BY LOUIS N. MOLINO SR.
Law enforcement often summons emergency medical services (EMS) for medical evaluation of subjects in custody. Increasingly, electronic control devices (ECDs) are involved in efforts to subdue highly agitated individuals. Subjects may have barbs imbedded in their skin and, at times, may continue to exhibit violent behavior or altered mental status. Individuals occasionally die unexpectedly following the use of an ECD. EMS responders must have an understanding of ECDs, their use, and appropriate care for a patient exposed to them.
WHAT ARE ECDs?
ECDs constitute a subset of conducted energy weapons law enforcement personnel use to control violent or agitated behavior. Presently, the Taser® is the most widely recognized and used ECD in the United States. For the majority of fire and EMS providers, it is the only such device they will likely encounter in the field.
Taser is an acronym for Thomas A. Swift’s Electric Rifle. Arizona inventor Jack Cover designed and patented it in 1969. Cover named it after the science fiction teenage inventor and adventure character Tom Swift. The Taser is a battery-operated unit that resembles a handgun and fires two barbed electrodes attached to copper wires at 180 feet/second (photo 1). The wires come in various lengths ranging from 15 to 35 feet. The weapon is aimed by a laser sight. The barbs attach to the subject’s skin or clothing and deliver electricity in rapid pulses over five seconds. The current can cross up to two inches of clothing or air space.
 (1) The Taser®. (Photos courtesy of Taser International.) |
The device’s current causes uncontrollable muscle contraction and overwhelming pain that can incapacitate a subject if the barbs are a sufficient distance apart. The weapon can be turned off before the end of the five-second default period. The barbs remain attached until removed. This allows further electrical discharges to be delivered by way of the copper wires should the subject resume noncompliant and threatening behavior.
The primary method of use is probe deployment. A secondary means of use is “Drive Stun” (DS), in which electrodes protruding from the device (with or without the barbed cartridge attached) are applied directly to a subject. Discharging the weapon drives a subject to the ground or into a position of compliance.
“DON’T TAZE ME, BRO!”
On September 17, 2007, the phrase “Don’t Taze me, Bro!” entered the American dictionary of classic phrases when University of Florida at Gainesville (UFLG) police officers removed 21-year-old fourth-year undergraduate student Andrew Meyer from a Constitution Day forum event where U.S. Senator John Kerry was speaking. In this incident, the UFLG police used “probe deployment” as well as “drive stunning” with a Taser device.
 Police models of the Taser: (2) Model M26 |
Within days, videos of the episode were posted on the Internet and played on national and international television. By the end of 2007, the New Oxford American Dictionary listed “tase/taze” as one of the “words of the year for 2007.” The statement “Don’t Taze me, Bro!” was emblazoned on the American psyche.
That UFLG event ended in a subject’s having a Taser applied and an arrest made. A heated controversy and debate arose over the use of force in this case. Outcomes have been considerably more dramatic in some cases of Taser device exposure.
 Police models of the Taser: (3) Model X26. |
According to media reports between October and November 2007, four individuals died unexpectedly after having a Taser applied. In Canada, the case with the highest-profile media exposure was that of Robert Dziekanski, a Polish immigrant who reportedly died less than two minutes after the Royal Canadian Mounted Police at Vancouver International Airport used a Taser on him on October 14, 2007. In this case, amateur video shot by a bystander rapidly made its way across the Internet and, like the UFLG event, was also broadcast internationally. This high-profile event was followed by three other “death after Taser device exposure” incidents in Montreal (Quebec), Halifax (Nova Scotia), and Chilliwack (British Columbia). These and other events led Amnesty International to demand an end to Taser use in Canada, a call they made on a worldwide basis in the past.
ECD CONTROVERSY IS NOT NEW
Scrutiny of the use of ECDs is not new. In 2004, a CBS News report described 70 deaths believed to be associated with the Taser, including 10 in August 2004 alone. At that time, Amnesty International reported 150 deaths since June 2001. The numbers of reported deaths “related” to the use of the Taser are highly dependent on the sources cited and the criteria applied to a death following exposure to the device. This has led to considerable differences in the numbers reported. To date, any causal effect between unexpected deaths and ECD exposure is hypothetical at best.
