Medical implications of Conducted Energy Devices in law enforcement.

This study examines the medical implications of Conducted Energy Devices (CEDs) in law enforcement, of which TASER® is the brand most recognised. In order to develop understanding of TASER® use, this study undertook both a literature review and original research using data provided by a number of UK police forces. The comprehensive review of literature identified a range of injures, including both primary and secondary complications. Research was conducted into TASER® use in the United Kingdom using a number of data sets, including a retrospective study of some 60,000 uses of force. This data shows TASER® was only discharged on 18% of occasions it was drawn from the holster. The injuries sustained by both subjects and Police Officers associated with TASER® use were compared and it was found that fewer injuries, as a proportion of use, were associated with TASER® than use of Police Dogs, baton, irritant spray or physical confrontation. The data examined 948 discharges of TASER® and recorded 159 attendances at the Emergency Department as a result. Only three hospital admissions were identified. The paper concludes that the use of CEDs as a police use-of-force may be associated with injury; the overwhelming majority of such are classified as minor. Death or the more severe injuries described in the medical literature are rare and any deaths occurring within temporal proximity to the use of a CED should be investigated thoroughly and the presentation of the individual carefully recorded. The collection of post-incident data provides evidence to the relative operational safety of the TASER® by the UK Police; it is accepted by the police that no use-of-force option is risk free, however data provided showed a greater incidence of injury to both the officers and subjects, as a proportion of use, when baton, irritant spray or physical confrontation was used.

Eye injuries from electrical weapon probes: Incidents, prevalence, and legal implications.

PURPOSE: While generally reducing morbidity and mortality, electrical weapons have risks associated with their usage, including burn injuries and trauma associated with uncontrolled fall impacts. However, the prevalence of significant eye injury has not been investigated. METHODS: We searched for incidents of penetrating eye injury from TASER® conducted electrical weapon (CEW) probes via open source media, litigation filings, and a survey of CEW law-enforcement master instructors. RESULTS: We report 20 previously-unpublished cases of penetrating eye injury from electrical weapon probes in law-enforcement field uses. Together with the 8 previously published cases, there are a total of 28 cases out of 3.44 million field uses, giving a demonstrated CEW field-use risk of penetrating eye injury of approximately 1:123 000. Confidence limits [85 000, 178 000] by Wilson score interval. There have been 18 cases of total unilateral blindness or enucleation. We also present legal decisions on this topic. CONCLUSIONS: The use of electrical weapons presents a rare but real risk of total or partial unilateral blindness from electrical weapon probes. Catastrophic eye injuries appear to be the dominant non-fatal complication of electronic control.

Acute inferior myocardial infarction after electrical weapon exposure: case report and review of the literature.

The use of conducted electrical weapons (CEWs) by legal security forces and in civil society is rapidly increasing. While they are generally considered safe devices, and fatal complications are rare, it is possible to see a small number of complications. In the present case, we describe the detection of acute inferior myocardial infarction in a patient who experienced chest pain after being exposed to a CEW. In such cases, multiple factors should be considered, and the choice of treatment and follow-up should be decided accordingly.

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

Arrest-related deaths proximate to the use of a conducted electrical weapon (CEW) continue to generate controversy despite a better understanding of the multi-factorial nature of many of these deaths. With the rapid adoption of this technology by law enforcement, and the proliferation of companies entering the marketplace, it is important to have a method to assess the relative safety of these weapons. We had previously developed a model to assess the relative cardiac safety of CEWs. In this study, we use this model to compare the TASER X2 and the Karbon Arms MPID. Our results suggest that the TASER X2 may have an improved cardiac safety margin over the Karbon Arms MPID as determined by a smaller area of cardiac pacing on the anterior chest in our model. This model seems to offer a reproducible means of comparing the cardiac effects of CEWs.

[Medical aspects of common non-lethal weapons]. / Medizinische Aspekte gängiger nicht-letaler Wirkmittel.

The development and provision of non-lethal weapons (NLW) allow military and law enforcement personnel to exploit gradual engagement in countering potentially hazardous threats. Chemical, kinetic and electrical weapons systems are used to curb violence in civilian crowds. With inappropriate usage, these technologies can cause potentially fatal injuries that are not only of clinical, but also of legal relevance. In this context, the practicing physician is faced with treatment as well as assessment issues of new forms of injuries. In order to assure medical care and to be able to draw competent expert's conclusions, a detailed knowledge of the medical effects of these NLW is necessary. The review at hand presents today's most popular NLW and gives an overview of their possible injury potential and required treatments.

