Less-lethal law enforcement weapons: clinical management of associated injuries in the emergency department.

Less-lethal weapons and tactics are being increasingly used by law enforcement to minimize the reliance on more-lethal force. While these methods are designated as "less-lethal," they can cause morbidity and mortality when deployed. Knowledge of these weapons and tactics can help direct the workup and management of patients with injuries from these methods and can protect clinicians from secondary exposure and injuries. This issue reviews the most common less-lethal weapons and tactics used by law enforcement, describes their mechanism of action, and discusses associated common injury patterns. Recommendations are provided for the evaluation and management of these patients in the emergency department.

Emergency Department Evaluation After Conducted Energy Weapon Use: Review of the Literature for the Clinician.

BACKGROUND: Conductive energy weapons (CEWs) are used daily by law enforcement, and patients are often brought to emergency departments (EDs) for medical clearance. OBJECTIVE: Our aim was to review the medical literature on the topic of CEWs and to offer evidence-based recommendations to emergency physicians for evaluation and treatment of patients who have received a CEW exposure. METHODS: A MEDLINE literature search from 1988 to 2018 was performed and limited to human studies published from January 1, 1988 to November 1, 2018 written in English with the following keywords: TASER, conductive energy device(s), electronic weapon(s), conductive energy weapon(s), non-lethal weapon(s), conducted energy device(s), conducted energy weapon(s), conductive electronic device(s), and electronic control device(s). Studies identified then underwent a structured review from which results could be evaluated. RESULTS: Two hundred and sixty-three articles on CEWs were screened and 37 appropriate articles were rigorously reviewed. Evaluation and treatment recommendations are presented. These studies did not report any evidence of dangerous laboratory abnormalities, physiologic changes, or immediate or delayed cardiac ischemia or dysrhythmias after exposure to CEW electrical discharges of up to 15 s. CONCLUSIONS: The current medical literature does not support routine performance of laboratory studies, electrocardiography, or prolonged ED observation or hospitalization for ongoing cardiac monitoring after CEW exposure in an otherwise asymptomatic awake and alert patient.

[The topical problems of the application of the TASER electroshock devices]. / Aktual'nye voprosy primeneniia élektroshokovogo ustroistva TASER.

The objective of the present study was the analysis of publications in the foreign medical literature concerning the problems of safety, clinical diagnostics, pathological morphology, and treatment of the patients subjected to the impact by various models of the TASER electroshock devices. The materials for this article were borrowed from the available Internet resources and libraries. The methods of scientific analysis were employed to follow up the dynamics of publication and to determine the number of publications on the issues of interest. The main attention was given to the overview of the subject matter of scientific research and experiments. The review covers 74 foreign articles presenting the discussion of various conditions and circumstances of the action of various types of the TASER electroshock devices (ESD) on the man with special reference to their effectiveness and safety as confirmed by numerous experimental impacts on the volunteers and animals. It is shown that the dynamics of relevant publications in the foreign scientific periodicals gives evidence of the strong interest shown by the specialists in various scientific disciplines to the problem of safety of various models of the TASER electroshock devices. The largest number of the articles (60 or 81.1%) published during the period covered by the present study were submitted by the American authors describing their experiments involving the volunteers, anthropometric dummies, and human corpses (n=38 or 51%). The subject matter of these publications included the forensic medical evaluation of the lethal outcomes of the application of the TASER electroshock devices with the related technical problems and characteristic of various ESD models. Despite the extensive studies on the volunteers and the experimental animals, the authors of the publications failed to present direct and conclusive evidence of the lethal consequences of the application of the TASER electroshock devices (ESD) on the man. Some of them recommend to prohibit (or restrict whenever possible) the targeted application of the electric shock weapons to the thoracic region. Experiments on the animals have demonstrated the possibility of development of cardiovascular and respiratory complications following the application of the TASER X2 electroshock devices operating at a frequency of 40 Hz during 30 minutes. The clinical and laboratory studies with the participation of the volunteers in an alcoholic intoxication condition have confirmed the long-term increase in the blood lactate levels under the influence of the electric shocking weapons. The analogous data suggesting the development of pronounced acidosis under effect of the TASER X2 electroshock devices due to the elevation of the lactate concentration in the venous blood have been obtained in the animal experiments. The studies of humans in a narcotic intoxication condition failed to provide direct evidence of induction of psychic disorders in the form of an acute confusional state (delirium) under the influence of the TASER electroshock devices. The evaluation of changes in the skin cover in the form of the punctured or contused wounds in the victims of the application of the electroshock gun projectiles did not revealed any specific signs of the local electrical action.

Impaled Orbital TASER Probe Injury Requiring Primary Enucleation.

The Conducted Electrical Weapon is a weapon often used by law enforcement agencies as a method of less lethal means to subdue a suspect. Injuries to the eye with these devices are usually due to the projectile force of the metal probes that are released when these devices are engaged. The authors report what may be the first case of an impaled orbital TASER probe that required primary enucleation for globe perforation.