As of this writing, the firm that produces the Taser, Taser International Inc., a publicly traded company based in Scottsdale, Arizona, has been sued for wrongful death more than 51 times. Not one of these cases has been successful. It is also notable that the firm has never in its history agreed to an out-of-court settlement for the device’s use against a criminal actor. All cases to date have been dismissed prior to trial or litigated in favor of the manufacturer.
The Taser comes with various accessories, including a laser sight and mounted digital video camera capable of recording in low-light situations. Taser International also markets civilian models.
Tasers are nonlethal weapons, according to the United States Department of Defense’s definition of “nonlethal,” which stipulates that the weapon is not designed to kill and, when used properly, has a negligible likelihood of fatality compared to a lethal weapon such as a firearm. The Taser was introduced as a less-than-lethal weapon. Police use it to subdue possibly dangerous suspects in situations where a lethal weapon would otherwise be used.
More than 11,000 police forces worldwide use the device as a means to reduce firearm-related deaths. The Phoenix (AZ) Police Department reported that officer-involved shootings had dropped following deployment of Taser technology as an alternative to deadly force. Taser use in Phoenix increased from 71 in 2002 to 164 in 2003. In addition, the number of officer-involved shootings decreased by seven during this same period. Although Tasers were originally proposed as an alternative to lethal force, they have frequently found routine use as a method to gain compliance at times when the use of firearms would not be considered. In most applications, they are used quite effectively for these purposes without adverse outcomes for the person to whom the device is applied or the police.
HOW DOES IT WORK?
A conducted electroshock weapon is an incapacitating weapon used for subduing a person by administering an electric current aimed at disrupting skeletal muscle functions. The Taser fires two small barbed projectiles that, once imbedded in the suspect, allow delivery of a series of electrical current pulses through thin, flexible wires. Other conducted electroshock weapons such as stun guns, stun batons, and electroshock belts administer an electric shock by directly applying the device to a suspect’s skin.
Conducted electroshock weapon technology uses high-voltage, low-amperage electrical discharge to override the body’s muscle-triggering mechanisms, which Taser International refers to as neuromuscular incapacitation, or NMI. NMI overrides the subject’s peripheral nervous system by disrupting the electrical impulses used to command skeletal muscle function. The peripheral nervous system includes the sensory and motor nerves. The sensory nerves carry information from the body toward the brain (temperature and touch, for example). The motor nerves carry commands from the spinal cord to the muscles, to control movement.
The technology uses electrical impulses to stimulate the sensory and motor nerves. NMI occurs when the device causes involuntary stimulation of the motor nerves, which interferes with the subject’s skeletal muscle commands. Older technology stun guns affect the sensory nerves only, resulting in pain. However, a subject with a very high tolerance to pain, such as a delirious drug abuser or a trained fighter, may be able to continue to resist and fight through the pain of a traditional stun gun. In the case of the Taser, the subject is immobilized by way of the two metal probes connected by metal wires to the Taser. When the Taser is applied, the subject feels pain and is immobilized while the electric current is being applied. The Taser also provides a painful stimulus to the subject through sensory nerve stimulation.
The most effective body areas for any conducted electroshock weapons are those that allow for recruitment of large skeletal muscle masses. It is reported that applying ECDs to more sensitive parts of the body can be more painful. The resulting “shock” is caused by muscles twitching uncontrollably, appearing as muscle spasms. In the case of a Taser drive stun, it works in the same fashion as a traditional stun gun.
The output voltages of available electrical weapons without an external “load” (in this case, the subject’s body) are claimed to be in the range of 50 kilovolts and, in some cases, up to 1,000 kilovolts; the most common is in the 200- to 300-kilovolt range. The output current on contact with the subject will depend on various factors such as subject electrical resistance and battery conditions.
