NON-LETHAL WEAPONS. K. Inaba, MD FRCSC FACS Division of Trauma Surgery & Critical Care LAC+USC Medical Center

Transcription

1 NON-LETHAL WEAPONS K. Inaba, MD FRCSC FACS Division of Trauma Surgery & Critical Care LAC+USC Medical Center

2 ü None DISCLOSURES

3 Non-Lethal Weapon Types ü Chemical Agents ü Impact Munitions ü Vivi-Systems ü Directed Energy ü Mechanical ü Electrical

4 Non-Lethal Weapon Types ü Chemical Agents ü Impact Munitions ü Vivi-Systems ü Directed Energy ü Mechanical ü Electrical

5 Impact Munitions ü Most commonly Pepperball Beanbag

6 Impact Munitions ü Most commonly Pepperball Beanbag

7 Pepper-ball ü Multiple impacts ü Distance dependent ü Treat as for any blunt force trauma ü Rare to see significant underlying damage, especially clothed ü Eye, face, hands

8 Impact Munitions ü Most commonly Pepperball Beanbag

9 Beanbag ü Usually single impact ü Distance dependent ü Much more significant energy transfer, even through clothing ü Warrants examination, imaging and observation

10 Beanbag ü Significant energy transfer, even through clothing ü Warrants examination ± imaging and observation

11 Non-Lethal Weapon Types ü Chemical Agents ü Impact Munitions ü Vivi-Systems ü Directed Energy ü Mechanical ü Electrical

12 Current Distribution ü >16,200 law enforcement agencies, 44 countries ü >543,000 devices ü 2010, 86.9M USD revenue, 79%US ü Civilian purchase, all but 7 states ü >136,000 devices ü >1.3 million documented discharges

13 Taser History ü Jack Cover-1974 Thomas A. Swift Electric Rifle-TASER 1911

14 X-26 ü Single shot cartridge ü Nitrogen propelled ü 2 darts at 170 fps, 35 feet ü Attached by insulated wires ü Darts in skin or clothing up to 2 inches

15 X-26 ü Battery - pulsed electricity ü 1200 V, 2.1 ma, 0.07 J/pulse ü 5 seconds per trigger pull ü Can stop, repeat or hold ü Can be used as a stun gun

16 For the Trauma Provider ü Non-Lethal ü Less-Lethal ü Less-Than-Lethal

17 ü Lethal weapons are defined by their capability ü Non-lethal weapons are defined by their intent

18 ü Lethal weapons are defined by their capability ü Non-lethal weapons are defined by their intent and can be lethal

19 For the Trauma Provider 1. Local 2. Systemic 3. Secondary

20 For the Trauma Provider 1. Local 2. Systemic 3. Secondary

21 ü Prospective, , Dallas PD ü 426 consecutive discharges ü Mean exposure 8.6±5.9 sec ü Minor bruises, abrasions, lacerations ü None required repair

22 2009 ü Prospective, , 6 US PDs ü 1,201 pts, 94% male, 13-80yo, 50% +EtOH/Tox ü 99.75% mild or no injury ü 2 - head injury from fall, d/c 48-72h ü 1 - ckñ, d/c, no dialysis required

23 Secondary ü Examination by EMS, RN or MD as per regional protocol ü Full scene history ü Physical Examination ü Treat as for blunt force trauma

24 Secondary ü Examination by EMS, RN or MD as per regional protocol ü Full scene history ü Physical Examination ü Treat as for blunt force trauma

25 For the Trauma Provider 1. Local 2. Systemic 3. Secondary

26 ü Most fall out ü Follow regional protocol leave wires intact cut wires pull at scene ü No further risk of harm to MD

27 ü Pull ü Retain and handle as evidence ü Check for other discharge sites ü Document well ü Rarely fracture, PTx, ocular injury

28 For the Trauma Provider 1. Local 2. Systemic 3. Secondary

29 ü Anesthetized swine, X-26, 10 sec ü Trans-cardiac Vector ü Real time TTE ü 85.2% ventricular capture with VT

30 ü Swine, 5 and 15 sec discharges ü EPI infusion simulating hyperadrenergic state ü Similar capture with VT/VF

31 ü Healthy human volunteers, n=34 ü Right upper sternal border to apex vector ü 10 second burst, X-26 ü No ventricular capture under TTE

32 ü Healthy human volunteers, n=66 ü X-26, standard 5 sec discharge ü No change in 24hr CK, lytes, RF, TPI ü No changes in delayed ECG

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36 Cardiac Capture ü Muscle response depends on the waveform, strength and duration of electrical stimulation ü Duration of stimulation for cardiac muscle fold skeletal motor or sensory nerve ü Short duration discharges sufficient for skeletal, but not cardiac muscle

37 ü Summary conclusion of US DOJ ü Low risk of serious injury ü No evidence of cardiac dysrhythmias ü Even in patients with Psychois or Agitation or Excited Delerium

38 2013

39 ü Council of Canadian Academies and Canadian Academy of Health Sciences ü 14 member multidisciplinary panel ü Chaired by Honorable Justice Stephen T. Goudge, ON Court of Appeals ü Review of primary research and technical engineering data

40 ü Available studies show death from cardiac causes biologically plausible but extremely rare ü Sudden death is multi-factorial, and CEW exposure could not be confirmed or excluded as a primary cause ü Further research and data compilation is required, especially with new devices

41 ü No evidence of clear causal association with death in large prospective studies ü May play a protective role in terminating escalation of events that can end in death

42 Summary ü Document well ü Local Pull darts ü Systemic and Secondary Likelihood of injury very low Work-up dictated by scene history and physical exam

43 Summary ü Individualize for select subgroups Drug intoxication Underlying cardiac disease Children Pregnancy ü Admit ECG, ABG/Lac, CK, TPI