The Physiologic Effects of Multiple Simultaneous Electronic Control Device Discharges

CEMC Abstracts the 627 patients admitted with that diagnosis, indicating agreement in 63.0% (95% confidence interval 59.2– 66.8%). No clinical factor was identified that made radiologist final reads more or less likely to concur with EP reads, including age (p ⫽ 0.22), sex (p ⫽ 0.24), race (p ⫽ 0.81), mode of arrival (p ⫽ 0.71), respiratory complaint (p ⫽ 0.28), community acquired vs. hospital acquired (p ⫽ 0.37), systolic blood pressure (p ⫽ 0.50), heart rate (p ⫽ 0.13), respiratory rate (p ⫽ 0.54), temperature ⬎ 38.0°C (p ⫽ 0.96), oxygen saturation ⬍ 95% (p ⫽ 0.14), daytime vs. nighttime arrival (p ⫽ 0.15), or weekday vs. weekend arrival (p ⫽ 0.08). Looking before and after our implementation of Joint Commission on Accreditation of Healthcare Organizations recommendations to administer antibiotics within 4 h, we were also unable to detect a difference, with 62.8% agreement before and 64.6% agreement after implementation (p ⫽ 0.72). Conclusion: Radiologists concur with EP diagnosis of pneumonia in about two-thirds of cases, indicating that EPs may be grossly over-diagnosing the disease. No clinical factors were identified that suggest which patients may be susceptible to discordance. Further studies are necessary to determine the reasons and implications of this discrepancy. Financial disclosure: There is no known conflict of interest for any of the authors of this article.

209 laser sight introduction of the device, two were full probe deployment with a 5-s activation cycle, one was an unholstering of the CEW but the laser sight was not turned on. Two injuries required evaluation: one was for probe removal and bandages to the probe sites, and one was for a laceration sustained when the suspect became combative after handcuffing and was taken to the ground (this injury was not related to the CEW use). Three incidents required use of significant “empty hand” control techniques (pain compliance techniques) in addition to CEW deployment. Witnesses at 16 incidents reported that injuries were avoided because the CEW demonstration prevented further behavior escalation. These included 18 instances of hospital personnel and agitated persons avoiding injury and one episode of an aborted patient suicide attempt from a sharp object held to the throat. Conclusion: Introduction of the CEW into an urban health care setting has initially shown a promising ability to avert and control violent situations that could result in further injury to both the agitated subject and health care personnel. Longer term, multicenter study of this phenomenon is recommended for validation. Disclosures: Drs. Ho and Dawes serve as consultants to TASER International and own shares of stock in the company; Dr. Heegaard is a member of the TASER International Scientific Medical Advisory Board; Dr. Miner has no conflicts to declare.

#904 (#24) Dawes #899 (#22) Ho 䡺 INTRODUCTION OF A CONDUCTED ELECTRICAL WEAPON IN A HOSPITAL SETTING: THE FIRST 8 MONTHS OF USE. Jeffrey D. Ho, MD, William G. Heegaard, MD, James R. Miner, MD, Department of Emergency Medicine, Hennepin County Medical Center Minneapolis, Minnesota; Donald M. Dawes, MD, Department of Emergency Medicine, Lompoc Valley Medical Center, Lompoc, California. Introduction/Objective: Use of the TASER威 X26 (TASER International Inc., Scottsdale, AZ) conducted electrical weapon (CEW) by law enforcement to control agitated and potentially violent persons in society is becoming common. CEWs are known to provide a visual deterrent to escalating behavior when the laser sighting device is activated and are also known to provide pain compliance stimuli and neuromuscular incapacitation of the person when the device is fully activated. CEW use by health care security and protection personnel has not previously been described. Our objective is to report on the utility of the introduction of the CEW into the hospital environment. Methods: Upon introduction of the CEW into our academic, urban, tertiary medical center campus, standardized reports describing all CEW use on human subjects by the Medical Center Protection Officers (MCPOs) have been made. These reports were retrospectively reviewed for this project. Collected data points included other force options used, potential injuries avoided, witness comments, outcomes, and whether or not the CEW required full activation or if visual laser sight introduction of the CEW was sufficient to control the situation. Data were tabulated in spreadsheet format. Results: MCPOs reported 19 incidents involving CEW deployments during the study period. Sixteen deployments were visual

