ECW/Taser Patient Management

[EpiEMS]

How are you managing Tased/ECW'ed patients?

Must they be transported? Do they necessarily require an ALS assessment?

I ask as I not infrequently interact with patients that are in custody, but haven't yet seen a Tased patient (perks of the suburbs, I guess).

My protocols are quite specific, and note that LEOs should generally be able to remove the probes, but should activate EMS when:
"The probe is embedded in the eye, genitals, or bone. Seizure is witnessed after Taser application. There is excessive bleeding from probe site after probe removal. Cardiac arrest, complaints of chest pain, palpitations. Respiratory distress. Change in mental status after application. Pregnancy"

They also state quite explicitly that :"Current medical literature does not support routine medical evaluation for an individual after Taser application." I love the reference to evidence, and I found some myself, but I am curious what the policy is throughout the country (and world).

If I were Tased, I know that I'd probably want an ED eval - would you?

 

[VentMonkey]

Ep, what's ECW? As far as how we handle them, case specifically. Most of the times LE asks for us as an "unknown medical aid". We can't remove them, if the patient is absolutely adamant about being evaluated at the ED via ambulance prior to incarceration then by all means that's their right, unless LE is adamant that it isn't; either way someone's signing my refusal or they're going. I can't imagine they feel great. @NysEms2117 where ya' at, bud?

 

[agregularguy]

Ep, what's ECW? As far as how we handle them, case specifically. Most of the times LE asks for us as an "unknown medical aid". We can't remove them, if the patient is absolutely adamant about being evaluated at the ED via ambulance prior to incarceration then by all means that's their right, unless LE is adamant that it isn't; either way someone's signing my refusal or they're going. I can't imagine they feel great. @NysEms2117 where ya' at, bud?

ECW would be Electrical Control Weapon.
And my protocols are pretty much the same as OP's. LE is the only ones who can remove the prongs, otherwise the MA protocols are literally "Routine patient care, 2. Ensure wires are disconnected from weapon. 3. Secure probe with padded dressing. 4. Transport to ED"

 

[EpiEMS]

Ep, what's ECW?

For inclusivity, I added ECW to my call for info on Tasers. ECW stands for electronic control weapon. An alternative term is CEW, or conducted energy weapons. And yet another is ECD, electronic control device.

Most of the times LE asks for us as an "unknown medical aid".

Interesting, we're usually given more context on this by our dispatch - like "subject in custody complaining of difficulty breathing"* or, I imagine, would be told "subject in custody was non-compliant and a taser was deployed."

We can't remove them, if the patient is absolutely adamant about being evaluated at the ED via ambulance prior to incarceration then by all means that's their right, unless LE is adamant that it isn't; either way someone's signing my refusal or they're going. I can't imagine they feel great.

Ok, I am surprised by that - so can LEOs remove them? Or do you have to transport?

Paging our resident LEO (@NysEms2117 )!

You know, with all the CYA we have to do, I am surprised that an ALS assessment isn't required, and that ALS isn't required to do a 12-lead, despite the evidence saying it's not usually needed.


*i.e. incarceritis in the cases I've seen, not that I don't use the opportunity to do a full workup (any excuse to listen to lung sounds is a good one!)

 

[Handsome Robb]

I've been tased. No I didn't deserve it it was a demonstration.

It sucks but as soon as the energy is stopped it goes away immediately.

Ours are basically "if LE wants them evaluated take them to the hospital". We can remove probes so long as they're not somewhere sketchy.

The thing about treating these patients is use your head. Young, healthy male I'm not going to use a bunch of tools and what not, just going to be a quick vital signs and conversation.

Elderly person or person with a cardiac history in going to be more thorough.

Be a clinician not a technician.


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[VentMonkey]

For inclusivity, I added ECW to my call for info on Tasers. ECW stands for electronic control weapon. An alternative term is CEW, or conducted energy weapons. And yet another is ECD, electronic control device.



