# Taser Barb Removal - ALS or BLS?



## daysleeper47 (Mar 1, 2011)

I'm curious to know if taser barb removal is an ALS or BLS skill in your jurisdiction and why? Does it depend on other factors which level of care is applied?


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## TransportJockey (Mar 1, 2011)

I don't see how it can be ALS... Hold skin down and pull the barb out. The only time I've not done a field removal was if it was stuck in the face or genitals. Otherwise our basics (and when I was a basic in NM, and I believe CO too) can yank em.


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## Veneficus (Mar 1, 2011)

The skill of removing the barbs is BLS.

Whether a person needs to be assessed by a higher level of care for potential complications is a matter of debate.


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## emt_irl (Mar 1, 2011)

currently in ireland, barb removal itself is an ils skill


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## jjesusfreak01 (Mar 1, 2011)

In Wake County NC, its a Tac-Medic skill...don't even ask...


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## usalsfyre (Mar 1, 2011)

The PD/SO officers do it themselves around here.


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## socalmedic (Mar 1, 2011)

here it is an MD skill, no joke, we transport...


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## rwik123 (Mar 1, 2011)

jjesusfreak01 said:


> In Wake County NC, its a Tac-Medic skill...don't even ask...



Is part of the protocol also to don ultra black tactical nitrile gloves with shemagh tied around the neck?


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## usalsfyre (Mar 1, 2011)

rwik123 said:


> Is part of the protocol also to don ultra black tactical nitrile gloves with shemagh tied around the neck?



Don't forget the baseball cap, Oakleys, and $5,000 dive watch...


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## HotelCo (Mar 1, 2011)

socalmedic said:


> here it is an MD skill, no joke, we transport...



In the area you're in, it doesn't surprise me...


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## LucidResq (Mar 1, 2011)

Veneficus said:


> The skill of removing the barbs is BLS.
> 
> Whether a person needs to be assessed by a higher level of care for potential complications is a matter of debate.



Yup... I'm gonna agree here. If it's just a superficial skin-injury... BLS... clearly. 


If there's any kind of sign of potential complications.... clearly better to have ALS assess and transport. We are dealing with... :wacko: electricity!!! Rare, but it happens.


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## DesertMedic66 (Mar 1, 2011)

socalmedic said:


> here it is an MD skill, no joke, we transport...



i was told that too. the reason they gave me for that was "it is a penetrating object so we dont remove" i dont know if thats true or not but usually the police will have (accidently) removed the barbs.


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## nakenyon (Mar 1, 2011)

firefite said:


> i was told that too. the reason they gave me for that was "it is a penetrating object so we dont remove" i dont know if thats true or not but usually the police will have (accidently) removed the barbs.



Same here. Used to be a BLS skill, then all of a sudden it became a penetrating object issue at some point and now it's a transport. PD rarely calls us for it anymore and if they do we are generally told to go available when they find out it requires a transport.


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## Icenine (Mar 1, 2011)

LEO's remove them here.  They are "specially trained" in the removal, which in most cases equates to a foot to the area and a quick yank.


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## Akulahawk (Mar 2, 2011)

Barb removal, whether or not it's via tazer or a fish hook is basically a BLS skill. About the only way to (relatively) painlessly remove them is to do a local anesthetization... or ice. Another method of pain control uses electricity, but I doubt anyone would be all that crazy about getting _more _electricity applied to them after riding the lightning. If it's in a sensitive area, transport to an ER that can anesthetize the area to allow for a more controlled removal.

Once the barbs are disconnected from their power source, there's no shock danger. 

Of course the quickest option is to just simply yank 'em out and deal with the minor penetrating wound.


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## Aidey (Mar 2, 2011)

BLS for just barb removal. 
ALS for barb removal and eval before being carted off to jail to be evaluated by the jail nurse.* 
Transport if the barbs are in sensitive places. 

*It is well known by all the local LEO, EMS and ED people that the jail nurses are a pain in the arse to deal with, so the LEOs will run busted up patients by us first to see if the jail nurse is going to kick them out or not. If we don't think the jail nurse will take the patient about 3/4 of the time the LEOs end up driving the guy to the ER themselves.


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## bradford (Mar 2, 2011)

socalmedic said:


> here it is an MD skill, no joke, we transport...



This holds true for where I used to work. I only encountered this one time, but we actually transported this patient to a trauma center. I don't remember if it was because of protocol or patient request, though.


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## daysleeper47 (Mar 2, 2011)

Thanks for the great comments. It is currently an ALS skill in our area. As a Basic, aside from the electricity that just flew through their body, I wonder why. I'm in the process of discovering that on my end, but wanted some outside perspective.


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## AndyK (Mar 2, 2011)

Pretty much BLS here too, treat as per fish-hook with the additional initial step of:

Remove german shepherd from victims arm/leg/posterior*

*Note: this step should be completed by the person that released said german shephard from it's lead and should not by attempted EMS personell!! B)


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## DesertMedic66 (Mar 2, 2011)

AndyK said:


> Pretty much BLS here too, treat as per fish-hook with the additional initial step of:
> 
> Remove german shepherd from victims arm/leg/posterior*
> 
> *Note: this step should be completed by the person that released said german shephard from it's lead and *should not by attempted EMS personell!!* B)



shucks we cant transport with the dog still clamped down? sucks for that guy if its real tho: German Shepherd bite, Tazered, lets go for the trifecta with pepper spray haha


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## rwik123 (Mar 2, 2011)

firefite said:


> shucks we cant transport with the dog still clamped down? sucks for that guy if its real tho: German Shepherd bite, Tazered, lets go for the trifecta with pepper spray haha



Or the 5'ski with an additional beanbag round to the abdomen and both femurs fractured from the ASP


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## MasterIntubator (Mar 3, 2011)

In our area, its a BLS skill.... but the pt is evaluated on the ALS level.  Before incarceration.... VS, ECG and temperature.


