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Baliatsas C, Gerbecks J, Dückers MLA, Yzermans CJ. Human Health Risks of Conducted Electrical Weapon Exposure: A Systematic Review. JAMA Netw Open 2021; 4:e2037209. [PMID: 33576818 PMCID: PMC7881359 DOI: 10.1001/jamanetworkopen.2020.37209] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
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.
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Affiliation(s)
- Christos Baliatsas
- Netherlands Institute for Health Services Research (Nivel), Utrecht, the Netherlands
| | - Jenny Gerbecks
- Netherlands Institute for Health Services Research (Nivel), Utrecht, the Netherlands
| | - Michel L. A. Dückers
- Netherlands Institute for Health Services Research (Nivel), Utrecht, the Netherlands
- ARQ National Psychotrauma Centre, Diemen, the Netherlands
- University of Groningen, Groningen, the Netherlands
| | - C. Joris Yzermans
- Netherlands Institute for Health Services Research (Nivel), Utrecht, the Netherlands
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Dawes DM, Ho JD, Halperin HR, Fink SJ, Driver BE, Klein LR. A comparison of three conducted electrical weapons in a surrogate swine cardiac safety model. J Forensic Leg Med 2020; 77:102088. [PMID: 33242742 DOI: 10.1016/j.jflm.2020.102088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/29/2020] [Accepted: 11/01/2020] [Indexed: 10/23/2022]
Abstract
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.
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Affiliation(s)
| | - Jeffrey D Ho
- Hennepin County Medical Center, Minneapolis, MN, United States.
| | | | - Sarah J Fink
- Johns Hopkins University, Baltimore, MD, United States
| | - Brian E Driver
- Hennepin County Medical Center, Minneapolis, MN, United States
| | - Lauren R Klein
- Hennepin County Medical Center, Minneapolis, MN, United States
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Emergency Department Evaluation After Conducted Energy Weapon Use: Review of the Literature for the Clinician. J Emerg Med 2019; 57:740-746. [DOI: 10.1016/j.jemermed.2019.06.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 06/22/2019] [Indexed: 01/08/2023]
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4
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A comparative brief on conducted electrical weapon safety. Wien Med Wochenschr 2018; 169:185-192. [DOI: 10.1007/s10354-018-0616-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 01/05/2018] [Indexed: 10/18/2022]
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Kunz SN, Calkins HG, Adamec J, Kroll MW. Adrenergic and metabolic effects of electrical weapons: review and meta-analysis of human data. Int J Legal Med 2018; 132:1469-1475. [DOI: 10.1007/s00414-018-1771-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 01/08/2018] [Indexed: 10/18/2022]
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Intracardiac electrocardiographic assessment of precordial TASER shocks in human subjects: A pilot study. J Forensic Leg Med 2017; 52:70-74. [PMID: 28866284 DOI: 10.1016/j.jflm.2017.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 06/06/2017] [Accepted: 08/23/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Case reports of cardiac arrest in temporal proximity to Conducted Electrical Weapon(CEW) exposure raise legitimate concerns about this as a rare possibility. In this pilot study, we respectfully navigate the oversight and regulatory hurdles and demonstrate the intra-shock electrocardiographic effects of an intentional transcardiac CEW discharge using subcutaneous probes placed directly across the precordium of patients with a previously implanted intracardiac EKG sensing lead. METHODS Adults scheduled to undergo diagnostic EP studies or replacement of an implanted cardiac device were enrolled. Sterile subcutaneous electrodes were placed at the right sternoclavicular junction and the left lower costal margin at the midclavicular line. A standard police issue TASER Model X26 CEW was attached to the subcutaneous electrodes and a 5 s discharge was delivered. Continuous surface and intracardiac EKG monitoring was performed. RESULTS A total of 157 subjects were reviewed for possible inclusion and 21 were interviewed. Among these, 4 subjects agreed and completed the study protocol. All subjects tolerated the 5 s CEW discharge without clinical complications. There were no significant changes in mean heart rate or blood pressure. Interrogation of the devices after CEW discharge revealed no ventricular pacing, dysrhythmias, damage or interference with the implanted devices. CONCLUSIONS In this pilot study, we have successfully navigated the regulatory hurdles and demonstrated the feasibility of performing intracardiac EKG recording during intentional precordial CEW discharges in humans. While no CEW-associated dysrhythmias were noted, the size of this preliminary dataset precludes making conclusions about the risk of such events. Larger studies are warranted and should consider exploring variations of the CEW electrode position in relation to the cardiac silhouette.