Interesting, we're usually given more context on this by our dispatch - like "subject in custody complaining of difficulty breathing"* or, I imagine, would be told "subject in custody was non-compliant and a taser was deployed."



Ok, I am surprised by that - so can LEOs remove them? Or do you have to transport?

Paging our resident LEO (@NysEms2117 )!

You know, with all the CYA we have to do, I am surprised that an ALS assessment isn't required, and that ALS isn't required to do a 12-lead, despite the evidence saying it's not usually needed.


*i.e. incarceritis in the cases I've seen, not that I don't use the opportunity to do a full workup (any excuse to listen to lung sounds is a good one!)

It depends with regard to transport. Oftentimes LEO's may not be exactly willing to uncuff a tased perp (reasonably so I'm sure). Obtaining accurate V/S and an assessment can prove challenging.

This, like so many other calls we run on requires mad verbal judo de-escalation skills, both for the perp, and the LEO as I'm sure both are full of adrenaline, and emotions.

Do they NEED to go? Well, that all depends. I'd be more concerned with what led up to them being tased? Are they on some wonky designer drug? Did they swallow a whole bag of dope before we got there? Stuff like that puts my feelers up and tells me they should probably get a line, maybe some fluids, and/ or sedatives.

Things of that nature I'd be convincing LE to put them on the gurney so we can transport them, yes ALS, for "everyone's piece of mind" (yes, I use that phrase quite often with calls of this nature).

As far as needing an ALS assessment on a otherwise rather benign taser deployment, meh, I can think of a good number of reasons they can be taken to the ED via LE who can then always call for us from wherever they are in relation to said ED if something happens to their perp en route.

I happen to think the whole "hey, can you guys check them out" is more often than not a cop out (pun intended) to cover their own hides that opens us (EMS) up to needless liability issues, not to mention ties up a unit oftentimes for low-acuity, and/ or no real acuity.

A good assessment, ALS or BLS should suffice IMO. If it's in LE's protocols to call for medical after every taser deployment though, so be it.

 

[VentMonkey]

My protocols are quite specific, and note that LEOs should generally be able to remove the probes, but should activate EMS when: The probe is embedded in the eye, genitals, or bone.

I've been tased. No I didn't deserve it it was a demonstration.

Sorry, couldn't help it...

...carry on.

 

[EpiEMS]

The thing about treating these patients is use your head. Young, healthy male I'm not going to use a bunch of tools and what not, just going to be a quick vital signs and conversation.

Elderly person or person with a cardiac history in going to be more thorough.

Be a clinician not a technician.

Thanks, Robb, that's sensible - I try to pay attention to my "uh oh" detector for high-risk types of patients, and I think that it would make sense for me (a BLS provider) to consider ALS on those folks, but for the bulk of incarcerated patients (or not), a good BLS assessment should be enough (V/S, physical exam, BGL).

@VentMonkey, what you said makes good sense to me - I want piece of mind, so, like Robb said, a high-risk patient should get a higher-level assessment.

 

[NysEms2117]

I didn't read anything except EPI and vents first post. Technically LE can remove it, if it was a successful control(prongs hit in a big hunk of flesh where we were aiming). However, look at when tasers, ECW's, pepperballs, beanbags and any other less than lethal force resources are used... Generally for me, on the run, and moving. What I do is i remove the cartridge from my taser gun, then i put the block(part that is in my taser gun**not the prongs** in the person whom i tased sock or pocket (leaving the prongs in) this is ofc after all the handcuffing and searching goes on. After i know everything is safe, i ask them if they want the ambulance to come, 90% of the time they delay going to state prison so they say yes. I wait for the medics to come, tell them what happened, they do their basic rundown at which point i then remove the prongs when they say "hey guy can we not have the big metal prongs in this persons back". I can count on one hand the amount of times i have uncuffed somebody i used any sort of force on to get evaluated. Part of the reason i dont take the prongs out is because i can put the block back in and tase them again. I also do not remove any complex prongs, i've never had one, but i would go with the medics in the ambulance to the ER and do all that jazz since i wouldn't remove.

