Subject: Taser Treatment
Section 1 - Purpose
It is the intent of this policy to outline and define the steps that are necessary for all Personnel to carry out when they encounter a patient that has been subdued with a TASER. Typically it is not the “TASER” event itself that leads to the need for transport to the hospital, rather the events that have led up to the individual being tased, such as “EXCITED DELIRIUM”.
Section 2 – Scope
These procedures apply to ALL Operations personnel.
Section 3 - Responsibility
All Fire-Rescue Personnel will treat and transport any patient from whom Fire-Rescue has been requested. The signs and symptoms that the patient is exhibiting, as well as possible occult injuries that may have occurred while the individual was being subdued, will guide this treatment. At minimum all “TASER” patients will receive the following:
a. A complete physical examination (including glucose).
b. Oxygen as needed.
c. Cardiac Monitor.
d. C-Spine precautions, unless a cervical spine injury can be definitively ruled out.
e. Intra-venous line as needed
In the event that a patient resists, these actions will be carried out with the safety of the crew in mind. A police officer will be required to accompany the patient in the rescue during transport.
Section 4 - Procedure
A. Establish that the scene has been secured and determine what events have led up to the individual being subdued with a TASER.
B. Determine how many 5-second cycles of energy that the individual has been exposed to and document this in the patient care report.
C. In the majority of TASER incidents it will not be possible for EMS personnel to determine the extent of injuries that the patient has sustained. While it is unlikely that the Taser itself will have caused an injury, there is a high likelihood of an occult injury secondary to the event. Examples of this would be fall injuries as a result of incapacitation; pathological fractures secondary to muscle contraction and impending demise secondary to a state of excited delirium.
D. The following is a systematic six step approach to responding to and evaluating patients who have been tased:
1. Find out what happened before the patient was tased – this will provide you with information regarding the patient’s mental status prior to being tased and potential for any future decompensation. Consider any report of extreme behavior prior to the tasing as significant, regardless of the patient’s current presentation.
2. Approach the patient with caution – The Taser can dramatically change a patient’s outward presentation. Assume that any patient who has been tased is violent and dangerous.
3. Complete a thorough physical exam and history - the exam should include a basic neurological exam, skin signs, pupil assessment, a complete set of vital signs and a close look for traumatic injuries. All tased patients are fall patients until proven otherwise.
4. It is not uncommon to find minor first-degree burns located between the Taser probes. Anything that looks worse than minor sunburn should be considered abnormal. Incontinence should be considered abnormal. Chest pain, shortness of breath, vomiting and headaches should all be treated according to the appropriate medical treatment protocol.
5. Consider the potential for sudden unexpected death syndrome – The vast majority of patients that have died in police custody have shown signs of excited delirium.
Excited Delirium - is a state in which a person is in a psychotic and extremely agitated state. Mentally the subject is unable to focus and process any rational thought or focus his/her attention to any one thing. Physically the organs within the subject are functioning at such an excited rate that they begin to shut down. These two factors occurring at the same time cause a person to act erratically enough that they become a danger to themselves and to the public. This is typically where law enforcement comes into contact with the person.
Essentially three things bring on excited delirium:
· Overdose on stimulant or hallucinogenic drugs
· Drug withdrawal
· Mental subject who is off of medication for a significant amount of time
Some of the symptoms of excited delirium are as follows:
· Bizarre and aggressive behavior
· Dilated pupils
· High body temperature
· Incoherent speech
· Inconsistent breathing patterns
· Fear and panic
· Profuse sweating
Another key symptom to the onset of death while experiencing excited delirium is “Instant tranquility”. This is when the suspect has been very violent and vocal and suddenly becomes quiet and docile while in the car or sitting at the scene.
6. Consideration During Transport – Be very consentience of patients whom exhibit one or more of the following:
· Evidence of excited delirium prior to being tased.
· Persistent abnormal vital signs.
· History or physical findings consistent with amphetamine or hallucinogenic drug use.
· Cardiac History.
· Altered level of consciousness, or aggressive, violent behavior, including resistance to evaluation.
· Evidence of hyperthermia
· Abnormal subjective complaints, including chest pain, shortness of breath, nausea or headaches.
7. Removing of probes – Removing of probes will not be performed by fire-rescue personnel. In the event that the probes are still embedded upon arrival, the probes will be treated as an impaled object and treated according to the appropriate medical protocol.
8. In order to transport the patient it will be likely that the wires to the probes need to be removed. This can be done by simply cutting them with a pair of trauma sheers.
In the event that the probes are removed by the police officer, the probes should be treated as a contaminated sharp. The probes can be stored in the Taser cartridge in the absence of a sharps container.
Whitehead, Steve, NREMT-P, After Shock, A Rational Response to TaserStrikes, JEMS, May 20-05, Vol 30, No. 5 Glendale Police Department, Excited Delirium, November 2003. DGG Taser, X-26 Taser Specifications, 2005.