Page 97 - Journal of Special Operations Medicine - Winter 2015

postoperatively. Li and Hamill report a catastrophic of neuromuscular tone; therefore, the suspect is almost
globe disruption from a Taser probe in a 47-year-old always going to fall. If this fall is from an elevated po-
woman with an injury penetrating through the central sition or onto a dangerous surface, secondary injuries
cornea. The injury resulted in a stellate corneal lac- can be expected to occur. Both the tactician and clini-
8
eration, which was repaired with a final visual acuity cian need to be aware of this possibility. In addition,
of light perception without projection. In general, any sparks from a CEW could ignite flammable liquids or
Taser probe injury near the orbits should raise the suspi- gases (including the alcohol-based carrier agent from
cion of a penetrating ocular injury and removal should early-generation w-chloroacetophenone [CN], o-chlo-
be performed in an operating room under general an- robenzylidene malononitrile [CS], or oleoresin capsicum
esthesia, preferably by an ophthalmologist (Figure 4). 7 [OC; pepper spray] aerosols). If the CEW was used on a
patient who was in water, it could result in submersion
Figure 4 Periorbital penetration of CEW probe or drowning.

None of this discussion of CEW injuries is meant to dis-
suade you from considering the Taser as anything but
a valuable control tool, especially when compared to
alternatives such as hand-to-hand, batons, and bullets.
Rather, it is meant to heighten your level of reflective
practice and encourage a high index of suspicion on a
case-by-case basis.

Is It Deadly?
Are CEWs deadly? This is a highly contentious issue.
Many groups have taken strong stances on either side
Given the short length of a standard Taser barb, you of this argument. An exhaustive review of this subject
might think it quite unlikely to penetrate into the pleu- is beyond the scope of this article, but it does warrant
ral cavity, but there is a singular case in which such a some exploration.
mechanism was considered. The patient was a 16-year-
old boy of slight build, 5 feet 11 inches tall (180cm), Some groups strenuously maintain that Taser and NMI
and weighing 145 pounds (66kg), who presented to technology are torture devices and pose an unsafe risk,
the emergency department with a probe in the upper directly related to sudden death. The American Civil
left pectoral region. Though mildly tachycardic at 102 Liberties Union (ACLU) released a statement in 2005
beats per minute, he had a room-air oxygen satura- that at least 148 people had died in the United States
tion of 98%, no complaint of dyspnea, and physical and Canada since 1999 after being shocked with Tas-
examination revealed good bilateral breath sounds and ers. Amnesty International has stated that the number
10
absence of subcutaneous air or apparent chest wall reached 500 in 2012. The counter argument maintains
11
trauma. After removal of the probe with local anes- that a temporal relationship between the application of
thetic and a simple incision, a chest radiograph revealed a CEW and sudden death does not establish causation.
what the consulting radiologist described as a “small- There are elements of these incidents that remain com-
to moderate-sized” pneumothorax. He underwent a plicated, multifactorial, and not completely understood.
tube thoracostomy and was discharged without further The use of a CEW has to be put in the context of what
complications after a 2-day stay. Though the authors alternative means of physically subduing and arresting
considered preexisting pneumothorax, accidental viola- the suspect could be used. Irritant gases (e.g., OC), K-9
tion of the pleura when the probe was dissected, direct units, batons, less-lethal rounds, and even hand-to-hand
trauma either from falling onto the probe (driving it physical restraint all carry the risk of injury or, in some
deeper than expected) or impact against a closed glottis cases, death.
(so-called paper bag syndrome), they ultimately ques-
tioned whether close range (higher velocity) deploy- Two systematic reviews recommend that prolonged ob-
ment of the Taser and the patient’s body habitus best servation and diagnostic testing are not necessary in pa-
explained the pneumothorax. 9 tients who are otherwise asymptomatic, not intoxicated,
and alert following a CEW exposure. 12,13 This provides
clinical support to the discharge of the unaltered, physi-
Secondary Injuries
ologically stable patient who has been exposed to an
Use of these CEWs carries the risk of secondary injury electrical weapon back to police custody without exten-
from falls. The basic principle of action is inactivation sive cardiac monitoring and laboratory workup.

Taser and Conducted Energy Weapons 85