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Medical implications of Force

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  • Transcript

    • 1. TASER
    • 2.
      • Police have the following force options for dealing with criminal or mental health issues:
        • Verbal commands
        • Pepper Spray
        • Defensive Tactics
        • Expandable Batons
        • Pepperball Launcher
        • Firearms
    • 3. Verbal De-escalation
      • Aim: To effect a peaceful arrest without further incident
      • Initial approach is to properly use verbal commands and clearly communicate.
      • Voice is a powerful tool that we use in conjunction with all other force options
    • 4. Pepper Spray
      • When verbal commands do not suffice
      • Pepper spray is a second line ‘force option’.
    • 5. Pepper Spray
      • Oleoresin capsicum (OC) is an oily extract of pepper plants of the genus Capsicum
        • Spice in salsa, chili, curries
        • Pharmacologic agent in topical anaesthetic and analgesic creams
        • Principal active ingredient in Pepper Spray
      • Complex mixture of
        • Fat soluble phenols (Capsaicinoids)
        • Capsaicin (trans-8-methyl-N-vanillyl-6-nonenamide)
        • Dihydrocapsaicin
      • Capsaicinoid content determines the "hotness" of the extract
        • Relative hotness is measured in Scoville units
          • The greatest dilution of pepper extract that can be detected by the human tongue
    • 6.
      • Advantages
      • Fear Compliance
        • People are afraid of being sprayed and will often cease resistant behavior at the mention of pepper spray.
      • Pain Compliance
        • Most people not under the influence of drugs are susceptible to pepper spray, and will feel respiratory and eye pain when sprayed; often gaining compliance.
      • Covers Large Area
        • Even if pepper spray is not a direct hit it can still have an effect on a subject.
      Pepper Spray
    • 7.
      • Disadvantages :
      • Long decontamination process
        • Up to an hour or more for pain from pepper spray to subside
      • Collateral Damage
        • Many Officers do not like to use pepper spray because it often effects bystanders (including officers) as well as the target.
      • Does not work on everyone
        • Highly determined people can overcome effects.
        • Some drugs such as angel dust and methamphetamine negate the effect
      • Not an instant stop
      • Close Proximity required
      Pepper Spray
    • 8.  
    • 9. Medical Implications
      • Potential risks of pepper Spray
        • Capsaicinoid exposure
          • May vary by as much as 30-fold among brands
        • Diluents
          • Alcohols, organic solvents
        • Propellants
          • Halogenated hydrocarbons
    • 10. Medical Implications - Dermal
      • Dermal
        • Burning, itching, erythema and severe dermatitis (Hunan Hand)
        • Exaggerated response secondary to
          • Repeated contact
          • Diminished sensitivity to heat- or chemical-induced pain
          • Augmentation of allergic dermatitis
        • Reflex vasodilatation and sweating mediating hypothalamus induced cooling
          • Risk of hypothermia if decontaminated with cold water
    • 11. Medical Implications - Respiratory
      • Respiratory
        • Broncho-constriction
          • Wheeze, dry cough, SOB
        • Release of Substance P
          • Increased vascular permeability/pul oedema
        • Rarely Laryngeal spasm/laryngeal paralysis
          • Cyanosis, apnoea
          • Respiratory arrest
    • 12.
      • Eye Symptoms
        • Redness, swelling, burning pain
        • Conjunctival inflammation
        • Blepharospasm
        • Loss of blink reflex with corneal abrasion
        • Keratitis
      Medical Implications - Ocular
    • 13. Treatment
      • Dermal
        • Decontamination with warm water (shower)
          • Pat dry with clean towel – do no rub
          • Wet towel/ice packs useful to reduce inflammation
        • Do not use lotion or creams on affected areas
          • These trap the active ingredient against the skin
    • 14.
      • Respiratory
        • Remove from enclosed space - Fresh air
        • Oxygen and Ventolin nebs for broncho-constriction
      Treatment
    • 15.
      • Ocular
        • Remove contact lens
        • Decontamination with irrigation (15 minutes saline/water)
        • Prevent patient from rubbing eyes
      Treatment
    • 16. Expandable Baton
    • 17. Expandable Baton
      • Advantages :
      • Carried on officer’s person
        • Rapid Deployment
      • Pain and fear response
      • No cross contamination
        • target of baton strike is typically who is hit
    • 18.
      • Disadvantages :
      • Expandable Baton strikes can cause severe and or lasting injuries
      • Public perception of striking someone with a hard object is not positive
      Expandable Baton
    • 19. 21 Foot Rule
      • If a subject is within 21 feet of an officer with a weapon:
        • Studies show that they can reach the officer and harm them before the officer can draw and fire their weapon
    • 20.  
    • 21.  
    • 22. TASER
      • A TASER is an electronic control device that uses propelled wires, or direct contact, to conduct energy to affect the sensory and motor functions of the nervous system
      • T homas A. S wift's E lectric R ifle
    • 23. TASER advantages
      • Carried on officer’s belt for immediate deployment
      • Affects only those who are hit with probes.
      • Almost immediate effect upon deployment.
