Conducted Electrical Weapon Injuries Must Be More Broadly Considered
Article Outline
To the Editor:
We appreciate the importance of the study by Bozeman et al in the March issue of Annals,1 as the first, multi-center, prospective evaluation of conductive electrical weapon use by law enforcement. There are a few aspects of their methodology and data interpretation that are concerning, however.
The authors' injury classification system acknowledges that conducted electrical weapon injuries could occur from direct effects (eg, electrical), indirect effects (eg, falls), or of an uncertain relationship. They do not describe, however, how direct or uncertain injuries would be determined. This is critically important, as the physiologic effect of conducted electrical weapon use is still part of a contentious debate.
The effect of these determinations could seriously impact the results of the paper. Only 3 “moderate or severe” injuries were identified in the study, but we are not told how many other subjects were found to have acidosis or other potentially significant pathophysiologic findings that have been linked to conducted electrical weapon use by prior studies.2 Furthermore, there is no reference to the injuries that were classified as “of uncertain” relationship to conducted electrical weapon use. We have analyzed data from 1000 conducted electrical weapon uses in an individual police force and have found that over 3% of individuals evaluated in the emergency department after conducted electrical weapon use had evidence of rhabdomyolisis; although these may have had an uncertain connection to the conducted electrical weapon use, such a relationship cannot be found unless all the data are presented and considered.
The risks of not casting a broad net when examining potential injuries from conducted electrical weapon use are apparent in key findings in their results. Two deaths are reported, both within 20 minutes of conducted electrical weapon use. The authors dismiss these cases as unrelated without any clear evidence that it is safe to do so; in fact, medical examiners have found conducted electrical weapons to be contributory in similar cases in the past3 and epidemiologic studies have shown a correlation between Taser deployment and an increase in in-custody deaths.4 The authors discuss the increasingly large literature on the physiologic effects of conducted electrical weapon use, stating that no findings would account for deaths minutes later, but other authors disagree, suggesting that the physiologic effects of conducted electrical weapon use might be safe in resting adults but could have a cumulative or priming effect in high-risk struggling individuals that impacts their outcome.5
In summary, we feel that the authors' dismissal of the broad physiologic impacts of conducted electrical weapon use creates a potentially misleading conclusion of safety. More importantly though, it excludes data that could be critical in identifying the infrequent cases when conducted electrical weapon use does impact subject safety. We feel that a much broader examination is necessary to continue the joint goal of the medical and law enforcement community of finding the situations when these otherwise safe weapons could become deadly. We endorse a national database of deaths occurring within 24 hours of conducted electrical weapon use to identify these infrequent cases and better define what impact conducted electrical weapon use has, if any, in restraint-related death.
References
- Safety and injury profile of conducted electrical weapons used by law enforcement officers against criminal suspects. Ann Emerg Med. 2009;53:480–489
- Physiological effects of a conducted electrical weapon on human subjects. Ann Emerg Med. 2007;50:569–575
- . Taser use in restraint-related deaths. Prehosp Emerg Care. 2006;10:447–450Oct-Dec
- Relation of taser (electrical stun gun) deployment to increase in in-custody sudden deaths. American Journal of Cardiology. 2009;In Press
- . Physiological effects of the taser. Ann Emerg Med. 2008;52(1):85;author reply 85-86
Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. The authors have stated that no such relationships exist. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement.
PII: S0196-0644(09)00269-8
doi:10.1016/j.annemergmed.2009.02.018
© 2009 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.
Refers to article:
- Safety and Injury Profile of Conducted Electrical Weapons Used by Law Enforcement Officers Against Criminal Suspects , 22 January 2009
