15-Second conducted electrical weapon exposure does not cause core temperature elevation in non-environmentally stressed resting adults

Non-lethal weapon: Injury patterns and imaging correlates for firearm alternatives

Law enforcement officers have adopted the use of non-lethal weapons to mitigate civilian casualties incurred by firearm use over recent years and decades. These weapons include, but are not limited to, TASER, beanbag rifles, pepper spray, tear gas, and Flash-ball guns. Nonetheless, severe injuries and even deaths do occur with use of these weapons, in rare instances. This review aims to comprehensively discuss these cases and associated injuries, as well as their according findings on imaging studies. It will also examine how often injuries occur in situations with non-lethal weapons.

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 excited delirium: shocks, stress, and serum serotonin

It has been suggested that a CEW (conducted electrical weapon) exposure could elicit a stress response that could cause ExDS (excited delirium syndrome). There are some parallels between the signs of ExDS and serotonin syndrome (SS). Electroconvulsive therapy raises serotonin levels and therefore provides a plausible link between CEW applications and elevated serotonin levels. This study was designed to determine whether a CEW exposure elevates serum serotonin. A total of 31 police academy cadets were exposed to a very broad-spread 5-s CEW stimulus from a TASER brand X26 CEW. Blood was drawn before and after the exposure and at 24 h post exposure to measure serum serotonin levels. Lactic acid and cortisol levels were also compared. Median serum serotonin levels were 30 IQR (21,46), 36 IQR (22,50), and 32 IQR (21,45) ng/mL before exposure, after exposure, and 24 h after exposure (NS by pooled comparisons). The increase from baseline to post-test serotonin (∆ median = +6, ∆ mean = +2.7) ng/mL was not significant by a paired T-test (p = .29) but was significant by the Wilcoxon signed-rank test (p = .037). The increase to post-test log serotonin was not significant by a paired T-test (p = .13) but was significant by the Wilcoxon test (p = .049). All serotonin levels remained within the normal reference range of 0-200 ng/mL. Post-hoc analysis demonstrated that the study was powered to detect a ½ SD change, in log serotonin, with a 90% likelihood. With a very-broad electrode spread, CEW exposure did not significantly raise serum serotonin levels.

[The topical problems of the application of the TASER electroshock devices]

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.

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.

Sudden cardiac arrest and death following application of shocks from a TASER electronic control device

BACKGROUND

The safety of electronic control devices (ECDs) has been questioned. The goal of this study was to analyze in detail cases of loss of consciousness associated with ECD deployment.

METHODS AND RESULTS

Eight cases of TASER X26 ECD-induced loss of consciousness were studied. In each instance, when available, police, medical, and emergency response records, ECD dataport interrogation, automated external defibrillator information, ECG strips, depositions, and autopsy results were analyzed. First recorded rhythms were ventricular tachycardia/fibrillation in 6 cases and asystole (after ≈ 30 minutes of nonresponsiveness) in 1 case. An external defibrillator reported a shockable rhythm in 1 case, but no recording was made. This report offers evidence detailing the mechanism by which an ECD can produce transthoracic stimulation resulting in cardiac electrical capture and ventricular arrhythmias leading to cardiac arrest.

CONCLUSIONS

ECD stimulation can cause cardiac electrical capture and provoke cardiac arrest resulting from ventricular tachycardia/ventricular fibrillation. After prolonged ventricular tachycardia/ventricular fibrillation without resuscitation, asystole develops.

Funding source and author affiliation in TASER research are strongly associated with a conclusion of device safety

BACKGROUND

Controversy exists regarding the safety of electrical stun guns (TASERs). Much of the research on TASERs is funded by the maker of the device and, therefore, could be biased. We sought to determine if funding source or author affiliation is associated with TASER research conclusions.

METHODS

MEDLINE was searched for TASER or electrical stun gun to identify relevant studies. All human and animal studies published up to September 01, 2010, were included. Reviews, editorials, letters, and case reports were excluded from the analysis. Two independent reviewers blinded to this study hypothesis evaluated each article with regard to conclusions of TASER safety.

RESULTS

Fifty studies were reviewed: 32 (64%) were human studies and 18 (36%) were animal studies. Twenty-three (46%) studies were funded by TASER International or written by an author affiliated with the company. Of these, 22 (96%) concluded that TASERs are unlikely harmful (26%) or not harmful (70%). In contrast, of the 22 studies not affiliated with TASER, 15 (55%) concluded that TASERs are unlikely harmful (29%) or not harmful (26%). A study with any affiliation with TASER International had nearly 18 times higher odds to conclude that the TASER is likely safe as compared with studies without such affiliation (odds ratio 17.6, 95% CI 2.1-150.1, P = .001).

CONCLUSIONS

Studies funded by TASER and/or written by an author affiliated with the company are substantially more likely to conclude that TASERs are safe. Research supported by TASER International may thus be significantly biased in favor of TASER safety.

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 an emergency department (ED) for medical clearance.

STUDY OBJECTIVES

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 2010 was performed and limited to human studies published from January 1988 to January 20, 2010 for English language articles 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

There were 140 articles on CEWs screened, and 20 appropriate articles were rigorously reviewed and recommendations given. 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, electrocardiograms, or prolonged ED observation or hospitalization for ongoing cardiac monitoring after CEW exposure in an otherwise asymptomatic awake and alert patient.

