Guerillas in the Mist: What EMS Should Know About Street Medics

Many of the jurisdictions touched by America’s 2020 summer of protest saw the presence of street medics—volunteers with a range of clinical training, immersed among and usually of a mind with demonstrators, treating their injuries and offering other basic assistance at scenes too volatile or restricted for formal EMS providers to reach.

Though occasionally in conflict with law enforcement, street medics typically aren’t adversarial to EMS—in fact, they may make its job easier. Handling lesser problems keeps EMS resources free for bigger ones, and in raucous crowds they often deliver the first assistance and stabilization injured protesters can get.

Most aren’t actual paramedics, but many come from the healthcare world, and street medicine has been driven by healthcare providers throughout its modern history. And its perspectives overlap many current approaches to healthcare. 

“Any real-life community organizing recognizes that you have to have all facets of alternatives,” says Noah Morris, a longtime street medic who’s worked at events like Hurricane Katrina in 2005 and the 2016 Dakota Access Pipeline protests. “What you see with street medics are the folks who are those helpers Mr. Rogers would have been looking for.”

Amid the Mayhem

It’s true that people who volunteer for street medicine are generally motivated by social-justice concerns—you didn’t see a lot of BLM opponents ducking tear gas and less-lethal munitions to care for injured BLM protesters. Most are galvanized by causes typically considered left-wing; right-wing street medic groups exist but are rarer. 

“We’re definitely activists,” says Erica Ernst, a paramedic and harm-reduction professional who has volunteered over the last year-plus for Chicago Action Medical, a longstanding street medic organization formed in 2002. “Many of us do activism and organizing outside our time with CAM. We have folks from doctors to massage therapists who are interested in helping people who might incur some sort of injury at a protest.” 

Healthcare providers have fueled the movement since its beginning. Modern street medicine in America basically began with the civil rights movement of the 1960s, with volunteers offering medical support to protesters who ran afoul of government. 

The first U.S. street medics were fielded through the Medical Committee for Human Rights (MCHR), a group of volunteer healthcare professionals who came together in 1964 in support of civil rights workers. MCHR created a Medical Presence Project, noting not only the security benefit to threatened activists but that “There…seems to be a preventative aspect to medical presence—actual violence seems to occur less often if it is known that medical professionals are present, particularly when civil rights workers are visited in jail.”¹ It noted the importance of medical components working closely with protest organizers. 

The civil rights era was a fertile time for the idea to grow, and the MPP helped spark other early street medic efforts in support of causes generating conflict at the time, like the American Indian movement and opposition to the Vietnam War. Beyond protests, street medics focused on improving public health, staffing people’s clinics and teaming with groups like the Black Panthers for projects like rodent abatement, drug treatment and prevention, and free breakfasts for children.² 

More modern street medic organizing flourished following the explosive 1999 World Trade Organization protest known as the “battle of Seattle.” That drew some 40,000 protesters in a range of activity from peaceful to vandalistic, and an emphatic police response that included pepper spray, tear gas, and stun grenades.³ Afterward activists nationwide began organizing street medic trainings to prepare for further antiglobalization protests; many of the organizations listed on the Medic Wiki page date from this era.⁴ More, seeing recent mayhem in the streets, formed in 2020. 

Reducing the Burden

One of those is Street Medics Dallas, which arose last summer from a community of “burners”—enthusiasts of Burning Man and similar countercultural events. With the big Nevada festival and its smaller Texas counterparts nixed by COVID-19, some were moved by the protests to try to help locally. They weren’t all healthcare professionals, but several had experience and training as part of those events’ safety teams. 

“I saw a lot of people I knew from the community wanting to head out to the protests and contribute their skills,” says Taylor Bolinger, one of the group’s creators. “My daughter was born the same day George Floyd died, so I was unable to participate in those protests, but I still wanted to contribute somehow.” 

Instead Bolinger used the Discord platform to create a street medic group and start adding members. The local cadre ultimately grew to about 30–40, with a command staff of eight. It was active over the summer at protests for Floyd and related causes, providing care like basic first aid, conflict resolution, and emotional support.

“It depends on the circumstances, but mostly it’s been heat exhaustion, Band-Aids for scrapes, minor first aid—the kinds of things that happen when large groups of people gather,” says Bolinger. “Previously, when the tear gas was being used more, there was a lot more of irrigating people and doing our best to bandage and treat wounds from batons and [less-lethal rounds], things like that.” 

Protest care typically doesn’t go beyond basic first aid, though some providers may have additional training and offer alternative and complementary therapies. While there are EMTs, paramedics, and even nurses and physicians who function as street medics, they generally know their clinical and legal limitations and stay in their lanes—no one’s looking to usurp EMS’s role or provide more than first care, stabilization, and extraction from the crowd. Good Samaritan laws generally protect that. 

“Actually part of our role is to take some of the burden off EMS, especially in times like this,” says Ernst. “If we’re at a protest, taking care of folks who are just mildly dehydrated or skinned their knee or need their eyes flushed, then 9-1-1 dispatch can handle more serious matters. And if we encounter a more serious issue, we can hand them off to 9-1-1, rather than them having to handle every little thing.” 