As parole i do not have to call after, but in parole i build a certain courtesy with my parolees, and ask.
Again i am a parole officer(not police officer), so i've never tased somebody with a cardiac condition, or a pacemaker because i know the health issues of my parolees.

**some officers leave the block in and leave the taser on the ground while the suspect is subdued(cuffed) and they will uncuff when the medics are doing evals but the taser is still "hot"--- meaning it's not actively producing shock, however one button means it will be** this is for safety reasons.
I have also been tased with prongs, not handheld... Once they are in it's really not that painful.

Anything else feel free to ask idk if i answered what you wanted.

 

[DrParasite]

You know, with all the CYA we have to do, I am surprised that an ALS assessment isn't required, and that ALS isn't required to do a 12-lead, despite the evidence saying it's not usually needed.

As we transition to EBM, and get away from "well, this could happen, so just in case, we need to do this" I will ask why does the person need a 12 lead, if the evidence says it's not needed?

It is my opinion that this is really a LEO matter, not an EMS one.

I happen to think the whole "hey, can you guys check them out" is more often than not a cop out (pun intended) to cover their own hides that opens us (EMS) up to needless liability issues, not to mention ties up a unit oftentimes for low-acuity, and/ or no real acuity.

A good assessment, ALS or BLS should suffice IMO. If it's in LE's protocols to call for medical after every taser deployment though, so be it.

I've been to too many calls where we were called to CYA for the officer.... one such time where the prisoner wanted to go to the hospital (and we bleeding), and the officer said, quite simply, "no your not."

Just because it's in LE's protocols, doesn't mean EMS should have to handle it. After all, if we can't remove taser probes, all we will be doing is taking the person to the hospital... can't that be done in the back of a cop car as it can in an ambulance?

And my protocols say the same the same thing that EpiEMS's do; LEO put them in there, they should be able to remove them, unless it's in a sensitive area.

 

[VentMonkey]

Just because it's in LE's protocols, doesn't mean EMS should have to handle it. After all, if we can't remove taser probes, all we will be doing is taking the person to the hospital... can't that be done in the back of a cop car as it can in an ambulance?

Personally? I agree, but what I meant was more so if they have no way around it. I'm not a lawman, I don't know laws like they do, but I do know that apprehended or not, these perps/ patients may still have a right to be evaluated.

If the LEO deploying their taser to such a patient works for a department that requires they offer an ambulance specifically there isn't much I can do, so why fret I figure.

Now again, the typical "let-them-check-you-out" for a number of reasons from taser deployment, to pepper spray, to any lame reason in between that I've seen LE "call for medical" I would agree, can, and does get a bit ridiculously old.

This is something that could probably be discussed endlessly, as most LEO's severely lack the insight, education, or training to realize what level of medical attention their suspect needs, and whether or not it can wait; some are pretty good about, but are often ex, or current EMS. It is part of the "safety net" problem we face. I've literally had them laughing as they walked away from our unit with a "they're your problem now" attitude; I'm sure we all have.

DrP again, I agree more often than not it should be their problem, and I've had my fair share of run-ins with LE on scene of calls where it's a blatant pawn off.

As I do this longer I find myself getting better at when, why, and where to pick and choose my battles with them though.

 

[DesertMedic66]

We don't have a policy for them. If they or the officer wants to go to the ED by ambulance then we take them. We also don't have anything that says we can remove them, however a doctor at one of our hospitals said "go for it" as long as it is not in a highly vascular area. We will put the patient on a 4-lead even though the risk of the tazer doing anything to the heart is not very likely (but still may happen).

 

[EpiEMS]

As we transition to EBM, and get away from "well, this could happen, so just in case, we need to do this" I will ask why does the person need a 12 lead, if the evidence says it's not needed?

