Review article: Emergency Department implications of the TASER

Traumatic injuries by conducted electrical weapons: Case report of self-injury to the hand during stun gun training

The use of non-lethal weapons has spread worldwide, being introduced as an alternative to firearms in many countries such as the United States or the United Kingdom. Among non-lethal weapons, conducted electrical weapons have been adopted worldwide, to control unruly suspected criminals or to neutralise violent situations. The stun gun belongs to this category and is the most widely available, with more than 140,000 units in use by police officers in the field in the US, and an additional 100,000 electrical stun guns owned by civilians worldwide. In Italy, the use of conducted electrical weapons by law enforcement has only recently been introduced, with private use and commercialisation still prohibited, mainly due to controversies related to the potential dangers of such devices.Before the official adoption, several experiments had to be carried out, with mechanisms that reproduced the ballistics of the stun gun. Here we present the case of a man who suffered a self-injury trauma to his hand during a ballistics exercise with a crossbow loaded with stun gun probes.

Leveraging Resources to Remove a Taser Barb Embedded in Bone: Case Report

Introduction

Conducted electrical weapons, commonly known by their proprietary eponym, TASER, are frequently used by law enforcement. A review of the literature yielded descriptions of taser barb removal from soft tissue and surgical intervention for barbs lodged in sensitive areas such as the eye and head, but not from other osseous sites.

Case Report

We report the case of a 30-year-old male transferred from another hospital with a taser dart embedded in his clavicle. Prior attempts at bedside removal had been unsuccessful. We describe bedside removal of the taser barb from bone using local anesthesia and simple fulcrum technique.

Conclusion

We describe a novel fulcrum technique for removal of a taser dart embedded in bone. This is a reasonable technique to attempt in patients with involvement of superficial osseous structures to avoid operative intervention.

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.

[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.

Injuries associated with law enforcement use of force

Prehospital personnel and physicians working in acute care settings need to be cognizant of the issues related to law enforcement use of force in order to properly evaluate and manage these patients. Types of force used by law enforcement range along a spectrum from physical presence to lethal use of firearms. Although the vast majority of use of force incidents does not lead to significant injury, certain weapons and situations may require more extensive evaluation and higher levels of concern.

Conducted electrical weapon (TASER) use against minors: a shocking analysis

OBJECTIVE

Conducted electrical weapons (CEWs) such as the TASER are often used by law enforcement (LE) personnel during suspect apprehension. Previous studies have reported an excellent safety profile and few adverse outcomes with CEW use in adults. We analyzed the safety and injury profile of CEWs when used during LE apprehension of children and adolescents, a potentially vulnerable population.

METHODS

Consecutive CEW uses by LE officers against criminal suspects were tracked at 10 LE agencies and entered into a database as part of an ongoing multicenter injury surveillance program. All CEW uses against minors younger than 18 years were retrieved for analysis. Primary outcomes included the incidence and type of mild, moderate, and severe CEW-related injury, as assessed by physician reviewers in each case. Ultimate outcomes, suspect demographics, and circumstances surrounding LE involvement are reported secondarily.

RESULTS

Of 2026 consecutive CEW uses, 100 (4.9%) were uses against minor suspects. Suspects ranged from 13 to 17 years, with a mean age of 16.1 (SD, 0.99) years (median, 16 years). There were no significant (moderate or severe) injuries reported (0%; 97.5% confidence interval, 0.0%-3.6%). Twenty suspects (20%; 95% confidence interval, 12.7%-29.1%) were noted to sustain 34 mild injuries. The majority of these injuries (67.6%) were expected superficial punctures from CEW probes. Other mild injuries included superficial abrasions and contusions in 7 cases (7%).

CONCLUSIONS

None of the minor suspects studied sustained significant injury, and only 20% reported minor injuries, mostly from the expected probe puncture sites. These data suggest that adolescents are not at a substantially higher risk than adults for serious injuries after CEW use.

Stun gun induced myotendinous injury of the iliopsoas and gluteus minimus

We report a 57-year-old man with a complete tear of his iliopsoas tendon at the distal myotendinous junction, a near complete tear of the iliopsoas tendon at the lesser trochanter of the femur, and a high-grade tear of his gluteus minimus tendon at the greater trochanter of the femur after being struck by a stun gun in the proximal left thigh. The stun gun discharge resulted in a forced contraction of the left hip flexor muscles, which resulted in pain, weakness and difficulty with active hip flexion. Three months after the being struck with the stun gun, the patient underwent magnetic resonance imaging (MRI) of the left hip. MRI of the left hip revealed a complete tear of the left iliopsoas tendon from the lesser trochanter with 4 cm of proximal retraction and a high-grade strain of the gluteus minimus tendon at the greater trochanter. The distal iliopsoas myotendinous junction and lesser trochanter tendon insertion were surgically repaired. This case illustrates that a stun gun can cause acute rupture of the iliopsoas tendon and tear of the gluteus minimus tendon, which is well visualized on MRI.