One place that worked last summer was Austin, which saw significant protests for Floyd and others. Spurred by an invitation from a local street medic, Wes Hopkins, LP, division chief for operations and special events with Austin-Travis County EMS, reached out to his main local group, Street Medics Austin, and established some basic communication and a general framework for cooperation. This paid off in faster evacuations of serious casualties from crowds, as well as other benefits. 

“The street medics, because they’re living among the protesters for long hours, develop a rapport and are really good at stopping some of those basic 9-1-1 calls like dehydration and heat exhaustion,” Hopkins says. “They hand out water and Band-Aids, they check on people in the crowd, and that’s a force multiplier for us.”   

Self-Defense

Street medics can have a variety of training. A course of 20–28 hours has emerged as a relative standard, though the Medic Wiki page also describes a basic 3–4-hour introduction to protest healthcare and a standard 6–8-hour first aid training.⁴   

For those who come from healthcare fields, there’s bridge training to acquaint them with working in the street environment. Morris and Rupa Marya, MD, an associate professor at the University of California, San Francisco, developed a widely used program for the Do No Harm Coalition.⁵  

“I think any medical training out there that’s peer-reviewed and science-informed is an excellent point to just start learning,” says Morris. “Times are tough; more medical knowledge in your pod or community is going to help you.”

Morris has been a street medic since 2002, a year after getting the worst of a conflict with police while protesting the inauguration of George W. Bush. “I was hit in the head somewhere to the tune of about 20 times,” he says, “and I wanted to pay forward the kindness and good care I was given by those street medics who took care of me.”

He did the 20-hour training and made a quick mark as one of the group that launched the first civilian-run medical clinic in New Orleans after Hurricane Katrina. (That facility, the Common Ground Health Clinic, is now a federally qualified health center that has provided free care for more than 60,000 patients.) Morris later got his EMT-B and worked EMS. Today he does acupuncture and remains involved with street medicine through an Appalachian group. 

Today as 50 years ago, Morris says, street medicine is first a form of self-defense for those beyond the help of existing resources. 

“It’s a pragmatic thing,” he says. “The police don’t allow EMS into scenes they haven’t declared secure. As we’ve seen in places like Portland, people have been shot in the head with kinetic weapons. And then they have control over whether EMS will have access to the people they’re harming—that’s the gap the street medic community fills.” 

Relationships with EMS and fire can go better: “I’ve had only positive interactions with EMS handing folks off,” says Ernst; “We had a wonderful working relationship with Standing Rock Ambulance” in North Dakota, says Morris, though other agencies wouldn’t engage without police presence. EMS leaders in many protest-afflicted cities reported generally positive experiences with local street medics during recent civil unrest. 

But as functional protesters, even nonviolent ones, street medics didn't receive much latitude from law enforcement in 2020. Beyond incidental gassings and errant projectiles, many say they were targeted for violence.^6–10 

“They haven’t always treated us well,” says Ernst. “They’ve treated us like agitators, and they’ve interfered with our patient care at times. When we were new they targeted us for arrest, but we haven’t seen that in a while. I’ve had mixed experiences—I’ve had officers screaming at me and officers who thanked me for helping someone. So it can go both ways.” 

Austin’s Experience

For EMS systems in protest cities, though, street medics may represent a resource that can add value. 

In Austin the idea wasn’t as outside-the-box as it seemed. ATCEMS has worked regularly with medical teams at local special events (e.g., the South by Southwest and Austin City Limits festivals, the Formula 1 U.S. Grand Prix), and this didn’t seem that different. So Hopkins took a quiet day to visit the protest zone and introduce himself. 

“What we said was, ‘These are unprecedented protests, and it’s going to take a village. So if you’re down here, we want to collaborate with you,’” he says. 

He passed on his cell number and invited the street medics to contact him directly with major problems. Even off duty, he could relay casualty information to the current command. The connection paid off most in crowd extractions. If a protester needed definitive care but was able to be moved, the direct link to ATCEMS facilitated the handoff.

“If they’d pinpoint the patient and then crowd-extract and tell us where they were going to go, then we’d rendezvous with them there,” Hopkins says. “It expedited patient access and made the process more seamless overall.” He estimates street medics evacuated 2–3 dozen casualties from crowds for ATCEMS over the course of the protests.

For those too badly hurt to be moved by the street medics, local authorities continued performing extractions using rescue task forces consisting of two police officers, a firefighter, and a medic on a Polaris Ranger. Street medics facilitated locating those by wearing high-visibility pink shirts easily identified in crowds.

Besides the faster care, Hopkins notes, the arrangement represented a safety benefit for Austin-Travis County and its providers.

“These protests were not something we’d encountered to this scale, scope, and magnitude before,” he says. “I don’t believe that in the middle of those protests, where you can have bad actors and different groups, is probably the best place for a city medic or governmental employee. So if the street medics want to be in that situation and want to help, utilizing them is very helpful.”

