Emergency medical technician Antonio Carlos Maia doesn't ride shotgun in his ambulance. He rides assault rifle. The scuffed barrel of his M-16 juts out of the passenger-side window, locked and loaded with a magazine full of bullets.
Just in case, a 9mm pistol is holstered under the bottom edge of his bulletproof vest. The ambulance driver and two additional EMTs riding in the back have their own guns, meaning that this military police medical crew in Brazil can -- and sometimes does -- spray hundreds of rounds at anyone who poses a threat during a rescue run.
"We only shoot to intimidate the gangs or to protect ourselves," said Maia, 36.
For years, violence has been an inextricable part of life in Rio's slums, known as favelas. Drug gangs, heavily armed militias and the police all fight for territory. The police say they have to take an aggressive stance against the gangs, and the gangs cite a long list of documented police abuse and corruption to justify their will to fight. Ambulance crews sometimes get in the middle of the action.
Some debate whether it's proper to apply the word "war" to the favela violence, but Maia and the other members of his crew dismiss such discussions as semantic nonsense. There is no question it's a war, they say. Tell the paramedics that under the Geneva Conventions, ambulance units are supposed to be noncombatants, and they suggest that whoever wrote those rules never rode through a Rio slum in a white ambulance with the words "Military Police" written on the side.
"It's frightening," said Andre Luiz Vidal, who has commanded the ambulance crews for eight years. "Sometimes the paramedics need to lie down in the back of the ambulance with the patient because people are shooting at us. So we have to defend ourselves."
All of the paramedics are military police officers who spent years fighting the gangs in the favelas and have since completed 14-week EMT training courses. As paramedics, they offer their services mostly to other military police officers, though they will make an occasional exception for civil police officers. Civilian ambulances rarely venture into most favelas and never go into some.
Hundreds of victims
Maia's ambulance corps, the Special Lifesaving and Rescue Group, was created in 1996, when 95 military police officers were shot and killed in Rio. Things haven't improved -- about 100 police officers are killed every year, along with thousands more gang members and favela residents. An unofficial Web site -- www.riobodycount.com.br-- this year began compiling local news media reports to keep track of the number of victims in the favela conflicts; this week it reported that 536 people had been killed since Feb. 1.
One recent afternoon, Maia's four-man crew was waiting for calls at a base downtown. The complex, built in 1906, shows its age in the scarred wrought-iron balconies, peeling paint and faulty clock tower. Two more crews were at other bases in the city.
"No calls yet today," said Alex Pereira Correa, 30, who has been an EMT here for seven years. "There was one, but one of the other bases took it because it was closer."
So instead they prepared the ambulance. The bandages were packed, the IV bags laid out, the heart monitor ready, the neck braces easily reachable, the stretcher secure, the guns loaded. Rodrigo da Silva de Castro, 26, stowed the medical kit he carries on calls. The bag makes it difficult for him to protect himself, so he demonstrated how he and the others would run to a victim: Maia and Correa would run alongside him, sticking close, with their M-16s in position.
They found themselves in exactly that situation a few weeks ago, after they had rolled out of the battalion complex on a call, Maia said. They were accompanied by other officers who provided cover, but as they drove, an officer in the trailing vehicle was shot and wounded. The paramedics ran to attend him in their three-man formation, with the driver following, also on foot, to provide more cover.
"We were shooting the whole time we were running to him," Maia said, recalling the firefight.
Correa said he squeezed the trigger of his rifle 12 times. He and the others continued to take fire as they sped away.
Protection or intimidation?
The ambulance corps has been asking the government for armored vehicles similar to the armored personnel carriers, or caveiroes, that special forces police here use to raid the favelas. They are black, tanklike vehicles, usually with the menacing image of a skull pierced by a dagger painted on the sides. Caveiroes are designed to be feared, and they are.
One, a mass of bullet-riddled metal, sat in a parking lot about 100 yards from Maia's ambulance. Half of the reinforced windshield was spiderwebbed from a head-on bullet, as were three slitlike side windows. A headlight had been shot out. The large front bumper was battered from ramming through makeshift roadblocks that favela residents sometimes erect to try to keep the caveiroes -- and their gun-wielding occupants -- out of their neighborhoods.
Though Amnesty International and other human rights advocates have complained that the caveiroes are used to intimidate communities and kill indiscriminately, these paramedics dream of having one of their own. They want to retrofit it to provide the same services as any other ambulance, Vidal said. It would offer the paramedics -- and their patients -- more protection against gangs they say are conditioned to attack the police, whether or not they wear a medical shield.
"We always try to keep the thought in our minds that we are here to help the injured," Vidal said. "Of course we feel nervous, because it's like being in a war zone. I have international standards I have to follow, but the criminals don't have any standards at all. We can't throw grenades at them, but they can throw them at us."