Absolutely fair - it's just those folks who aren't asymptomatic, awake, and alert who may benefit from further assessment (e.g. a 12-lead). Heck, I might even get an ALS assessment if it's a "prolonged" use of a taser (though this would probably be covered by the other qualifications I stated).

We will put the patient on a 4-lead even though the risk of the tazer doing anything to the heart is not very likely (but still may happen).

Is this for all tased patients, or just those who need something removed?

 

[Jim37F]

Our County policy for "Conducted Electrical Weapons" says:
PRINCIPLES:
1. Safety is the first priority in any situation involving the use of a conducted electrical weapon (CEW), trade name Taser®. Law enforcement should secure the scene and ensure the safety of EMS personnel before the patient is assessed or treated.
2. Aggressive or violent behavior may be symptomatic of medical conditions such as head trauma, alcohol or drug related problems, metabolic disorders, stress or psychiatric problems.
3. Concurrent intoxication with cocaine, methamphetamine, phencyclidine (PCP), or other stimulants is common among those subdued by law enforcement with electrical weapons.
4. Physical assessment should include evaluation for any potential injury that may have occurred as a result of the use of a CEW.
5. Paramedics cannot medically clear CEW patients for booking by law enforcement.

GUIDELINES:
1. Do not remove CEW barbs, probes or darts unless they interfere with the patient’s airway, for life-saving measures, or the individual cannot be safely transported with the barbs in place.
2. Complete a thorough physical assessment for all patients who have sustained the use of a CEW.
3. Maintain a high index of suspicion for traumatic injuries (i.e., sustained from fall) as a result of the deployment and discharge of the CEW.
4. Paramedics shall make base hospital contact and transport in accordance with Reference No. 808, Base Hospital Contact and Transport, and Reference No. 502, Patient Destination.
5. Documentation on the EMS Report shall be in accordance with Reference No. 606, Documentation of Prehospital Care.

Of course I've ran calls where the medics checked out the guy, and let PD remove the barbs and take them themselves so yeah lol

 

[VentMonkey]

@Jim37F, do they really make base, and/ or follow up every time? I'm curious.

 

[Jim37F]

Nope they'll determine BLS and ship it usually, or let the cops take it, unless the vital signs are wonky. Then again I actually haven't been on a tased pt in a while, and that was with another non LACoFD dept (a South bay dept that thinks they're in Orange County cuz they insist the ambulance drives to every call code 2 while they send a BLS engine + ALS Rescue squad code 3....who's newest squads are Type 1 Freightliner ambulances bigger than some brush trucks, yet still use us for transport lol) and they had us sit in the right while they checked out the guy on the back seat of PDs car, and then declared him good to go with the boys in blue and we cleared lol

 

[MMohler]

This thread just reminds me of all those cops episodes where I am dying laughing because of all the horrendous and absurd noises people make. Even just watching that almost and if not every time a taser is deployed they roll fire/medics to check the guy/girl out. Definitely think it is a CYA situation for police but an excuse MOST of the time to delay jail. Either way it definitely makes for a good laugh.

 

[VentMonkey]

This thread just reminds me of all those cops episodes where I am dying laughing because of all the horrendous and absurd noises people make. Even just watching that almost and if not every time a taser is deployed they roll fire/medics to check the guy/girl out. Definitely think it is a CYA situation for police but an excuse MOST of the time to delay jail. Either way it definitely makes for a good laugh.

10 years from now at 4 a.m. let us know how funny it is...

 

[MMohler]

10 years from now at 4 a.m. let us know how funny it is...

For now I will stay positive lol

 

[VentMonkey]

For now I will stay positive lol

Oh, I'm not saying I encourage burn out, but 10 years from now on your umpeenth call such as this when your bones hurt a little more, you've been running all day, and/ or a higher acuity call drops right around the time you go on scene it's hard to find them humorous.