Cardiovascular effects of SPARK conducted electrical weapon in healthy subjects.

BACKGROUND: The increasing use of conducted electronic weapons (CEW) cause concern regarding its secure application, specially regarding the implications in the cardiovascular system. METHODS: The objective was to determine Spark CEW safety through cardiovascular parameters analysis of healthy volunteers subjected to its use. RESULTS: Volunteers over 18years without cardiovascular disease or recent use of illegal drugs were submitted, before and after being affected with Spark CEW, to clinical evaluation; blood collection for serum laboratory tests; transthoracic electrocardiography at rest, transthoracic echodopplercardiogram and 24hour Holter. RESULTS: All 71 patients reported being incapable of any voluntary reaction during the shock of the application time. No arrhythmia or myocardial necrosis was related to the use of non-lethal weapon SPARK. Reported adverse events were self-limited, and mostly mild. CONCLUSIONS: SPARK brand CEW is effective in incapacitating individuals by the shock of the application time, without causing.

TASER® conducted electrical weapons: misconceptions in the scientific/medical and other literature.

TASER(®) conducted electrical weapons (CEWs) have become an important law-enforcement tool. Controversial questions are often raised during discussion of some incidents in which the devices have been used. The main purpose of this paper is to point out some misconceptions about CEWs that have been published in the scientific/medical and other literature. This is a narrative review, using a multidisciplinary approach of analyzing reports from scientific/medical and other literature sources. In previous reports, durations of incapacitating effects and possible associations of CEWs with deaths-in-custody have often been overstated or exaggerated. Comparisons of CEW effects with "electrocution" are misleading. Clarification of these misconceptions may be important during policymaker decisions, practitioner operations, expert witness testimonies, and court proceedings. Despite misconceptions in the literature, CEWs can still be a valuable tool for law enforcement activities. Scientists, medical professionals, legal advisors, and investigators of police tactics should be aware of these misconceptions.

The neurocognitive effects of simulated use-of-force scenarios.

While the physiologic effects of modern conducted electrical weapons (CEW) have been the subject of numerous studies, their effects on neurocognitive functioning, both short-term and long-term, are less well understood. It is also unclear how these effects compare to other use-of-force options or other arrest-related stressors. We compared the neurocognitive effects of an exposure to a TASER(®) (TASER International, Inc, Scottsdale, AZ) X26™ CEW to four other use-of-force scenarios during a training exercise using a well-established neurocognitive metric administered repeatedly over 1 h. Overall, we found that there was a decline in neurocognitive performance immediately post-scenario in all groups, but this effect was transient, of questionable clinical significance, and returned to baseline by 1 h post-scenario.

An evaluation of two conducted electrical weapons and two probe designs using a swine comparative cardiac safety model.

Despite human laboratory and field studies that have demonstrated a reasonable safety profile for TASER brand conducted electrical weapons (CEW), the results of some swine studies and arrest related deaths temporal to the use of the CEWs continue to raise questions regarding cardiac safety. TASER International, Inc., has released a new CEW, the TASER X2, touted to have a better safety profile than its long-standing predecessor, the TASER X26. We have developed a model to assess the relative cardiac safety of CEWs and used it to compare the TASER X2 and the TASER X26. This safety model was also used to assess the relative safety of an experimental probe design as compared to the standard steel probe. Our results suggest that the TASER X2 has an improved safety margin over the TASER X26. The new probe design also has promise for enhanced cardiac safety, although may have some disadvantages when compared to the existing design which would make field use impractical.

The cardiovascular, respiratory, and metabolic effects of a long duration electronic control device exposure in human volunteers.

Electronic control devices (ECD) have become popular in law enforcement because they have filled a gap left by other law enforcement devices, tactics, or tools and have been shown to reduce officer and suspect injuries. Civilians are using the same technology for defensive purposes. TASER C2 is the latest generation civilian-marketed device from the manufacturer. Unlike the law enforcement devices, the device discharges for 30 s continuously. This study is the first to look at the cardiovascular, respiratory, and metabolic effects of this device on human subjects. This was a prospective, observational study of human subjects involved in a training course. Subjects were exposed for 30 s on the anterior thorax. Vital signs, ECG, troponin I, pH, lactate, and creatine kinase (CK) were measured before and immediately after the exposure. Troponin I, pH, lactate, and CK were measured again 24 h after the exposure. Continuous spirometry was used to evaluate the respiratory effects. Echocardiography was also performed before, during, and immediately after the exposure to determine heart rate and rhythm. Eleven subjects completed the study. There were no clinically important electrocardiogram changes and no positive troponins. Spirometry showed an increase in minute ventilation during the exposure. There was no important change in CK at 24 h. Lactate was slightly higher and pH was slightly lower after the exposure, but similar to the effects of physical exertion. Echocardiography was performed in 6 subjects. In half of these subjects, the rhythm was determined to be "sinus" and in the other half the rhythm was indeterminant. In our study, the civilian device caused a mild lactic acidosis. No other important physiologic effects were found.