(01/10) Sun H, Haemmerich D, Rahko PS, Webster JG. Estimating the probability that the Taser(R) directly causes human ventricular fibrillation. J Med Eng Technol. Jan 12 2010.
(12/09) Donald L. Nevins, III, Municipal Liability Under 42 U.S.C. § 1983 for Failing to Equip Police With TASERs, 28 Quinnipiac L. Rev. 225.
(12/22/09) Strote, Jared; Walsh, Mimi; Angelidis, Matthew; Basta, Amaya; Hutson, H Range, Conducted Electrical Weapon Use by Law Enforcement: An Evaluation of Safety and Injury, The Journal of Trauma, 22 December 2009, doi: 10.1097/TA.0b013e3181b28b78. Conclusions: Significant injuries related to 6 years of law enforcement CEW use [1,101 individuals] in one city were rare. A large percentage of those subjected to CEW use had diagnoses of substance abuse and/or psychiatric conditions. Most admissions after CEW use were unrelated to law enforcement restraint.
(12/09) Dawes DM, Ho JD, Reardon RF, Miner JR, Echocardiographic evaluation of TASER X26 probe deployment into the chests of human volunteers, Am J Emerg Med. 2010 Jan;28(1):49-55. Conclusion. In agreement with 2 prior studies by these authors, the TASER X26 did not capture the myocardium when used with probe deployment, even in the cardiac electrical axis. These data are contrary to animal studies in which capture occurred. We recommend other investigators replicate our findings.
(12/09) Dawes DM, Ho JD, Kroll MW, Miner JR, Electrical Characteristics of an Electronic Control Device Under a Physiologic Load: A Brief Report, Pacing Clin Electrophysiol. 2009 Dec 10. [Epub ahead of print]. Conclusions: The mean tissue resistance was 602.3 Ω in this study. There was a decrease in resistance of 8% over the 5-second exposure. This physiologic load is different than the 400 Ω laboratory load used historically by the manufacturer. We recommend future characterization of these devices use a physiologic load for reporting electrical characteristics. We also recommend that all the electrical characteristics be reported.
Recent In-Custody Death and/or Excited Delirium Articles
(06/10) Otahbachi M, Cevik C, Bagdure S, Nugent K., Excited delirium, restraints, and unexpected death: a review of pathogenesis, Am J Forensic Med Pathol. 2010 Jun;31(2):107-12.
Abstract. Unexpected deaths periodically occur in individuals held in police custody. These decedents usually have had significant physical exertion associated with violent and/or bizarre behavior, have been restrained by the police, and often have drug intoxication. Autopsy material from these cases may not provide a satisfactory explanation for the cause of death, and these deaths are then attributed to the excited delirium syndrome. The pathogenesis of excited delirium deaths is likely multifactorial and includes positional asphyxia, hyperthermia, drug toxicity, and/or catecholamine-induced fatal arrhythmias. We suggest that these deaths are secondary to stress cardiomyopathy similar to the cardiomyopathy seen in older women following either mental or physical stress. This syndrome develops secondary to the toxic effects of high levels of catecholamines on either cardiac myocytes or on the coronary microvasculature. Patients with stress cardiomyopathy have unique ventricular morphology on echocardiograms and left ventricular angiography and have had normal coronary angiograms. People who die under unusual circumstances associated with high catecholamine levels have contraction bands in their myocardium. Consequently, the pathogenesis of the excited delirium syndrome could be evaluated by using echocardiograms in patients brought to the emergency centers, and by more careful assessment of the myocardium and coronary vessels at autopsy. Treatment should focus on prevention through the reduction of stress.
(12/09) Heide S, Kleiber M, Hanke S, Stiller D., Deaths in German Police Custody, Eur J Public Health. 2009 Dec;19(6):597-601. Epub 2009 Jun 25. CONCLUSIONS: Our study gives recommendations on how to improve various measures to increase the quality of medical attention given to persons taken into police custody.
(07/09) Morgan, Joseph, Allen, Jennifer, M., Use of Force and Excited Delirium Syndrome, pages 95-105, Critical Issues of Use of Force by Law Enforcement (Special Edition), Law Enforcement Executive Forum, Volume 9, Number 3, July 2009.
(06/24/09) Deborah C. Mash, Linda Duque, John Pablo, Yujing Qin, Nikhil Adi, W. Lee Hearn, Bruce. Hyma, Steven B. Karch, Henrik Druid, Charles V. Wetli, Brain biomarkers for identifying excited delirium as a cause of sudden death, Forensic Science International, Sci. Int. (2009), doi:10.1016/j.forsciint.2009.05.012.
John Peters, Ph.D.- IPICD - ICD Articles Series - Police & Security News
(05/17/07) Model Policy for Excited Delrium, by David Hatch, Corrections Managers' Report, Volume XIII, No. 1, June/July 2007, Pgs 7-9, 12 , ISSN 1083-3382.
(03/19/07) Management of Subjects in Excited Delirium, San Jose (CA) Police Department Training Bulletin No: 006-2007.
(06/01/07) NEW EXCITED DELIRIUM PROTOCOL ISSUED BY SAN JOSE PD, Force Science News #73, June 1, 2007.
Other ED & ICD Related Articles, Posters, Etc.
(05/09) Ho J, Heegaard W, Dawes D, Natarajan S, Reardon R, Miner J. Unexpected Arrest Related Deaths in America: 12 Months of Open Source Surveillance. Western Journal of Emergency Medicine. May 2009(2).
Conclusion: This surveillance report can be a foundation for discussing ARD. These data support the premise that ARDs primarily occur in persons with a certain demographic and behavior profile that includes middle-aged males exhibiting agitated, bizarre behavior generally following illicit drug abuse. Collapse time associations were demonstrated with the use of TASER devices and impact weapons. We recommend further study in this area to validate our data collection method and findings.
(03/09) Excited Delirium Deaths in Custody Past and Present, Jami R. Grant, PhD, Pamela E. Southall, MD, Joan Mealey, BS, Shauna R. Scott, BS, and David R. Fowler, MB, ChB, M Med(Path), The American Journal of Forensic Medicine and Pathology • Volume 30, Number 1, March 2009.
Abstract: First identified in institutionalized psychiatric populations, chronic excited delirium syndrome was not uncommon in the first half of the 20th century. After a temporal pause, excited delirium re-emerged in the 1980s, in an acute form. Generally occurring in victims without organic mental disease, acute excited delirium is associated with stimulant abuse. This exploratory research examines the evolution of excited delirium deaths in custody to determine if medical examiner cases in Maryland reflect the historical and clinical patterns identified in the existing literature. All deaths occurring from 1939 to 2005, under the purview of the Office of the Chief Medical Examiner, were reviewed. Sixty-two custodial deaths were subsequently identified, all of which documented excited delirium as a cause of death or presented with characteristics associated with excited delirium (eg, endogenous mental disease, drug intoxication, violent behavior, paranoia, or the use of physical restraints). Consistent with extant literature, acute onset excited delirium was first identified in Maryland during the 1980s. These cases generally included violent behavior, drug intoxication, and the use of restraints. In contrast, chronic forms of excited delirium were not clearly identified. This divergent finding may be an artifact of case documentation, case inclusion criteria and/or medico-legal protocol, specific to Maryland.
(02/01/09) Jennifer L. Pilgrim, B.Sc.(Hons.); Dimitri Gerostamoulos, Ph.D.; Olaf H. Drummer, Ph.D.; and Marc Bollmann, M.D., Involvement of Amphetamines in Sudden and Unexpected Death, J Forensic Sci, March 2009, Vol. 54, No. 2, doi: 10.1111/j.1556-4029.2008.00949.x.
Abstract: In the present study, the effects of amphetamine-class drugs were examined in cases reported to the Victorian coroner from 2001 to 2005 to determine if death can occur from the use of amphetamine-class drugs alone. A total of 169 cases were reviewed where a forensic autopsy detected amphetamine(s) in the blood. Pathology, toxicology, and police reports were analyzed in all cases to ascertain the involvement of amphetamine-class drugs in these deaths. In Victoria, methamphetamine (MA) is the principal abused amphetamine-class followed by methylenedioxymethamphetamine (MDMA). There were six cases in which a cerebral hemorrhage caused death and three cases in which serotonin syndrome was established as being caused by the interaction of MDMA and moclobemide. There were 19 cases in which long-term use of amphetamines was associated with heart disease. There were three cases where amphetamine-class drugs alone were regarded as the cause of death, of which two cases exhibited high levels of MDMA and lesser amounts of MA and/or amphetamine. There were no cases in which significant natural disease was absent and death was regarded as caused by the use of MA. There was no correlation between blood concentration of drug and outcome.
This program is being offered, free of charge, as a public service by Dr. Michael D. Curtis, in cooperation with KRM's Law Enforcement Training Division.
What can law enforcement leaders do to prevent in-custody deaths? Can law enforcement leaders initiate a community effort to prevent in-custody deaths resulting from excited delirium during violent confrontations with police? Do effective action plans exist in other communities and what do they look like?
(10/14/07) [1:00 p.m. to 2:15 p.m.) Excited Delirium, Police Physicians Section Track, Donald Dawes, MD, and Jeffrey Ho, MD.
Deaths in police custody can evoke strong reactions from the victims' families, the lay press, and the public. Police departments may be forced to prove that their actions (or inactions) did not contribute to these deaths. It is imperative for police chiefs and their staffs to have a good understanding of the history of this phenomenon, to understand the theories of causation in these sudden deaths, and to have a basic understanding of the current medical literature. In this workshop, these topics will be reviewed with a particular emphasis on conducted electrical weapons (CEW). The complex phenomenon of excited delirium will be reviewed as a theory of causation.
(10/14/07) [2:30 p.m. to 3:00 p.m.] Investigation of In-Custody Deaths, Police Physicians Track, Chris Lawrence.
A systematic protocol to investigate sudden in-custody deaths will be presented.
(10/14/07) [3:00 p.m. to 3:30 p.m.] Panel on Excited Delirium, Police Physicians Section Track, Robert M. Bragg MSPE, Fabrice Czarnecki, MD, MA, MPH, Donald Dawes, MD, Jeffrey Ho, MD MD, Chris Lawrence.
Participants will review current issues and recent research regarding excited delirium. Recommendations to prevent sudden in-custody deaths will be presented.
(05/17/07) Myth of Positional Asphyxia, Fatal Excited Delirium Case Studies, Model Policy for Excited Delirium, by David Hatch, Corrections Managers' Report, Volume XIII, No. 1, June/July 2007, Pgs 7-9, 12 , ISSN 1083-3382.
(02/21/07) AAFS Presentation: Fatal Ephedrine Intoxication in a Chronic Ephedrine User Who Had Cardiovascular Disease,
Diana G. Wilkins, PhD., Center for Human Toxicology, Biomed Research Polymers Building, Room 490, Salt Lake City, UT 84112; Ling Li, MD and David R. Fowler, MD, Office of the Chief Medical Examiner State of Maryland, 111 Penn Street, Baltimore, MD 21201; Brienne Brown, MS, Center for Human Toxicology, Biomend Research Polymers Building, Room 490, Salt Lake City, UT 84112; and Stephen J. Kish, PhD, Centre Addiction Mental Health, 250 College Street, Toronto, Ontario, M5T 1R8, Canada.
(11-12/05)Sudden Custody Death Syndrome, Matthew D. Sztajnkrycer, MD, PhD and Sgt. Michael Walsh, The Police Marksman Magazine, November/December 2005, pp. 19-24.
(10/10/05)Boomers' Overdose Deaths Up Markedly, Los Angeles Times - "Californians age 40 and older are dying of drug overdoses at double the rate recorded in 1990 ...."
(10/05)Cocaine, Excited Delirium and Sudden Unexpected Death, by Sztajnkrycer MD, Baez AA., Mayo Clinic, Rochester, MN, USA. sztajnkrycer.matthew@mayo.edu, PMID: 15900873 [PubMed - indexed for MEDLINE], Emerg Med Serv. 2005 Apr;34(4):77-81.
(06/00)Cocaine metabolism in hyperthermic patients with excited delirium, by Blaho K, Winbery S, Park L, Logan B, Karch SB, Barker LA., Department of Emergency Medicine and Clinical Toxicology, UT Medical Group, Memphis, USA. J Clin Forensic Med. 2000 Jun;7(2):71-6.
(2000)Metabolic consequences of drug misuse, by J. A. Henry, Academic Department of Accident and Emergency Medicine, Imperial College School of Medicine, St Mary’s Hospital, London W2 1NY, UK, British Journal of Anaesthesia, 2000, Vol. 85, No. 1 136-142.
