The patient was one the medic recognized.
She had been to his home more than a few times. A diabetic who often slipped into hypoglycemic shock, the man's family called medics over once or twice a week.
The medic - a veteran with 13 years on the job, seven of them in Philadelphia - and her partner, a trainee, found the patient passed out in the basement. As they treated him, he started to come to.
And that's when he reached under his pillow and pulled out a gun.
"I'm not going to the hospital," he told the stunned paramedics.
"Run - that's the only thing that was going through my mind: Run," the medic said in an interview with The Inquirer. She pushed her trainee up the stairs and bolted out of the house.
The medic spoke with The Inquirer on condition of anonymity, as the fire department prohibits employees from speaking to the media.
The patient's mother, apologizing, would later tell the medics that their house had recently been robbed, and her son kept the gun for protection. The medic understood. She knew the patient hadn't been in his right mind.
It was just part of the job, she said.
It's a mindset that's prevalent among many in the ranks of the Philadelphia Fire Department's paramedics and emergency medical technicians: in a big city with hundreds of thousands of calls per year and only a few hundred medics, some encounters with patients are bound to be dangerous.
But the stress of such incidents takes a toll on medics, according to a new study by researchers at Drexel University, published earlier this month in the American Journal of Industrial Medicine.
The researchers tracked reported injuries and assaults of medics between 2005 and 2013 in a fire department in a major U.S. city that is unnamed in the paper.
Department sources confirmed that the subject of the study, titled "Expecting the Unexpected: A Mixed Methods Study of Violence to EMS Responders in an Urban Fire Department," is Philadelphia's fire department.
Fire Commissioner Derrick Sawyer said he had not read the study and declined to comment.
The research, led by Drexel professor Jennifer Taylor, found that paramedics in the department had "significantly higher odds" of being injured by patients than their firefighter counterparts.
Fifty-six out of 365 paramedics reported being assaulted by a patient - as opposed to 35 firefighters out of 2,809 - in the eight years scrutinized in the study.
"I have been kicked, punched, bitten, spit on and verbally abused. You name it, I've had it all," one paramedic, part of a focus group of 10 medics interviewed for the study, told Taylor.
But many assaults go unreported, the researchers found.
"Participants rationalized their risk as typical, especially when the patient is elderly, ill, or has a certain medical condition" like seizures or mental health issues, Taylor wrote in the study. "Many participants appeared sympathetic to these types of combative patients and made individual judgments about whether the incident warranted reporting."
The paramedics Taylor spoke with were clearly experiencing high levels of stress, she said. They said experiencing violence on the job had changed them - made them detached and wary of new patients.
"It's always on your mind going forward," one paramedic told Taylor.
And when the researchers asked the medics how the department could prevent such incidents from occurring in the future, two women suggested that paramedics be equipped with Tasers.
"I'm tasing first, and asking questions later," one said.
Taylor said she was "certainly not comfortable" equipping medics with Tasers. But the medics' gravitation to an "extreme intervention" showed the stress they were under on the job, she said.
"The quotes in [the study] are from people who are very stressed and strained, from people who think nobody's got their backs," she said.
Taylor and her team are applying for more research grants to look at fire departments around the country - and come up with solutions to address burnout and stress among medics.
It's an industry that sorely needs solutions, she said - across the country, paramedic units are understaffed, overworked, and at risk. And many end up quitting, leading to high turnover in the industry at large, she said.
According to the study, 900,000 medics in the country treat 22 million patients a year. In 2012, some 2,400 medics around the country were sent to emergency rooms after a violent encounter with a patient.
"We just don't have the supply to meet the demand," Taylor said. "We need to think about how many paramedics and EMS workers we have to meet this need, and what skills they should have."
Andy Thomas, the head of Philadelphia's fire union, said the department should increase staffing on ambulances.
Under the current system, one paramedic drives the ambulance and one treats patients in the back. Thomas said ambulances should carry three medics - one to drive, and two to treat patients while transporting them.
More paramedics keeping an eye on patients, he said, could prevent injuries to medics and make them feel safer on the job.
"We are there to help," Thomas said, but medics can't predict situations where a patient may lash out at them. "All we can do is try to protect ourselves, and it happens very often."
Taylor said giving paramedics tools to help patients in the communities they serve - connecting patients to social services to address underlying conditions like drug abuse and poverty that contribute to poor health - might stem the city's flood of 911 calls and also help medics combat burnout.
"The thing about medics is that if they're out there anyway, and they're seeing this stuff and they're feeling burnt out and stressed - perhaps if we give them the skills to actually do something about it, they'd feel more satisified with their jobs."