      • Fear, pain and motor function response
      • Control a subject/situation from a safer distance
      • Integrated camera allows for added accountability
    • 24. From
    • 25. TASER
    • 26. TASER Introduced
      • 2002: At risk of being privately un-insurable
      • TASER as part of 3 element plan eliminated injuries for 2 years
      • (through Sept 17, 2004)
    • 27.  
    • 28. Traditional “Blunt” Pulse High Energy, “Brute Force” Approach 90% Energy Loss Traditional “Blunt” Pulse New Shaped Pulse ™ Arc Phase Stim Phase New Shaped Pulse ™ Full Energy Penetration
    • 29. Shaped Pulse Tech
    • 30. 60% SMALLER
    • 31.  
    • 32.  
    • 33. Medical Safety Fibrillation Results, 5 Second Burst
    • 34. Lower Pulse Rates Increase Safety Margin
    • 35. X26: Digital Pulse Controller (DPC)
      • Digitally controls pulse rate
      • Consistent performance
      • -4  F to +122  F
      • -20 C to +50 C
      • 5-second burst
        • 0-2 sec @ 19 pps
        • 2-5 sec @ 15 pps
        • If trigger held beyond 5-second cycle @15 pps
      • Initial “punch” to drop
        • Increases effectiveness
        • Enhances safety
        • Extends battery life
      • Standard Procedure
        • Maximum 5 second pulse
        • Maximum of 3 shocks
    • 36.
      • Taser-use by RCMP
        • 2002 to 2007
        • 28 per cent, or 910 of the 3,226 people who were shot, had to go to a medical facility
      Medical Implications - Potential Injuries
    • 37. Medical Implications - Potential Injuries
      • Local
        • Taser penetration – laceration (0.5-1cm subdermis)
        • Secondary electric burn at entry point
        • Require ED and medical removal from head, neck and groin
      • Other recorded injuries
        • dart penetrating through the skull
        • Fractured vertebrae, even when no fall has occurred
        • Seizures
        • Eye injuries leading to blindness
        • Trauma secondary to fall
        • Drowning if the assailant falls into water.
    • 38. Unknown 162 N.A. None / Minor 1,852 98.09% (Puncture wounds from probes, abrasions) Moderate 23 1.2% (Abrasion, skinned knee, carpet burn, testicle shot, penis shot, cut to mouth, cuts from falling onto glass) Severe 13 0.69% (Dog bites, self-infliction, officer battle) Field Data Injuries to Subjects
    • 39. Unknown 114 N.A. None / Minor 1,927 99.54% (Officers involved with fighting suspects or arresting them) Moderate 7 0.4% (Knife thrown at officer cutting arm, knee injury officer ran into obstacle, struggle prior to TASER use, officer fell during chase & fractured arm, groin kick prior to TASER) Severe 2 0.1% (Officer attacked by 6-8 juveniles, M26/X26 used in stun gun mode - suspect poor batteries) Field Data Injuries to Officers
    • 40. Excited delirium
      • Not officially recognised as medical condition
        • Studies always done on healthy police volunteers (Vilke)
        • Animal studies (pigs on speed)
      • Pre-disposition
        • Increased occurrence with illicit drug use/withdrawal
        • Psychosis or psychiatric problems. 
      • Symptoms
        • Profound agitation excitable behaviour
      • Effect
        • Seizures, AF, VF, CHF, cardiac arrest
        • Most common coroner finding at Taser related autopsy
    • 41. Source: Study of Use of Force at Los Angeles Police Department, Capt. Greg Meyer. Statistics are for TASER technology deployed at LAPD in the TASER TE-86, a 7-Watt TASER. However, human volunteer studies of over 100,000 volunteers have confirmed a 0% injury rate for the 26-Watt ADVANCED TASER and 5-Watt TASER X26 .
    • 42.
      • Jared Feuer - reported 277 fatalities
        • From 675,000 Taser related incidents from June 2001 and October 2007 in the US
      • YouTube and other videos record Taser deaths
      • However fatalities form Firearms has reduced
        • Of those fatally wounded with firearms 76% had a lethal weapon in hand
        • 82% of those fatally wounded with Taser were unarmed
      Medical Implications - Fatalities
    • 43.
      • October and November 2007 – Canada
        • Four individuals died after being tasered
        • Robert Dziekański
          • Non-English speaking man from Poland who died in less than two minutes after being tasered at the Vancouver International Airport
      • Emily Marie Delafield
        • April 2006 a 56 year old, wheelchair-bound woman, died after being shocked at least 10 times.
        • The death was ruled justified homicide
      Medical Implications - Fatalities
    • 44. Phoenix PD Field Results First Top-10 City to Deploy to All Patrol Officers
      • Suspect Injuries
      67% Lethal Force 50%
    • 45.  
    • 46. Times are changing
      • June 2008
        • Federal jury ordered Taser International to pay $6 million in punitive and compensatory damages for the 2005 death of the man who died a day after being shocked repeatedly by officers using Tasers
        • The jury found that Taser International should have “more effectively warned police that Taser shocks were potentially dangerous”
    • 47. … .so following Taser
      • Remove Taser darts
      • Treat local wounds/burns
      • Perform ECG
      • Note lactate continues dropping for up to 60 minutes
      • Beware excited delirium
      • Observe patients with
        • >3 shocks >5 seconds each
        • Female, short people, aged<16
      • if patient arrests……..
    • 48.