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Abstract
Electromuscular incapacitating devices (EMDs) are high-voltage, low-current stimulators causing involuntary muscle contractions and sensory response. Existing evidence about cardiac effects of EMD remains inconclusive. The aim of our study was to analyze electrocardiographic, echocardiographic, and microvolt T-wave alternans (MTWA) changes induced by EMD discharge. We examined 26 volunteers (22 men; median age 30 years) who underwent single standard 5-second duration exposure to TASER X26 under continuous echocardiographic and electrocardiographic monitoring. Microvolt T-wave alternans testing was performed at baseline (MTWA-1), as well as immediately and 60 minutes after EMD exposure (MTWA-2 and MTWA-3, respectively). Mean heart rate (HR) increased significantly from 88 ± 17 beats per minute before to 129 ± 17 beats per minute after exposure (P < 0.001). However, in 2 individuals, an abrupt decrease in HR was observed. In one of them, interval between two consecutive beats increased up to 1.7 seconds during the discharge. New onset of supraventricular premature beats was observed after discharge in 1 patient. Results of MTWA-1, MTWA-2, and MTWA-3 tests were positive in one of the subjects, each time in a different case. Standard EMD exposure can be associated with a nonuniform reaction of HR and followed by heart rhythm disturbances. New MTWA positivity can reflect either the effect of EMD exposure or a potential false positivity of MTWA assessments.
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Ho J, Dawes D, Nystrom P, Moore J, Steinberg L, Tilton A, Miner J. Effect of simulated resistance, fleeing, and use of force on standardized field sobriety testing. MEDICINE, SCIENCE, AND THE LAW 2015; 55:208-215. [PMID: 24934160 DOI: 10.1177/0025802414536152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION When a law enforcement officer (LEO) stops a suspect believed to be operating (a vehicle) while impaired (OWI), the suspect may resist or flee, and the LEO may respond with force. The suspect may then undergo a Standardized Field Sobriety Test (SFST) to gauge impairment. It is not known whether resistance, fleeing, or actions of force can create an inaccurate SFST result. We examined the effect of resistance, fleeing, and force on the SFST. MATERIALS AND METHODS Human volunteers were prospectively randomized to have a SFST before and after one of five scenarios: (1) five-second conducted electrical weapon exposure; (2) 100-yard (91.4 m) sprint; (3) 45-second physical fight; (4) police dog bite with protective gear; and (5) Oleoresin Capsicum spray to the face with eyes shielded. The SFST was administered and graded by a qualified LEO. After the SFST, the volunteer entered their scenario and was then administered another SFST. Data were analyzed using descriptive statistics. SFST performance was compared before and after using chi-square tests. RESULTS Fifty-seven subjects enrolled. Three received a single-point penalty during one component of the three-component SFST pre-scenario. No subject received a penalty point in any components of the SFST post-scenario (p = 0.08). CONCLUSIONS This is the first human study to examine the effects of physical resistance, flight, and use of force on the SFST result. We did not detect a difference in the performance of subjects taking the SFST before and after exposure to resistance, flight, or a simulated use of force.
