Less-Lethal Law Enforcement Weapons: Clinical Management of Associated Injuries in the Emergency Department (Trauma CME) -
Publication Date: August 2021 (Volume 18, Number 08)
CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAP Prescribed Credits, 4 AOA Category 2-A or 2-B Credits. CME expires 08/01/2024.
Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 1.5 Trauma CME credits, subject to your state and institutional approval.
Jessica Osterman, MD, MS
Associate Professor of Clinical Emergency Medicine, Keck School of Medicine; Associate Residency Director, LAC+USC Department of Emergency Medicine, Los Angeles, CA
Cara Buchanan, MD
Resident Physician, LAC+USC Department of Emergency Medicine, Los Angeles, CA
Edouard Coupet, Jr, MD, MS
Assistant Professor, Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
James Dodington, MD, CPST, FAAP
Assistant Professor of Pediatrics and Emergency Medicine, Yale School of Medicine, Medical Director, Center for Injury and Violence Prevention, Yale New Haven Hospital, New Haven, CT
Matthew Harris, MD, FAAP, FAEMS
Medical Director, Northwell Health Emergency Management and Clinical Preparedness; Assistant Professor of Pediatrics and Emergency Medicine, Cohen Children’s Medical Center, Zucker School of Medicine at Hofstra University, New Hyde Park, NY
Less-lethal weapons and tactics are being increasingly used by law enforcement to minimize the reliance on more-lethal force. While these methods are designated as “less-lethal,” they can cause morbidity and mortality when deployed. Knowledge of these weapons and tactics can help direct the workup and management of patients with injuries from these methods and can protect clinicians from secondary exposure and injuries. This issue reviews the most common less-lethal weapons and tactics used by law enforcement, describes their mechanism of action, and discusses associated common injury patterns. Recommendations are provided for the evaluation and management of these patients in the emergency department.
A 10-year-old girl is brought to your ED with the chief complaint of eye burning and tearing...
The girl was attending a peaceful march downtown when some protestors became violent and began shoving the attendees. Law enforcement responded and dispersed a “gas” into the crowd to clear the area. The girl and her mother remember seeing large cannon-like weapons and then being surrounded by thick smoke. The girl initially had some coughing that improved after they removed themselves from the crowd, but now she has persistent “burning” eye pain and constant eye watering.
On examination, you note mild conjunctival injection bilaterally with persistent tearing. The girl’s pupils are round and reactive to light, and her extraocular movements are intact. You notice traces of powder on the child’s face. Her vital signs are within normal limits, her lungs are clear, and her heartbeat is regular.
What was this patient most likely exposed to? How can you best decontaminate her? How can you protect your staff from secondary exposure? What additional findings should you be looking for on examination? What treatment is needed?
A 14-year-old girl is brought in by law enforcement for medical clearance for booking at a juvenile detention facility...
The girl and her friends were arrested for stealing a car, and during the arrest, the girl was combative. In an attempt to subdue the girl, law enforcement officers deployed a beanbag gun. The patient was struck in the right leg and the right upper quadrant by beanbag projectiles. She complains of pain in the locations where she was struck. Otherwise, the history is limited.
On examination, you note a contusion to the abdominal right upper quadrant, with surrounding erythema and tenderness. The girl’s breath sounds are equal bilaterally, and her heartbeat is regular. Her right anterior thigh has a small contusion with tenderness, but compartments are soft, and the patient is otherwise neurovascularly intact in that extremity. The girl’s vital signs are remarkable for mild tachycardia but are otherwise within normal limits.
What types of injuries are associated with beanbag deployment? What internal injuries should be considered in this patient? What is the appropriate imaging for this patient?
A 17-year-old boy is brought in from a juvenile detention facility in law enforcement custody for evaluation of a TASER injury sustained during a riot in the facility...
The boy complains of pain to his left mid-abdominal area as well as some pain in his low back and feeling “sore all over.” He presents without a shirt on and has cut wires protruding from his left mid-abdominal area and a TASER dart embedded in the skin with a small amount of dried blood surrounding the puncture site.
On examination, he has some mild tenderness at the site of the lodged dart, but otherwise his abdomen is soft and nontender. On back examination, he has midline tenderness at L1 but is neurologically intact in the lower extremities, and there is no gross evidence of trauma to the back. His vital signs are otherwise unremarkable except for some mild tachycardia.
How should you remove the dart? Is there any further electrical risk to the patient or staff? What laboratory studies or other tests should you order for this patient? What could be causing the patient’s back pain?
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