9.19. INJURY FROM AN ELECTRICALLY CHARGED WEAPON (FOR EXAMPLE, A stun gun)

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Applying a shock discharge.

Purpose of assistance

1. Monitor the patient’s condition after applying a stun gun, paying special attention to identifying signs of severe delirium (see guideline “Agitated or Aggressive Patient/Emergency Behavioral Care”).
2. Ensure adequate immobilization of the patient after involvement of law enforcement to ensure the safety of the patient and the EMD team (see guideline “Agitating or Aggressive Patient/Behavioral Emergency”).
3. Conducting a full medical examination, as the patient to whom the electric shock was applied may have previously been in a state of confrontation with someone.
4. If using at a distance, you need to find 2 darts (13 mm long). Do not remove darts from sensitive areas (neck, head, arms, legs, genitals).

Description of the patient

Inclusion criteria

1. The patient received either a direct discharge contact, or from a distance of two barbed darts, from an electric weapon.
2. A patient with an existing injury due to a fall or physical action.
3. The patient may be under the influence of toxic substances and may have corresponding mental disorders.

Exclusion criteria

No recommendations.

Management of the patient

Status assessment

1. After securing the patient with law enforcement, perform primary and secondary assessment, including EKG recording (3- and 12-lead) and pulse oximetry.
2. Assess for signs of marked delirium, which manifests as agitation, decreased pain sensitivity, elevated body temperature, persistent resistance, and hallucinations.

Treatment and intervention

1. Ensure the patient is adequately immobilized after involving law enforcement to ensure the safety of the patient and the EMD team, administer medical drugs to control the patient if he resists immobilization and may cause further injury.
2. Conservative programs treat all barbed darts as foreign bodies and leave them to be removed by doctors, while more progressive programs allow EMD crews or law enforcement to remove barbed darts, except for sensitive areas (head, neck, arms, legs, or genitals ).
3. Appropriate treatment of disorders and injuries.

Patient safety

1. Before removing the darts, make sure that the cartridge has been removed from the stun gun.
2. The patient should not be immobilized in the prone position or tie the limbs because of the high risk of respiratory failure.
3. The presence of previous pathologies in the patient is possible (refer to the relevant instruction in the presence of a certain medical/traumatic pathology).
4. Perform a thorough assessment, focusing on looking for signs and symptoms of delirium.
5. Transport patient to hospital if alarming symptoms or signs are present.
6. EMD providers who are responsible for a patient with an electrical weapon injury are not required to perform a “medical clearance” for law enforcement.

Useful information for training

Key points

1. The stun gun can be used in three ways:

a) direct contact without using a remote electrode;
b) gradual use of one electrode followed by direct contact with a stunner;
c) use of an stunner from a distance of approx. 10 meters using both electrodes.

2. The device transmits a discharge with a frequency of 19 beats/sec with an average power of 2.1 milliamps, which in combination with toxins/drugs, previous pathological conditions can lead to the occurrence of arrhythmias, accordingly, careful monitoring of the 12-lead ECG should be carried out.

3. A stun gun is a direct-action weapon with two electrodes that causes pain but does not impair the subject’s capacity. Only local muscle groups are stimulated by the technique.

Corresponding evaluation results

1. Careful assessment of the patient to identify injuries due to a possible fall from a height of one’s own height or higher.
2. Verify the number of used shock cartridges (to determine the total number of electrodes potentially used).

Key elements of documentation

1. If electrodes are removed, indicate their location in the relevant documentation.
2. Results of physical examination.
3. Heart rhythm and its changes.
4. Results of assessment of neurological status.

Criteria for the effectiveness of aid provision

1. Impairment of vital signs or other damage and treatment that was carried out.
2. The patient received an ECG or a 12-lead ECG.
3. If shown, review appropriate security techniques.