Letters
to the Editor
, EMERGENCY DEPARTMENT EVALUATION
OF CONDUCTED ENERGY WEAPON (CEW)INJURED
PATIENTS
, To the Editor:
We appreciate the recent review provided by Vilke et al.
on emergency department (ED) evaluation of patients after
conducted energy weapon (CEW) use (1). Their position
against routine electrocardiographic and laboratory
evaluation for patients presenting with isolated CEW
injury is well supported and we agree with that conclusion.
The conclusion that the use of CEWs in certain
vulnerable populations (e.g., patients exhibiting signs of
“excited delirium” or after extended resistance to restraint)
does not, in and of itself, warrant further evaluation;
however, it is concerning.
The references that comprise the majority of evidence
for their conclusions are in controlled populations that
do not accurately reflect the complex, clearly more
dangerous environments of law enforcement restraint
(which more commonly present to the ED). In the two
references that retrospectively look at this population,
one cites numerous examples of elevated lactate or
troponin, and the other excluded this information for
the patients studied (2–4). In our published study,
which examined CEW-related deaths, patients who died
proximal to CEW use frequently had underlying cardiac
disease that would make them more likely to have coronary
events and laboratory abnormalities contributing to
their deaths (5).
Given the still-incomplete understanding of the
physiologic effects in these circumstances, as we have
argued elsewhere, we would recommend that, in patients
presenting to EDs after CEW use in the context
of law enforcement restraint, observation and evaluation,
including cardiac monitoring, electrocardiographic
studies, and laboratory evaluation, should be the standard
of care (5).
Jared Strote, MD
University of Washington
Seattle, Washington
H. Range Hutson, MD
Harvard Medical School
Boston, Massachusetts
http://dx.doi.org/10.1016/j.jemermed.2011.10.034
REFERENCES
1. Vilke GM, Bozeman WP, Chan TC. Emergency department evaluation
after conducted energy weapon use: review of the literature for
the clinician. J Emerg Med 2011;40:598–604.
2. Strote J, Walsh M, Angelidis M, Basta A, Hutson HR. Conducted
electrical weapon use by law enforcement: an evaluation of safety
and injury. J Trauma 2010;68:1239–46.
3. Bozeman WP, Hauda WE 2nd, Heck JJ, Graham DD Jr, Martin BP,
Winslow JE. Safety and injury profile of conducted electrical
weapons used by law enforcement officers against criminal suspects.
Ann Emerg Med 2009;53:480–9.
4. Strote J, Hutson HR. Conducted electrical weapon injuries must be
more broadly considered. Ann Emerg Med 2009;54:310–1. author
reply 1–2.
5. Strote J, Range Hutson H. Taser use in restraint-related deaths. Prehosp
Emerg Care 2006;10:447–50.
, RE: EMERGENCY DEPARTMENT
EVALUATION OF CONDUCTED ENERGY
WEAPON (CEW)-INJURED PATIENTS
, To the Editor:
We appreciate the comments offered by Drs. Strote and
Hutson regarding our recent publication on emergency
department (ED) evaluation of patients after conducted
energy weapon (CEW) use (1). Their letter interpreted
our article as concluding that the use of CEWs in certain
vulnerable populations (e.g., patients exhibiting signs of
“excited delirium” or after extended resistance to restraint)
does not, in and of itself, warrant further evaluation, for
which Strote and Hutson registered some concern.
However, we were very clear, particularly as to specific
recommendations in regards to excited delirium syndrome
when we concluded.
“Therefore, the current medical literature does not
support routine performance of laboratory studies,
ECGs, or prolonged ED observation or hospitalization
for ongoing cardiac monitoring after CEW exposure in
533
The Journal of Emergency Medicine, Vol. 46, No. 4, pp. 533–536, 2014
Copyright Ó 2014 Elsevier Inc.
Printed in the USA. All rights reserved
0736-4679/$ - see front matter