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Affiliation(s)
- Jeffrey Ho
- Hennepin County Medical Center, Minnesota, USA Meeker County Sheriff's Office, Minnesota, USA
| | - Donald Dawes
- Lompoc Valley Medical Center, California, USA Santa Barbara Police Department, California, USA
| | - Paul Nystrom
- Hennepin County Medical Center, Minnesota, USA Meeker County Sheriff's Office, Minnesota, USA
| | | | | | | | - James Miner
- Hennepin County Medical Center, Minnesota, USA
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Ho JD, Dawes DM, Chang RJ, Nelson RS, Miner JR. Physiologic effects of a new-generation conducted electrical weapon on human volunteers. J Emerg Med 2013; 46:428-35. [PMID: 24238599 DOI: 10.1016/j.jemermed.2013.08.069] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Revised: 05/16/2013] [Accepted: 08/15/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Conducted electrical weapons (CEWs) are used by law enforcement to restrain or repel potentially violent persons. The TASER X2 CEW is a next-generation device with new technology, including new electrical waveform and output specifications. It has not previously been studied in humans. OBJECTIVE The objective of this study was to evaluate the human physiologic effect of a new-generation CEW. METHODS This was a prospective, observational human study. Volunteers received a 10-s exposure via deployed probes from an X2 CEW in the abdomen and upper thigh. Measured data included vital signs; 12-lead electrocardiograms; and blood serum biomarkers before, immediately after, and 24 h post exposure. Biomarkers measured included pH, lactate, potassium, creatine kinase (CK), and troponin-I. Real-time spirometry and echocardiography were performed before, during, and after the exposure. RESULTS Ten volunteers completed the study. There were no important changes in vital signs or potassium. Median increase in lactate as a consequence of the exposure was 1.2 mg/dL (range 0.6-2.8 mg/dL). Median change in pH was -0.031 (range -0.011 to -0.067). No subject had a positive troponin. Median change in CK at 24 h was 313 ng/mL (range -40 to 3418 ng/mL). There was no evidence of respiratory impairment. Baseline median minute ventilation was 14.2 L/min, increased to 21.6 L/min intra-exposure (p = 0.05), and remained elevated at 21.6 L/min post exposure (p = 0.01). CONCLUSIONS There was no evidence of dangerous physiology found in the measured parameters. The physiologic effects of the X2 CEW are similar to older-generation CEWs. We encourage further study to validate these results.
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Affiliation(s)
- Jeffrey D Ho
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota; Meeker County Sheriff's Office, Litchfield, Minnesota
| | - Donald M Dawes
- Department of Emergency Medicine, Lompoc Valley Medical Center, Lompoc, California; Santa Barbara Police Department, Santa Barbara, California
| | - Richard J Chang
- Department of Emergency Medicine, Providence Regional Medical Center, Everett, Washington
| | - Rebecca S Nelson
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota
| | - James R Miner
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota
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Vanmeenen KM, Lavietes MH, Cherniack NS, Bergen MT, Teichman R, Servatius RJ. Respiratory and Cardiovascular Response during Electronic Control Device Exposure in Law Enforcement Trainees. Front Physiol 2013; 4:78. [PMID: 23616772 PMCID: PMC3629983 DOI: 10.3389/fphys.2013.00078] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Accepted: 03/22/2013] [Indexed: 11/16/2022] Open
Abstract
Objective: Law enforcement represents a large population of workers who may be exposed to electronic control devices (ECDs). Little is known about the potential effect of exposure to these devices on respiration or cardiovascular response during current discharge. Methods: Participants (N = 23) were trainees exposed to 5 s of an ECD (Taser X26®) as a component of training. Trainees were asked to volitionally inhale during exposure. Respiratory recordings involved a continuous waveform recorded throughout the session including during the exposure period. Heart rate was calculated from a continuous pulse oximetry recording. Results: The exposure period resulted in the cessation of normal breathing patterns in all participants and in particular a decrease in inspiratory activity. No significant changes in heart rate during ECD exposure were found. Conclusion: This is the first study to examine breathing patterns during ECD exposure with the resolution to detect changes over this discrete period of time. In contrast to reports suggesting respiration is unaffected by ECDs, present evidence suggests that voluntary inspiration is severely compromised. There is no evidence of cardiac disruption during ECD exposure.
