[Morphological features of skin injuries caused by conducted energy weapons (CEWs)]. / Morfologicheskie osobennosti povrezhdenii kozhi, prichinennykh vystrelami iz distantsionnykh elektroshokovykh ustroistv.

The objective of the study is to identify, compare and analyze morphological features of skin injuries resulting from the experimental firing of various models of conducted energy weapons (CEWs) In the experimental study, the design features of the provided CEWs models and characteristics of skin injuries were studied using a simulator, a pig carcass, shot without a barrier point-blank, and at the distance of 0.5 cm, 5 cm, 50 cm, and 4.5 m. The results of expert and experimental studies showed differences in morphological features of skin lesions from two different CEW models with different designs. To make an objective expert conclusion on the kind of CEW used to damage the skin, distance, and angle to the target, it is necessary to perform appropriate experiments with at least two different models of these devices.

Assessing and managing people exposed to conducted energy device (Taser) discharge.

The use of conducted energy devices - better known under the brand name Taser - by police officers is subject to scrutiny. Consequently, the clinical assessment and management of people who have been exposed to Taser discharge is also subject to scrutiny. In 2021 the Conducted Energy Device Joint Working Group published a new guideline on assessment in police custody after Taser discharge. The guideline enables any appropriately trained and competent healthcare professional, including nurses, to undertake post-Taser assessments and determine the person's fitness to be detained in police custody. This would be done in the first instance by nurses working in police custody suites, but emergency department (ED) nurses may also be involved, as people who have been 'tasered' may need referral to the ED. This article explains how Tasers work, their physiological effects and potential complications, and the required approaches to clinical assessment and management as outlined in the new guideline.

Police shootings after electrical weapon seizure: homicide or suicide-by-cop.

PURPOSE: Risks of handheld electrical weapons include head impact trauma associated with uncontrolled falls, ocular probe penetration injuries, thermal injuries from the ignition of volatile fumes, and weapon confusion police-involved shooting. There is also an uncommon but critical risk of a shooting after a subject gained control of an officer's electrical weapons. METHODS: The authors searched for police shooting incidents involving loss of control of TASER® weapons via open-source media reports, crowd-sourced internet sites, litigation filings, and a survey of Axon law-enforcement master instructors. RESULTS: The authors report 131 incidents of subjects attempting to or gaining control of an officer's electrical weapon from 2004 to 2020, 53 of which resulting in a shooting. These incidents demonstrated a risk of 11.8 shootings per million electrical weapon discharges (95% confidence limits of 9.0 to 15.1 per million by Wilson score interval). CONCLUSIONS: The use of electrical weapons presents a rare but real risk of injury and death from a shooting following a subject's attempts to gain control of the weapon.

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.

Las pistolas Taser®. Algunas consideraciones médico-legales / The TASER® guns. Some medical-legal considerations

Las pistolas TASER® fueron introducidos en nuestra sociedad de forma progresiva, con confusión e ignorancia sobre el uso particular de los mismos para intentar inmovilizar o reducir un sujeto en diferentes lugares y circunstancias; Por tanto, han generado un amplio debate social debido a las polémicas de su uso por parte de las fuerzas de seguridad. En este trabajo se describe una actualización de los mecanismos de acción, una descripción detallada de la lesiología que se presenta y los efectos no deseados que pueden derivarse de su uso en diferentes partes del cuerpo, en virtud de las discusiones sobre su inocuidad en la Salud

Taser® guns were introduced in our society progressively, with confusion and ignorance about the particular use of them to try to immobilize or reduce a subject in different places and circumstances. Therefore, they have generated a wide social debate due to the controversies of their use by the security forces. In this work, an update on the mechanisms of action is described, a detailed description of the lesiology that occurs and the unwanted effects that may derive from its use in different parts of the body, by virtue of the discussions about its harmlessness in the Health

Human Health Risks of Conducted Electrical Weapon Exposure: A Systematic Review.

