Tasers and The Accident and Emergency Department
|Next review: 05/09/2022|
|Copyright© Leeds Teaching Hospitals NHS Trust 2019|
This Clinical Guideline is intended for use by healthcare professionals within Leeds unless otherwise stated.
Management of Patients Presenting to LTHT Emergency Departments After Exposure to a TASER device
Individuals who have been subject to a TASER discharge may be brought to the ED or self-present sometime afterwards. There is little evidence to support robust guidance on the actions required, but the general theme is of symptomatic investigation and treatment only, with a focus on any medical cause or substance use that lead to the deployment of a TASER in the first place, and also on any injuries caused by either the implantation of barbs, or as a result of falling as the charge is activated.
To improve the management of patients who have received an electrical discharge from a TASER device
To provide recommendations for the appropriate investigation and management of individuals who have received an electrical discharge from a TASER device
TASER® conducted energy devices are battery-operated, pistol-like devices and are one of several so-called less-lethal options available to the police that assist them in managing violent and aggressive people and those with other forms of acute behavioural disturbance. In UK practice police use either a TASER X26 or X2. The main difference between these is the barb design
The Faculty of Forensic & Legal Medicine have published background information and advice ‘ TASER: Clinical effects and management of those subjected to TASER discharge’ which offers basic guidance for UK police forces and medical professionals and a discharge advice note for TASERed individuals, but this is not intended to supplant or replace local polices or pathways.
Since the introduction of Conducted Energy Device Systems (CEDs) into British policing in 2003, the devices have been discharged operationally more than 13,000 times. Over this period, there have been seventeen fatalities in which the discharge of TASER CEDs featured as one of the uses of force. In two of these deaths, both of which occurred in 2013, the TASER CED discharge was concluded to have been a causal or contributory factor. One of these cases involved the discharge-induced ignition of petrol. In the other case, the inquest concluded that the TASER CED discharge was one of a number of factors that contributed towards the fatal outcome. The cause of death has yet to be determined in five of the seventeen UK fatalities in which the use of a CED featured. Two of these deaths were in 2014 and three have been recorded to date in 2016.
The Scientific Advisory Committee on the Medical Implications of Less-Lethal Weapons (SACMILL) is aware of two non-fatal serious adverse outcomes in the UK involving police use of the TASER CED. In 2012, a man required defibrillation following the application of 11 seconds of discharge to his chest delivered from a TASER X26. A subsequent High Court ruling in 2015 found the duration of the discharge to be “excessive and disproportionate” and that the police had been
negligent in their failure to obtain timely treatment. More recently, a man was reported to have sustained a serious head injury following discharge of a TASER CED.
Despite the broad range of potential injuries that have been linked to the use of CEDs, the internationally reported incidence of serious injury – as judged by the relatively low number of published clinical case reports – appears to be low relative to the widespread use of CEDs.
Notwithstanding the likelihood of under-reporting in the medical literature, the infrequency of reports of serious injury implies that most uses of CEDs result in unremarkable medical outcome
- Consider The Cause of the Need to Deploy a TASER
Take a detailed history to establish why the TASER was used, what other forms of restraint may have been used and the circumstances of its deployment. Careful consideration should be given to the cause of any patient agitation, be that a medical cause such as hypoglycaemia, an intoxicant or a mental health disorder. Specific but standard investigations and treatments should be targeted at these
- Investigate & Treat Symptoms
In asymptomatic patients there is no need to perform any investigation beyond a physical review that includes cardiovascular, neurological and musculoskeletal examinations. There is no role in for routine Troponin testing, nor is admission required solely because a TASER has been deployed. Targeted investigations resulting from the history and examination may be required eg ECG, Troponins
- Investigate & Treat Injuries
Injuries can result from the implantation of barbs (see below) but in general injuries are related to the ‘semi-controlled’ collapse that TASERed individuals suffer as a result of the electrical discharge. These injuries should be investigated and treated according to standard protocols (eg. NICE Head and Neck CT) Offer simple analgesia for muscular pains
- Barb Removal
Darts that have penetrated the skin may be removed by stabilising the
skin surrounding the TASER® dart and, while firmly grasping the probe, removing it with rapid traction. Ensure that the extracted dart is intact (see figure above).
An antiseptic wipe should be used to clean the skin around the dart exit wound.
Where darts have penetrated or are adjacent to sensitive and/or high risk areas, such as the eyes, ears, nose, mouth, face, neck, genitalia, spine, hands, feet or joints, doctors should use their clinical judgment and if necessary, seek specialist advice on dart removal.
- Special Cases
There is little evidence to support any specific action in special cases however it is considered reasonable practice to make the following recommendations;
A patient with a pacemaker should undergo pacemaker assessment. That is, a pacemaker 'interrogation' should be performed by the Pacemaker technicians.
The potential effects of TASER® discharge on the fetus are unknown, and pregnant women should be referred for specialist obstetric review.
Provide the patient with discharge advice leaflet found here
|Objective:||To provide recommendations for the appropriate investigation and management of individuals who have received an electrical discharge from a TASER device|
|Clinical condition:||Management of Patients Presenting to LTHT Emergency Departments After Exposure to a TASER device|
|Target patient group:||Patients who have been exposed to a TASER|
|Target professional group(s):||Secondary Care Doctors
Secondary Care Nurses
Tertiary care teams
Level C Evidence -. Expert consensus.
The Faculty of Forensic & Legal Medicine advice ‘TASER: Clinical effects and management of those subjected to TASER discharge’
Scientific Advisory Committee on the Medical Implications of Less-Lethal Weapons (SACMILL) Statement on the Medical Implications of Use of the TASER X2 Conducted Energy Device System 30tyh August 2016 (amended 12th October 2016)
EMERGENCY DEPARTMENT EVALUATION AFTER CONDUCTED ENERGY
WEAPON USE: REVIEW OF THE LITERATURE FOR THE CLINICIAN - The Journal of Emergency Medicine, Vol. 40, No. 5, pp. 598–604, 2011
Bleetman, et al, EMJ 2004;21:136-140
LHP version 2.0
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