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## JJR512 (Mar 3, 2011)

Why not ask the manufacturer of the TASER what should be done with the barbs? Actually, someone's already done that for you:



> Deployed Probe Removal & Treatment
> 
> If the Deployed Probe method has been used and the probe(s) pierce the skin or other body organ, the ECD probes should be removed if they are still embedded in the skin or organ. To remove the probes stabilize the surrounding tissue with one hand and provide inward pressure for counter-traction. With your other hand, take hold of the visible metal part of the probe and yank firmly straight back - there will be resistance due to the barb but the probe will come out. If embedded in bone, removal may require the use of a pair of pliers, Kelly’s, or similar tool to grab the visible metal part. The removal sequence is the same. Anesthesia is almost never required due to the electrocautery effect of the surrounding tissue. Do not attempt to pull the probes out by the wires, the wires are very fragile and will easily break if tugged. The areas affected should be disinfected and bandaged if necessary.
> 
> ...


From http://www.taser.com/research/Pages/PhysicianFAQs.aspx

In Maryland, according to my former EMT instructor (Paramedic, county EMS officer, etc.), an EMT-B can remove the barbs if *all three of the following are true*:


The barb is not in a critical area.
The barb interferes with transport.
The EMT-B is an approved tactical medic operating under tactical protocols.

Effectively, this means no Maryland EMT-B can remove taser barbs at all, for the simple reason that no tactical program in the state has EMT-Bs in their program, according to my instructor.

Actually I'm repeating myself here... http://www.emtlife.com/showthread.php?t=20300


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## usalsfyre (Mar 3, 2011)

Apparently there's a lot of medical directors who are frightened by fishhooks (including mine, I went back and looked out our guidelines and Taser barbs are considered an "impaled object" :facepalm


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## Kidquick (Mar 3, 2011)

Where I work PD is trained to remove them, unless they are in the face, neck, or breast, then we transport.


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## MrBrown (Mar 3, 2011)

Any Ambulance Officer can remove a taser barb, no specific assessment or intervention is needed unless clinically indicated, and transport is generally not necessary.

Take it out and leave them with the Police.


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## Veneficus (Mar 3, 2011)

usalsfyre said:


> Apparently there's a lot of medical directors who are frightened by fishhooks (including mine, I went back and looked out our guidelines and Taser barbs are considered an "impaled object" :facepalm



I understand where this point of view comes from, I am not really sure what I think of it.

In general, when an impaled object penetrates deep fascia, irrigation and prophylactic antibiotic is usually indicated. 

In my experience, rather think people or medium built people where the barb penetrates parts of exposed skin with minimal fat deposite, this level of penetration can be seen. To the level of being expected. 

I would bet it has happened to somebody somewhere, but I have never seen a fishhook penetrate deep fascia myself. I am also willing to bet if it does occur, medical treatment isn't saught by the victim anyway unless there is some complication days later.

Impaled objects and the EMS treatment of, is something that I think warrents looking at again. But alas, the prpose of EMS training is hell bent on simplification. apparently asking said healthcare providers to evaluate wounds is not in the program. 

The jury is also still out on the potential pathologic effects of the electrical exposure, so many docs I am sure want to have a look at the person anyway.

It was so much simpler when the cops just beat people down or shot them. All these new fancy toys make life too complex.


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## spike91 (Mar 3, 2011)

With NYS as a BLS provider I technically can't remove them. Haven't been faced with it yet, honestly I'd probably call med control and see what the docs want me to do. I honestly don't think its worth a transport assuming its not a hit in a critical region and they're asymptomatic otherwise. But not putting my tags on the line for something stupid like that.


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## Madmedic780 (Mar 4, 2011)

my area has purposely left it unmentioned in the protocols and leaves it to the individual EMT/Paramedic/Officer to decide who does the removing.


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## nakenyon (Mar 4, 2011)

Silverman780 said:


> my area has purposely left it unmentioned in the protocols and leaves it to the individual EMT/Paramedic/Officer to decide who does the removing.



Purposely unmentioned. That'll work until a company gets sued because an EMT yanks the barbs out of somewhere they shouldn't and causes damage.


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## mycrofft (Mar 5, 2011)

*Blanket rules and blanket discussion of medical condition equals screwups*

They told us as jail nurses that we could remove the barbs with a quick yank, yet we were not allowed to remove any other foreign object no matter how small. Someone asked "What if it's in his (male genitalia) ?".  Male medical director instantly reversed himself. No pun intended.

Back to basics:
1. Visualize the area.
2. Treat appropriately.

The electricity thing is like being afraid a post-defib pt still harbors an electric charge. If VS shows cardiac problems, burns, or whatever from whatever source, then you treat.


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## lowrider_62 (Mar 6, 2011)

In Ontario, Canada, it's an ALS skill.

Taser must be deactivated
Pt. must be greater or equal to 16 y/o
Must have consent from pt. and officer to remove it
Must not be above clavicles, nipple or genitals.


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