EMS response to Tasered patients

[WAS967 97]

The other thread brought something to mind. What EMS agencies around the main EMTBravo catchment have protocols/policies for the treatment of tasered patients? Those that have specific policies/protocols, what do they entail? Do they require ALS ridealong/assessment? Do they require specific treatments/measures?

[Goose 188]

barbs stay in, ALS patient w/ continual ECG monitoring, PD in the bus

[INIT915 1,119]

barbs stay in, ALS patient w/ continual ECG monitoring, PD in the bus

With uncomplicated Taser usage, the Barbs can be (and are) removed by LE in the field. Many PD agencies don't even involve EMS in Taser actions, barring some other co-morbid factors.

[aacofd40 6]

For us:

1. It is an ALS call

2. Barbs stay in and are bandaged accordingly

3. Transport units choice if they want cops in the back or following

Be safe,

[Guest alsfirefighter]

The other thread brought something to mind. What EMS agencies around the main EMTBravo catchment have protocols/policies for the treatment of tasered patients? Those that have specific policies/protocols, what do they entail? Do they require ALS ridealong/assessment? Do they require specific treatments/measures?

We actually have a policy pending that I wrote over a year ago that's just finally going through the process to be approved that falls in line with TASER guidelines. And I developed a Less Lethal Weapons CME for EMS Providers that covers several LL weapons but I focus heavy on TASER. I was trained through the Tac Team I'm assigned to on their operation and studied the medical aspects of them intently and have removed barbs and evaluated persons who have had them deployed on them several dozen times since they've been rolled out in our local PD. They are an extremely safe LESS LETHAL option for LE that is much safer then the other conventional less lethal options, particularly hands on which can cause injury to both perp and officer(s). I even took a full 5 second ride with the last training my local PD did as I was the medical standby for it as a tac medic and I can tell you 1. I will never ever do that again, 2. It is immediately incapacitating, 3. Everyone bounced right back up and other then some minor muscle aches a few hours later it was like nothing was wrong.

barbs stay in, ALS patient w/ continual ECG monitoring, PD in the bus

In most cases there is no need for ECG monitoring, nor ALS intervention and the most favorable time to remove the barbs is as soon as possible after deployment as the area is quarterized and numbed by the electrical output.

TASER has changed their recommendations over the past year due to 1 successful lawsuit after not having one lost in I beleive nearly or over 100 attempts. Bottom line is if a person is going to have an issue they will often show immediate signs of distress or within several minutes of deployment it doesn't happen by magic some 15 mins. to a hour later. Statistically those at risk for issues are those who have excited delerium, prior drug usage and/or multiple taser cycles and if they had a prolonged period of struggle. The energy delivered is well below the cardiac fibrillation threshold and steps down in amps the last 2 seconds of the 5 second cycle. The barbs are not long enough to penetrate organs.

A common policy (not in detail)is:

1. Gain history of situation from PD

2. Gain medical/personal history of patient including substance useage

3. Remove barbs in accordance with TASER guidelines

4. Take set of vitals and repeat within 5 to 10 mins.

5. Any abnormal vitals, get a 12 lead, provide routine medical care, treat any medical condition present and transport.

The single most important piece of the puzzle is to simply observe the patient over a good 10 to 15 minute span once you arrive. There has already been several minutes that has passed if you have been called to PD HQ since deployment.

[FFLieu 70]

Having been one of the unfortunate recipients of a TASER shot while still in the Academy, I can say with some certainty that as long as it's an uncomplicated deployment and the perp wasn't hit with more than 3 5-second rides, then the barbs can come out in the field. EMS should be called in after because it's real easy to have, at the very least, an SNS activation after being TASERed. (And, if the person removing the barbs isn't careful, they can do some damage. I still have a hole in my right butt cheek...lol.)

[JohnnyOV 2]

In FL, it used to be a BLS procedure... not to sure why you would want ALS to ride in someone with 2 minor puncture wounds

Section 400.19: Taser Removal

1. Skill level

1.1. Basic life support (BLS)

2. Physician authorization required prior to performing skill

2.1. No

3. Indications

3.1. Combative patients who pose a potential threat to themselves or to healthcare providers.

4. Contraindications

4.1. Tasers lodged in any portion of the body above the clavicles.

5. Complications/Precautions

6. Procedure

6.1. Apply gentle and in line traction to the probe in order to remove.

6.2. If resistance if felt, stabilize in place and transport.

7. Equipment

7.1. None.

8. EDMCP Contact and Special Considerations

8.1. Contact EDMCP for treatment other than standing orders, dispute resolution or other clarification, as necessary.

8.2. Taser deployment by law enforcement is frequently associated with combative or violent patients. EMS personnel must ensure that there is no underlying medical problem. Patients with an altered mental state, exhibiting highly erratic behavior or breathing patterns, or with suspected substance abuse should be transported to an appropriate receiving facility.

[Guest alsfirefighter]

Good post Johnny. Barb removal is simple..pull skin taught..pull by the probe not the wire at the same angle it went in.