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Affiliation(s)
- Kirsten M Vanmeenen
- Stress and Motivated Behavior Institute, New Jersey Medical School, University of Medicine and Dentistry of New Jersey Newark, NJ, USA ; Department of Veterans Affairs Medical Center, New Jersey Health Care System East Orange, NJ, USA
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An evaluation of two conducted electrical weapons and two probe designs using a swine comparative cardiac safety model. Forensic Sci Med Pathol 2013; 9:333-42. [DOI: 10.1007/s12024-013-9422-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2013] [Indexed: 11/26/2022]
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Bozeman WP, Teacher E, Winslow JE. Transcardiac Conducted Electrical Weapon (TASER) Probe Deployments: Incidence and Outcomes. J Emerg Med 2012; 43:970-5. [DOI: 10.1016/j.jemermed.2012.03.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Revised: 12/21/2011] [Accepted: 03/20/2012] [Indexed: 10/28/2022]
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Cardiac fibrillation risk of TASER X-26 dart mode application. Wien Med Wochenschr 2011; 161:571-7. [PMID: 22037697 DOI: 10.1007/s10354-011-0038-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2011] [Accepted: 08/28/2011] [Indexed: 10/15/2022]
Abstract
In view of reported fatalities there are still controversial discussions on whether electronic stun law enforcement weapons can cause cardiac fibrillation. Experimental data are contradictory. Simplified theoretical estimations led to a negligible low risk of 8.10(-7). With a detailed numerical-anatomical model of an adult man (NORMAN) cardiac exposure to Taser X26 high-tension pulses was quantitatively assessed and the fibrillation risk estimated by accounting for its dependence on excited volume based on 3D cardiac exposure patterns. For distance mode and worst case dart hits it could be demonstrated that cardiac exposure can reach the 30% fibrillation risk level. Risk reduces considerably if direct current flow across the heart is prevented. The overall fibrillation risk of Taser application is further reduced by the limited probability of critical hits. However, in agreement with experimental findings it is demonstrated that cardiac fibrillation risk of Taser X26 dart mode application is small, however, not negligible.
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Azadani PN, Tseng ZH, Ermakov S, Marcus GM, Lee BK. Funding source and author affiliation in TASER research are strongly associated with a conclusion of device safety. Am Heart J 2011; 162:533-7. [PMID: 21884872 DOI: 10.1016/j.ahj.2011.05.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2011] [Accepted: 05/21/2011] [Indexed: 11/26/2022]
Abstract
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.
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Ho JD, Clinton JE, Lappe MA, Heegaard WG, Williams MF, Miner JR. Introduction of the Conducted Electrical Weapon into a Hospital Setting. J Emerg Med 2011; 41:317-23. [DOI: 10.1016/j.jemermed.2009.09.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Revised: 09/14/2009] [Accepted: 09/28/2009] [Indexed: 11/24/2022]
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Dawes DM, Ho JD, Cole JB. Response to "Acute Agitated Delirious State Associated With TASER Exposure". J Natl Med Assoc 2011; 103:986-8. [DOI: 10.1016/s0027-9684(15)30458-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Electronic Control Device Exposure: A Review of Morbidity and Mortality. Ann Emerg Med 2011; 58:178-88. [DOI: 10.1016/j.annemergmed.2011.01.023] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Revised: 12/20/2010] [Accepted: 01/28/2011] [Indexed: 11/21/2022]
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Vilke GM, Bozeman WP, Chan TC. Emergency department evaluation after conducted energy weapon use: review of the literature for the clinician. J Emerg Med 2011; 40:598-604. [PMID: 21220194 DOI: 10.1016/j.jemermed.2010.10.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Revised: 10/09/2010] [Accepted: 10/31/2010] [Indexed: 10/18/2022]
Abstract
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.
