Taser/Electronic Control Weapons (ECW) injury often happens in jails, prisons, and in the community when individuals are being apprehended, and the correctional nurse often must address its physical and emotional effects. Here is the truth about Taser/ECW injury.

Joyce is working at the local county jail on Friday night when a man-down code is called for the booking area. She arrives to find an obese, disheveled  man lying face-down on the floor being cuffed by a deputy. The booking hall looks as disheveled as the man, who is now the center of activity. Another deputy tells you that the individual had ‘freaked out’ during the intake process and, after attempts to de-escalate the situation occurred, an Electronic Control Weapon was used on him. No health screening has been completed.

Tasers/ECWs are used by many law enforcement agencies to temporarily incapacitate individuals when de-escalation techniques and other, “lesser” uses of force are ineffective. Guidelines for officers and for clinicians have been published that can help correctional nurses and correctional healthcare providers determine an appropriate assessment and plan of care for the patient on whom an Electronic Control Weapon has been used.

Tasers/Electronic Control Weapons are battery-operated hand-held units that fire two barbed electrodes up to 35 feet. Copper wires connect these electrodes to the main unit  that delivers a pulse of up to 50,000 volts of electricity, temporarily disrupting electrical conduction in the body. Once tased, the individual falls to the ground and is unable to think or move for a short period of time.

Assessing the ECW Effect

As with any medical condition, nurses need to assess the immediate and ongoing effects of the Taser/ECW shock. Disrupted electrical conduction affects all muscles and causes uncontrolled contraction during the time of the impulse. Heart and brain activity may also be affected.  Consider the following:

• Assess airway, breathing, and circulation at the scene. Joyce’s patient is face down with officer’s weight on his back as he is cuffed. Positional asphyxia is a concern, and the patient should be moved from the prone position as soon as possible.
• Consider injuries due to the de-escalation process and any other uses of force during the event. For example, Joyce needs to evaluate for trauma caused by the fall and needs to get a report of the pre-Taser/ECW interventions. Getting as much information as possible about the context of the event will help interpret assessment findings. For example, find out if there was extensive physical struggling with the individual prior to or during the use of the Taser/ECW.
• Locate the Taser/ECW barb entry points – there will be at least 2 – and determine if any vital areas are affected. Special concern is needed if the barb entry is near an eye, on the face or neck, or in the breast, axilla or genital areas.
• Find out how long and how many stuns were used in the incident. Increased risk for after effects are found with a cumulative use of over 15 seconds.
• Discover as much about the individual’s health history as possible. Joyce did not have a health record in this situation because the patient had not yet had a Receiving Screening, but another patient may have a health record indicating a past health history important to the evaluation, such as mental illness, a heart condition, or current drug or alcohol use.

Treating the Taser/ECW Wound

Superficial skin injury and surface burns are the most frequent direct injury of a Taser/ECW activation. Before making contact with the patient, be sure the Taser/ECW device is no longer active. Wear gloves and expose the two or more barbs attached to the skin. If these barbs are in any of the sensitive areas indicated above, it is strongly advised that they be removed by healthcare providers in an emergency room setting.

• Disconnect the darts from the Taser/ECW cartridge by bending and snapping the copper wire.
• Next, grasp the frame of the dart between your thumb and index finder and pull directly up from the skin surface. This will minimize any further skin damage.
• Carefully dispose of the dart as a sharp in a standard sharps container or, if needed for evidence, possibly thread the dart into the Taser/ECW cartridge and give it to the appropriate security individual.
• Inspect the wound, clean with an alcohol pad, and apply a sterile dressing. A Band-Aid is acceptable.

Monitoring At-Risk Patients

Generally speaking, healthy individuals recover quickly from a Taser/ECW experience without lasting effect. However, a National Institute of Justice Study found that the use of Taser/ECWs was implicated in the death of 200 individuals. Ongoing monitoring is recommended for several high risk categories of patients:

• Cardiac Disease: A weakened cardiac system may not withstand a Taser/ECW shock. Take all reports of chest pain and shortness of breath seriously. EKG monitoring may be advisable for those with a history of arrhythmias.
• Pregnancy: Pregnant or potentially pregnant females need added attention. In the former, obstetric evaluation soon after the event is warranted. In the latter, pregnancy testing should be performed.
• Medical/Mental Health Crisis: The electrical voltage of a Taser/ECW activation can exacerbate a crisis situation. An individual in active crisis due to amphetamine drug use, asthma, or excited delirium can tip over the edge after this intervention.

The use of Tasers/ECWs has decreased officer and suspect injury but is not without risk. Correctional nurses who work in facilities that use this technology are called upon to assess and treat the physical results of deployment. It is important for them to know the proper assessment to conduct and those high risk patients for whom additional monitoring may be required after a Taser/ECW deployment, as well as the proper technique to use for the removal of barbs.   Joyce had a busy Friday night but her patient pulled through the experience without incident due to her assessment and interventions.

Have you had an experience assessing and treating a patient after an ECW activation? Do you have a written treatment protocol? Share your experiences in the comments section of this post.

Special thanks to Margaret Collatt, Training and Development Specialist with the Oregon Department of Corrections, for sharing ODOC Taser Dart Removal protocols.