䡺 THE PHYSIOLOGIC EFFECTS OF MULTIPLE SIMULTANEOUS ELECTRONIC CONTROL DEVICE DISCHARGES. Donald M. Dawes, MD, Lompoc Valley Medical Center, Lompoc, California; Jeffrey D. Ho, MD, Robert F. Reardon, MD, James R. Miner, Hennepin County Medical Center, Minneapolis, Minnesota. Introduction: Electronic control devices are utilized by law enforcement and military to control non-compliant and actively resistive subjects. The TASER® Shock Wave (TASER International Inc., Scottsdale, AZ) is a new electronic control device designed specifically as an area denial device. It operates as a remotely triggered stationary platform that saturates a target area with multiple electronic control device electrical circuits. This is the first study to examine the effects of multiple simultaneous device discharges in humans. Methods: Sixteen human volunteers were exposed to multiple (two to three), simultaneous 5-s discharges from the Shock Wave device. Applications were to the chest, back, chest to abdomen, or thighs. Blood was analyzed before and after discharge for pH, lactate, potassium, creatine kinase (CK), and troponin. Continuous spirometry was performed. In addition, electrocardiograms (ECGs) before and after discharge were recorded, and echocardiography was used to determine the rhythm during discharge. Results: There were no statistical or clinically important changes in pH. There were small elevations of lactate (mean change of 2.44 immediately after the exposure for two exposures, 0.93 for three exposures). There were moderate increases in CK at 24 h (mean change 381 for two exposures, 843 for three exposures). There were no clinically important or statistically significant changes in potassium. Troponin, drawn pre, immediately post, and at 24 h, was always within the refer-

210 ence range for the i-STAT device (Abbott Point of Care Inc., Princeton, NJ). There was a trend to a decrease in minute ventilation in the subjects with chest or back exposures (two devices), although it did not reach statistical significance. The ECG changes only reflected some increased vagal tone after the discharge. There were no important rhythm changes. In 4 of the 6 subjects, the echocardiographer was able to determine that the rhythm during discharge was sinus. In 2 subjects, motion artifact precluded this. One of these subjects had a heart rate during the exposure of 79 beats/min, not suggesting electrical capture. Conclusion: Five-second, simultaneous, multiple exposures to the TASER Shock Wave device do not seem to have significant deleterious effects on human physiology, except for a moderate increase in CK. Funding: TASER International provided partial funding for this study. Drs. Dawes and Ho are external medical consultants to the company, and stockholders.

#905 (#25) Dawes 䡺 THE NEURO-ENDOCRINE EFFECTS OF THE TASER X26 CONDUCTED ELECTRICAL WEAPON. D. Dawes, Lompoc Valley Medical Center, Lompoc, California; J. Ho, J. Miner, Hennepin County Medical Center, Minneapolis, Minnesota. Introduction: This is the first study to examine the human stress response to a conducted electrical weapon (CEW), oleoresin capsicum, a cold-water tank immersion, and a defensive tactic drill. Methods: Subjects received either a 5-s exposure from the TASER X26 (TASER International Inc., Scottsdale, AZ) CEW with the probes fired into the back from 7 feet, a 5-s spray of oleoresin capsicum (OC), a skin and mucous membrane irritant, to the eyes, a 45-s exposure of the hand and forearm in a 0°C cold water tank, or a 1-min defensive tactics drill. Salivary alpha-amylase, a measure of the sympatheticadrenal-medulla axis of the human stress response (vs. sympathetic tone), and salivary cortisol, a measure of the hypothalamus-pituitary-adrenal axis of the human stress response, was collected by passive drool before and after the exposures and analyzed by Salimetrics, Inc. (State College, PA). Results: Fifty-three subjects were enrolled, with 16 each in the CEW and cold-water tank groups, and 10 each in the OC and defensive tactics groups. The mean ages were 43 years for the cold-water tank group, 35 years for the CEW group, 28 years for the OC group, and 45 years for the defensive tactics drill. The defensive tactics drill resulted in the greatest change in salivary alpha-amylase at 10 –15 min, with a change of 63.8 U/mL. OC was next, with a change of 37.4. The CEW and cold-water tank immersion did not seem particularly activating. OC had the greatest change in salivary cortisol at 15–20 min, with a change of 0.5 ␮g/dL. The CEW was next, with a change of 0.38, and the defensive tactics drill after that with a change of 0.25. The defensive tactics drill had the greatest delayed change from baseline in cortisol, with a change of 0.47. The cold-water tank immersion did not seem particularly activating. Conclusion: Our preliminary data suggest that physical exer-