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Affiliation(s)
- Gary M Vilke
- Department of Emergency Medicine, University of California at San Diego Medical Center, San Diego, California 92103, USA
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Ho JD, Dawes DM, Reardon RF, Strote SR, Kunz SN, Nelson RS, Lundin EJ, Orozco BS, Miner JR. Human cardiovascular effects of a new generation conducted electrical weapon. Forensic Sci Int 2011; 204:50-7. [PMID: 20537475 DOI: 10.1016/j.forsciint.2010.05.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Revised: 04/26/2010] [Accepted: 05/03/2010] [Indexed: 10/19/2022]
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Leitgeb N, Niedermayr F, Neubauer R, Loos G. Numerically simulated cardiac exposure to electric current densities induced by TASER X-26 pulses in adult men. Phys Med Biol 2010; 55:6187-95. [PMID: 20876969 DOI: 10.1088/0031-9155/55/20/010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
There is still an ongoing debate whether or not electronic stun devices (ESDs) induce cardiac fibrillation. To assess the ventricular fibrillation risk of law enforcing electronic control devices, quantitative estimates of cardiac electric current densities induced by delivered electric pulses are essential. Numerical simulations were performed with the finite integration technique and the anatomical model of a standardized European man (NORMAN) segmented into 2 mm voxels and 35 different tissues. The load-dependent delivery of TASER X-26 pulses has been taken into account. Cardiac exposure to electric current densities of vertically and horizontally aligned dart electrodes was quantified and different hit scenarios compared. Since fibrillation thresholds critically depend on exposed volume, the provided quantitative data are essential for risk assessment. The maximum cardiac rms current densities amounted to 7730 A m(-2). Such high current densities and exposed cardiac volumes do not exclude ventricular fibrillation.
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Affiliation(s)
- N Leitgeb
- Institute of Clinical Engineering with European Notified Body of Medical Devices, Graz University of Technology, Inffeldgasse 18, A-8010 Graz, Austria.
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Dawes DM, Ho JD, Reardon RF, Miner JR. The cardiovascular, respiratory, and metabolic effects of a long duration electronic control device exposure in human volunteers. Forensic Sci Med Pathol 2010; 6:268-74. [PMID: 20502988 DOI: 10.1007/s12024-010-9166-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2010] [Indexed: 11/24/2022]
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Conducted Electrical Weapon Use by Law Enforcement: An Evaluation of Safety and Injury. ACTA ACUST UNITED AC 2010; 68:1239-46. [DOI: 10.1097/ta.0b013e3181b28b78] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cardiovascular evaluation of electronic control device exposure in law enforcement trainees: a multisite study. J Occup Environ Med 2010; 52:197-201. [PMID: 20134349 DOI: 10.1097/jom.0b013e3181cc58ba] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
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.
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Dawes DM, Ho JD, Cole JB, Reardon RF, Lundin EJ, Terwey KS, Falvey DG, Miner JR. Effect of an electronic control device exposure on a methamphetamine-intoxicated animal model. Acad Emerg Med 2010; 17:436-43. [PMID: 20370784 DOI: 10.1111/j.1553-2712.2010.00708.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Because of the prevalence of methamphetamine abuse worldwide, it is not uncommon for subjects in law enforcement encounters to be methamphetamine-intoxicated. Methamphetamine has been present in arrest-related death cases in which an electronic control device (ECD) was used. The primary purpose of this study was to determine the cardiac effects of an ECD in a methamphetamine intoxication model. METHODS Sixteen anesthetized Dorset sheep (26-78 kg) received 0.0 mg/kg (control animals, n = 4), 0.5 mg/kg (n = 4), 1.0 mg/kg (n = 4), or 1.5 mg/kg (n = 4) of methamphetamine hydrochloride as a slow intravenous (IV) bolus during continuous cardiac monitoring. The animals received the following exposures in sequence from a TASER X26 ECD beginning at 30 minutes after the administration of the drug: 1) 5-second continuous exposure, 2) 15-second intermittent exposure, 3) 30-second intermittent exposure, and 4) 40-second intermittent exposure. Darts were inserted at the sternal notch and the cardiac apex, to a depth of 9 mm. Cardiac motion was determined by thoracotomy (smaller animals, < or = 32 kg) or echocardiography (larger animals, > 68 kg). Data were analyzed using descriptive statistics and chi-square tests. RESULTS Animals given methamphetamine demonstrated signs of methamphetamine toxicity with tachycardia, hypertension, and atrial and ventricular ectopy in the 30-minute period immediately after administration of the drug. Smaller animals (n = 8, < or = 32 kg, mean = 29.4 kg) had supraventricular dysrhythmias immediately after the ECD exposures. Larger animals (n = 8, > 68 kg, mean = 72.4) had only sinus tachycardia after the exposures. One of the smaller animals had frequent episodes of ventricular ectopy after two exposures, including runs of delayed onset, nonsustained six- to eight-beat unifocal and multifocal ventricular tachycardia that spontaneously resolved. This animal had significant ectopy prior to the exposures as well. Thoracotomy performed on three smaller animals demonstrated cardiac capture during ECD exposure consistent with previous animal studies. In the larger animals, none of the methamphetamine-intoxicated animals demonstrated cardiac capture. Two control sheep showed evidence of capture similar to the smaller animals. No ventricular fibrillation occurred after the exposure in any animal. CONCLUSIONS In smaller animals (32 kg or less), ECD exposure exacerbated atrial and ventricular irritability induced by methamphetamine intoxication, but this effect was not seen in larger, adult-sized animals. There were no episodes of ventricular fibrillation after exposure associated with ECD exposure in methamphetamine-intoxicated sheep.
