Taser Barb Removal - ALS or BLS?

[rwik123]

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

 

[MasterIntubator]

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

 

[JJR512]

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.

Be aware that on rare occasions, ECD probes may come into contact with sensitive areas and may require specialty consultation for removal. These would include contacts such as ocular, laryngeal or urethral penetration. Be aware that on extremely rare occasions, TASER probes embedded in the chest have been associated with a pneumothorax (to date, TASER International, Inc. is aware of only one such case). The subject at apparent higher risk for this condition is the extremely thin, asthenic subject with minimal thoracic soft tissue.

Additionally, on rare occasion, a probe tip may become embed into the bone if the area of penetration has a superficial bone surface present (such as anterior tibia, hand, or face). Removal of the probe from the bone can be more difficult but can still be easily accomplished in an emergency department. Occasionally, a small avulsion fracture may result from probe removal in these areas.

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:

1. The barb is not in a critical area.
2. The barb interferes with transport.
3. 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

 

[usalsfyre]

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

 

[Kidquick]

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

 

[MrBrown]

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.

 

[Veneficus]

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.

 

[spike91]

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.

 

[Madmedic780]

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.

 

[nakenyon]

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.

 

[mycrofft]

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.

 

[lowrider_62]

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.