Medical implications of Force


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  • Medical implications of Force

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