THE EFFECT ON THE HUMAN BODY
When a person has a Taser applied to his body, it is reported that a single shock of one-half-second duration will cause intense pain and muscle contractions, startling most people intensely. A shock of two to three seconds will often cause the subject to drop to the ground for at least several seconds.
Taser International warns law enforcement agencies that “prolonged or continuous exposures to the Taser device’s electrical charge” may lead to medical risks such as cumulative exhaustion and breathing impairment. The current models of Taser have no automatic stops. There have been allegations that officers have used the Taser repeatedly for a prolonged period. Anti-Taser activists have described prolonged or repeated use as torture.
THE MEDICAL EVIDENCE
Unexpected deaths have occurred following Taser use by police. However, the question of whether the Taser contributed to these deaths is not easy to answer.
When searching the available medical research, an overwhelming amount of evidence shows that the device is safe when used as intended and designed. One such study, “Cardiac Monitoring of Human Subjects Exposed to the Taser,” was designed to “evaluate for rhythm changes utilizing cardiac monitoring during deployment of the Taser on healthy human volunteers.” This study used police officers who received training on the Taser X-26. All of the officers had already volunteered to receive a Taser application and had continuous electrocardiography (ECG) monitoring immediately before, during, and after the firing of the Taser. Endpoints of the study included development of changes in cardiac rate, rhythm, and morphology.
In that study, 76 subjects were enrolled; nine were excluded because of equipment malfunctions. Of the remaining 67 subjects, the mean Taser shock was 2.2 seconds (range 0.95.0). Change in heart rate (HR) after Taser shock was significant, with an average increase of 19.4 beats/min. No changes in QRS morphology or aberrantly conducted beats were noted; however, one subject was found to have single premature ventricular contraction (PVC) before and after the Taser shock, but no other subject was found to have any other dysrhythmia except sinus tachycardia. The study concluded: “Other than an increase in heart rate, there was no cardiac dysrhythmia or ECG morphology changes in human subjects who received a Taser shock.” The authors of the study noted that the clinical implications of this study require further investigation.
WHY DO THEY DIE?
There have been occasional cases where U.S. medical examiners have ruled that the Taser was “directly responsible” for a subject’s death. At best, these cases are questionable because of other aggravating conditions, such as drug or alcohol intoxication coupled with the ongoing controversial medical condition known as “excited delirium.”
Critics of the device, however, argue that “excited delirium” is not a valid medical term and is not listed in the “Diagnostic and Statistical Manual of Mental Disorders.” They further point out that neither the American Medical Association nor the American Psychological Association recognize excited delirium as a medical or mental health condition.
WHAT IS EXCITED DELIRIUM SYNDROME?
Again, while not officially a recognized medical or mental disorder, excited delirium has been described as “a delirium characterized by a severe disturbance in the level of consciousness and change in mental status over a relatively short period of time.” The subject has an apparent reduced clarity of awareness of his environment; the ability to focus, sustain, or shift attention is impaired; and attention wanders and is easily distracted by other stimuli. The subject appears markedly disoriented and may exhibit signs of hallucinations.
Excited delirium often refers to a series of signs and symptoms typically exhibited as follows:
- Bizarre and violent behavior, most commonly violence toward glass;
- Removal of clothing, public nudity (even in cold weather);
- Aggression;
- Hyperactivity;
- Paranoia;
- Hallucination;
- Incoherent speech or shouting;
- Grunting or animal-like sounds;
- Incredible strength or endurance (typically noticed during attempts to restrain the victim);
- Imperviousness to pain (observed during violent acts or restraint); and
- Hyperthermia (overheating)/profuse sweating (even in cold weather).
Other medical conditions that can resemble excited delirium are panic attack, hyperthermia, diabetes, head injury, delirium tremens, and thyroid storm.
EMS RESPONSE TO TASER INCIDENTS
For all EMS responses to police incidents, the safety of the EMS crew and the patient must be the top priorities. Once the police have determined that the scene is safe, the EMS crew should approach the patient and determine his status. Obviously, in many cases, subjects detained by law enforcement often remain extremely agitated.