Street Medicine

Although it shares the desire to bring needed care to the marginalized and underserved, street medicine as a concept goes a bit beyond guerilla first aid at protests. At its core it’s an idea that resembles and reflects current conceptions of patient-centered and mobile integrated healthcare. 

Pittsburgh physician Jim Withers pioneered the idea of taking healthcare to the homeless on the streets where they lived in the early 1990s. Over time those efforts grew to address their social, legal, and housing needs.¹¹ Like those early revolutionary public health endeavors of the 1960s, street medicine attempted to meet urgent needs where the vulnerable lived and address the social determinants that caused and exacerbated their problems. In all three eras—the ’60s, the ’90/’00s, and now—it represented a grassroots approach to filling holes in existing care structures in a way that appealed to radical (i.e., open to extreme ideas) thinkers. 

Morris notes this help largely occurs outside the auspices of government. 

“‘Antifa’ doesn’t just crack heads,” he says. “Folks who identify as antifascist also are the ones helping to operate a lot of the community aid efforts happening right now since the coronavirus. They’re the ones stepping up to fill these voids. 

“There’s a lot of misunderstanding about the folks in the street,” he adds. “We’re not scary. We’re not trying to dispossess everyone of their homes. We’re standing with folks who are trying to stand up peacefully during these hard times, and most of us, like most of them, are being judged by folks who aren’t hard up. I’m not going to criticize people who are willing to risk their freedom and safety to do what EMS personnel say they’re all willing to do.”

At Standing Rock, where protests stretched for 10 months and drew thousands, street medics established a clinic and set up a series of yurts to provide services like midwifery, herbalism, counseling, and sobriety meetings. As it did in the 1960s, their immediate activity evolved into longer-term, holistic care. 

“It’s in those sort of long-term situations that we’re free to realize the highest ideal of what we’re doing,” Morris says. “The Common Ground Health Clinic succeeded because we weren’t constrained by bureaucracy to act on our higher moral authority. We started in a mosque, but we provided care for everyone. We helped people with everything from their toiletry to navigating NGOs and getting federal help.

“If you look toward the people doing this radical, grassroots response, you see these alternative futures that could be possible. When no one’s tear-gassing folks or shooting them with rubber bullets, you realize some of our elders and other vulnerable members of our community are food-scarce—we can help facilitate them getting food. We can help them manage their COVID needs. We’re learning about the vulnerable in our communities and building stronger networks. Then if something happens locally—if there’s a tornado in your area, if there are floods—you already have that Rolodex! You have those contacts and can reach out. It’s a natural building process that’s very grassroots.” 

References

1. Paper Revolution. Street Medic Guide, v. 6, 2018; www.paperrevolution.org/Street-Medic-Guide. 

2. Paper Revolution Collective. Street Medic Handbook for Occupy Chicago and the mobilization against the 2012 NATO summit, 2012; www.paperrevolution.org/wp-content/uploads/2018/03/Street-Medic-Handbook-Occupy-Chicago-2012.pdf. 

3. Wikipedia. 1999 Seattle WTO Protests, https://en.wikipedia.org/wiki/1999_Seattle_WTO_protests. 

4. Medic Wiki. List of street medic organizations, https://medic.wikia.org/wiki/List_of_street_medic_organizations. 

5. Do No Harm Coalition. Street Medic Bridge Training, www.donoharmcoalition.org/street-medic-training.html. 

6. Bernstein M. Physicians for Human Rights finds ‘disproportionate, excessive’ force used against volunteer medics in Portland protests. OregonLive, 2020 Oct 8; www.oregonlive.com/crime/2020/10/physicians-for-human-rights-group-finds-disproportionate-excessive-force-used-against-volunteer-medics-in-portland-protests.html. 

7. Pedneault J. Police Targeting ‘Street Medics’ at US Protests. Human Rights Watch, 2020 Jun 17; www.hrw.org/news/2020/06/17/police-targeting-street-medics-us-protests#. 

8. Yan W. Health Professionals Say Police Are Targeting Them at Protests. Elemental, 2020 Jun 14; https://elemental.medium.com/health-professionals-say-police-are-targeting-them-at-protests-52419b716282. 

9. Grant MG, McDonough K. Protest Medics on Being Targeted by the Police, in Their Own Words. New Republic, 2020 Jun 3; https://newrepublic.com/article/157985/protest-medics-targeted-police-words. 

10. Rambo K. Protest medics in Portland not spared from force, targeting by police. OregonLive, 2020 Aug 8; www.oregonlive.com/news/2020/08/protest-medics-in-portland-not-spared-from-force-targeting-by-police.html. 

11. Varma R. What You Need to Know About Street Medicine Movement and Homeless Healthcare. Medium.com, 2018 Nov 13; https://medium.com/@DrRohitVarma/what-you-need-to-know-about-street-medicine-movement-and-homeless-healthcare-bf33eaf04efa. 

John Erich is the senior editor of EMS World.