Importance: Conducted electrical weapons (CEWs) are used broadly as a less-lethal force option for police officers. However, there is no clear picture of the possible health risks in humans on the basis of rigorously assessed scientific evidence from the international peer-reviewed literature. Objective: To synthesize and systematically evaluate the strength of published evidence for an association between exposure to different models of CEWs and adverse acute as well as chronic conditions. Evidence Review: Following a preregistered review protocol, the literature search strategy was based on a search of reviews published between January 1, 2000, and April 24, 2020, of PubMed, MEDLINE, EMBASE, Web of Science, PsycINFO, and Cochrane Library, as well as relevant online databases and bibliographic sources, such as reference sections of recent publications. The identified studies were independently assessed in terms of scope, relevance, methodologic bias, and quality. Peer-reviewed publications of human studies were included, using original data and with a focus on the use of taser CEWs in the context of law enforcement. Eligible studies examined clearly defined health outcomes as dependent variables following exposure to a CEW. The review followed the relevant sections of the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline. A meta-analysis could not be conducted. Findings: Of the 1081 unique records screened, 33 relevant studies were identified, all of them of experimental design and conducted in the US. Eleven studies had a low risk of bias and 22 had a higher bias risk. Studies focused on outcomes such as physiologic stress responses, heart rate, blood pressure, arrhythmias, or cognitive performance. Independently of bias risk, the studies reported few or no acute health problems, apart from the wounds caused by the darts. Furthermore, no long-term outcomes were studied. Most of the studies were performed on healthy, physically fit individuals (eg, police officers) in a controlled setting, with short exposure duration (5 seconds). Half of the studies, mainly those with a higher risk of bias, were at least partly funded by the manufacturer. Conclusions and Relevance: Based on the findings of the reviewed studies, the risk for adverse health outcomes due to CEW exposure can be currently estimated as low. However, most of the reviewed studies had methodologic limitations. Considering that recruited participants were not representative of the population that usually encounters a CEW deployment, it is not possible to draw conclusions regarding exposure outcomes in potentially vulnerable populations or high-risk groups, such as those under the influence of substances.

Electrical weapons and rhabdomyolysis.

It has been suggested that an application of a conducted electrical weapon (CEW) might cause muscle injury such as rhabdomyolysis and an acute inflammatory response. We explored this hypothesis by testing the effects of electrical weapons on circulating markers of inflammation and muscle damage. In a prospective study, 29 volunteers received a full-trunk 5-s TASER® X26(E) CEW exposure. Venous blood samples were taken before, 5 min after, and at 24 h following the discharge. We tested for changes in serum levels of C-reactive protein (CRP), alkaline phosphatase (ALP), myoglobin, albumin, globulin, albumin/globulin ratio, aspartate and alanine aminotransferase, creatine kinase, total protein, bilirubin, and lactic acid dehydrogenase. Uncorrected CRP and myoglobin levels were lower in the immediate post exposure period (CRP levels 1.44 ± 1.39 v 1.43 ± 1.32 mg/L; p = 0.046 and myoglobin 36.8 ± 11.9 v 36.1 ± 13.9 µg/L; p = 0.0019) but these changes were not significant after correction for multiple comparisons. There were no changes in other biomarkers. At 24 h, CRP levels had decreased by 30% to 1.01 ± 0.80 mg/L (p = 0.001 from baseline). ALP was unchanged immediately after the CEW application but was reduced by 5% from baseline (66.2 ± 16.1 to 62.7 ± 16.1 IU/L; p = 0.0003) at 24 h. No other biomarkers were different from baseline at 24 h. A full-trunk electrical weapon exposure did not lead to clinically significant changes in the acute phase protein levels or changes in measures of muscle cellular injury. We found no biomarker evidence of rhabdomyolysis.

A comparison of three conducted electrical weapons in a surrogate swine cardiac safety model.

We used a previously described methodology in a swine model to compare the relative cardiac safety of the Axon T7 Conducted Electrical Weapon (CEW), released in October of 2018, to two prior generations of Axon CEWs to include the X2 and the X26E. A total of 5 swine (252 total CEW exposures) were tested by alternating the three weapons at each chest exposure location. Our testing, using systemic hypotension as the quantitative surrogate for cardiac capture, demonstrated that the T7 and X2 were not statistically different. Both were superior, in terms of reduced hypotension during exposure, to the X26E. This study is important as it demonstrates that the newly released weapon is non-inferior to the X2 and superior to the X26E using this surrogate safety model. It is also important because it is the first study to examine the cardiac effects of simultaneous multi-bay exposures. Our prior study compared the X2 to the X26E but examined only single bay exposures from the X2. Lastly, we feel we have improved the methodology for studying the comparative cardiac effects of CEWs.