Cardiovascular evaluation of electronic control device exposure in law enforcement trainees: a multisite study

OBJECTIVE

Occupational health risk with regard to training exercises is a relatively under studied domain for law enforcement officers. One potential health risk is exposure to electronic control devices (ECDs).

METHODS

Seven different training facilities in six states participated. Law enforcement trainees (N = 118) were exposed to Taser International's (Scottsdale, AZ) X26 for up to 5 seconds.

RESULTS

There was no evidence of cardiac or skeletal muscle breakdown. Exposure did not adversely affect electrocardiogram (ECG) morphology obtained 24 hours after exposure in 99 trainees. For two trainees with preexisting ECG abnormalities, ECG morphology differed in the post-ECD samples.

CONCLUSIONS

The results from this large, multisite study suggest that, for most trainees, ECD exposure does not represent a significant health risk. Further investigation is warranted for cardiac vulnerability and potential interactions with ECD exposure.

Review article: Emergency Department implications of the TASER

The TASER is a conducted electricity device currently being introduced to the Australian and New Zealand police forces as an alternative to firearms in dealing with violent and dangerous individuals. It incapacitates the subject by delivering rapid pulses of electricity causing involuntary muscle contraction and pain. The use of this device might lead to cardiovascular, respiratory, biochemical, obstetric, ocular and traumatic sequelae. This article will summarize the current literature and propose assessment and management recommendations to guide emergency physicians who will be required to review these patients.

The Application and Use of TASERs by a Midwestern Police Agency

Of the some 18,000 law enforcement agencies in the United States, TASERs have been adopted by approximately 7,000 departments. Following on the call of White and Ready (2007) for more research on TASER use by police, this paper investigates the use of TASERs by a medium sized, Midwestern police agency. All TASER deployments by police officers in this Midwestern city are examined for a three-and-a-half-year time period (January 2004–August 2007). Findings indicate that the TASER was used primarily against physically resistant white male suspects with a history of police contact. The majority of the incidents took place at a private residence or apartment as opposed to a public place of business. The TASER was overwhelmingly effective and, as for officer safety, on the few occasions that an officer was injured, the injury was not related to the TASER.

The effect of less-lethal weapons on injuries in police use-of-force events

OBJECTIVES

We investigated the effect of the use of less-lethal weapons, conductive energy devices (CEDs), and oleoresin capsicum (OC) spray on the prevalence and incidence of injuries to police officers and civilians in encounters involving the use of force.

METHODS

We analyzed data from 12 police departments that documented injuries to officers and civilians in 24,380 cases. We examined monthly injury rates for 2 police departments before and after their adoption of CEDs.

RESULTS

Odds of injury to civilians and officers were significantly lower when police used CED weapons, after control for differences in case attributes and departmental policies restricting use of these weapons. Monthly incidence of injury in 2 police departments declined significantly, by 25% to 62%, after adoption of CED devices.

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.

Physiologic effects of the TASER after exercise

OBJECTIVES

Incidents of sudden death following TASER exposure are poorly studied, and substantive links between TASER exposure and sudden death are minimal. The authors studied the effects of a single TASER exposure on markers of physiologic stress in humans.

METHODS

This prospective, controlled study evaluated the effects of a TASER exposure on healthy police volunteers after vigorous exercise, compared to a subsequent, identical exercise session that was not followed by TASER exposure. Subjects exercised to 85% of predicted heart rate (HR) on an ergometer and then were given a standard 5-second TASER activation. Measures before and for 60 minutes after the TASER activation included minute ventilation, tidal volume, respiratory rate, end-tidal pCO(2), oxygen saturation, HR, blood pressure (systolic BP/diastolic BP), 12-lead electrocardiogram, and arterialized blood for pH, pO(2), pCO(2), and lactate. Each subject repeated the exercise and data collection session on a subsequent data, without TASER activation. Data were analyzed using paired Student's t-tests with differences and 95% confidence intervals (CIs). Statistical significance was adjusted for multiple comparisons.

RESULTS

A total of 25 officers (21 men and 4 women) completed both portions of the study. After adjusting for multiple comparisons, the TASER group was significantly higher for systolic BP at baseline (difference of 14.1, 95% CI = 8.7 to 19.5, p < 0.001) and HR at 5, 30, and 60 minutes with the largest difference at 30 minutes (difference of 7.0, 95% CI = 2.5 to 11.5, p = 0.004). There were no other significant differences between the two groups in any other measure at any time.

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.

Physiology and pathology of TASER electronic control devices

TASER ECDs (electronic control device) are small, battery powered, handheld devices. They deliver short duration, low energy pulses to stimulate motor neurons, causing transient paralysis. While the experience is painful, proper use of the device is rarely associated with significant side effects in spite of 1070 human worldwide exposures daily. In fact, there have been more than 780,000 training exposures and 630,000 field uses (total of over 1.4 million human uses) without any credible evidence of a resulting cardiac arrhythmia. In this article we describe the mechanisms by which the device operates, and review possible morbidities.

Human research review of the TASER electronic control device

TASER Electronic Control Devices have become mainstream methods of applying electricity to control unruly suspects. There has been speculation that they may be associated with worsening human physiology or death. The lay impressions that these devices are unsafe are not founded on known human research findings. This presentation briefly reviews the most pertinent human research on this subject.