We do not remove if its any shot to the neck/head, genitals and spinal column. We are looking into updating ours with TASER now saying to use caution with deployments to the chest. Only other thing to remember is to ask the officer to remove the cartridge from the device to prevent an accidental discharge.

[WAS967 97]

ALS: Is your protocol a local one or something destined for the county/MAC level?

[Guest alsfirefighter]

ALS: Is your protocol a local one or something destined for the county/MAC level?

Local based on common sense and knowledge of the devices specifications. Otherwise you get the I live in a book that you can't remove penetrating objects. Despite I've removed splinters deeper then the probes go in.

[Goose 188]

The only additional thing i want to add is that the majority of protocols regarding tasered patients seem to be liability driven - hence why PD calls EMS and why EMS agencies have unique protocols pertaining to the subject (remove/don't remove barbs, ALS patient vs. BLS patient, etc).

It may be beneficial for the region to release a position and protocol regarding this.

Edited May 22, 2011 by Goose

[Guest alsfirefighter]

The only additional thing i want to add is that the majority of protocols regarding tasered patients seem to be liability driven - hence why PD calls EMS and why EMS agencies have unique protocols pertaining to the subject (remove/don't remove barbs, ALS patient vs. BLS patient, etc).

It may be beneficial for the region to release a position and protocol regarding this.

I think its something that would need to be addressed at the state level first. Its ridiculous to say you can't remove a simple barb (many PD's do this anyway on their own) because its a "penetrating" object when there are clear suggested protocols on when they should and shouldn't be removed based on scientific evidence. The region will more then likely do like they always do and submit to their over conservatism on it and then we can clog up alerady busy ED's with simple taser cases that could be handled and evaluated right at the PD without the additional cost to taxpayers for a ED visit.

[DDixie 12]

<BR>In FL, it used to be a BLS procedure... not to sure why you would want ALS to ride in someone with 2 minor puncture wounds<BR><BR>Section 400.19: Taser Removal<BR>1. Skill level

<BLOCKQUOTE>1.1. Basic life support (BLS)</BLOCKQUOTE>2. Physician authorization required prior to performing skill<BR>

<BLOCKQUOTE>2.1. No</BLOCKQUOTE>3. Indications<BR>

<BLOCKQUOTE>3.1. Combative patients who pose a potential threat to themselves or to healthcare providers.</BLOCKQUOTE>4. Contraindications<BR>

<BLOCKQUOTE>4.1. Tasers lodged in any portion of the body above the clavicles.</BLOCKQUOTE>5. Complications/Precautions<BR>6. Procedure<BR>

<BLOCKQUOTE>6.1. Apply gentle and in line traction to the probe in order to remove.</BLOCKQUOTE>

<BLOCKQUOTE>6.2. If resistance if felt, stabilize in place and transport.</BLOCKQUOTE>7. Equipment<BR>

<BLOCKQUOTE>7.1. None.</BLOCKQUOTE>8. EDMCP Contact and Special Considerations<BR>

<BLOCKQUOTE>8.1. Contact EDMCP for treatment other than standing orders, dispute resolution or other clarification, as necessary.</BLOCKQUOTE>

<BLOCKQUOTE>8.2. Taser deployment by law enforcement is frequently associated with combative or violent patients. EMS personnel must ensure that there is no underlying medical problem. Patients with an altered mental state, exhibiting highly erratic behavior or breathing patterns, or with suspected substance abuse should be transported to an appropriate receiving facility.<BR>

<BR><BR>We're not just talking about removal of barbs here....you should read the previous posts and learn about the valid reasons why ALS should be strongly considered.<BR>I've had a significant experience with Taser'd patients, and the barbs are the LEAST of my worries.<BR></BLOCKQUOTE>

[JJB531 652]

<BR><BR>We're not just talking about removal of barbs here....you should read the previous posts and learn about the valid reasons why ALS should be strongly considered.<BR>I've had a significant experience with Taser'd patients, and the barbs are the LEAST of my worries.<BR></BLOCKQUOTE>

A tasered patient is not automatically an ALS patient. If there's an underlying condition, especially a history of recent drug use, then you have to consider "excited delerium syndrome", rhabdomyolysis, etc... but the deployment of the Taser does not automatically make the patient an ALS patient. If you've read any of the studies conducted where continual EKG monitoring pre-deployment, during deployment, and post-deployment of the Taser, studies have proven the Taser does not affect cardiac muscle tissue or the electrical conduction pathways. This is another one of those cases where a good history and information gathering techniques will assist in determining whether your patients requires ALS interventions or not.

Edited June 19, 2011 by JJB531

[Guest alsfirefighter]

<BR><BR>We're not just talking about removal of barbs here....you should read the previous posts and learn about the valid reasons why ALS should be strongly considered.<BR>I've had a significant experience with Taser'd patients, and the barbs are the LEAST of my worries.<BR></BLOCKQUOTE>

99% of the time..the barbs are your only concern. Unless its a entry that's within the recommendations for transport...face, groin, spinal column. Again by the time we get to them if they are not in any distress...statistically they are not going to be. And I've had significant experience with TASER persons..and have been TASER'd myself.