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.

Electrical weapons, hematocytes, and ischemic cardiovascular accidents.

BACKGROUND: There have been case reports following the use of a conducted electrical weapon (CEW) suggesting that these devices might affect coagulation or thrombosis in at-risk individuals. The aim of this manuscript therefore is firstly to explore this hypothesis by reviewing each of these cases and secondly to report the results of a prospective study exploring a priori the effects of electrical weapons on hematocytes in a group of human volunteers. METHODS: First, we systematically reviewed all cases of adverse outcomes following CEW discharge that could be due to an effect on coagulation or thrombosis, with particular focus on the clinical scenario and its relationship with the weapon discharge. Second, we assessed hematocyte levels in venous blood from 29 volunteers before, 5 min after, and 24 h after receiving a full-trunk 5-s TASER® X26(E) CEW exposure. RESULTS: Following extensive review of the literature, we found 3 relevant case reports of possible vascular thromboembolic clinical events after CEW exposure, specifically a case of ischemic stroke, and 2 cases of ST-segment elevation myocardial infarctions. Review of these published cases failed to establish a plausible linkage to the CEW beyond a temporal association with significant emotional and physiological stress from a violent struggle. Our prospective study of biomarker change following CEW discharge revealed acutely increased values for WBC (white blood cells), specifically lymphocytes and monocytes, and a raised platelet count. Neutrophil levels decreased as a percentage of WBC. While these changes were statistically significant at 5 min, all results remained within established reference ranges. At 24 h, all values had returned to baseline except total WBC which decreased to slightly below baseline but was still within the normal reference range. CONCLUSIONS: A review of clinical cases, of ischemic or thrombotic events revealed no direct association with the CEW discharge. A full-trunk electrical weapon exposure did not lead to hematocyte changes beyond normal clinically expected variations in similar acute response scenarios. The case report and biomarker data do not support the hypothesis that a CEW discharge is associated with changes likely to promote coagulation or thrombus formation.

[Tasered: medical consequences of the use of electric stun guns]. / Getaserd.

The Electronic Control Device (ECD) will be used by the primary police force in the Netherlands. Hence medical personnel will be confronted with persons that have received ECD shocks more often. In light of these developments, it is important that care providers are aware of potential medical consequences resulting from the use of electric stun guns. The darts usually result in minor injury with small penetration wounds requiring minimal treatment. However, in vulnerable areas, such as the eyes, the darts can cause serious injury and specialist care is indicated. The electric shock causes muscle contractions, potentially resulting in traumatic falls, or fractures. Cardiac problems occur only in exceptional cases; risk factors include long duration of the power surge, short distance from the darts to the heart and underlying heart problems. In rare cases a pneumothorax may occur. Finally, often there are underlying medical problems requiring appropriate treatment such as drug intoxication, excited delirium or psychiatric disorders. Systematic recording of the medical problems caused by anECD is indicated.

Prolonged Electro-muscular Incapacitation in a Porcine Model Causes Spinal Injury.

Conducted electrical weapons are designed to cause temporary electro-muscular incapacitation (EMI) without significant injury. The objective of this study was to assess the risk and cause of spinal injury due to exposure to a benchtop EMI device. Porcine subjects were exposed to 19 and 40 Hz electrical stimuli for a prolonged duration of 30 sec. X-ray imaging, necropsy, and accelerometry found that lumbosacral spinal fractures occurred in at least 89% of all subjects, regardless of the stimulus group, and were likely caused by musculoskeletal fatigue-related stress in the lumbosacral spine. Spinal fractures occurred in the porcine model at an unusually high rate compared to human. This may be due to both the prolonged duration of electrical stimulation and significant musculoskeletal differences between humans and pigs, which suggests that the porcine model is not a good model of EMI-induced spinal fracture in humans.

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.

Penetration Depths of Conducted Electrical Weapon Probes Into Human Skull Phantoms.