(07/99) Georg Roggla and Martin Roggla, Death in a hobble restraint, Can. Med. Assoc. J., Jul 1999; 161: 21.
(1998)Deaths in Police Custody: Learning the Lessons, Police Research Series, Paper 26, by Adrian Leigh, Graham Johnson, Alan Ingram, Police Research Group, Home Office, London, United Kingdom.
(1998) Alprazolam (Xanax) withdrawal delirium: A case report. Zalasman, G., Hermesh, H., Munitz, H., Clinical Neuropharmacology, 1998; 21: 201-202.
[(1994) Custody death is not new -- John Peters and Michael Brave's first published article (on this topic) in 1994)] Brave, Michael A., and Peters, John G., Jr., Custody Death Syndrome; Policy and Procedure, pages 12-17, Law Enforcement Legal Defense Manual, Brief 95-1.
(1993) O'Halloran, M.D., Ronald L., and Lewman, M.D., Larry V., "Restraint Asphyxiation in Excited Delirium," The American Journal of Forensic Medicine and Pathology, 14(4):289-295, 1993. (1992) Reay, Donald T., M.D., Fligner, Corinne L., M.D., Shilwell, Allan D., M.D., Arnold, Judy. "Positional Asphyxia During Law Enforcement Transport," The American Journal of Medicine and Pathology, 12(2):pp 90-97, 1992.
(1992) Custody Death Task Force, Final Report, San Diego (CA) Police Department, June 1992.
(1987) Mittleman, R.E. and Wetli, C.V., "Cocaine and Sudden 'Natural' Death," Journal of Forensic Sciences, JFSCA, Vol. 32, No. 1, Jan. 1987, pp. 11-19.
(1985) Wetli, C.V. and Fishbain, D.A., "Cocaine-Induced Psychosis and Sudden Death in Recreational Cocaine Users," Journal of Forensic Sciences, JFSCA Vol. 30, No. 3, July 1985, pp. 873-880.
Antipsychotic Drugs and Sudden Death
(2004) Sabine M. J. M. Straus, MD; Gyse`le S. Bleumink, MD; Jeanne P. Dieleman, PhD; Johan van der Lei, MD, PhD; Geert W. ‘t Jong, PhD; J. Herre Kingma, MD, PhD; Miriam C. J. M. Sturkenboom, PhD; Bruno H. C. Stricker, PhD; Antipsychotics and the Risk of Sudden Cardiac Death, Arch Intern Med. 2004;164:1293-1297.
Drug Deaths Reports - US & FL Medical Examiners Reports
(10/01/07) Speed, Cocaine, and Other Psychostimulants Death Rates, The American Journal of Cardiology , Volume 100 , Issue 7 , Pages 1184 - 1184, M. Gold, N. Graham, F. Kobeissy, C. Pepine, B. Goldberger. (02/06/07) (Free) Two-Hour Webinar - Tim Shultz, Methamphetamine: All You Want to Know and More (12300). KRM Law Enforcement Training Division (KRM-LETD).
"The research, based on the shooting experiences of one large sheriff’s department in California, shows that subjects who are under the influence of drugs or alcohol and/or have a history of violence are far more likely to be on the receiving end of police gunfire.
Specifically, among subjects the sheriff’s personnel responded to with deadly force,
- those under the influence of drugs were 3 times more likely to be shot or shot at by officers than those who weren’t,
- intoxicated suspects 3.4 times more likely than those who were sober; and
- people with previous arrests for violent crimes 3.7 times more likely than those without that history."
In 2004, poisoning was second only to motor-vehicle crashes as a cause of death from unintentional injury in the United States (1). Nearly all poisoning deaths in the United States are attributed to drugs, and most drug poisonings result from the abuse of prescription and illegal drugs. The number of unintentional poisoning deaths increased from 12,186 in 1999 to 20,950 in 2004.
In 2004, poisoning was second only to motor-vehicle crashes as a cause of death from unintentional injury in the United States (1). Nearly all poisoning deaths in the United States are attributed to drugs, and most drug poisonings result from the abuse of prescription and illegal drugs. The number of unintentional poisoning deaths increased from 12,186 in 1999 to 20,950 in 2004.
- 8,620 drug related deaths - people died with one ore more of the drugs in the report in their bodies. This is an increase of 11% from 7,741 cases reported in 2006.The vast majority of these 8,620 cases involved more than one drug listed in the report.
- The drugs that caused the most deaths were:
- Cocaine (843), (2006 cocaine was 829)
- Methadone (785), (2006 methadone was 716)
- all Benzodiazepines (743) (2006 was 553), (2007 includes 572 deaths caused by Alprazolam) (2006 Alprazolam was 456),
- 7,741 drug related deaths - people died with one ore more of the drugs in the report in their bodies. The vast majority of these 7,741 cases involved more than one drug listed in the report.
- The drugs that caused the most deaths were Cocaine (829), Methadone (716), all Benzodiazepines (553), Oxycodone (496), Alprazolam (456), Ethyl Alcohol (378), Hydrocodone (236), and Morphine (229)
- 7,573 people died with one or more of the drugs in the report in their bodies. This number is up from 7,128 cases reported in 2004.
- of those, 115 had meth in their bodies (29 meth was the cause of death, 86 meth present)
- The drugs that caused the most deaths were Cocaine (732), Methadone (620), all Benzodiazepines (574), Alprazolam (414), Ethyl Alcohol (343), Oxycodone (340), Morphine (247), and Hydrocodone (221).
- 1,943 had cocaine in their bodies (732 cocaine was the cause of death, 1,211 cocaine present)
2004 Report of Drugs: Identified in Deceased Persons by Florida Medical Examiners
- 93 had meth in their bodies (19 meth was the cause of death, 74 meth present)
- 1,702 had cocaine in their bodies (591 cocaine was the cause of death, 1,111 cocaine present)
- In 2005, occurrences of Cocaine continued to rise to its highest level since being tracked and is 14% higher than 2004. Deaths in 2005 caused by Cocaine increased 23.9% over 2004.
(FL) Cocaine Abuse in 2006 -A Recurring Epidemic? Mark S. Gold, M.D., Matthew A. Cunningham, MS-41, Noni A. Graham, M.P.H., Christopher J. Hammond, MS, Bruce A. Goldberger, Ph.D., DABFT.
(11/15/09) Dawes, D., J. Ho, et al. (2009). "Effect of an Electronic Control Device Exposure on a Methamphetamine-Intoxicated Animal Model." Australasian College for Emergency Medicine Scientific Assembly 2009. Conclusions: In smaller animals, ECD exposure exacerbated atrial and ventricular irritability, but this effect was not seen in larger animals. In adult sized animals, the study did not indicate that methaphetamine intoxication precluded the use of electronic control devices.
(10/05-9/09) 2009 American College of Emergency Physicians (ACEP) Boston Scientific Assembly, Boston, MA.
(10/05/09) Ho J, Dawes D, Lundin E, Miner J. Comparison of Acidosis Markers Associated with Law Enforcement Applications of Force. American College of Emergency Physicians 2009 Scientific Assembly. 2009. Conclusions: The exertional groups of heavy bag and spring had a lower pH and higher lactate after the exposure than the other groups. The exposures to the TASER ECD and the OC spray had higher pH and lower lactate than the other groups. Volitional behaviors of resistance and fleeing induced the most profound levels of acidosis. Measured LEA tools/tactics did not induce acidosis to the same levels as volitional subject behavior. The common activity of briskly going up and down stairs causes similar acidosis physiology to a 10 second ECD application. This work represents the first known study to evaluate acidosis that may be associated with LEA applications of force.
(10/05/09) Lundin E, Dawes D, Ho J, Ryan F, Miner J. Catecholamines in Simulated Arrest Scenarios. American College of Emergency Physicians 2009 Scientific Assembly. 2009. Conclusions: The comparison of use of force encounters demonstrated that the TASER X26 was one of the least activating of catecholamines while the simulated combat was one of the most activating of catecholamines. The authors recommend further study in this area to assist law enforcement officers in determining the best tactics and devices to utilize in arrest scenarios that have higher likelihood of being associated with an arrest-related death.
(10/09) Bozeman, W P. Additional Information on TASER safety. Annals of Emergency Medicine. November 2009. Vol. 54, No. 5.
There is a combined experience of 4,058 consecutively monitored conducted electrical weapon uses with an electrical shock delivered. Serious injuries are clearly rare, and there are no cases in any of the reports suggesting sudden cardiac death related to the TASER ECD.
Conclusions. Injuries sustained during police use-of-force events affect thousands of police officers and civilians in the United States each year. Incidence of these injuries can be reduced dramatically when law enforcement agencies responsibly employ less-lethal weapons in lieu of physical force.
(09/09/09) The Fifth Mediterranean Emergency Medicine Congress (MEMC V). September 14‐17 2009.
(09/09) Ho J, Dawes D, Ryan F, et al. Catecholamines and Troponin in Simulated Arrest Scenarios. The Fifth Mediterranean Emergency Medicine Congress (MEMC V). September 14‐17 2009. Conclusions: The comparison of use of force encounters demonstrated that the simulated combat was one of the most activating of catecholamines.
(09/09) Ho J, Dawes D, Ryan F, et al. Acidosis in Simulated Arrest Scenarios. The Fifth Mediterranean Emergency Medicine Congress (MEMC V). September 14‐17 2009. Conclusions: The comparison of use of force encounters demonstrated that the simulated combat was one of the most activating of acidosis. The simulated combat also lowered the pH the most of all the tasks. These results combined suggest that fighting with LEOs may be the most detrimental from a physiologic standpoint. The authors recommend further study in this area to assist LEOs in determining the best tactics and devices to utilize in arrest scenarios that have higher likelihood of being associated with an ARD.
(09/09) Ho J, Dawes D, Cole J, et al. Effect of An Electronic Control Device Exposure on a Methamphetamine Intoxicated Animal Model. The Fifth Mediterranean Emergency Medicine Congress (MEMC V). September 14‐17 2009. Conclusions: In smaller animals, electronic control device exposure exacerbated atrial and ventricular irritability, but this effect was not seen in larger animals.
(09/09) Comparing safety outcomes in police use-of-force cases for law enforcement agencies that have deployed conducted energy devices and a matched comparison group that have not: A quasi-experimental evaluation. Police Executive Research Forum, National Institute of Justice.
(09/09) Recommended Guidelines for the Use of Conducted Energy Devices, Municipal Police Training Council, Division of Criminal Justice Services, State of New York.
(09/09) Conducted Energy Device Course, Student Guide, Municipal Police Training Council, Division of Criminal Justice Services, State of New York.
Conclusion: In the current study, the 50% probability of fibrillation level of X26-like pulses ranged from 4 to 5 times higher than the X26 itself. Relatively large variations about the X26 operating level were found not to result in fibrillation or asystole. Therefore, it should be possible to design and build an X26-type device that operates efficiently at levels higher than the X26.
(09/04/09) Ho J, Dawes D, Heegaard W, Miner J. Human Research Review of the TASER Electronic Control Device. Minneapolis: IEEE 2009;2009.
(09/09) Dorin Panescu, M.W. Kroll, R.A. Stratbucker, Medical safety of TASER conducted energy weapon in a hybrid 3‐point deployment mode, Conf. Proc. IEEE Eng. Med. Biol. Soc., Vol. 2009, pp. 3191‐3194, 2009.
(09/09) Hinchey PR, Subramaniam G. Pneumothorax as a complication after TASER [ECD] activation. Prehosp Emerg Care. Oct‐Dec 2009;13(4): 532‐535.
(08/09) International Association of Chiefs of Police (IACP) Model ECW Policy. (replaces August 2005 IACP Model ECW Policy).
Conclusion: It is concluded that no further cardiac evaluation is necessary in the emergency department in adults who have a normal sinus rhythm after receiving a Taser discharge.
(08/09) Ho, Jeffrey D., Commentary. Can There Be Truth About TASERs? Academic Emergency Medicine. Volume 16, Issue 8, Date: August 2009, Pages: 771-773.
Conclusion: CEW exposure produced no detectable dysrhythmias and a statistically significant increase in heart rate. Overall, Taser CEW exposure appears to be safe and well tolerated from a cardiovascular standpoint in this population. This study increases the cumulative human subject experience of CEW exposure with continuous ECG monitoring and includes 28 full 5-s exposures.
(08/09) Robb M, Close B, Furyk J, Aitken P. Review article: Emergency Department implications of the TASER. Emerg Med Australas. Aug 2009;21(4):250-258.
