a win for gun rights advocates. The gun debate our country is facing is so much larger than a single state law protecting a small subset of its citizens. This is a law putting intention, perception and reality into a three way tug-of-war.

I have trouble believing that EMS was the intended target. More often than not we are the forgotten half-brother when policy makers create "first responder" laws. This feels no different, especially given the current political climate. That said EMS is covered under this law so I agree that a measured discussion is necessary.

This is reminiscent of a Bull in a China Shop scenario, and I mean that literally. When Mythbusters tested this myth they were shocked to realize that when you put a bull (or two) in a corral full of breakable items, the bulls are surprisingly nimble. I see the same thing happening here. Yes this law exists, but the outcry surrounding it seems disproportional to what the implementation will look like. Just because the law is there, doesn’t mean everyone is going to immediately take advantage of their new found freedom.

As I’ve previously discussed, the vast majority of LODDs are somehow connected to vehicles or traffic. However, if LODD standards were amended to include mental health issues, it’s highly likely that PTSD would eclipse all other causes of death exponentially. If state legislatures really want to show support for first responders they should start with the extreme emotional toll this profession takes on police, fire, and EMS personnel and their families.

This article, originally published on August 9, 2016, has been updated with current information