One fact is certain: Even if excellent protocols are in place, EMS is on-scene quickly, transport to the hospital occurs, and the subject receives top-notch care, sudden custodial deaths still occur. Field providers and physicians in major medical centers can describe a handful of deaths each year that occur despite using every resource available to intervene. There are no clear explanations for this phenomenon.
The majority of deaths associated with Taser discharge occur minutes to hours after application. The usual scenario involves a violent subject who needs multiple police officers to restrain him. The subject continues to struggle while in custody and then with no warning suddenly “goes quiet,” typically because of respiratory arrest. Treat the patient in the same fashion as for any other respiratory arrest.
If the patient is not in respiratory arrest but is still agitated, bring him to an emergency department for further assessment. Most police officers likely will be willing to comply with this request, since they are well aware of the risks of in-custody deaths and the associated potential litigation. If the officer is unwilling to comply with this request, you may have to act as a patient advocate. The best way to avoid such a situation is to have preplans, training, and protocols with local law enforcement so that everyone is in agreement that such an occurrence is a medical emergency. Proper advance preparation prevents arguments at the scene.
Highly agitated patients in custody for whom EMS is summoned may be hyperthermic, tachycardic, or volume-depleted and may even show signs of metabolic acidosis and rhabdomyolysis. Your department should have protocols for dealing with subjects in police custody. Consider requesting a supervisor from the EMS and the police agency if disagreements arise on-scene.
If the patient is calm and appears normal, assess and treat him as any other patient, based on local protocols. Remember that all patients who have been subject to a Taser device require a head-to-toe physical examination to rule out other injuries.
Keep in mind that every year, a number of sudden in-custody deaths occur for no definable reason. These deaths happen with excellent EMS and emergency department interventions in place and with proper training on the part of all parties involved.
REMOVAL OF TASER BARBS
EMS’ removing the Taser’s barbs can be controversial. Many agencies allow barb removal in certain circumstances. As always, follow local protocols. The barb is a straight #8 fishhook (photo 4). The length of the barb is 4 mm; the entire length of the shaft and barb measures 9.53 mm on the standard probe and 13.33 mm on the XP probe. The XP probe allows “extra penetration” and is available to penetrate thicker clothing for colder climates. There is minimal risk to the lungs, heart, or bowel from the Taser, given the length of the shaft and barb. There is a theoretical risk to the neck vasculature and genitalia, although there have been no reported cases of significant injury. There is one report of a penetrating eye injury from a Taser barb that necessitated surgical repair; in one case, a very thin male subject suffered a reported pneumothorax when a Taser was applied to his chest. Treat any barbs embedded in major vascular structures as impaled objects, and package and transport the patient to the emergency department.
 (4) Probe imbedded. |
Procedure: To remove barbs that can be removed, place one hand on the skin around the barb to pull the skin taut. With the other hand, grasp the barb and apply steady, inline traction (photo 5). Given the small size of the barb, there is no need to advance the end of the barb through the skin to cut off the tip, as is done with other fishhooks. If the patient cannot tolerate removal as described above, treat the barb as an impaled object and transport the patient.
 (5) Stabilizing surrounding tissue. |
In some systems, the EMS provider can inject a small amount of lidocaine at the site of the wound and attempt the removal or use a scalpel to cut down to the base of the tip of the barb; this technique is seldom necessary. Because of the local “cautery” effect of the electrical current, the area immediately surrounding the barb is insensate, so anesthesia is usually not a concern. Again, always follow local protocol.
If the patient was standing while the Taser was applied, the involuntary muscle contraction caused by the device will invariably lead to a fall. Evaluate the patient like any other patient who suffers a fall from a standing position. Although the Taser has been used on pregnant women, no clear recommendations on treatment have emerged. As with any pregnant patient, emergency department evaluation is likely warranted following falls with injury.