(08/09) Strote J, Hutson HR. Conducted electrical weapon injuries must be more broadly considered. Ann Emerg Med. Aug 2009;54(2):310-311; author reply 311-312.
(07/09) Gary M Vilke, Christian M Sloane, Amanda Suffecool, Fred W Kolkhorst, Tom S Neuman, Edward M Castillo, and Theodore C Chan, Physiologic Effects of the TASER After Exercise. Acad Emerg Med 10 Jul 2009.
Conclusions: A 5-second exposure of a TASER following vigorous exercise to healthy law enforcement personnel does not result in clinically significant changes in ventilatory or blood parameters of physiologic stress.
(07/09) Hough, Sr., Richard, M., Tatum, Kimberly M., Examining the Utility of the Use of Force Continuum: TASERs and Potential Liability, pages 37-50, Critical Issues of Use of Force by Law Enforcement (Special Edition), Law Enforcement Executive Forum, Volume 9, Number 3, July 2009.
(07/09) Johnston, Joel, Stuart, Bruce, Lawrence, Chris, Police Use of Conducted Energy Weapons in Canada, pages 51-74, Critical Issues of Use of Force by Law Enforcement (Special Edition), Law Enforcement Executive Forum, Volume 9, Number 3, July 2009.
(07/09) Kasanof, TASER Use Policy, pages 75-87, Critical Issues of Use of Force by Law Enforcement (Special Edition), Law Enforcement Executive Forum, Volume 9, Number 3, July 2009.
Conclusions. The comparison of use of force encounters demonstrated that the ECD was one of the least activating of catecholamines while the simulated combat was one of the most activating. The simulated combat also lowered the pH the most of all the tasks.
These results combined suggest that fighting with LEOs may be the most detrimental from a physiologic standpoing. The authors recommend further study in this area to assist LEOs in determining the best tactics and devices to utilize in arrest scenarios that have higher likelihood of being associated with an ARD (arrest-related death).
(06/09) S.R. Vanga, M.W. Kroll, M. Carver, C. Swerdlow and D. Lakkireddy, “Cardiac capture and fibrillation by CEW: An electrophysiologist’s perspective,” Conf. Proc. IEEE Eng. Med. Biol. Soc., vol. 2009, in press, 2009.
(06/09) Chand M, Nash GF. Are TASER guns really safe. Br J Hosp Med (Lond) 1 Jun 2009 70(6): p. 314.
Conclusions. Certainly it is difficult to blame TASER use for directly causing any deaths. All the current evidence suggests that they cause no long-term effects and deaths associated with such devices may be considered coincidental. Clearly, there will always be a risk of penetrating injury depending on where the gun is aimed, but professional removal of the dart should prevent further injury.
As an alternative to more conventional firearms, TASER guns are no doubt a better option, but any invasive incapacitating device will always have the potential to do harm. As clinicians and scientists it is our responsibility to weigh up both clinical experience and research when confronted with such issues. It seems likely that doctors will see more TASER-related injuries and for the time being we must be alert to managing these patients appropriately.
Conclusion: Subjects who had CEW Exposure only had higher pH and lower lactate values than subjects who completed the Exertion protocol only. CEW exposure does not appear to worsen acidosis in exhausted subjects any differently than briefly continued exertion.
(05/14/09) Academy of Emergency Medicine Scientific (SAEM) Assembly New Orleans, LA. May 14-17 2009.
(05/09) Smith G. TASER in the UK: An Analysis of Trends and Use. 5th European Symposium on Non Lethal Weapons. Vol Ettlingen: Fraunhofer Instiut Chemishe Technologie; 2009.
(05/09) Ho J. Research Update on the TASER Electronic Control Device. 5th European Symposium on Non Lethal Weapons. Vol Ettlingen: Fraunhofer Instiut Chemishe Technologie; 2009.
Conclusion. Prolonged CEW application on exhausted, acidotic volunteers was not associated with a further change in pH or an elevation in serum troponin. It was associated with a small decrease in pCO2, a small increase in lactate, and a small decrease in potassium. Prolonged CEW exposure in exhausted humans does not appear to result in worsening acidosis, hyperkalemia, or cardiac injury but was associated with a small increase in serum lactate.
Conclusions: In sudden deaths proximate to CEW discharge, immediate collapse is unusual, and VF is an uncommon VF presenting rhythm. Within study limitations, including selection bias and the possibility that VF terminated before the presenting rhythm was recorded, these data do not support electrically induced VF as a common mechanism of these sudden deaths.
(05/09) A Sharma, NS Theivacumar, and HM Souka, Tasers--less than lethal! Ann R Coll Surg Engl 1 May 2009 91(4): p. W20.
We report a case of potentially lethal injury associated with the use of Taser. A 42-year-old man was stopped by police for potential detention. He held a large carving knife over his epigasrium threatening to stab himself. With a view to achieving immobilisation, a Taser gun was used. On activation of the Taser, the subject suffered a 7-cm wide and 10-cm deep stab injury to the upper abdomen. In this case, activation of the Taser resulted in the contraction of skeletal muscles, flexors more intensely than extensors, resulting in the stab injury.
(04/09) Angelidis M, Basta A, Walsh M, Hutson R., Strote J, Injuries associated with law enforcement use of conducted electrical weapons. Acad Emerg Med. 2009;16(suppl. 1):S229.
Conclusions: Significant injuries related to six years [January 2001 to December 2006] of law enforcement CEW use in one city [Seattle, WA] were rare. A large percentage of those [1,101 people] subjected to CEW use had diagnoses of substance abuse and/or psychiatric conditions. Most admissions following CEW use were unrelated to law enforcement restraint.
(03/09) Are TASER Devices Really Dangerous? Forensic Drug Abuse Advisor, Volume 21, Issue 3, March 2009, pp 17-19.
Ho, J.D., D.M. Dawes, and J.R. Miner, Multiple Simultaneous Exposures of the TASER X26 in Human Volunteers. 2009, CardioRhythm, Hong Kong: Dept. of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN Dept. of Emergency Medicine, Lompoc Valley Medical Center, Lompoc, CA.
Conclusion. Five-second multiple (2-3) simultaneous exposures to an ECD device do not appear to have significant deleterious effects on the heart.
Conclusion. Acidosis is worse from continued exertion when compared to an ECD application. This does not support an association between TASER device applications and sudden death to worsening acidosis. It does support a worsening acidosis from continued exertion.
(01/09) Hall, MD, MsC, Christine, A., Public risk from tasers: Unacceptably high or low enough to accept? Editorial, CJEM 2009;11(1):84-6, January • janvier 2009; 11 (1).
(01/30/09) Jauchem, PhD, James R., Deaths in custody: Are some due to electronic control devices (including TASER® devices) or excited delirium? Journal of Forensic and Legal Medicine, doi:10.1016/j.jflm.2008.05.011.
Conclusion: To our knowledge, these findings represent the first large, independent, multicenter study of conducted electrical weapon injury epidemiology and suggest that more than 99% of (1201) subjects do not experience significant injuries after conducted electrical weapon use.
Conclusions: Our preliminary data suggests that physical exertion during custodial arrest may be most activating of the human stress response, particularly the sympathetic–adrenal–medulla axis. This may suggest that techniques to limit the duration of this exertion may be the safest means to apprehend subjects, particularly those at high-risk for in-custody death. Conducted electrical weapons were not more activating of the human stress response than other uses of force.
Conclusions: Five-second simultaneous, multiple exposures to the TASER Shockwave device do not appear to have significant deleterious effects on human physiology except for a moderate increase in CK.
Conclusions: Introduction of the ECD into an urban healthcare 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 healthcare personnel. Longer term, mutli-center study of this phenomenon is recommended for validation.
[Pg 36] "...The Monitoring Team also noted a significant decline in serious force-related incidents at this time. We attribute much of this decrease to the department-wide deployment of the Taser. Our review of use of force reporting and investigative files showed that the Taser replaced other types of force in the majority of incidents. Moreover, injuries to officers and citizens also declined."
(12/08) Cihan Cevik, Mohammad Otahbachi, Elizabeth Miller, Satish Bagdure, Kenneth M. Nugent, Acute stress cardiomyopathy and deaths associated with electronic weapons, Review, International Journal of Cardiology, xx (2009) xxx–xxx.
The maximum distance between the heart and a model Taser stimulation dart, called the dart-to-heart distance, at which the Taser can directly cause ventricular fibrillation (VF), was measured in pigs. A 9-mm-long blunt probe was advanced snugly through the surrounding tissues toward the heart. Five animals [pig mass=61.2+/-6.23 standard deviation (SD) kg] for ten dart-to-heart distances where the Taser caused VF were tested. The dart-to-heart distances where the Taser caused VF of the first stimulation site ranged from 4 to 8 mm with average 6.2 mm+/-1.79 (SD) and of the second stimulation site ranged from 2 to 8 mm with average 5.4 mm+/-2.41 (SD). The results help inform the evolving discussion of risks associated with Tasers.
(Part of Discussion) The commonly held belief that the conducted energy weapon carries a significant risk of injury or death for the population of interest is not supported by the data. Within the force modality framework most commonly available to police officers, the CEW was less injurious than either the baton or empty hand physical control.
Although the study used the intention to treat analysis, when we removed the incidents where the use of the CEW was unsuccessful (n = 14) (thereby requiring subsequent alternative force options—typically physical control), the safety profile of the CEW rose to 88.7% (i.e., no injury or minor injury to subjects only).
(11/23-27/08) Australasian College for Emergency Medicine, 25th Scientific Meeting, Wellington, New Zealand.
Conclusions. In agreement with two prior studies by these authors, the TASER X26 did not electrically capture the human myocardium when used with probe deployment. This data is contrary to animal studies in which capture occurred.
Conclusions. Our preliminary data suggests that 60-seconds of physical exertion during custodial arrest may be most activating of the human stress response compared to CEW and OC.
Conclusions. A 20-30 second TASER C2 exposure does not appear to have significant deleterious effects on human physiology. Our study suggest that this device has a reasonable risk/benefit ratio when used in circumstances in which a person has a sufficient fear of personal injury from assault.
Conclusions: Our preliminary data suggests that physical exertion during custodial arrest may be most activating of the human stress response, particularly the sympathetic–adrenal–medulla axis. This may suggest that techniques to limit the duration of this exertion may be the safest means to apprehend subjects, particularly those at high-risk for in-custody death. Conducted electrical weapons were not more activating of the human stress response than other uses of force.
(11/08) Abstract 645: Effect of Stun Gun Discharges on Pacemaker Function, Azamuddin Khaja, Gurushankar Govindarajan, Wayne McDaniel, and Greg Flaker, Circulation. 2008; 118(18_MeetingAbstracts): p. S_592-b.
Conclusions: stun gun discharges,
1. were recognized by the pulse generator and sensed as either high rate atrial or ventricular activity depending on which vector is more in line with the electric field created by the two taser electrodes,
2. did not affect the native rhythm,
3. did not conduct down the lead systems to cause any extra systoles,
4. and, had no effect on paced rhythm. The use of these devices appears safe in victims with this type of pulse generator.
(10/27-30/08) American College of Emergency Physicians (ACEP), Scientific Assembly, Chicago, Illinois, October 27-30, 2008:
Conclusions. There was an increase in the respiratory rate, minute ventilation, and end-tidal oxygen and a decrease in the tidal volume and end-tidal carbon dioxide during the exposure. After the exposure, tidal volume and minute ventilation remained elevated. This study demonstrates that the cross-chest exposure does not significantly impair respiratory function.
Conclusion. Although motion artifact limited a few of the evaluations, we were able to document sinus rhythm in over half of the subjects and were able to obtain heart rates in all but three. In all but those three subjects where the rhythm was undetermined, we saw no evidence of myocardial capture or arrhythmia during a 20-second trans-thoracic TASER XREP exposure.
(10/08)Medical Panel Issues Interim Findings on Stun Gun Safety, by John Morgan, Ph.D., NIJ Journal, National Institute of Justice, Office of Justice Programs, U.S. Department of Justice, Issue No. 261, pages 20-23, October 2008.
(09/30/08) D. Panescu, "Implantable neurostimulation devices," IEEE Eng Med Biol Mag., vol. 27(5), pp.100-105, 2008.
(09/24/08) Jiun-Yan Wu, Amit J Nimunkar, Hongyu Sun, Ann O'Rourke, Shane Huebner, James A Will, and John G Webster, Ventricular fibrillation time constant for swine. Physiol Meas 24 Sep 2008 29(10): p. 1209.