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Affiliation(s)
- Donald M Dawes
- Department of Physiology and Biophysics, University of Louisville, Louisville, KY, USA
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Vanga SR, Bommana S, Kroll MW, Swerdlow C, Lakkireddy D. TASER conducted electrical weapons and implanted pacemakers and defibrillators. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2010; 2009:3199-204. [PMID: 19964055 DOI: 10.1109/iembs.2009.5333136] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Conducted electrical weapons (CEW) have generated controversy in recent years regarding their effect on heart rhythm and on their suspected interaction with implanted devices such as the pacemakers and ICDs (implantable cardioverter defibrillators). We review the current evidence available on device interactions and pre-sent a new case series of 6 patients. LITERATURE We used the available case reports and animal studies on TASER or CEW related publications in PubMed. CONCLUSION Oversensing of TASER CEW discharges may cause noise reversion pacing in pacemakers and inappropriate detection of VF in ICDs. The nominal 5-second discharge is sufficiently short that neither clinically significant inhibition of bradycardia pacing nor inappropriate ICD shocks have been reported. Current evidence indicates that CEW discharges do not have adverse effects on pacemakers and ICDs.
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DAWES DONALDM, HO JEFFREYD, KROLL MARKW, MINER JAMESR. Electrical Characteristics of an Electronic Control Device Under a Physiologic Load: A Brief Report. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 33:330-6. [DOI: 10.1111/j.1540-8159.2009.02612.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Swerdlow CD, Fishbein MC, Chaman L, Lakkireddy DR, Tchou P. Presenting rhythm in sudden deaths temporally proximate to discharge of TASER conducted electrical weapons. Acad Emerg Med 2009; 16:726-39. [PMID: 19473120 DOI: 10.1111/j.1553-2712.2009.00432.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Sudden deaths proximate to use of conducted electrical weapons (CEWs) have been attributed to cardiac electrical stimulation. The rhythm in death caused by rapid, cardiac electrical stimulation usually is ventricular fibrillation (VF); electrical stimulation has not been reported to cause asystole or pulseless electrical activity (PEA). The authors studied the presenting rhythms in sudden deaths temporally proximate to use of TASER CEWs to estimate the likelihood that these deaths could be caused by cardiac electrical stimulation. METHODS This was a retrospective review of CEW-associated, nontraumatic sudden deaths from 2001 to 2008. Emergency medical services (EMS), autopsy, and law enforcement reports were requested and analyzed. Subjects were included if they collapsed within 15 minutes of CEW discharge and the first cardiac arrest rhythm was reported. RESULTS Records for 200 cases were received. The presenting rhythm was reported for 56 of 118 subjects who collapsed within 15 minutes (47%). The rhythm was VF in four subjects (7%; 95% confidence interval [CI] = 3% to 17%) and bradycardia-asystole or PEA in 52 subjects (93%; 95% CI = 83% to 97%). None of the eight subjects who collapsed during electrocardiogram (ECG) monitoring had VF. Only one subject (2%) collapsed immediately after CEW discharge. This was the only death typical of electrically induced VF (2%, 95% CI = 0% to 9%). An additional 4 subjects (7%) collapsed within 1 minute, and the remaining 51 subjects (91%) collapsed more than 1 minute later. The time from collapse to first recorded rhythm was 3 minutes or less in 35 subjects (62%) and 5 minutes or less in 43 subjects (77%). CONCLUSIONS In sudden deaths proximate to CEW discharge, immediate collapse is unusual, and VF is an uncommon VF presenting rhythm. Within study limitations, including selection bias and the possibility that VF terminated before the presenting rhythm was recorded, these data do not support electrically induced VF as a common mechanism of these sudden deaths.