The Journal of Emergency Medicine tion during custodial arrest may be most activating of the human stress response. Funding: TASER International provided partial funding for this project. Drs. Dawes and Ho are external consultants to the company and stockholders.

#909 (#27) Browne 䡺 CLINICAL EFFECTS FOLLOWING ACUTE PREGABALIN (LYRICA®) INGESTION BY YOUNG CHILDREN. Brandon A. Browne, David L. Morgan, Doug J. Borys, Rhandi Stanford, Scott and White Hospital, Texas A&M College of Medicine, Central Texas Poison Center, Temple, Texas. Background: Pregabalin (Lyrica®; Pfizer Inc., New York, NY) has been available in the United States only since 2005, and it is indicated for the treatment of seizures and pain in adults. In June 2007, it became the only medication approved by the Food and Drug Administration for the treatment of fibromyalgia in adults. Although it has become a common prescription medication, there have been no published reports on its adverse effects in children. Objective: The purpose of this study was to determine the clinical effects of accidental pregabalin ingestion by young children. Methods: Retrospective, observational study of one state’s poison centers’ calls of exposures to pregabalin from January 2006 through September 2008 for children under 6 years of age. Results: There were 57 children who met the inclusion criteria. They were 3 months to 5 years of age, and they ingested 25 to 400 mg. Fifty-one subjects (89.5%; 95% confidence interval [CI] 78.9%– 95.1%) had no clinical symptoms. The only symptoms noted were lethargy (9.8%) and ataxia (7.0%). There were no deaths or major clinical effects (0%; 95% CI 0%– 6.3%). Only 12 (21.1%) children received activated charcoal, and none received gastric lavage or syrup of ipecac. Most (68.4%) children were managed in an emergency department, and 4 (7.0%) were admitted for observation (2 to the intensive care unit). None remained in the hospital longer than 1 day. Conclusion: This is the first study of pregabalin’s clinical effects in young children, but it is limited by its retrospective nature, the small number of subjects, and its reliance on caller information. Because none of these children had a major adverse effect, it is likely that more of them could be safely managed at home. More studies are needed to determine the appropriate emergency management of this age group.

#910 (#28) Letsinger 䡺 ACUTE HYDROXYCHLOROQUINE (PLAQUENIL®) INGESTION BY YOUNG CHILDREN. Terry J. Letsinger, David L. Morgan, Douglas J. Borys, Scott and White Hospital, Temple, Texas. Introduction: Hydroxychloroquine (Plaquenil®; sanofiaventis Inc., Bridgewater, NJ) is a derivative of chloroquine used in the treatment and prophylaxis of malaria, rheumatoid arthritis, and systemic lupus erythematosus. Although chloroquine has been associated with significant toxicity from ingestion of one pill in young children, no reports have evaluated the clinical effects of accidental hydroxychloroquine ingestions in children. Many authors suggest that hydroxychloroquine, like chloroquine, should be considered toxic with ingestion of one