This paper modifies previous (gel) paper in that in the previous (gel paper) the dart-to-heart distance (DTHD) where TASER ECD caused VF (in porcine model) was 17 millimeters (mm) ± 6.48 (SD) for the first VF event for a particular pig and 13.7 mm ± 6.79 (SD) for the successive VF events. This new paper finds DTHD where ECD caused VF of site 1 ranged from 4 to 8 mm with average of 6.2 mm ± 1.79 (SD) and the DTHD of site 2 ranged from 2 to 8 mm with average of 5.4 mm ± 2.41 (SD).
Also, note, the estimated probability of ECD induced VF in humans in the first (gel) paper was 0.0014. Using the newer data the estimated probability of ECD induced VF in humans is 0.0000061. (see Slide 30 from Braidwood Commission Webster presentation).
(09/15/08) European Society of Emergency Medicine Scientific Assembly, Munich, Germany:
Conclusion: The XREP ECD does not appear to induce any concerning changes in the ECG in humans after exposures greater than 15 seconds. Changes were consistent with increased vagel tone after the exposure consistent with a noxious exposure.
Conclusions: The TASER XREP ECD is a new technology projectile that will be used to control dangerous, agitated or potentially violent persons in the community. It will allow greater law enforcement and subject safety because of its ability to help control indviduals from a great distance. This is the first investigation into the physiologic effect that this ECD will have on humans with regard to serum biomarkers. Prolonged XREP ECD application caused small but statistically significant changes in measured serum biomarkers. These small changes would likely result in limited clinical significance. It appears that the XREP ECD represents an adequate risk/benefit ratio if used for its intended purpose.
(09/07/08) NAME (National Association of Medical Examiners) 2008 Annual Conference Poster Presentations (Louisville, Kentucky):
Conclusions: There was an increase in the respiratory rate, end-tidal oxygen, and minute ventilation, and a decrease in tidal volume and end-tidal carbon dioxide during XREP exposure. This study demonstrates that the XREP does not significantly impair respiratory function.
Conclusions: The TASER XREP ECD is a new technology projectile that will be used to control dangerous, agitated or potentially violent persons in the community. It will allow greater law enforcement and suspect safety because of its ability to help control individuals from a great distance. This is the first investigation into the physiologic effect that this ECD will have on humans with regard to serum biomarkers. Prolonged XREP ECD application caused small but statistically significant changes in measured serum biomarkers. These small changes would likely result in limited clinical significance. It appears that this XREP ECD represents an adequate risk/benefit ratio if used for its intended purpose.
Conclusions: Drive Stun (DS) exposure did not cause abnormal rhythms or apnea in this small sample of ECD exposed subjects. There was an increase in heart rate that resolved within one minute of the exposure. We did not find a connection between measureable, worsening human physiology and ECD DS exposure. This work is consistent with previously reported findings of human ECD studies utilizing deployed probe methodology.
Conclusion: The results indicated that TASER devices, while not risk free, have a very low cardiac risk profile when used for suspect temporary incapacitation.
Conclusions: A 10-second ECD exposure in an ideal cardiac axis application did not demonstrate concerning tachyarrhythmias using human models. The swine model may have limitations when evaluating ECD technology.
Conclusions: None of the subjects had a positive troponin I level 6 h after exposure. It was concluded that human volunteers exposed to a single shock from the Taser did not develop an abnormal serum troponin I level 6 h after shock, suggesting that there was no myocardial necrosis or infarction.
(08/08) MW Kroll, H Calkins, RM Luceri, MA Graham, and WG Heegaard, Electronic control devices. CMAJ 12 Aug 2008 179(4): p. 342.
(08/08) A Mukherjee, Tasers. CMAJ 12 Aug 2008 179(4): p. 342.
(07/08) Dawes DM, Ho JD, Johnson MA, Lundin E, Janchar TA, Miner JR. 15-Second conducted electrical weapon exposure does not cause core temperature elevation in non-environmentally stressed resting adults. Forensic Sci Int 2008;176:253-7.
CONCLUSION: A 15-s discharge from a TASER X26 CEW does not increase the core body temperature of resting, non-environmentally stressed adult subjects. These results challenge the speculation that this weapon technology may be contributing to the hyperthermia in subjects who die from excited delirium, drug toxicity, or other causes while in custody.
Conclusion: Police were compliant with policy in all cases, and, in addition to avoiding the use of lethal force in a significant number of circumstances, the safety of CED use was demonstrated despite one death subsequently attributed to lethal toxic hyperthermia. Collaborative nationwide research using similar registries is strongly recommended to document compliance and ensure ongoing safety monitoring.
(06/08) Australian College of Emergence Medicine, Winter Symposium, New Castle, New South Wales:
Conclusions: Drive Stun exposure did not cause abnormal rhythms or apnea in this small sample of ECD exposed subjects. There was an increase in heart rate that resolved within one minute of the exposure. We did not find a connection between measureable, worsening human physiology and ECD DS exposure. This work is consistent with previously reported findings of human ECD studies utilizing deployed probe methodology.
Conclusion: Although motion artifact limited a few of the evaluations, we were able to document sinus rhythm in over half of the subjects and were able to obtain heart rates in all but three. In all but those three subjects, we saw no evidence of myocardial capture or arrhythmia during a 20-second trans-thoracic XREP exposure.
Conclusion: There was an increase in the respiratory rate, end-tidal oxygen, and minute ventilation, and a decrease in tidal volume and end-tidal carbon dioxide during XREP exposure. This study demonstrates that the XREP does not significantly impair respiratory function.
(06/18-21/08) CardioStim 2008, 16th World Congress in Cardiac Electrophysiology and Cardiac Techniques, Nice, France.
Ho, J. D., D. M. Dawes, et al. Echocardiographic Evaluation of Human Transcutaneous TASER® Application Along the Cardiac Axis. Hennepin County Medical Center, Minneapolis, MN, Lompoc District Hospital, Lompoc, CA, Cardiostim, Nice, France, 2008.
Swerdlow, C., M. W. Kroll, et al. Presenting Rhythm in Sudden Custodial Deaths After Use of TASER® Electronic Control Device. Cedars‐Sinai Medical Center, Los Angeles, CA, University of Minnesota, Minneapolis, MN San Marcos Police Department, San Marcos, TX University of Kansas Medical Center, Kansas City, KS, Cleveland Clinic, Cleveland, OH, Cardiostim, Nice, France, 2008.
(05/20/08) NIJ Sponsored Medical Study - Deaths Following Electro Muscular Disruption. Study Framework: The study is directed by a steering group with representation from NIJ, the College of American Pathologists, the Centers for Disease Control, and the National Association of Medical Examiners.
To support the study, the steering group appointed a medical panel comprised of physicians, medical examiners and other relevant specialists in cardiology, emergency medicine, epidemiology, pathology, and toxicology.
"While exposure to CED is not risk-free, there is no conclusive medical evidence within the state of current research that indicates a high risk of serious injury or death from the direct effects of CED exposure. Field experience with CED use indicates that exposure is safe in the vast majority of cases. Therefore, law enforcement need not refrain from deploying CED’s, provided the devices are used in accordance with accepted national guidelines such as the model policy of the International Association of Chiefs of Police."
John Morgan, Deputy Director for Science & Technology, National Institute of Justice, May 20, 2008, Less Lethal and Critical Incident Technologies.
(05/14-17/08) Heart Rhythm 2008, 29th Annual Scientific Sessions, May 14-17, 2008, San Francisco, CA USA:
(05/15/08) Presenting Rhythm in Sudden Custodial Deaths After Use of TASER® Electronic Control Device,
Charles Swerdlow, MD, FHRS, Mark W. Kroll, PhD, FHRS, Howard Williams, Mazda Biria, MD, Dhanunjaya Lakkireddy, MD and Patrick J. Tchou, MD. Cedars-Sinai Medical Center, Los Angeles, CA, University of Minnesota, Minneapolis, MN, San Marcos Police Department, San Marcos, TX, University of Kansas Medical Center, Kansas City, KS, Cleveland Clinic, Cleveland, OH.
(05/16/08) Can Electrical-Conductive Weapons (TASER®) alter the functional integrity of pacemakers and defibrillators and cause rapid myocardial capture?
Dhanunjaya R. Lakkireddy, MD, Mazda Biria, MD, Esam Baryun, MD, Loren Berenbom, MD, Rhea Pimentel, MD, Martin P. Emert, MD, Kevin Kreighbaum, RN, Mark W. Kroll, PhD and Atul Verma, MD. Mid America Cardiology @ University of Kansas Hospital, Kansas City, KS, University of Minnesota, Minneapolis, MN, Southlake Regional Health Center, Toronto, ON, Canada.
(05/16/08) (Poster) Echocardiographic Evaluation of Human Transcutaneous TASER® Application Along the Cardiac Axis,
Jeffrey D. Ho, MD, Donald M. Dawes, MD, Robert F. Reardon, MD, Anne L. Lapine, MD, Jeremy D. Olsen, MD, Benjamin J. Dolan, BA and James R. Miner, MD. Hennepin County Medical Center, Minneapolis, MN, Lompoc District Hospital, Lompoc, CA.
CONCLUSIONS: Standard TASER discharges did not cause VF at any of the positions. Induction of VF at higher output multiples appear to be sensitive to electrode distance from the heart, giving highest ventricular fibrillation safety margin when the electrodes are placed on the dorsum. Rapid ventricular capture appears to be a likely mechanism of VF induction by higher output TASER discharges.
Page 23: There was general consensus that officers were using conducted energy devices (CEDs), primarily the TASER® [ECD], as the first option.
Page 37: Deployment of conducted energy devices (CEDs), primarily TASER [ECD], within many jurisdictions has affected the consideration and deployment of other tactical options and less-lethal weapons. There was general consensus that officers were using TASER [ECD] as the first option. This was, perhaps, borne out of growing confidence in the system over time and a reduced likelihood of injury to both fficers and subjects (actual and perceived) - as well as the accompanying potential to reduce the likelihood of complaint and post- incident investigation.
Page 38: It is important to note that TASER lnternational [,Inc.] is the leader in the development and manufacture of CEDs. The ILEF recognizes that this vendor has invested in and conducted exhaustive research in order to increase device effectiveness as a tool for law enforcement while minimizing injury to subjects. Additionally, they have cooperated with and supported both government and independent researchers to continue to grow the body of knowledge on these systems. The ILEF views this open and responsible approach to research and testing as a model for other manufacturers to emulate.
Page 39: The psychological impact of CEDs on subjects has been illuminating. Subjects often become defiant when an officer presents a lethal weapon. They do not believe an officer will fire. When an officer presents a CEO, however, often that is enough to gain compliance, since these subjects believe officers are very willing to actually fire the device. Some in the group related experiences where merely pointing the device, orienting the laser dot, or verbally warning,"stop or I will taze you" was enough to gain compliance.
Page 39: Of note also was the sense from many of the group members that police use of CEOs to gain compliance of subjects who are suffering from mental health problems (e.g., schizophrenia) has found broad support among mental health groups (The Schizophrenic Society in Canada, The Schizophrenic Association in the UK, and the National Institute of Mental Health in the US were all mentioned).
Conclusion: A 15-s discharge from a TASER X26® CEW does not increase the core body temperature of resting, non-environmentally stressed adult subjects. These results challenge the speculation that this weapon technology may be contributing to the hyperthermia in subjects who die from excited delirium, drug toxicity, or other causes while in custody.
Conclusion: None of the subjects had a positive troponin I level 6 h after exposure. It was concluded that human volunteers exposed to a single shock from the Taser(R) did not develop an abnormal serum troponin I level 6 h after shock, suggesting that there was no myocardial necrosis or infarction.
(02/08) Medical Effects of TASERs, In Focus, Part 4 of a Series, Emergency Medicine News. 29(12):14-16, December 2007. Roberts, James R. MD.
(Poster) (01/11/08) (78.) PROLONGED TASER® “DRIVE STUN” EXPOSURE IN HUMANS DOES NOT CAUSE WORRISOME BIOMARKER CHANGES, Ho JD, Dawes DM, Lapine AL, et al., Hennepin County Medical Center: National Association of EMS Physicians (NAEMSP); 2008.
The TASER is a less lethal weapon seeing increased use by police jurisdictions across the country. As a result, subjects of TASER use are being seen with increasing frequency in emergency departments across the country. The potential injury patterns of the device are important for emergency physicians to understand. This report describes the case of an officer who complained of back pain after a single 5-s TASER discharge during a routine training exercise. Subsequent evaluation led to the diagnosis of an acute thoracic vertebral compression fracture. We discuss the potential mechanisms of injury in this case. Because we were unable to find any cases like this in our review of TASER-related injuries, we liken it to compression fractures that have been documented after seizures. We recommend that physicians consider obtaining back radiographs to rule out a vertebral compression fracture in any individual who has sustained a TASER discharge and has ongoing or persistent back pain.