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Affiliation(s)
- Jeffrey D Ho
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA.
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Physiological effects of the TASER® C2 conducted energy weapon. Forensic Sci Med Pathol 2009; 5:189-98. [PMID: 19598011 DOI: 10.1007/s12024-009-9100-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2009] [Accepted: 06/03/2009] [Indexed: 10/20/2022]
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Acute effects of an alternative electronic-control-device waveform in swine. Forensic Sci Med Pathol 2009; 5:2-10. [PMID: 19330471 DOI: 10.1007/s12024-009-9076-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2008] [Accepted: 02/04/2009] [Indexed: 10/21/2022]
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Fortuitous Effect of TASER Shock Misleading. Ann Emerg Med 2009; 53:286-7. [DOI: 10.1016/j.annemergmed.2008.07.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2008] [Revised: 07/15/2008] [Accepted: 07/21/2008] [Indexed: 11/17/2022]
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Physiology and pathology of TASER electronic control devices. J Forensic Leg Med 2009; 16:173-7. [PMID: 19329071 DOI: 10.1016/j.jflm.2008.12.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2008] [Revised: 08/20/2008] [Accepted: 12/09/2008] [Indexed: 11/20/2022]
Abstract
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.
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Kroll MW, Panescu D, Carver M, Kroll RM, Hinz AF. Cardiac effects of varying pulse charge and polarity of TASER conducted electrical weapons. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2009; 2009:3195-3198. [PMID: 19964054 DOI: 10.1109/iembs.2009.5333135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The TASER(R) CEW (Conducted Electrical Weapon) is rapidly replacing the club in the English-speaking world for assisting in the arrest of resistant subjects and is now used by the majority of law enforcement agencies in the USA, Canada, and the UK. Animal safety studies of the CEW have focused on the risk of VF. We sought to determine the difference in cardiac capture and VF risk between the approximately 102 +/- 8 microC of the ubiquitous X26 and a me-tered 72 microC charge from an experimental device. It is well established from the bidomain theory and experimental data that a pacing electrode will capture the heart with significantly lower charge when the electrode touching the cardiac tissue is a cathode However, experimental data show that there is no difference in the ability of the anode vs the cathode to induce VF. We sought to evaluate the effect of polarity changes on cardiac capture and the induction of VF. Small swine ( approximately 20.0 kg) were anesthetized and ventilated. The apex of the heart was located via echocar-diography and a CEW probe was fully inserted towards the apex. Echocardiography was used to monitor cardiac contractions to determine cardiac capture. Both the X26 and the 72 microC pulses were delivered at both polarities to test for cardiac capture. Higher charge pulses (375 microC) were then delivered with both polarities to test for VF risk. The 72 microC experimental unit was unable to cause cardiac capture even in small swine with fully inserted probes directly over the apex of the heart. We found no polarity effect in the risk of VF in small swine with larger charge ( approximately 5x) pulses.
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Ho JD, Dawes DM, Heegaard WG, Miner JR. Human research review of the TASER electronic control device. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2009; 2009:3181-3183. [PMID: 19964797 DOI: 10.1109/iembs.2009.5334540] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
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.
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Affiliation(s)
- Jeffrey D Ho
- Dept. of Emergency Medicine, University of Minnesota-Hennepin Co Medical Center, Minneapolis, Minnesota, USA
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