Blood lactate concentration after exposure to conducted energy weapons (including TASER® devices): is it clinically relevant?

In previous studies, blood lactate concentration (BLac) consistently increased in anesthetized animals and in human subjects after exposures to TASER(®) conducted energy weapons (CEWs). Some have suggested the increased BLac would have detrimental consequences. In the current review, the following are evaluated: (a) the nature of muscle contractions due to CEWs, (b) general aspects of increased BLac, (c) previous studies of conventional neuromuscular electrical stimulation and CEW exposures, and (d) BLac in disease states. On the basis of these analyses, one can conclude that BLac, per se (independent of acidemia), would not be clinically relevant immediately after short-duration CEW applications, due to the short time course of any increase.

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.

Effects of a TASER® conducted energy weapon on the circulating red-blood-cell population and other factors in Sus scrofa.

In previous studies hematocrit has been consistently increased in an anesthetized animal model after exposures to TASER(®) conducted energy weapons (CEWs). In the present study we analyzed changes in blood cell counts and red blood cell membrane proteins following two 30-s applications of a TASER C2 device (which is designed for civilian use). Hematocrit increased significantly from 33.2 ± 2.4 (mean ± SD) to 42.8 ± 4.6 % immediately after CEW exposure of eleven pigs (Sus scrofa). Red blood cell count increased significantly from 6.10 ± 0.55 × 10(12)/L to 7.45 ± 0.94 × 10(12)/L, and mean corpuscular volume increased significantly from 54.5 ± 2.4 fl to 57.8 ± 2.6 fl. Mean corpuscular hemoglobin concentration decreased significantly from 20.5 ± 0.7 to 18.5 ± 0.6 mM. Thirty protein spots (from two-dimensional sodium dodecyl sulfate polyacrylamide gel electrophoresis, selected for detailed comparison) exhibited greater densities 30-min post-exposure compared with pre-exposure values. A greater number of echinocytes were observed following CEW exposure. On the basis of these results it appears that, during the strong muscle contractions produced by TASER CEWs, a specific population of red blood cells (RBCs) may be released from the spleen or other reservoirs within the body. The total time of CEW exposure in the present study was relatively long compared with exposures in common law-enforcement scenarios. Despite statistically significant changes in red blood cell counts (and other measures directly related to RBCs), the alterations were short-lived. The transient nature of the changes would be likely to counteract any potentially detrimental effects.

[Analysis of death cases involved in TASER in the State of Maryland].

OBJECTIVE: To evaluate the features of autopsy cases involved in electronic weapon (TASER) in the State of Maryland, and to discuss the appraisable points. METHODS: Thirteen autopsy cases involving TASER were collected from 2004 to 2011 in the Office of the Chief Medical Examiner, State of Maryland. All the cases include detailed scene investigations, complete autopsy, toxicological analysis and histopathological examination. Statistical analysis were conducted including general information of victim, type of TASER, type of contact, toxicological results, manner and cause of death. RESULTS: Majority of victims were male with an acute onset of agitated and delusional behavior. Drugs were often involved. Deaths were attributed to multiple factors. CONCLUSION: Most of cases involved in TASER resulted from multiple fatal factors. Further researches are needed for the principal mechanism. Thorough scene investigation and complete autopsy examination play crucial role in evaluation of such cases.

Analysis of death cases involved in TASER in the State of Maryland / 法医学杂志

OBJECTIVE@#To evaluate the features of autopsy cases involved in electronic weapon (TASER) in the State of Maryland, and to discuss the appraisable points.@*METHODS@#Thirteen autopsy cases involving TASER were collected from 2004 to 2011 in the Office of the Chief Medical Examiner, State of Maryland. All the cases include detailed scene investigations, complete autopsy, toxicological analysis and histopathological examination. Statistical analysis were conducted including general information of victim, type of TASER, type of contact, toxicological results, manner and cause of death.@*RESULTS@#Majority of victims were male with an acute onset of agitated and delusional behavior. Drugs were often involved. Deaths were attributed to multiple factors.@*CONCLUSION@#Most of cases involved in TASER resulted from multiple fatal factors. Further researches are needed for the principal mechanism. Thorough scene investigation and complete autopsy examination play crucial role in evaluation of such cases.

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.