Thursday, May 6, 2010

Taser Tag

So with athletes and paying customers to protect, what is a police force to do when someone ignores frequent warnings over the public-address system and scoreboard -- "Anyone trespassing on the field will be ejected and prosecuted" -- and invades the playing surface anyway? In Philly, hotbed of lunatic sports fans, they aren't taking chances anymore. When (Steve) Consalvi tried to sprint away from a police officer and security personnel, the cop drew his Taser and fired several shots before hitting him. Consalvi stiffened on impact, then dove onto the turf, where he was apprehended and taken away.

Jay Marriotti, Fanhouse.com, May 4, 2010.

One of the things I’ve never seen in the ED is someone getting zapped with a Taser. It’s not that I wouldn’t like to see it…I actually would, in a weird voyeuristic sort of way. It’s also not that everyone who comes to see us in unfailingly polite. It’s more a function of geography. When patients in the ED get unruly, they usually do so in small spaces such as exam rooms or confined hallways. There’s no place for the offender to flee, and often so many security staff present that if we shot off a Taser in the room, there’s a better chance of hitting one of us than the one of them.

Well over a year ago, the police brought in a patient who had been hit by a Taser. He had been caught breaking and entering into a home, and the cops had cornered him after a long chase. He was hiding beneath the raised foundation of an older home in what you might call the “crawl space,” and the police were unable to reach in and drag him out without endangering themselves. Since he wasn’t coming out on his own, the reasonable solution was to immobilize him with the Taser device so he could be extracted from the crawl space without resistance.

This worked pretty well at the start. The man was immobilized with the Taser shock, and the officers were able to remove him from under the house without problem. But when the initial shock wore off, he became uncooperative once again, and wound up being hog-tied and brought to the ED for care prior to arrival at the jail.

(For the record, this is same the patient that I think I’ve mentioned in an earlier blog. He’s the one who told the law enforcement officer that he was concurrently a person who had an Oedipal relationship with his mother and who performed certain oral acts with his same-sex peers. Because I often think too hard, I spent a good five minutes trying to work out exactly what that meant for the officer’s sexual orientation.

It’s been a while since I’ve been called those kind of names myself. Usually I just let it slide, but every now and then I enter the fray. I think the last time I really responded to someone was a few years back, when the police brought in an intoxicated man who had ascended the summit of disorderly conduct. As they wheeled him in, cuffed to a stretcher, he looked up at me and yelled, “You’re just a (homonym for clucking) (homonym for May) boy.!” For whatever reason…time of day, lack of vegetables in my diet, whatever…he just hit a nerve. So my response, as memory serves was, “Well, that’s quite possible. But I’ll make more (euphemism for intimate relations) money in a day that you’ll see in your life. And I’m sleeping with a girl with huge (homonym for The Hotel Ritz). Maybe she can break me. Meanwhile, you’ll be tied down here with a large rubber tube in your (synonym for male member), assuming we find a (nickname for Richard) or any balls on you at all, and then you’ll be going to jail.” Ah, the ecstasy of the moment. )

Now here was a clinical conundrum. Even though the patient had obnoxious down to an art form, in a way you kind of felt bad for him. A hog-tie binds your wrists to your ankles behind your back. I don’t know why it’s called a hog-tie, because there’s no way to get pig wrists and ankle…or front and rear trotters, or whatever they’re called…to bend that way. Regardless, when you’re hog-tied, the only thing you can do is lie on your chest and stomach. However, the Taser darts were imbedded in his chest, one in each breast. This meant that if he tried to relax, the Taser darts would dig into his skin; if he tried to take the pressure off the darts, his legs and arms would tighten up. (Nice shootin’, Tex.)

Medically, the task was to remove the darts. If you look at a Taser dart, what you find is that it’s not a straight needle like the dart you throw at the pub. It’s got a little barb on it, just like a fish hook. This is so the dart doesn’t just fall out as the person runs away from the officer, but stays in place so the immobilizing shock of electricity can be conducted through the microthin wires connecting the darts to the battery in the gun. (Most often the wires have already been cut away by the time the patient reaches the ED).

So you can’t just pull the darts out. In most cases, you have to physically remove them. The way you do this is to numb up the skin around where the dart went in, make a small incision at the base of the dart that allows the barb to “unsnag” from the underlying tissues, and then pull it out. The wound are actually left open. Puncture wounds are more likely to get infected if you sew them up, so they’re left open to heal from the bottom up. But overall, it’s a pretty easy procedure. So easy, in fact, that a medical student can do it.

Now the way medical students cut is very tentative. They make just the barest line on the skin using the last pressure possible, so that the “incision” looks like you scratched the skin with your fingernail. Then they stand back and wonder why nothing’s happening. You’ll ask them to cut a little deeper, which they do until they see the faintest ooze of blood form the uppermost layers of the skin and ask, “Is this enough?” At some point, you usually wind up taking the scalpel yourself, while saying something wise and academic such as, “Cut like you mean it.” Eventually they get the hint, and they do just fine the next time. (This sequence is the source of the medical school dictum, “See one, do one, teach one.”)

The patient got flipped over and cuffed face up on the bed. This made him even more upset. And while you rarely think about it, the fact is that if you are strapped to a stretcher that is not bolted to the floor and move your body violently in an effort to get up, the stretcher will bounce up and down and may even tip over on the side. This tends to unnerve medical students, who are suddenly convinced beyond the shadow of a doubt that the small incision they were about to make to remove the Taser barb is going to wind up gouging out someone’s eyeball.

Eventually, we got the darts out. Took about twenty seconds on my end, and seven minutes for the student. But she was a good soldier and did well, and she was so kind and considerate and apologetic as she worked that the patient even asked for her name and phone number. I don’t think they ever went out. It’s really hard to date in a crawl space.

1 comment:

  1. David Morehead RNMay 17, 2010 at 6:10 PM

    We had one come in with the taser dart firmly embedded in the mandible of the lower left jaw. That x-ray was AWESOME! HEENT had to be called in to get that sucker out.

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