From the Guidelines
The use of conducted electrical weapons (CEWs) on patients requires immediate medical evaluation to assess for potential injuries and complications, such as cardiac abnormalities, traumatic injuries, and mental status changes. When a patient has been subjected to a CEW, they should be assessed for the severity of electric injuries, which can vary widely, from an unpleasant tingling sensation to thermal burns, cardiopulmonary arrest, and death 1. The primary cause of immediate death from electrocution is cardiopulmonary arrest, and cardiac arrhythmias, including ventricular fibrillation, ventricular asystole, and ventricular tachycardia, may result from exposure to low- or high-voltage current 1.
Some key considerations in the medical evaluation of a patient who has been subjected to a CEW include:
- Monitoring vital signs to detect any abnormalities
- Performing an ECG to rule out arrhythmias
- Assessing for traumatic injuries from falls
- Evaluating mental status changes
- Removing the barbs if embedded in non-sensitive areas, cleaning the wounds with antiseptic solution, and administering tetanus prophylaxis if needed
- Providing pain management with acetaminophen or ibuprofen as needed
It is essential to note that patients with pre-existing cardiac conditions, those who are pregnant, or those showing signs of excited delirium syndrome require more intensive monitoring 1. Most patients without complications can be discharged after observation, but those with persistent abnormal vital signs, ECG changes, or altered mental status should be admitted for further evaluation and treatment. CEWs can cause muscle contractions and rarely lead to rhabdomyolysis or cardiac complications, particularly in vulnerable populations, which is why medical evaluation is essential even when patients appear stable 1.
From the Research
Conducted Electrical Weapons on Patients
- The use of conducted electrical weapons (CEWs) in healthcare settings has been studied, with a focus on their safety and effectiveness in controlling violent situations 2, 3.
- A study published in 2011 found that the introduction of CEWs into a hospital setting resulted in a decrease in personnel injuries and was effective in controlling situations that could result in further injury to subjects, patients, and personnel 2.
- Another study published in 2014 proposed a comprehensive use of force model incorporating CEWs as a necessary and best-practice goal for healthcare security professionals 3.
- In terms of medical evaluation after CEW use, a review of the literature found that there is no 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 4.
- A comparative brief on CEW safety published in 2019 found that the body of data reviewed provides reasonable support for the safety of CEWs, although the assessment of possible health risks is limited due to different research approaches and test subjects 5.
Medical Evaluation and Treatment
- 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 4.
- However, it is essential to note that CEW use may be associated with other medical conditions, such as delirium, which requires careful evaluation and treatment 6.
- In the context of delirium, psychopharmacotherapy with antipsychotics or benzodiazepines should be limited to severely symptomatic patients and used with caution, as they can aggravate, precipitate, or mask delirium, resulting in adverse events or unfavorable survival outcomes 6.