The use of TASER devices in UK policing: an update for clinicians following the recent introduction of the TASER 7.

Taser was introduced into UK policing in 2003 to bridge the operational gap between use of incapacitant sprays and firearms. Use of force reporting in the UK indicates that Taser is relatively safe provided that it is used lawfully. Taser use can result in injuries and has been implicated in a small number of deaths. The latest version of the weapon, the TASER 7, has entered UK policing. The TASER 7 uses a novel probe that has implications for the medical community. A review of Taser medical effects and probe removal for TASER 7 are presented.

Injury scoring systems for blast injuries: a narrative review.

Injury scoring systems can be used for triaging, predicting morbidity and mortality, and prognosis in mass casualty incidents. Recent conflicts and civilian incidents have highlighted the unique nature of blast injuries, exposing deficiencies in current scoring systems. Here, we classify and describe deficiencies with current systems used for blast injury. Although current scoring systems highlight survival trends for populations, there are several major limitations. The reliable prediction of mortality on an individual basis is inaccurate. Other limitations include the saturation effect (where scoring systems are unable to discriminate between high injury score individuals), the effect of the overall injury burden, lack of precision in discriminating between mechanisms of injury, and a lack of data underpinning scoring system coefficients. Other factors influence outcomes, including the level of healthcare and the delay between injury and presentation. We recommend that a new score incorporates the severity of injuries with the mechanism of blast injury. This may include refined or additional codes, severity scores, or both, being added to the Abbreviated Injury Scale for high-frequency, blast-specific injuries; weighting for body regions associated with a higher risk for death; and blast-specific trauma coefficients. Finally, the saturation effect (maximum value) should be removed, which would enable the classification of more severe constellations of injury. An early accurate assessment of blast injury may improve management of mass casualty incidents.

Forensic reconstruction of two military combat related shooting incidents using an anatomically correct synthetic skull with a surrogate skin/soft tissue layer.

Six synthetic head models wearing ballistic protective helmets were used to recreate two military combat-related shooting incidents (three per incident, designated 'Incident 1' and 'Incident 2'). Data on the events including engagement distances, weapon and ammunition types was collated by the Defence Science and Technology Laboratory. The models were shot with 7.62 × 39 mm ammunition downloaded to mean impact velocities of 581 m/s (SD 3.5 m/s) and 418 m/s (SD 8 m/s), respectively, to simulate the engagement distances. The damage to the models was assessed using CT imaging and dissection by a forensic pathologist experienced in reviewing military gunshot wounds. The helmets were examined by an MoD engineer experienced in ballistic incident analysis. Damage to the helmets was consistent with that seen in real incidents. Fracture patterns and CT imaging on two of the models for Incident 1 (a frontal impact) were congruent with the actual incident being modelled. The results for Incident 2 (a temporoparietal impact) produced realistic simulations of tangential gunshot injury but were less representative of the scenario being modelled. Other aspects of the wounds produced also exhibited differences. Further work is ongoing to develop the models for greater ballistic injury fidelity.

Modelling the blast environment and relating this to clinical injury: experience from the 7/7 inquest.

This paper addresses the computational modelling of a series of specific blast-related incidents and the relationships of clinical and engineering interpretations. The Royal Centre for Defence Medicine and the Defence Science and Technology Laboratory were tasked in 2010 by the UK Ministry of Defence to assist the Coroner's inquests into the 7 July 2005 London bombings. A three phase approach was taken. The first phase included an engineering expert in blast effects on structures reviewing photographs of the damaged carriages and bus to give a view on the likely physical effects on people close to the explosions. The second phase was a clinical review of the evidence by military clinicians to assess blast injury in the casualties. The third phase was to model the blast environment by structural dynamics experts to assess likely blast loading on victims to evaluate the potential blast loading on individuals. This loading information was then assessed by physiology experts. Once all teams (engineering, clinical and modelling/physiological) had separately arrived at their conclusions, the information streams were integrated to arrive at a consensus. The aim of this paper is to describe the methodology used as a potential model for others to consider if faced with a similar investigation, and to show the benefit of the transition of military knowledge to a civilian environment.

