Clinical Reviews
Emergency Department Evaluation after Conducted Energy Weapon Use: Review of the Literature for the Clinician

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Abstract

Background

Conductive energy weapons (CEWs) are used daily by law enforcement, and patients are often brought to an emergency department (ED) for medical clearance.

Study Objectives

To review the medical literature on the topic of CEWs and to offer evidence-based recommendations to Emergency Physicians for evaluation and treatment of patients who have received a CEW exposure.

Methods

A MEDLINE literature search from 1988 to 2010 was performed and limited to human studies published from January 1988 to January 20, 2010 for English language articles with the following keywords: TASER, conductive energy device(s), electronic weapon(s), conductive energy weapon(s), non-lethal weapon(s), conducted energy device(s), conducted energy weapon(s), conductive electronic device(s), and electronic control device(s). Studies identified then underwent a structured review from which results could be evaluated.

Results

There were 140 articles on CEWs screened, and 20 appropriate articles were rigorously reviewed and recommendations given. These studies did not report any evidence of dangerous laboratory abnormalities, physiologic changes, or immediate or delayed cardiac ischemia or dysrhythmias after exposure to CEW electrical discharges of up to 15 s.

Conclusions

The current medical literature does not support routine performance of laboratory studies, electrocardiograms, or prolonged ED observation or hospitalization for ongoing cardiac monitoring after CEW exposure in an otherwise asymptomatic awake and alert patient.

Introduction

Use of conducted energy weapons (CEWs) such as the TASER (TASER International Inc., Scottsdale, AZ) includes delivery of a series of brief electrical pulses, which result in pain and muscular contractions. The pulses may be delivered via a pair of sharp metal probes fired from the device, commonly referred to as “probe mode,” or by direct contact with the front of the device, commonly referred to as “drive stun” or “touch stun” mode.

Current practice in managing patients who present to the Emergency Department (ED) after being exposed to a CEW varies from place to place and by individual practitioners. Some hospitals have the practice of admitting all patients who were exposed to a TASER to the hospital for overnight telemetry monitoring, whereas other systems allow Emergency Medical Services providers to remove the darts in the field and the police take the patient directly to jail without ever going to an ED.

This article seeks to review the medical literature on the topic of CEWs and to offer evidence-based recommendations to Emergency Physicians for evaluation and treatment of patients who have received a CEW exposure. The clinical question being asked was: Do patients who present to an ED after a CEW exposure need any specific radiographic or laboratory evaluation or any specific monitoring based solely because a CEW was used? This work was done at the request of and published as a position statement by the American Academy of Emergency Medicine Clinical Guidelines Committee.

Section snippets

Materials and Methods

This was a structured review of the literature on the topic of CEWs. A literature search of the National Library of Medicine’s MEDLINE database’s PubMed system was performed and limited to studies published from January 1988 to January 20, 2010 written in the English language. Keywords used in the search were: TASER, conductive energy device(s), electronic weapon(s), conductive energy weapon(s), non-lethal weapon(s), conducted energy device(s), conducted energy weapon(s), conductive electronic

Results

The findings of the original key word search in MEDLINE are noted in Table 4 under the column “# ALL references.” Combining these references resulted in 140 unique articles on CEWs. From these original 140 articles, the Reference sections were also reviewed, and no further novel articles were identified. It was noted that not all articles that were captured with these key words involved CEWs, which is why there were 145 articles found using the key words “conductive electronic devices” but only

Discussion

CEWs are commonly used by police as an intermediate force option. Civilian models of CEWs are also available to the public. Patients may be brought to EDs for medical evaluation after CEW exposure. The primary goal in conducting this literature search was to identify whether routine monitoring, ECG, with or without laboratory tests are necessary for a patient who presents after receiving an electrical discharge from a CEW.

Our evaluation considered both techniques in which a CEW can be used.

Conclusions

The current human literature has not found evidence of dangerous laboratory abnormalities, physiologic changes, or immediate or delayed cardiac ischemia or dysrhythmias after exposure to CEW electrical discharges of up to 15 s. Therefore, the current medical literature does not support routine performance of laboratory studies, ECGs, or prolonged ED observation or hospitalization for ongoing cardiac monitoring after CEW exposure in an otherwise asymptomatic awake and alert patient.

Testing for

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Position Paper Approved by the American Academy of Emergency Medicine Clinical Guidelines Committee

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