Correctional officers, sheriffs, military police, and local police (law enforcement) officers often utilize various alternative means to apprehend and subdue combative or violent individuals which they encounter. The alternative means include the use of: bean bag rounds, chemical irritant sprays, conducted electrical weapons (CEW), manual choke holds, rubber bullets, and trained canines. 1-5 These alternative means are not without controversy because they are considered to be a less-lethal alternative for using deadly force. 6, 7
Or are they? 2, 4, 8-14, 16- 19 A 2013 report by Amnesty International states that the Taser® (Taser International, Scottsdale, AZ, USA), a CEW, has been implicated in over 540 deaths since 2001; a number disputed by the manufacturer. 11, 16, 20, 21
Often, prehospital and emergency department personnel are the primary medical professionals, providing urgent care whenever an alternative means is used. When a sudden death occurs the alternative means, device or method, is scrutinized by the media, officials, and healthcare professionals. 4, 5, 22- 25 This article will address the potential injuries a patient may experience after the deployment of the most commonly used alternative device, the Taser®
Using a Taser
Conducted electrical weapons: Conducted electrical weapons are meant to provide an electric shock causing a disruption of muscles which temporarily incapacitates an individual. CEW include: stun batons, stun guns, and stun prods when close and direct contact is necessary. When a more distant contact occurs, products such as the Taser® extended range projectile (a shotgun shell) or Taser® gun are used because it can discharge projectiles 15-100 feet away. 3, 4, 17-19, 26-28
Taser® gun: The medical literature and companies who sell the Taser® Model 26 gun, the most commonly used device by law enforcement, report it delivers from 1,200- 50,000 volts of battery generated, direct current when discharged. It can be used for both close and distant contact. For distant contact the Taser® gun shoots two barbed projectiles, connected by wires up to 35 feet. Law enforcement officers can then charge the projectiles by pulling the trigger. Once activated, short bursts of current are sent through the wires to the projectiles and into the individual, temporarily incapacitating them. 3, 4, 8, 13, 14, 17-19, 29, 30, 32
Taser International reports that the voltage output is 1,340-2,150 volts and warns that once the projectiles are charged they are capable of inflicting immediate pain and uncontrollable muscle contractures. 21, 31, 32, 44 This allows time for law enforcement officers to subdue and restrain the individual further. 33
Deaths: Deaths that occur after law enforcement activity almost always require a postmortem examination to determine the exact cause of the death. 5,12 The medical literature regarding Taser® injury and death, however is often conflicting, confusing, and have many limitations. 3, 13, 15, 25, 34, 34 Thus, postmortem examinations after a Taser® incident are often deemed as inconclusive and are listed as undetermined on death certificates. 9, 35
Soleimanirahbar and Lee (2011) and others 3, 5, 7, 13, 29, 30, 34, 36 report this is because:
“.data collection . is not uniform and is performed sporadically by police departments,”police cadet volunteers are often used in a controlled environment, and do not represent real-world experience, a bias occurs due to the author(s) affiliation, (pro or con), with Taser International, 36-38 and results of animal studies must be interpreted with caution.