An analysis of officer-reported TASER X2™ probe discharge effectiveness in the United Kingdom.

Conducted energy devices (CEDs) are designed to immobilise aggressive individuals through the application of an electrical discharge administered via probes fired at the subject. Although the discharge is intended to disrupt voluntary movement, CEDs have their limitations and several factors are qualitatively understood to adversely influence CED effectiveness. The introduction of the twin-cartridge TASER X2™ into UK policing in 2017 provided a unique opportunity to undertake a quantitative assessment of the factors modulating probe discharge effectiveness based on data reported by police officers firing the device operationally. The overall operational subdual effectiveness of the TASER X2™ was 68.5%. However, several factors were identified that could alter the likelihood of achieving subdual of the subject. The officer-reported data show that probe discharge was highly effective at subduing subjects when both probes had penetrated the skin, least effective when both probes were in clothing and confirmed the reduced effectiveness of narrow probe spreads. The most commonly cited reasons why probe discharge failed to subdue the subject were thick or loose clothing, probe misses and narrow probe spread. These findings, which are likely to generalise to other types of CED, may be used to inform tactics and training to optimise the likelihood of achieving incapacitation when probes are deployed, with benefits for the safety of both the police and the public. The findings may also assist investigations requiring the reconstruction of incidents in which probe discharge has been deployed.

Computed tomography can improve the selection of fragment simulating projectiles from which to test future body armor materials.

INTRODUCTION: Ballistic protective materials used in body armor are tested with fragment simulating projectiles (FSPs). The type of FSP used has historically been made by choosing fragments representative of those produced by controlled explosions, which may not be representative of those fragments actually injuring soldiers. METHOD: 75 cylindrical FSPs of three different sizes were fired into six euthanized pigs, imaged using computed tomography (CT) and the wound tracks dissected. Skin entry wound locations, as determined by surface-shaded CT, were compared to clinical photographs. FSP dimensions and depth of penetration derived from CT were compared to surgical dissection using a Mann-Whitney U test. RESULTS: Skin entry wound locations derived from CT were identical to that seen clinically. FSP dimensions were consistently 15% to 19% larger than the true measurements, reflecting the magnifying effect associated with metallic artifact. No statistical difference (p = 0.26) was found between depth of penetration measured radiologically compared to dissection when a projectile did not hit bone but there was a statistical difference when bone was hit (p < 0.05). CONCLUSIONS: CT has the potential to accurately ascertain values required to improve the selection of representative FSPs from which future ballistic protective materials are tested.

Mortality and morbidity from combat neck injury.

BACKGROUND: Neck injury represents 11% of battle injuries in UK forces in comparison with 2% to 5% in US forces. The aim of this study was to determine the causes of death and long-term morbidity from combat neck injury in an attempt to recommend new methods of protecting the neck. METHOD: Hospital and postmortem records for all UK servicemen sustaining battle injuries to the neck between January 1, 2006 and December 31, 2010 were analyzed. RESULTS: Neck wounds were found in 152 of 1,528 (10%) of battle injured service personnel. Seventy-nine percent of neck wounds were caused by explosions and were associated with a mortality rate of 41% compared with 78% from gunshot wounds (GSWs). Although current UK OSPREY neck collars can potentially protect zone I from explosive fragments, in the 58% in which the wearing of a neck collar was known, all service personnel chose not to wear the collar. The most common cause of death from explosive fragments was vascular injury (85%). Zone II was the most commonly affected area overall by explosive fragments and had the highest mortality but zone I was associated with the highest morbidity in survivors. CONCLUSIONS: Nape protectors, that cover zone III of the neck posteriorly, would only have potentially prevented 3% of injuries and therefore this study does not support their use. Current UK OSPREY neck collars potentially protect against the majority of explosive fragments to zones I and II and had these collars been worn potentially 16 deaths may have been prevented. Reasons for their lack of uptake by UK servicemen is therefore being evaluated. Surface wound mapping of penetrating explosive fragments in our series has been used to validate the area of coverage required for future designs of neck protection.