(01/02/08) Less Lethal Weapons for Law Enforcement: A Performance-Based Analysis, Mesloh, Wolf, Henych & Thompson, 18 (1) Law Enf. Exec. Forum 133-149 (2008).
OBJECTIVES: Data from the authors and others suggest that TASER X26 stun devices can acutely alter cardiac function in swine. The authors hypothesized that TASER discharges degrade cardiac performance through a mechanism not involving concurrent acidosis.
METHODS: Using an Institutional Animal Care and Use Committee (IACUC)-approved protocol, Yorkshire pigs (25-71 kg) were anesthetized, paralyzed with succinylcholine (SCh; 2 mg/kg), and then exposed to two 40-second discharges from a TASER X26 with a transcardiac vector. Vital signs, blood chemistry, and electrolyte levels were obtained before exposure and periodically for 48 hours postdischarge. Electrocardiograms and echocardiography (echo) were performed before, during, and after the discharges. p-Values < 0.05 were considered significant.
RESULTS: Electrocardiograms were unreadable during the discharges due to electrical interference, but echo images showed unmistakably that cardiac rhythm was captured immediately at a rate of 301 +/- 18 beats/min (n = 8) in all animals tested. Capture continued for the duration of the discharge and in one animal degenerated into fatal ventricular fibrillation (VF). In the remaining animals, ventricular tachycardia (VT) occurred postdischarge for 1-17 seconds, whereupon sinus rhythm was regained spontaneously. Blood chemistry values and vital signs were minimally altered postdischarge and no significant acidosis was seen.
CONCLUSIONS: Extreme acid-base disturbances usually seen after lengthy TASER discharges were absent with SCh, but TASER X26 discharges immediately and invariably produced myocardial capture. This usually reverted spontaneously to sinus rhythm postdischarge, but fatal VF was seen in one animal. Thus, in the absence of systemic acidosis, lengthy transcardiac TASER X26 discharges (2 x 40 seconds) captured myocardial rhythm, potentially resulting in VT or VF in swine.
CONCLUSIONS: There were no cardiac dysrhythmia and interval or morphology changes in subjects who received a Taser discharge based on a 12-lead ECG performed immediately before and within 1 minute after a Taser activation.
Increasing use by law enforcement agencies of the M26 and X26 TASER electrical incapacitation devices has raised concerns about the arrhythmogenic potential of these weapons. Using a numerical phantom constructed from medical images of the human body in which the material properties of the tissues are represented, computational electromagnetic modelling has been used to predict the currents arising at the heart following injection of M26 and X26 waveforms at the anterior surface of the chest (with one TASER 'barb' directly overlying the ventricles). The modelling indicated that the peak absolute current densities at the ventricles were 0.66 and 0.11 mA mm-2 for the M26 and X26 waveforms, respectively. When applied during the vulnerable period to the ventricular epicardial surface of guinea-pig isolated hearts, the M26 and X26 waveforms induced ectopic beats, but only at current densities greater than 60-fold those predicted by the modelling. When applied to the ventricles in trains designed to mimic the discharge patterns of the TASER devices, neither waveform induced ventricular fibrillation at peak currents >70-fold (for the M26 waveform) and >240-fold (for the X26) higher than the modelled current densities. This study provides evidence for a lack of arrhythmogenic action of the M26 and X26 TASER devices.
(11/30/07) E.L. Hughes, M.J. Kennett, W.B. Murray, J.R. Werner and D.M. Jenkins, Electro-Muscular Disruption (EMD) Bioeffects: A Study on the Effects of Continuous Application of the TASER X26 Waveform on Swine.
(10/07) (Poster) 15-Second Conducted Electrical Weapon Application Does Not Impair Basic Respiratory Parameters, Venous Blood Gases, or Blood Chemistries, Jeffrey Ho, MD, Robert Reardon, MD, Donald Dawes, MD, MarkJohnson, BS, Erik Lundin, BS, James Miner, MD.
(10/07) (Poster) 15-Second Conducted Electrical Weapon Exposure Does Not Cause Core Temperature Elevation In Non-Environmentally Stressed Resting Adults, Jeffrey Ho, MD, Robert Reardon, MD, Donald Dawes, MD, Mark Johnson, BS, Erik Lundin, BS, James Miner, MD.
(10/07) (Poster) Breathing Parameters, Venous Blood Gases, Serum Chemistries and Physiologic Effects of a New Wireless Projectile Conducted Electrical Weapon in Human Volunteers, Jeffrey Ho, MD, Robert Reardon, MD, Donald Dawes, MD, Mark Johnson, BS, Erik Lundin, BS, James Miner, MD.
(10/07) (Poster) The Neuroendocrine Effects of the TASER X26 Conducted Electrical Weapon as Compared to Oleoresin Capsicum, Jeffrey Ho, MD, Robert Reardon, MD, Donald Dawes, MD, Mark Johnson, BS, Erik Lundin, BS, James Miner, MO.
(10/14/07) [11:15 a.m. to 11:45 a.m.] Updates on NIJ Research on Less Lethal Devices, Police Physicans Section Track, Joseph Cecconi.
Recent research topics funded by the National Institute of Justice on less lethal devices will be presented.
(10/14/07) [3:45 p.m. to 4: 15 p.m.] Update on Electronic Control Weapons: Review of the Recent Medical Publications and Recommensations, Police Physicians Section Track, Febrice Czarnecki, MD, MA, MPH.
We will review recent medical literature to guide law enforcement leadership in the proper and safer use of electronic control weapons. We will present specific recommendations to decrease the risk of medical complications after electronic control weapon application.
(Poster) 16. 15-Second Conducted Electrical Weapon Application Does Not Impair Basic Respiratory Parameters, Venous Blood Gases, or Blood Chemistries and Does Not Increase Core Body Temperature, Dawes DM, Lompoc District Hospital, Lompoc, CA.
Conclusion: As with the previous study, this study suggests that exposure to a CEW does not significantly impair respiration. As in the previous study, pCO2 decreased and pO2 increased as a result of the exposure. There was no change in blood pH. There was no change in core temperature. While this study is small, it adds to the growing body of literature that is demonstrating that these weapons have a favorable risk-benefit ratio and are appropriate additions to the use of force continua of police agencies.
(09/07) 16: 15-Second Conducted Electrical Weapon Application Does Not Impair Basic Respiratory Parameters, Venous Blood Gases, or Blood Chemistries and Does Not Increase Core Body Temperature, D.M. Dawes, J.D. Ho, M.A. Johnson, E. Lundin, J.R. Miner, Annals of Emergency Medicine, September 2007 (Vol. 50, Issue 3, Page S6).
173. Physiologic Effects of the TASER on Human Subjects After Exercise, Vilke GM, University of California, San Diego Medical Center, San Diego, CA.
Conclusion: There were no clinically significant or lasting statistically significant changes in selected blood measures or cardiovascular levels in exercised human subjects after rigorous exercise and a 5 second TASER activation.
(09/07) 173: Physiologic Effects of the TASER on Human Subjects After Exercise, G.M. Vilke, C. Sloane, A.C. Suffecool, T.S. Neuman, E.M. Castillo, F.W. Kolkhorst, T.C. Chan, Annals of Emergency Medicine, September 2007 (Vol. 50, Issue 3, Page S55).
Conclusions: In a review of 962, 99.7 per cent of those subjected to a TASER ECD had mild injuries, such as scrapes and bruises, or none at all. Only three subjects (0.3%) suffered injuries severe enough to need hospital admission. Two had head injuries suffered in falls after TASER ECD use. A third subject was admitted to a hospital two days after arrest with a medical condition of unclear relationship to the TASER ECD. Two subjects died, but autopsy reports indicate that neither death was related to the TASER device. Earlier partial results involving 597 cases were published in the September issue of Annals of Emergency Medicine.
Earlier Published Conclusions: After CEW use, 99.5% of 597 subjects had no injuries or mild injuries only. The observed significant injury rate was 0.5%, and is unlikely to be greater than 1.4%. No deaths related to CEWs occurred. These preliminary data represent the largest independent injury epidemiology study of these weapons to date and support the safety of CEW use. Data collection will continue through summer 2007; final data will be presented at the fall ACEP meeting.
(10/08/07) (Press Release) Nationwide Independent TASER® Study Results Suggest Devices are Safe, Wake Forest University Baptist Medical Center®.
345. Ultrasound Measurement of Cardiac Activity During Conducted Electrical Weapon Application in Exercising Adults. Ho JD, Hennepin County Medical Center, Minneapolis, MN.
Conclusion: A 15 second CEW application on exercised volunteers did not demonstrate any evidence of induced tachyarrhythmia. It is unlikely that CEW exposure induces cardiac rate capture or tachyarrhythmia in humans.
(09/07) 345: Ultrasound Measurement of Cardiac Activity During Conducted Electrical Weapon Application in Exercising Adults, J.D. Ho, R.F. Reardon, D.M. Dawes, M.A. Johnson, J.R. Miner, Annals of Emergency Medicine, September 2007 (Vol. 50, Issue 3, Page S108).
(Poster) 421. The Neuroendocrine Effects of the TASER X26 Conducted Electrical Weapon as Compared to Oleoresin Capsicum. Dawes DM, Lompoc District Hospital, Santa Barbara, CA.
Conclusion: The results suggest a significant greater level of activation of the SAM cascade with O.C. compared to the CEW. Overlapping confidence intervals preclude a definitive statement about the other measurements, but do not suggest a greater activation of the stress cascade by the CEW than O.C. Given that the CEW is generally considered more efficacious in the control of subjects with impaired nocioception secondary to drug intoxication or an excited delirium, and that it induces a smaller or equal stress response, it maybe the use of force of choice in certain settings.
(09/07) 421: The Neuroendocrine Effects of the TASER X26 Conducted Electrical Weapon as Compared to Oleoresin Capsicum, D.M. Dawes, J.D. Ho, J.R. Miner, M. Johnson, Annals of Emergency Medicine, September 2007 (Vol. 50, Issue 3, Pages S132-S133).
(Poster) 423. Breathing Parameters, Venous Blood Gases, and Serum Chemistries with Exposure to a New Wireless Projectile Conducted Electrical Weapon in Human Volunteers. Dawes DM, Lompoc District Hospital, Lompoc, CA.
Conclusion: This study demonstrates that the new CEW has no important deleterious effects on respiratory parameters, blood chemistries, or venous blood gases. These results are consistent with previous results for the TASER X26 CEW.
(09/07) 423: Breathing Parameters, Venous Blood Gases, and Serum Chemistries With Exposure to a New Wireless Projectile Conducted Electrical Weapon in Human Volunteers, D.M. Dawes, J.D. Ho, M.A. Johnson, E. Lundin, J. Miner, Annals of Emergency Medicine, September 2007 (Vol. 50, Issue 3, Page S133).
Conclusion: A comprehensive approach to workplace violence that allows for the selected use of the TASER and requires mandatory reviews of all uses can be effectively implemented to help to control dangerous situations in heath care environments.
(09/07) 428: Evaluation of the Use of the TASER and Elevated Force to Control Workplace Violence in a Health Care Environment, R.L. Norton, G. Granger, Annals of Emergency Medicine, September 2007 (Vol. 50, Issue 3, Page S135).
(10/09/07)Less lethal technology: medical issues, Gary M. Vilke, Theodore C. Chan, Policing: An International Journal of Police Strategies & Management, 2007 Volume: 30 Issue: 3 Page: 341 - 357.
Findings – In general, these three different types of less lethal weapons have been effective for their intended use. Each type of less lethal weapon has a number of physiologic effects and specific medical issues that must be considered when the weapon is used. There is no clear evidence that these devices are inherently lethal, nor is there good evidence to suggest a causal link between sudden in-custody death and the use of irritant sprays or conducted energy devices.
Findings – The essential attributes of less lethal weapons for law enforcement applications are described as well as the many practical considerations that must be made when acquiring and using them.
Findings – The majority of reported cases have resulted in the dismissal of claims against officers and municipalities for alleged Taser-related excessive force violations. In most cases, plaintiffs were unable to show the existence of an unconstitutional policy or custom to support municipal liability. As for the liability of individual officers, most cases were decided in the officer’s favor on summary judgment, particularly when the suspect was exhibiting physical resistance. In a few cases, summary judgment was denied to officers when the plaintiff alleged that he or she was fully compliant when the Tasering occurred.