Occasional case reports have described isolated cases of conducted electrical weapon (CEW) probes piercing the human skull. In an experimental setting, we examined whether these cases were just unfortunate incidents, how deeply such probes can pierce the skull, and whether firing distance and CEW probe type play a role in the skull-piercing capability.We fired 5 different CEW cartridges (XP 10.6 m, XP 7.6 m, smart 10.6 m, smart 7.6 m, and smart probe 7.6 m) from 4 different distances (0.5, 1, 2, and 4 m) at head phantoms made of either 5- or 7-mm-thick polyurethane spheres covered with a thin layer of gelatine and buckskin. The piercing depths were recorded by computed tomographic scanning.All tested cartridges managed to pierce the head phantoms. Piercing depths of up to 6.6 mm in the 5-mm heads and depths of almost 5 mm in the 7-mm heads were recorded. Deepest piercing depths were attained with firing distances of 2 m or less.Our results showed that all tested CEW probes are capable of piercing the skull and that shorter firing distances tend to lead to deeper piercing depths.

A comparative brief on conducted electrical weapon safety.

The variety and high number of published research articles on conducted electrical weapons (CEW) provides a detailed, yet in some parts inconclusive overview of medical aspects of CEW. Due to different research approaches and the use of dissimilar test subjects, an assessment of possible health risks of CEW is limited. The present work provides a brief on CEW safety based on currently available animal, computer and human research data. Using the medical database PubMed, articles published on this topic are critically evaluated and compared with each other. Special focuses are the differences and similarities of human and animal research as well as computer simulation programs. The authors explain why some studies are more reliable than others and give their expert opinion on the safety of CEW. The body of data that have been reviewed provides reasonable support for the safety of CEW.

Eye injury from electrical weapon probes: Mechanisms and treatment.

PURPOSE: While generally reducing morbidity and mortality, TASER® electrical weapons have risks associated with their usage, including burn injuries and head and cervical trauma associated with uncontrolled falls. The primary non-fatal complications appear to be significant eye injury but no analysis of the mechanisms or suggested treatments has been published. METHODS: We used a biomechanical model to predict the risk of eye injury as a function of distance from the weapon muzzle to the eye. We compared our model results to recently published epidemiological findings. We also describe the typical presentation and suggest treatment options. RESULTS: The globe rupture model predicted that a globe rupture can be expected (50% risk) when the eye is within 6 m of the muzzle and decreases rapidly beyond that. This critical distance is 9 m for lens and retinal damage which is approximately the range of the most common probe cartridges. Beyond 9 m, hyphema is expected along with a perforation by the dart portion of the probe. Our prediction of globe rupture out to 6 m (out of a typical range of 9 m) is consistent with the published risk of enucleation or unilateral blindness being 69 ±â€¯18%, with an eye penetration. CONCLUSIONS: Significant eye injury is expected from a penetration by an electrical weapon probe at close range. The risk decreases rapidly at extended distances from the muzzle. Not all penetrating globe injuries from electrical weapon probes will result in blindness.

Electrical Weapon Charge Delivery With Arcing.

INTRODUCTION: Human electronic control with the Conducted Electrical Weapon (CEW) has gained widespread acceptance as the preferred law enforcement force option technology due to its dramatic injury and fatal shooting reduction. However, with bulky or baggy clothing, a CEW probe may fail to make direct skin contact and thus arcing is critical to complete the circuit. The goal of the study was to evaluate the ability of modern CEWs to deliver their pulse charges across typical required arcing distances. METHODS: Popular TASER® CEW models X26E (openloop output), and the X2 and X26P (with closed-loop outputs) were activated using a cartridge connected to a custom polymer air-gap fixture. For each model 5 units were tested. The raw and normalized charge delivery were evaluated according to ANSI-CPLSO-17. RESULTS: All 5 units of each model satisfied ANSICPLSO-17 even at maximum arcing length. The X26P CEW had the greatest arcing gap capability. CONCLUSIONS: The stabilized closed-loop charge output feedback of modern electrical weapons (X2 and X26P CEWs) provides a significantly improved output consistency under arcing conditions. With arc lengths of 10-20 mm per probe, the X2 CEW normalized output charge exceeds that of some units of the older higher output X26E CEW model.