Physical Restraint Methods

1. Physical Restraint Methods Police may need to or have already deployed an ECD to subdue the patient. It may be more appropriate to have police physically restrain patient, especially when the patient is violent or has suspected weapons. Physical restraint by EMS should always be a well planned occurrence & involve PD if possible.

2. When ECD’s are Deployed… • ECD – Electronic Control Device • Used to propel wires or direct contact to conduct energy to affect the sensory & motor functions of the nervous system. • Motor • Sensory CNS Sensory Motor

3. TASERs 101…

4. Electricity 101Volts IncapacitateAmps Kill • When the energy from a TASER is traveling across the body the peak voltage drops to 5,000 V. • There is an average of 3.6 milliAmps discharged into the human body

5. TASER Facts: Low Average Current 110 V. Wall Outlet 1.0 A Christmas Tree Bulb 0.0036 A Taser Output

6. Electricity 102The electricity needs to travel to work. • Electricity must be able to flow between the probes of the electrodes • It follows the path of least resistance • The greater the spread of electrodes, the greater the effectiveness. • Electricity will not pass to others in contact with the subject, unless contacting between the probes.

7. Facts Pacemakers & Internal Defibrillators are not affected Defibrillators send 800 times stronger impulse In study’s, blood pressure and heart rates were unaffected when energy was sent directly over the heart.

8. Facts TASERS work on virtually EVERYONE 650,000 + Volunteers 99% were incapacitated In “worst case” scenarios, cardiac safety experts found no induction of abnormal heart rhythms Even when given Epi or Isoprel, animal studies showed no provocation of VF or VT.

9. Facts TASER use when cocaine or meth is on board won’t cause VF or VT. 7 Drugs Tested “There is no experimental evidence that the aforementioned pro-arrhythmic factors increase the susceptibility of the heart to low or high power TASERS specifically, sufficient to cause an arrhythmic event.” Defense Scientific Advisory Council Subcommittee on the medical implications Of less-lethal weapons (DOMILL) Ecstasy PCP Cocaine Marijuana Meth

10. TASER Probe Removal • Who removes the probes? • When shouldn’t you remove a probe? • How do you remove? • What are you looking for? • Proper handling • Medical Follow Up

11. Who Should Remove? BASIC GUIDELINES Occasionally barbs will self evacuate in case of thin skin or thick clothing. PD may remove. Subject may request that medical personnel remove. PD may request EMS to evaluate first before removal. Sensitive Areas Face, neck, genitals, etc. (More about this later.)

12. When you SHOULD NOT remove. DO NOT REMOVE IF PROBE IS LOCATED IN THE FOLLOWING AREAS: Face Eyes Neck Throat Groin Breast Hands Joints

13. How do you remove? Locate the barb Flatten the skin & pull skin tight. Pull barb straight out at 90 degree angle to skin. Inspect puncture site. Signs of broken barb Inspect barb. Ensure all parts of the barb are accounted for. 1 2 3 4

14. Step by Step Removal • Utilize appropriate PPE (gloves.) Inform all caregivers of the intent to remove the contaminated sharp. • Remove one barb at a time. Stabilize the skin surrounding the TASER barb. Firmly grasp the barb and with one smooth hard jerk, remove barb from patient’s skin. • Visually examine the barb tip to ensure it is intact. If any part of the barb remains in the subject, transport the patient to a medical facility for removal. • EMS personnel should take all precautions to avoid accidental needle sticks when removing barbs. • Place the barb in an appropriate container and return the barb/container to the law enforcement officer for evidence. • Provide wound care by cleansing the affected area with antiseptic and cover with an adhesive bandage. • Inform subject of basic wound care and the need to seek additional care in the event that signs of infection occur (redness-pain-drainage-swelling-fever.) The subject will need a tetanus shot if he or she has not received one within the previous 5 years.

15. What are we looking for? PD will often call EMS for evaluation of the subject that has been tasered. There are a number of reasons why a patient may need evaluation after being subdued with a taser. Barb located in a sensitive location Barb needs to be removed by EMS or physician Evaluation for underlying medical condition Determine if patient is suffering a condition due to taser use.

16. Proper Handling & Other Considerations Be sure to dispose of the barbs in a sharps container. Dispose of ONLY AFTER ensuring the entire probe / barb is accounted for. If not sure if patient is suffering from pre-tase condition, or condition as a result of being tasered, transport for further evaluation and monitoring.

17. Transport by (PD or EMS) if… • Barb lodged in any of the above listed sensitive areas; • Subject has a previous cardiac history; • Subject appears intoxicated; • Subject is non-compliant to direct instructions; • Subject meets criteria for other BioTel protocol(s) requiring transport (e.g., chest pain, altered mental status, electrical injury, age greater than 65 etc.) • Complete medical documentation is required whether or not EMS transports the subject. • If emergency department evaluation is necessary, transport to the closest appropriate hospital.

18. THE END