(10/09/07)What we do not know about police use of Tasers™, Kenneth Adams, Victoria Jennison, Policing: An International Journal of Police Strategies & Management, 2007 Volume: 30 Issue: 3 Page: 447 – 465.
Findings – Limited research reflects a lack of consensus in the development and application of policies related toTaser training and use.Variations in policy and training and the substitution of Tasers for other technologies across the use-of-force continuum result in operational inconsistency. This inconsistency makes it difficult to compare police departments in terms of the impact of Tasers on improved officer and citizen safety and reductions in the use of lethal force. This inconsistency is also reflected inmedia reports and has the potential to jeopardize community relations. Key policy issues center on length and content of training, training staff qualifications, and substitutions on the use-of-force continuum. Further study of Taser policy development, implementation, and evaluation is necessary to build a substantial and reliable body of knowledge to informsafe and effective police policy. Additional research is needed to evaluate the organizational and community implications of Taser implementation.
Findings – The use of CEDs was associated with reduced odds of officer and suspect injury and the severity of suspect injury in one agency. In the other agency CED use was unrelated to the odds of injury; however, the use of pepper spray was associated with reduced odds of suspect injury. Among other findings, in both agencies the use of hands-on tactics by police was associated with increased odds of officer and suspect injury, while the use of canines was associated with increased odds of suspect injury.
Pg 437 - "CED use was associated with a 677 percent increase in the odds of suspects not being injured during use-of-force encounters. Thus, whereas hands on tactics significantly increased the risk of injury among both officers and suspects, CEDs significantly decreased the risk of injury to both groups."
"[T]he use of soft-hand tactics,hard-hand tactics, and canines by officers increased the odds of both minor and major injury to suspects, while the use of CEDs significantly decreased the odds of both types of injury."
"The findings from Richland County indicated that the use of OC on suspects was one of the most important variables linked to a reduction in suspect injury, while CED use was not associated with either a decrease or increase in injury."
"The data from the MDPD, whose [438] officers did not have access to OC as an intermediate weapon, showed that the use of CEDs was associated with reductions in injury to both officers and suspects."
Pg 438 - "[T]he analysis of suspect injury severity in the MDPD found that the use of CEDs was associated with reductions of both minor and major injuries, clearly a more desirable outcome than if CEDs were linked to reductions in minor injuries only."
"Why CED use was not associated with a significant reduction in injuries in the RCSD is unclear. However, since the majority of the RCSD deputies had a long history of using OC spray and the introduction of CEDs was relatively recent, the reliance on OC may have mitigated its injury reduction effects. Perhaps, if both sites had a similar history with the same less-lethal weapon options, the findings would have been more comparable."
"Additional research in other settings may shed further light on this, but [439] the results of this study suggest that not every agency’s experience will be the same regarding CED use and injuries. Nonetheless, it is clear that the use of CEDs and OC can have a significant and positive effect on injury reduction."
"To the degree that OC and/or CEDs would be authorized and appropriate for use in such encounters, their deployment in place of soft empty-hand controls may help prevent some injuries, albeit mostly minor ones."
"Although our research did not address specifically the reduction in deadly force,other research and common sense demonstrates that it is probable that the use of CEDs would replace the use of firearms in some limited number of instances where lethal force is justified, and thereby reduce deaths that would occur had a firearm been used (Ho et al., 2006a; Adams, this volume). Further, although rare cases of sudden in-custody death do occur with the use of CEDs, the causal connection remains unclear (Vilke and Chan, this volume) and the number of lives saved appears to far outweigh the number of deaths associated with CED exposure (Ho et al., 2006a). Therefore, given the accumulated evidence to date and the results of the present study, and assuming the existence of appropriate training, policies, restrictions on use and monitoring (Police Executive Research Forum, 2005; ACLU of South California, 1995), it is our conclusion and recommendation that police agencies adopt use-of-force policies and training regimens that permit officers to use CEDs to control threatening or physically resistant suspects. The findings from Miami-Dade and Richland Counties suggest that officers and citizens are at greatest risk for injury when they engage in physical struggles, particularly when the suspect is actively or violently resisting arrest, and that CEDs and OC spray reduce the probability of injury."
Pg 440 - "Given the minor nature of most injuries to officers and suspects, though, the substitution of OC spray or CEDs for hands-on control primarily will result in the prevention of bruises, abrasions, sprains, and the like. Balanced against this injury savings are the pain, irritation, and decontamination requirements associated with OC spray and the minor dart puncture wounds and rare complications associated with CEDs. Nonetheless, every use-of-force encounter carries with it the potential for serious injury and even minor injuries can result in the need for medical treatment or time lost from work. More importantly, the use of less lethal technologies from a stand-off distance may help to prevent the occasional serious injury that might otherwise occur from physical contact between officers and citizens. Consequently, the use of CEDs or OC spray under these conditions makes the control of resistant persons safer for everyone."
TASERs deliver electrical pulses that can temporarily incapacitate subjects. The goal of this paper is to analyze the distribution of TASER currents in the heart and understand their chances of triggering cardiac arrhythmias. The models analyzed herein describe strength-duration thresholds for myocyte excitation and ventricular fibrillation induction. Finite element modeling is used to compute current density in the heart for worst-case TASER electrode placement. The model predicts a maximum TASER current density of 0.27 mA/cm<sup>2</sup> in the heart. It is conclude that the numerically simulated TASER current density in the heart is about half the threshold for myocytes excitation and more than 500 times lower than the threshold required for inducing ventricular fibrillation. Showing a substantial cardiac safety margin, TASER devices do not generate currents in the heart that are high enough to excite myocytes or trigger VF.
TASERs deliver electrical pulses that can temporarily incapacitate subjects. The goal of this paper is to analyze the distribution of currents in muscle layers and understand the electro-muscular incapacitation safety and efficacy of TASERs. The analyses describe skeletal muscle and motor nerve activation, cell electroporation and current and electric field distributions through skin, fat and muscle layers, under worst-case assumptions for TASER electrode penetration and separation. For the muscle layer, the analysis predicts worst-case current-density and field-strength values of 94 mA/cm2 and 47 V/cm. Both values are higher than thresholds required for neuromuscular activation but significantly lower than levels needed for permanent cellular electroporation or tissue damage. The results indicate that TASERs are safe and effective in producing temporary subject incapacitation.
(Abstract)(Poster)(09/17/07) ULTRASOUND MEASUREMENT OF CARDIAC ACTIVITY DURING CONDUCTED ELECTRICAL WEAPON APPLICATION IN EXERCISING ADULTS. J. Ho; R. Reardon; D. M. Dawes; M. Johnson; J. Miner.
CONCLUSIONS: A 15 second CEW application on exercised volunteers did not demonstrate any evidence of induced tachyarrhythmia. It is unlikely that CEW exposure induces cardiac rate capture or tachyarrhythmia in humans.
(Abstract)(Poster)(09/18/07) ABSENCE OF ELECTROCARDIOGRAPHIC CHANGE FOLLOWING PROLONGED APPLICATION OF A CONDUCTED ELECTRICAL WEAPON IN PHYSICALLY EXHAUSTED ADULTS. J. Ho; D. Dawes; H. Calkins; M. Johnson.
CONCLUSIONS: Prolonged 15 second CEW application in a physically exhausted adult human sample did not cause a detectable change in their 12-lead ECGs. Theories of CEW induced dysrhythmias are not supported by our findings.
(Abstract)(Poster)(09/19/07) 15-SECOND CONDUCTED ELECTRICAL WEAPON EXPOSURE DOES NOT CAUSE CORE TEMPERATURE ELEVATION IN NON-ENVIRONMENTALLY STRESSED RESTING ADULTS. D. M. Dawes; J. Ho; M. Johnson; J. Miner.
CONCLUSIONS: In summary, our results do not show that a 15-second conducted electrical weapon discharge significantly affects core body temperature in non-environmentally stressed resting adults. While additional studies are needed, our data suggests that theories about conducted electrical weapons contributing to hyperthermia are likely unfounded.
(Abstract)(Poster)(09/19/07) THE NEUROENDOCRINE EFFECTS OF THE TASER X26 CONDUCTED ELECTRICAL WEAPON AS COMPARED TO OLEORESIN CAPSICUM. D. M. Dawes; J. Ho; M. Johnson; J. Miner.
CONCLUSIONS: The results suggest a significant greater level of activation of the SAM cascade with O.C. compared to the CEW. Overlapping confidence intervals preclude a definitive statement about the other measurements, but do not suggest a greater activation of the stress cascade by the CEW than O.C.
(Abstract)(Poster)(09/19/07) 15-SECOND CONDUCTED ELECTRICAL WEAPON APPLICATION DOES NOT IMPAIR BASIC RESPIRATORY PARAMETERS, VENOUS BLOOD GASES, OR BLOOD CHEMISTRIES. D. M. Dawes; J. Ho; M. Johnson; J. Miner.
CONCLUSIONS: As with the previous study, this study suggests that exposure to a CEW does not significantly impair respiration. As in the previous study, pCO2 decreased and pO2 increased as a result of the exposure. There was no change in blood pH. While this study is small, it adds to the growing body of literature that is demonstrating that these weapons have a favorable risk-benefit ratio and are appropriate additions to the use of force continua of police agencies.
(Abstract)(Poster)(09/19/07) BREATHING PARAMETERS, VENOUS GASES, AND CHEMISTRIES WITH EXPOSURE TO A NEW WIRELESS PROJECTILE CONDUCTED ELECTRICAL WEAPON. D. M. Dawes; J. Ho; M. Johnson; J. Miner; E. Lundin.
CONCLUSIONS: This study demonstrates that the new CEW has no important deleterious effects on respiratory parameters, blood chemistries, or venous blood gases. These results are consistent with previous results for the TASER X26 CEW.
(09/15/07)Acute Effects of TASER X26 Discharges in a Swine Model. Dennis, Andrew J. DO; Valentino, Daniel J. MD; Walter, Robert J. PhD; Nagy, Kimberly K. MD; Winners, Jerry BS; Bokhari, Faran MD; Wiley, Dorion E. MD; Joseph, Kimberly T. MD; Roberts, Roxanne R. MD, Journal of Trauma-Injury Infection & Critical Care. 63(3):581-590, September 2007.
Conclusions: Immediately after the [two 40 second ECD] discharge [with a 10 second pause between the 40 second continuous discharges], two [swine] deaths [29 kilogram (kg) (63.93 pounds (lbs)) and 31 kg (68.34 lbs)] occurred because of ventricular fibrillation. In this model of prolonged EID exposure, clinically significant acid-base and cardiovascular disturbances were clearly seen. The severe metabolic and respiratory acidosis seen here suggests the involvement of a primary cardiovascular mechanism.
The Taser is an electrical conducted energy weapon used by law enforcement officers throughout the United States and the world. Though generally regarded as safe, conducted energy weapons can produce injuries. In this case report we describe for the first time thoracic spine compression fractures resulting from a conducted energy weapon discharge. Physicians who may care for patients who have been exposed to a conducted energy weapon discharge should be aware of this as a possible complication.
Conclusion: The mentally ill represents a significant portion of subjects upon whom CEWs are used. These data suggest frequent use of CEWs in situations where deadly force would otherwise be justified and in situations where subjects exhibit imminent danger to themselves. These data also suggest that escalation to deadly force was avoided in many mental illness and suicidal situations by the presence of a CEW.
(08/29/07) Physiological Effects of a Conducted Electrical Weapon on Human Subjects, Gary M. Vilke, MD, Christian M. Sloane, MD, Katie D. Bouton, BS, Fred W. Kolkhorst, PhD, Saul D. Levine, MD, Tom S. Neuman, MD, Edward M. Castillo, PhD, MPH, Theodore C. Chan, MD. Article in Press, Ann Emerg Med. 2007;xx:xxx.
Conclusion: A 5-second exposure of a Taser X-26 to healthy law enforcement personnel does not result in clinically significant changes of physiologic stress.
Conclusion: In summary, this review of the scientific literature suggests that the immediate induction of ventricular fibrillation by the direct electrical effects of the TASER X26 on the normal adult heart is unlikely and that the induction of delayed cardiac arrest by this mechanism is extremely unlikely. This conclusion is partially based on several assumptions, eg, that the depiction of the TASER X26 pulse in the paper by McDaniel et al is accurate and that Blair’s method and the fundamental law of electrostimulation accurately predict the stimulatory effects of 0.1-ms pulses. However, unless these assumptions are grossly in error, the large safety factors for the induction of immediate or delayed ventricular fibrillation suggest that this conclusion is still true even if some of the assumptions, such as the effective time constant of the heart for electrical stimulation from the body surface, are not precisely correct. In addition, this conclusion is bolstered by the limited amount of experimental evidence in animals.
