Be wise. Be brave. Be tricky. (slithytove) wrote,
Be wise. Be brave. Be tricky.

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Don't tase me, bro

The other night in my ER I saw a patient who had fought with the police and been hit with a nightstick above the left eye. He had no other significant injuries, his CAT scan was normal. My resident sutured him up, and he was uneventfully returned to police lock-up by the officer who brought him.

Ten years ago, I saw nightstick injuries all the time, generally to the head. But before the one the other night, it had been a long time since I'd seen one. Years. Maybe back before the turn of the century.

What happened? Have criminals become less violent? Instead of whacking them, are the police listening sympathetically to their problems and convincing them by sweet reason to come spend a night in the pokey?


What happened, I'm almost positive, is the Taser.

You're familiar with the Taser? A cattle prod mashed up with a wire-guided anti-tank missile. The business end is a dart with a barbed, fishhook-like prong that sticks in the target's flesh. It then delivers an electrical jolt which will stop almost anyone from doing what they're doing. It's sold as a non-lethal alternative to the handgun. Which it is. Usually.

In the ER, we get to take out a lot of Taser darts. Usually it's not difficult. I haven't yet seen a serious injury, although the guy in which the dart was stuck in the suprasternal space (the soft spot at the base of your neck, just above the breastbone) was kinda scary.

I think the Taser, at least in the neighborhood in which I work, the inner suburbs of Philly, has largely replaced the nightstick.

I *think* that's a good thing. It is for me: it's a lot easier to remove a dart than to suture up a gaping, bleeding head wound, and worry about brain injury. Which does happen when you're whacked with a nightstick. Sometimes just a little bruise. (But do you want even a little bruise on your thinkin' organ? No, you don't.) Sometimes it's much worse. In the mid-90s, I helped care for a patient who had been in decompensated schizophrenia, out of control, and violent. The police were called, and hit him on the head with their nightsticks many times before he slowed down enough to be brought to the hospital. He died of his injuries.

So, Tasers are often not only a non-lethal alternative to firearms, but also a non-lethal alternative to billy-clubs.

The problem is, they're not always non-lethal. Scores of people have died after having been tased. I don't know what the denominator is, the total number of people tased by the police, but it must be huge. The percent of tased individuals who die is surely small.

In addition, it's not clear that the Taser is always to blame. Tased suspects often also have drugs on board, like cocaine or amphetamines, which cause heart arrhythmias, abnormal electrical rhythms which do not allow the heart muscle to pump blood. And these suspects are generally engaging in vigorous physical activity; that's why they got tased. A middle-aged guy who tries to shovel a heavy snowfall off his walk and drops dead of a heart attack is common occurrence. I have no doubt that guys who struggle with the cops and wind up dead also are often the victims of heart attacks, often helped along by coke or meth.

However—it seems very likely that the Taser is to blame at least part of the time. If a person is tased and drops dead immediately, like that guy in the Vancouver airport, it's the Taser. Most of us will tolerate an electrical shock such as the Taser delivers. But people with a electrically unstable heart can be sent into a lethal arrhythmia with even a trivial shock. Special attention is paid to the grounding of hospital equipment for this reason.

Did Robert Dziekanski have an unstable myocardium? How about Klutzo, the pedophile clown? You can't tell by looking at someone. You have no idea whether this particular person will die if you shoot your Taser.

So, I don't know what the answer is here. I've heard pepper spray recommended. The police do indeed use that sometimes. I've had them bring pepper-sprayed suspects to the ER to have them washed down and their eyes examined. Pepper spray will probably discourage someone from doing what they're doing—like beating someone else—but it won't stop a seriously agitated patient, so that the police can bring them in, or take them to the hospital. It will probably make the agitation worse, and may make the suspect even more difficult to handle.

There's no perfect answer. Actively violent people need to be restrained. Every method of subduing them that I know of has the potential for causing injury or death. The police should use the least dangerous method that will successfully subdue a suspect, but in an emergent situation, it's often unknowable what that is.

As maybe you can tell, I'm generally sympathetic to the police in this plight. I, too, sometimes have to make urgent life-and-death decisions on the basis of limited information. Sometimes I'm right. Sometimes I'm wrong. Although there are certainly a few bad cops (and a few bad doctors, bad cordwainers, bad leech-gatherers...), I think most cops try hard to do a good job, try to understand what the community wants out of them, and are actually pretty good at talking down violent people, and dealing with them in the least violent way.

But some people can't be talked down. We don't yet have a method of dealing with them that is completely safe.

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