The Taser is just one tool law enforcement uses to obtain compliance from a subject. An EMS provider who encounters a situation where a person in custody has potential injuries for any reason should ensure his own safety and then treat the patient. It is important to provide the best and most appropriate care for patients in custody, regardless of what may have transpired between the subject and the police. By treating all patients equally and with respect, you will fulfill your role as a patient advocate.
References
Ross, DL. “Recent medical studies hail the safe use of conducted energy weapons,” PoliceOne.com, November, 22, 2007.
Ross DL. “Factors Associated with Excited Delirium Deaths in Police Custody,” Mod Pathol. 1998; 11:1127-1137.
Stratton SJ, C Rogers, K Brickett , et al., “Factors Associated with Sudden Death of Individuals Requiring Restraint for Excited Delirium.” Am J Emerg Med. 2001; 19:187-191.
Ho, JD, DM Dawes, MA Johnson, EJ Lundic; and JR Miner. “Impact of conducted electrical weapons in a mentally ill population: a brief report,” Am J Emerg Med. 2007; 25:780-785.
Vilke, GM; CM Sloane, KD Bouton, FW Kolkhorst, SD Levine, TS Neuman, EM Castillo, TC Chan. “Physiological Effects of a Conducted Electrical Weapon on Human Subjects.” Presented at the Society for Academic Emergency Medicine annual meeting, Chicago, IL. May 2007.
Lakkireddy, D, D Wallick, K Ryschon, MK Chung, B Butany, D Martin, W Saliba, W Kowalewski, A Natale, PJ Tchou. “Effects of Cocaine Intoxication on the Threshold for Stun Gun Induction of Ventricular Fibrillation,” J Am Col Card. 2006; 48:805-811.
Levine, SD, C Sloane, TC Chan, GM Vilke, J Dunford. “Cardiac Monitoring of Human Subjects Exposed to the Taser.” J Emerg Med. 2007; 33:113-117.
Lutes, M. “Focus On: Management of TASER Injuries,” ACEP News, May 2006.
Ho JD, JR Miner, DR Lakireddy, et al., “Cardiovascular and physiologic effects of conducted electrical weapon discharge in resting adults,” Acad Emerg Med. 2006; 13:589-595.
Ho JD, DM Dawes, LL Bultman, et al, “Respiratory effect of prolonged electrical weapon application on human volunteers,” Acad Emerg Med.2007; 14:197-201.
Moscati R, JD Ho, D Dawes, et al. “Physiologic effects of prolonged conducted electrical weapon discharge on intoxicated adults,” Acad Emerg Med. 2007; 14 (supplement 1):S63-S64.
Ho J, D Dawes, L Bultman, et al, “Physiologic effects of prolonged conducted electrical weapon discharge on acidotic adults,” Acad Emerg Med, 2007; 14 (supplement 1):S63.
Ho J, D Dawes, H Calkins, et al. “Absence of electrocardiographic change following prolonged application of a conducted electrical weapon in physically exhausted adults,” Acad Emerg Med.2007; 14 (supplement 1):S128-S129.
Ho J, R Reardon, D Dawes, et al. “Ultrasound measurement of cardiac activity during conducted electrical weapon application in exercising adults.” Accepted for presentation at the 2007 Annual Meeting of the American College of Emergency Physicians, Seattle, Wash., September 2007.
Dawes DM and JD Ho, “Effect of prolonged discharge from a conducted electrical weapon on human core temperature.” Accepted for presentation at the 2007 Annual Meeting of the American College of Emergency Physicians, Seattle, Wash, September 2007.
Ho J, D Dawes, A Lapine, et al, “Prolonged TASER ‘Drive Stun’ Exposure in Humans Does Not Cause Worrisome Biomarker Changes.” Accepted for presentation at the Annual Meeting of the National Association of EMS Physicians, Phoenix, Ariz., January 2008.
Louis N. Molino Sr.has been a firefighter/EMT since 1981 and has served in career and volunteer positions ranging from field provider to chief officer. He is a published author as well as a frequent speaker at fire and EMS conferences. Molino is an independent fire protection and EMS consultant and freelance author based in College Station, Texas.