(08/24/07) The Physiologic Effects of a Conducted Electrical Weapon [Stinger S-400] in Swine, Amanda O. Esquivel, MS, Elizabeth J. Dawe, DVM, Javier A. Sala-Mercado, MD, PhD., Robert L. Hammond, PhD, Cynthia A. Bir, PhD., Article in Press, American College of Emergency Physicians, Trauma/Original Research, dol:10.1016/j.annemergmed.2007.05.003, Ann Emerg Med. 2007;xx:xxx.
Conclusion: Repeated exposures to a conducted electrical weapon result in respiratory acidosis, metabolic vasodilation, and an increase in blood lactate level. These effects were transient in this study, with full recovery by 4 hours post exposure. The Stinger S-400 appears to have no serious adverse physiologic effects on healthy, anesthetized swine.
(07/18/07) Are TASERs Really Non-Lethal? Current Research on Both Animals and Humans shows that TASERs are among the safest cop weapons, Jeffrey D. Ho, MD, FACEP, Police Magazine, July 2007, pages 32-38.
Conclusion: "Study after study continues to show that TASERs are a safe, non-lethal weapon for law enforcement applications. Based on all of the available data, including the most recent human study, there seems to be no reason to prevent law enforcement agancies from continuing to use these devices with confidence.
In a previous study, 18 repeated exposures of anaesthetized swine to an electro-muscular incapacitating device (TASER International's ADVANCED TASER((R)) X26 electronic control device) resulted in acidosis and increases in blood electrolytes. In the current study, experiments were performed to investigate effects of a more typical scenario of repeated exposures of the device on muscle contraction and changes in blood factors. Ten swine were exposed for 5s, followed by a 5-s period of no exposure, three times. Selected blood factors were monitored for 3h following exposure. Transient increases in blood glucose, lactate, sodium, potassium, calcium, and pCO(2) were consistent with previous reports in the literature dealing with studies of muscle stimulation or exercise. Blood pH was decreased immediately following exposure, but subsequently returned toward a normal level. Oxygen saturation (measured by pulse oximetry) was not changed significantly. In conclusion, three repeated TASER device exposures had only transient effects on blood factors, which all returned to pre-exposure levels, with the exception of hematocrit (which remained elevated after 3h). Since the increase in this factor was less than that which may occur after short periods of exercise, it is unlikely that this would be an indicator of any serious harm. (emphasis added).
Conclusions: Based on these limited observations, a 5 s TASER exposure does not cause clinically significant indications of physiological stress that could be causally linked to sudden death. However, our subjects were healthy and were not under the influence of any illicit drugs, thus these results may not be generalizable to populations who are were taking common drugs of abuse and/or who had developed lactic acidosis from high-intensity exercise.
(05/31/07) Physiological Effects of a Five Second Taser Exposure: 1897: Board #185 May 31 8:00 AM - 9:30 AM., KD Bouton, GM Vilke, TC Chan, C Sloane, S Levine, TS Neuman, SS Levy, and FW Kolkhorst, Med Sci Sports Exerc, May 1, 2007; 39(5 Suppl): S323.
Conclusions: In this study in human volunteers, a significant increase in heart rate was found after a brief shock from a CED, the Taser X-26®. There were no other identified cardiac rhythm disturbances or morphology changes except for a few subjects who appeared to have QT changes, the significance of which is unclear.
(05/23/07)The State of Current Human Research and Electronic Control Devices (ECDs), Jeffrey Douglas Ho, M.D., Mark Alexander Johnson, Donald Murray Dawes, M.D., European Working Group, Non-Lethal Weapons, presented at 4th European Symposium on Non-Lethal Weapons, May 21-23, 2007, Stadthalle Ettlingen, Germany.
Conclusions: NMI discharge does not affect the short-term functional integrity of implantable pacemakers and defibrillators even when the darts are placed in a manner to sandwich the generator.
The standard NMI application duration of 5 seconds should not trigger an ICD shock in devices programmed to a non-committed shock delivery mode.
Conclusions. Even with the worst-case locations, with barbs plunged fully towards the heart, we were never able to induce ventricular fibrillation in 34 kg (76 lb) pigs.
Conclusion Pacemakers and ICD generators and leads functions were not affected by the tested standard 5 s stun gun shocks.
(04/26/07) (Poster)(Abstract) Does the Taser Cause Electrical Changes in Twelve Lead ECG Monitoring of Human Subjects, Gary Vilke, Christian Sloane, Saul Levine, Tom Neuman, Edward Castillo,and Theodore Chan, Acad. Emerg. Med. 2007; 14(5_Supplement_1): p. S104.
Conclusions: There were no cardiac dysrhythmia, interval or morphology changes in human subjects who received a Taser shock on evaluation of a 12 lead ECG performed immediately before and after Taser activation.
(04/26/07) (Poster)(Abstract) Serum Troponin I Measurement of Subjects Exposed to the Taser X-26, Christian Sloane, Gary Vilke, Theodore Chan, Saul Levine, and James Dunford, Acad. Emerg. Med. 2007; 14(5_Supplement_1): p. S103-b-104S -b.
Conclusions: Though limited by short shock duration, human volunteers exposed to a single shock from the Taser did not develop an abnormal serum troponin I level 6 hours after shock, suggesting that there was no myocardial necrosis.
(04/26/07) (Poster) (Abstract) The Impact of the Taser Weapon on Respiratory And Ventilatory Function in Human Subjects? Ted Chan, Christian Sloane, Tom Neuman, Saul Levine, Edward Castillo, Gary Vilke, Katie Bouton, and Fred Kohokorst, Acad. Emerg. Med. 2007; 14(5_Supplement_1): p. S191-b-192S -b.
Conclusions: In our study on human volunteers, VE, TV, and RR increased immediately following a standard Taser discharge, but returned to baseline within 10 minutes.There was no evidence of hypoxemia or hypoventilation in our study subjects.
(04/26/07)TASER Discharges Capture Cardiac Rhythm in a Swine Model, Daniel Valentino, Robert Walter, Andrew Dennis, Bosko Margeta, Kimberly Nagy, Jerry Winners, Faran Bokhari, Dorion Wiley, Kimberly Joseph, and Roxanne Roberts, Acad. Emerg. Med. 2007; 14(5_Supplement_1): p. S104-a.
Conclusions: Given the possibility of cardiac capture with TASER discharges, cardiac monitoring should be performed on exposed subjects.
(04/26/07) (Poster)(Abstract) Cardiovascular and Metabolic Effects of the Taser on Human Subjects, Gary Vilke, Christian Sloane, Katie Bouton, Saul Levine, Tom Neuman, Edward Castillo, Fred Kolkhorst, and Theodore Chan, Acad. Emerg. Med. 2007; 14(5_Supplement_1): p. S104-b-105S -b.
Conclusions: There were no clinically significant or lasting statistically significant changes in cardiovascular, electrolyte, lactate or pH levels in human subjects after a 5 second Taser activation.
(04/26/07) (Poster) (Abstract) Absence of Electrocardiographic Change Following Prolonged Application of a Conducted Electrical Weapon in Physically Exhausted Adults,Jeffrey Ho, Donald Dawes, Hugh Calkins, and Mark Johnson, Acad. Emerg. Med. 2007; 14(5_Supplement_1): p. S128-b-129S -b.
Conclusions: Prolonged 15 second CEW application in a physically exhausted adult human sample did not cause a detectable change in their 12-lead ECGs. Theories of CEW induced dysrhythmias are not supported by our findings.
(04/26/07) (Poster)(Abstract) Physiologic Effects of Prolonged Conducted Electrical Weapon Discharge on Intoxicated Adults, Ronald Moscati, Jeffrey Ho, Donald Dawes, James Miner, Robert Reardon, William Heegaard, Timothy Mark Johnson, and Laura Bultman, Acad. Emerg. Med. 2007; 14(5_Supplement_1): p. S63-b-64S -b.
Conclusions: Intoxicated adults with prolonged CEW exposure demonstrate small transient increases in measures of acidosis and no change in markers of cardiac injury. The increased acidosis was not clinically significant and self corrected.
(04/26/07) (Poster) (Abstract) Physiologic Effects of Prolonged Conducted Electrical Weapon Discharge on Acidotic Adults, Jeffrey Ho, Donald Dawes, Laura Bultman, Ronald Moscati, Lisa Skinner, Jennifer Bahr, Robert Reardon, Mark Johnson, and James Miner,Acad. Emerg. Med. 2007; 14(5_Supplement_1): p. S63-a.
Conclusions: Markers of acidosis and cardiac injury were similar among acidotic subjects who underwent both sham and real prolonged CEW exposure. Prolonged CEW exposure in humans does not appear to have an effect with regard to worsening acidosis that is already present.
(02/24/07)Conducted Energy Devices:Development of Standards for Consistency and Guidance, The Creation of National CED Policy and Training Guidelines, by James M. Cronin and Joshua A. Ederheimer. U.S. Department of Justice, Office of Community Oriented Policing Services.
(02/07) MW Kroll, H Calkins, and RM Luceri, Electronic control devices and the clinical milieu. J Am Coll Cardiol 13 Feb 2007 49(6): p. 732; author reply 732.
(02/07) Reply, Dorian and Nanthakumar J Am Coll Cardiol.2007; 49: 732-733
" ... [S]tudies have not reported a single case in which the presenting rhythm was VF when an ECD was used. A study of 162 consecutive in-custody deaths found that, whereas there was a significant association of impact weapons with sudden death, the ECDs were never (0 of 50; p = 0.0001) associated with a sudden collapse. This would seem to eliminate electrically induced VF as the cause of death."
"We did not state that NIDs cause ventricular fibrillation in humans, and we agree that we cannot conclude from our study that NID discharges cause arrhythmias in typical use."
(2007) Jauchem, James R., Reply to Letter to the Editor, Forensic Science International. Letter dated August 28, 2006. Re: Acidosis, lactate, electrolytes, muscle enzymes, and other factors in the blood of Sus scrofa following repeated TASER® exposures. Forensic Science International, Volume 168, Issue 1, Pages e19-e19 J. Jauchem.
"It is important to note that our exposure conditions were somewhat extreme compared with those commonly experienced during civilian law-enforcement use of TASER International’s Advanced TASER X26. Therefore, it would not be prudent to draw conclusions about such use on the basis of our study alone."
(10/06) 75:Evaluation of In-Custody Deaths Proximal to Use of Conductive Energy Devices, G. Vilke, W. Johnson, E.M. Castillo, J.A. Ederheimer, C. Wexler, C.M. Sloane, T.C. Chan, Annals of Emergency Medicine, October 2006 (Vol. 48, Issue 4, Pages 23-24).
Conclusion: Taser shocks produced no detectable dysrhythmias and a statistically significant increase in heart rate. A dose response relationship was not demonstrated. This study more than doubles the previously reported human subject experience of Taser shock during EKG monitoring and includes a significant number of full 5 second exposures. Overall, Taser exposure appears to be safe and in this population well tolerated from a cardiovascular standpoint.
(09/06)Long Beach, California: Less-lethal Weaponry Case Study. By Chief Anthony W. Batts and Sergeant Susanne Steiner, Long Beach Police Department, California, and Data Collection and Analysis by Lieutenant John Lembi, Long Beach Police Department, California, The Police Chief, vol. 73, no. 9, September 2006.
(09/06)Taser use in restraint-related deaths, 10 (4) Prehospital Emergency Care 447-50 (Oct-Dec. 2006) Strote Jared; Range Hutson H Division of Emergency Medicine, Department of Medicine, University of Washington Medical Center, Seattle, WA.
The study concluded that cocaine increased the VFT of NMI discharges at all dart locations tested and reduced cardiac vulnerability to VF. The application of cocaine increased the safety margin by 50% to 100% above the baseline safety margin.
Conclusions: A 5-second TASER X26 application did not cause a detectable change in the 12-lead electrocardiograms of this sample population. Theories of TASER induced dysrhythimic death or myocardial damage are not supported by our findings. Presented in Nice, France.
Conclusions: Other than an increase in heart rate, there were no cardiac dysrhythmia or ECG morphology changes in human subjects who received a Taser shock. The clinical implications of these findings require further investigation.
CEW use appears to play a signficant role on the types of force that is used by law enforcement in contacts with mentally-ill persons. In the database queried, 45.3% (1,111 or 2,452 reports) of CEW uses were in situations where lethal force would have been justified or in situations where the subject posed an imminent lethal danger to himself.