Case reports: Case reports are available involving law enforcement volunteers who have had effects of have been injured during training exercises. These include: atrial and ventricular fibrillation, cardiac capture, compression fractures of the thoracic vertebrae, extremity fractures, increase in creatine kinase and myoglobin, joint dislocations, pneumothorax, and new onset seizures. 3, 7, 9, 12, 13, 15, 29, 32, 33,35
Results of animal studies have replicated acidosis, cardiac capture, hyperglycemia, mitral valve standstill, ventricular fibrillation, ventricular tachycardia, and death; however, similar studies have refuted some of these”
results. 4, 8, 13-15, 31, 35, 39-41
Range of Injuries
Primary: A safety and health information document developed by Taser® International warns law enforcement officers that:
“CEW exposure causes certain effects, including physiologic and metabolic changes, stress, and pain. In some individuals, the risk of death or serious injury may increase with cumulative CEW exposure. Repeated, prolonged, or continuous CEW applications may contribute to cumulative exhaustion, stress, cardiac, physiologic, metabolic, respiratory, and associated medical risks.” 19
Secondary: Secondary injuries usually occur after the individual who has been Tased suddenly falls from an upright position. These include: abrasions, burns, lacerations and soft tissue injuries; dental injuries; epistaxis; facial and extremity fractures; epidural and intracranial bleeding, and concussions. 2, 4, 7, 12, 42 Secondary injuries may also result in individuals falling on a fixed object, such as the knife they were holding or onto nearby objects. 3,17-19,42,43 Taser International cautions law enforcement personnel not to discharge a CEW when flammable materials are present, due to the risk of fire or explosion. 17-19
Projectile: Projectile injuries usually include: burns, lacerations, and puncture wounds. Projectiles may become impaled and strike bone, nerves, organs, and have caused local tissue damage, pneumothorax, and later a possibly of infection at the puncture site. Other injuries include impaled projectiles into the eye, genitals, head, joints, neck, breast, or penetration to the body cavity. 2-4, 17-19, 29, 42
High Risk Patients: Children, elderly and pregnant woman may be more susceptible to injury. In addition, other contributing factors for potential injury include: thinly built individuals, close projectile distance near the head or heart, history of asthma, dyspnea, or heart condition, continuous or repeated shocks, implantable defibrillators and pacemakers, use of alcohol, stimulants, and illicit drugs 3,4,13- 15, 17 19, 25, 29, 32, 35, 40, 42, 44
Death: A potential, controversial, and unsubstantiated mechanism where-by those who are Tased die shortly thereafter, is a syndrome associated with “excited delirium.” This syndrome is not recognized in the DMS-5 and quite often by medical professionals as a true disorder; 12, 13, 35, 45, 46 however it “. is recognized by the National Association of Medical Examiners. 13
Takeuchi, Ahern, and Henderson (2011) report this syndrome has been recognized under various names since the mid-1800s and should be considered. They and others 3,8,13,30,35, 40, 46 describe, the same sequence of events which include a sudden onset of: delirium with agitation, [paranoia], (fear, panic, shouting, violence and hyperactivity), sudden cessation of struggle, respiratory arrest and death. In the majority of cases an unexpected [superhuman] strength and signs of hyperthermia are described as well.” 45
First Line Medical Care
Medical care after being tased, may or may not be required. However, when pre hospital emergency medical service (EMS) personnel are summoned, treatment is based on their State’s treatment protocols. 47-51 Primary treatment includes establishing airway, breathing, circulation, and placing the patient on an automatic external defibrillator or cardiac monitor. Treatment is then aimed at other medical conditions and/or injuries.
Projectiles may have already been removed by law enforcement officers prior to EMS arrival. Dislodged projectiles are a biohazard and considered evidence. EMS personnel have been instructed to not remove the impaled projectiles unless specifically authorized. Projectiles that remain must be secured in place to avoid further injury during transport.
Ho et al (2009) and others report death from CEWs usually occur within the first sixty minutes. 3-5, 35, 42 Takeuchi, Ahern, and Henderson (2011), report, clinicians “. must recognize . and act in an expeditious and aggressive manner to avoid. complications including metabolic acidosis, rhabdomyolysis, hyperthermia, and multisystem failure and/or death,” especially when excited delirium is suspected. 45
Vilke (2011) recommends conservative treatment for “. an asymptomatic awake and alert patient with short duration of [tased] exposure” and screening high risk patients for associated injuries. 42 Robb et al (2009) have developed a Taser® management and treatment guideline to assist clinicians in their decision making process.
Clinicians should examine and establish if additional diagnostic studies are necessary which may include: baseline labs, (blood sugar, electrocardiogram, hematocrit, lactate level, venous blood gases, radiographs), and observation prior to admission and/or discharge. High risk patients may require additional management. 3, 29, 40
The author acknowledges that the use of a Taser® has saved many law enforcement lives, including the lives of individuals they have had to apprehend by its use. The case reports and warnings by Taser International, clearly indicate that an individual, who has been tased, may very well have been injured and succumb shortly thereafter. Emergency personnel must be cognizant that Taser® injuries and their after effects are not all that benign. The medical literature is conflicting and confusing and the medical community must ensure they publish reliable, evidence based literature, without conflict or bias.
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M. Thomas Quail works as a nurse at the Bureau of Environmental Health for the Commonwealth of Massachusetts Department of Public Health.