(01/06) The relative risk of police use-of-force options: evaluating the potential for deployment of electronic weaponry. Jenkinson E, Neeson C, Bleetman A. J Clin Forensic Med. 2006 Jul;13(5):229-41. Epub 2006 Jan 25.
(2006) UK policing and less lethal technologies--an operational, legal and medical perspective. Burrows C, Cooper G. Med Leg J. 2006;74(Pt 3):83-98.
(11/04/05) NEW REPORTS STRESS TASER'S SAFETY & EFFECTIVENESS, YET ACLU DEMANDS GREATER RESTRICTION ON DEPLOYMENT, Force Science News #31, November 4, 2005.
(09/05) TASER and Less Lethal Weapons: An Exploratory Analysis of Deployments and Effectiveness,
Charlie Mesloh, PhD, Assistant Professor and Director, Weapons and Equipment Research Institute, Florida Gulf Coast University; Mark Henych, PhD, Independent Researcher; Steven Hougland, PhD, Captain, Orange County, Florida, Sheriff’s Office; Frank Thompson, Graduate Student and Researcher, Weapons and Equipment Research Institute, Florida Gulf Coast University; Law Enforcement Executive Forum, 2005, 5(5), pp 67-79.
(09/05)Cardiac Monitoring of Subjects Exposed to the Taser, Saul Levine, MD, Christian Sloane, MD, Theodore Chan, MD, Gary Vilke, MD, James Dunford, MD, University of California San Diego Emergency Medicine.
(09/05)The Role of Tasers in Police Restraint-Related Death, Jared Strote, MD, Shane Hamman, MD, Rich Campbell, MD, John Pease, MD, and H. Range Hutson, MD, University of Washington School of Medicine, Division of Emergency Medicine and Harvard Medical School.
Definitive research or evidence does not exist that implicates a causal relationship between the use of CEDs [Conducted Energy Devices] and death.
Existing studies indicate that the risk of cardiac harm to subjects from a CED is very low.
Excited Delirium (ED), although not a universally recognized medical condition, is gaining increasing acceptance as a main contributor to deaths proximal to CED use.
A single TASER application made before the subject has been exhausted, followed by a restraint technique that does not impair respiration may provide the optimum outcome. Page 32.
(02/05)Chief's Counsel: Electronic Control Weapons: Liability Issues. By Randy Means, Attorney at Law, Thomas and Means, LLP, and Eric Edwards, Lieutenant and Legal Advisor, Phoenix Police Department, and Executive Director, Arizona Association of Chiefs of Police, The Police Chief, vol. 72, no. 2, February 2005.
(11/01)SPD Special Report, Use of Force by Seattle Police Department Officers.
(05/91) Electronic weaponry — A question of safety, Daniel J O'Brien
Annals of Emergency Medicine, May 1991 (Vol. 20, Issue 5, Pages 583-587).
(09/00) TR-01-2000, TASER Technology Research Report, Technical Report, September 2000, by Sgt. Darren Laur, Victoria Police Service, Canadian Police Research Centre.
(10/85) The Taser® weapon: A new emergency medicine problem, Eric M Koscove, Annals of Emergency Medicine, December 1985 (Vol. 14, Issue 12, Pages 1205-1208).
Electronic Control Devices Policies
(02/24/07) Conducted Energy Devices:Development of Standards for Consistency and Guidance, The Creation of National CED Policy and Training Guidelines, by James M. Cronin and Joshua A. Ederheimer. U.S. Department of Justice, Office of Community Oriented Policing Services.
Police Executive Research Forum (PERF):
PERF Conducted Energy Device, Policy and Training Guidelines for Consideration
PERF Conducted Energy Device (CED) Glossary of Terms
International Association of Chiefs of Police (IACP):
(01/05)Electronic Control Weapons, Concepts and Issues Paper, IACP National Law Enforcement Policy Center. (02/98) IACP National Law Enforcement Policy Center, Electronic Restraint Device: The Taser®, Concepts and Issues Paper, February 1998.
(04/96) IACP National Law Enforcement Policy Center, ELECTRONIC RESTRAINT DEVICE: THE TASER® Model Policy, April 1996.
IACP Publications: EMD & Model Policy
Electro-Muscular Disruption Technology: A Nine-Step Strategy for Effective Deployment has recently been published by the International Association of Chiefs of Police (IACP), Alexandria, Virginia. If you or your agency is thinking about adopting electronic control devices, make sure you get this 18-page Executive Brief.
IACP Model ECW Policy (August 2005)
An Electronic Control WeaponsModel Policy has also been published by the IACP. Please note the TASER® International, Inc.'s electronic control devices are excluded from this policy based upon the Model Policy's definition of electronic control weapon. For more information about these publications, please visit the IACP.
IACP Training Keys:
(1988) IACP Training Key No. 497, The TASER.
(2003) IACP Training Key No. 567, The Advanced TASER
IACP Training Key No. 575, Electronic Control Weapons: Update
IACP Training Key No. 583, Electronic Control Weapons (ECW): Update 2005
IACP Training Key No. 581, Suicide (Homicide) Bombers: Part I
IACP Training Key No. 582, Suicide (Homicide) Bombers: Part II
(01/10/06) LAAW International, Inc. Sample ECD Policy Set
FL TASER Advisory Group ECD Sample Policy Orange County (FL) Sheriff's Office General Order - ECW>
Miami (FL) Police Department TASER Policy
Leon County (FL) Sheriff's Office Use of Force General Order
(2003) Deaths associated with restraint use in health and social care in the UK. The results of a preliminary survey, Paterson, B., Bradley P., Stark C., Saddler D., Leadbetter D. & Allen D., (2003), Journal of Psychiatric and Mental Health Nursing, 10, 3–15.
Restraint Asphyxia
(02/16-21/09) American Academy of Forensic Sciences (AAFS) 61st Annual Scientific Meeting, Denver, Colorado.
(02/20/09) Asphyxial Deaths, Michael Graham, MD. Pathology/Biology. Suicide, Mass Disaster, & Bizarre Death. AAFS 2009
(03/07) Restraint asphyxia in in-custody deaths: Medical examiner’s role in prevention of deaths, Lakshmanan Sathyavagiswaran, Christopher Rogers, Thomas T. Noguchi, Legal Medicine, March 2007 (Vol. 9, Issue 2, Pages 88-93).
(03/00) Asphyxial Death During Prone Restraint Revisited: A Report of 21 Cases, O'Halloran, Ronald L. M.D., Frank, Janice G. M.D., The American Journal of Forensic Medicine and Pathology, Volume 21(1), March 2000, pp 39-52.
Law Enforcement Bean Bags
(10/01) The injury pattern of a new law enforcement weapon: The police bean bag, Dirk de Brito, Kathryn R. Challoner, Ashish Sehgal, William Mallon, Annals of Emergency Medicine, October 2001 (Vol. 38, Issue 4, Pages 383-390).
Law Enforcement Impact Munitions
(10/09/07)Impact munitions: a discussion of key information, David Klinger, Policing: An International Journal of Police Strategies & Management, 2007 Volume: 30 Issue: 3 Page: 385 – 397.
Findings – Impact munitions are an increasingly popular feature of contemporary American policing that rarely lead to serious injury, but can, under certain circumstances, cause fatal injuries.
(07/07)National Study On Neck Restraints in Policing, Technical Report, Christine Hall, MD, MSc, FRCPC, Sergeant Chris Butler, Canadian Police Research Centre, June 2007.
(08/06)Calgary Police Service Neck Restraint Literature Review: A Review of Medical, Legal, and Police Literature on Carotid Neck Restraint Techniques, Technical Report TR-01-2007, August 2006, Prepared by Noreen Barros, Research and Development Section, Calgary Police Service, Canadian Police Research Centre.
Law Enforcement OC Spray and Other Chemical Irritants
(11/09) Mendelson J, Tolliver B, Delucchi K, Baggott M, Flower K, Harris C, Galloway G., Berger P, Capsaicin, an active ingredient in pepper sprays, increases the lethality of cocaine, Forensic Toxicol, DOI 10.1007/s11419-009-0079-9. (Japanese Association of Forensic Toxicology. 2009.)
(02/16-21/09) American Academy of Forensic Sciences (AAFS) 61st Annual Scientific Meeting, Denver, Colorado.
(02/21/09) (A190) A Comparison of Pepper Spray and Hot Sauce Stains. Craig Bryant, MSc; Kevin Farrugia, MSc. Criminalistics. Miscellaneous. AAFS 2009.
(06/07)CPRC Survey of Canadian Police Services on the Use of OC Spray During Training, Technical Memorandum TM-04-2007 E, June 2007, Prepared by Alexandra Lewis, Canadian Police Research Centre.
(04/07)Bibliography of Selected Resources on OC Spray and Other Chemical Irritants, Technical Memorandum TM-03-2007 E, Prepared by John Evans and Alexandra Lewis, Canadian Police Research Centre.
Mental Illness Articles
(03/24/08)Report of the Fifth International Law Enforcement Forum for Minimal Force Options and Less-Lethal Technologies, Washington & Fairfax - November 2006, International Law Enforcement Forum.
Page 39: Of note also was the sense from many of the group members that police use of CEOs to gain compliance of subjects who are suffering from mental health problems (e.g., schizophrenia) has found broad support among mental health groups (The Schizophrenic Society in Canada, The Schizophrenic Association in the UK, and the National Institute of Mental Health in the US were all mentioned).
Conclusion: The mentally ill represents a significant portion of subjects upon whom CEWs are used. These data suggest frequent use of CEWs in situations where deadly force would otherwise be justified and in situations where subjects exhibit imminent danger to themselves. These data also suggest that escalation to deadly force was avoided in many mental illness and suicidal situations by the presence of a CEW.
(02/05)Law enforcement and people with severe mental illnesses, Treatment Advocacy Center Briefing Paper.
SUMMARY: A natural outgrowth of a mental health system that withholds needed treatment until a person with a mental illness becomes dangerous is that police officers and sheriff’s deputies are forced to become front line mental health workers. The safety of both law enforcement officers and citizens is compromised when law enforcement responds to crises involving people with severe mental illnesses who are not being treated. In 1998, law enforcement officers were more likely to be killed by a person with mental illness than by an assailant with a prior arrest for assaulting police or resisting arrest. And people with mental illnesses are killed by police in justifiable homicides at a rate nearly four times greater than the general public.
(01-02/06)Force Continuums: Are They Still Needed? Police and Security News, January/February 2006, Vol. 22 Issue 1, by John G. Peters, Jr., M.B.A., Ph.D., CLS., and Michael Brave, Esq., M.S., CLS3, CLET.
(01-06)Force Continuums: Three Questions, Police Chief, January 2006. pgs 8-9, by John G. Peters, Jr., M.B.A., Ph.D., CLS., and Michael Brave, Esq., M.S., CLS3, CLET.
More Articles of Interest
Article (PDF) - George Facher and Steve Carter recently published through the United States Department of Justice Community Oriented Policing Services (COPS) a report about the Philadelphia (Pennsylvania) Police Department. Collaborative Reform Initiative: An Assessment of Deadly Force in the Philadelphia Police Department is a must read for law enforcement trainers and administrators. Several key findings and recommendations focus upon the need for more and better training, investigations, etc.
Excited Delirium, Restraint Asphyxia, Positional Asphyxia and "In-Custody Death" Syndromes: Controversial theories that may explain why some chilidren in treatment programs die when restrained. Available fromEducationOptions.
Excited Delirium and its Correlation to Sudden and Unexpected Death Proximal to Restraint, TR-02-2005, By Sgt. Darren Laur, Victoria Police Department, Canadian Police Research Centre, December 2004.
The evaluation and management of patients with neuroleptic malignant syndrome; Minal J. Bhanushali, MBBSa, Paul J. Tuite, MD, Neurol Clin N Am 22 (2004) 389–411.
Akiko Ishigami, Shin-ichi Kubo, Takako Gotohda and Itsuo Tokunaga, Department of Legal Medicine, The University of Tokushima School of Medicine, Tokushima, Japan; CASE REPORT, The application of immunohistochemical findings in the diagnosis in methamphetamine-related death-two forensic autopsy cases,The Journal of Medical Investigation Vol. 50 2003, pp 112-116.
“SUICIDE-BY-COP”: LIABILITY, TRAINING, AND MUNICIPAL CONCERNS, by John G. Peters, Jr., M.B.A., Ph.D., COI, Police & Security News, January/February 2003, Vol. 19, Issue 1.