Brief
Reports
PHYSIOLOGIC EFFECTS OF A NEW-GENERATION CONDUCTED ELECTRICAL
WEAPON ON HUMAN VOLUNTEERS
Jeffrey D. Ho, MD,*† Donald M. Dawes, MD,‡§ Richard J. Chang, MD,k Rebecca S. Nelson, BS,* and
James R. Miner, MD*
*Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, †Meeker County Sheriff’s Ofﬁce, Litchﬁeld,
Minnesota, ‡Department of Emergency Medicine, Lompoc Valley Medical Center, Lompoc, California, §Santa Barbara Police Department,
Santa Barbara, California, and kDepartment of Emergency Medicine, Providence Regional Medical Center, Everett, Washington
Reprint Address: Jeffrey D. Ho, MD, Department of Emergency Medicine, Hennepin County Medical Center, 701 Park Avenue South,
Minneapolis, MN 55415
, Abstract—Background: Conducted electrical weapons
(CEWs) are used by law enforcement to restrain or repel
potentially violent persons. The TASER X2 CEW is a nextgeneration
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
À0.031 (range À0.011 to À0.067). No subject had a positive
troponin. Median change in CK at 24 h was 313 ng/mL
(range À40 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. Ó 2014 Elsevier Inc.
, Keywords—TASER; electronic control device; conducted
electrical weapon; human physiology
INTRODUCTION
Conducted electrical weapons (CEWs) are used by lawenforcement
ofﬁcers (LEOs) as intermediate weapons,
deﬁned as items that generally can induce subject compliance
due to pain or incapacitation and are a level above
empty-hand control techniques but less than deadly force.
They have ﬁlled a gap left by other law-enforcement devices,
tactics, or tools and have been shown to reduce
LEO and suspect injuries (1À3). CEWs deliver electrical
charge from a capacitor system in discrete pulses at fast
rates (19 pulses per second in most models) leading to
the depolarization of peripheral motor neurons within a
‘‘zone of capture.’’ This results in subsequent involuntary
TASER International, Inc. provided partial funding for this
study. Dr. Ho is the medical director to TASER International,
Inc. and Dr. Dawes is an expert to TASER International. Both
are own shares of stock in the company.
RECEIVED: 2 March 2013; FINAL SUBMISSION RECEIVED: 16 May 2013;
ACCEPTED: 15 August 2013
428
The Journal of Emergency Medicine, Vol. 46, No. 3, pp. 428–435, 2014
Copyright Ó 2014 Elsevier Inc.
Printed in the USA. All rights reserved
0736-4679/$ - see front matter
http://dx.doi.org/10.1016/j.jemermed.2013.08.069
subtetanic muscle contraction. The devices also depolarize
afferent sensory neurons leading to pain.
The TASER X26 CEW (Figure 1) is currently the most
prevalent CEW in use in the world and has been in service
since 2003. It is considered to be older-generation technology
and is based on electrical waveform characteristics
developed more than a decade ago. Its operational
limitations include the ability to ﬁre a single cartridge
only without reloading. This can present a distinct disadvantage
during scenarios with unsuccessful current delivery
(such as missing probe contact with the intended
target), if the probe spread distance is too close to be
effective, or there are multiple subjects to engage. There
have been numerous human physiology studies performed
using the older-technology X26 CEW (4À14).
The older-technology CEWs are understood by experts
to be safe and the newer-technology CEWs are proposed
to be even safer. The TASER X2 CEW (Figure 2) represents
new-generation CEW technology and has completely
different waveform and output speciﬁcations
that have signiﬁcantly changed the electrical characteristics
of this weapon when compared with previous CEWs.
It also has the capability of ﬁring two cartridges in a
‘‘semi-automatic’’ mode. This study is the ﬁrst to
examine comprehensive human physiologic effects of
this newer-generation CEW.
METHODS
This was a prospective, observational study of human
subjects. The Minneapolis Medical Research Foundation
Institutional Review Board (Minneapolis, MN) approved
this study. The study was conducted at the CEW manufacturer
corporate headquarters in Scottsdale, AZ during
a 2-day time period. The study volunteers were a convenience
sample of LEOs or correctional ofﬁcers participating
in a training exercise and receiving an X2 CEW
exposure as part of their training. They were approached
during their training course with the offer to be a part of
this study. Declining to participate in this study did not
absolve them from receiving CEW exposure during
training.
The volunteers provided informed consent and completed
a medical history questionnaire that was reviewed
by a study physician. There were no speciﬁc exclusion
criteria except known pregnancy and subjects had to be
at full-duty status with their department and taking part
in the training course. Each study volunteer was given a
TASER X26 CEWas compensation for their participation.
Each volunteer had an i.v. placed by a certiﬁed paramedic
before the testing. Baseline vital signs (blood pressure,
heart rate, and pulse oximetry) were measured with
an automated machine (Nonin 2120 Tabletop Monitor,
Plymouth, MN) and baseline blood sampling from the
i.v. occurred for the following values: creatine kinase
(CK), potassium, pH, lactate, and troponin-I. The pH
and lactate were immediately analyzed after withdrawing
the blood sample using a Point-of-Care i-STAT analyzer
and CG4 cartridges (Abbott Laboratories, East Windsor,
NJ). The remaining blood was centrifuged and stored on
site in ice, and transported at the end of each testing day to
a local professional laboratory analysis site (Laboratory
Corporation of America, Burlington, NC) for completion
of the remaining tests. A commercial skin resistance
analyzer (Omron Fat Loss Monitor HBF-306, Omron
Healthcare, Inc., Bannockburn, IL) was used to determine
body-fat percentage. All volunteers had been instructed
to refrain from signiﬁcant exertion for 24 h before and
after their CEW exposure to avoid confusing their blood
sample analyses.
The volunteers were ﬁtted with face, neck, and groin
protection and wore athletic shorts. Male volunteers
wore no shirt and female volunteers wore a T-shirt orFigure 1. Old generation TASER X26 CEW.
Figure 2. New generation TASER X2 CEW.
New Generation CEW 429
sports bra, depending on their preference. ATASER Master
Instructor deployed X2 probes into the volunteers
from 10 feet (3.05 meters) with a modiﬁed X2 CEW
that ﬁred the probes, but did not discharge any electrical
charge into the volunteers. The X2 cartridges used were
factory standard. The probe deployments were made
into frontal locations consistent with recommended target
sites per the manufacturer. The superior probe deployment
location was within the abdomen and the inferior
probe deployment location was within the thigh.
After the initial probe deployment, each volunteer was
laid supine for testing and a factory-standard X2 CEW
ﬁeld-deployable device was attached to the previously
ﬁred cartridge. Each volunteer was ﬁtted with a neoprene
mask and comprehensive, continuous respiratory data
were collected using an Ultima CPX breath-by-breath
gas exchange analyzer system (Medical Graphics, Inc.,
St Paul, MN). The system measured the oxygen and carbon
dioxide concentrations, respiratory rate, and tidal
volume on a breath-by-breath basis. Subjects had surface
12-lead electrocardiography (ECG) done immediately
before the exposure (Welch Allyn Cardio-Perfect, Skaneateles
Falls, NY). In addition, they had real-time
echocardiography performed by a trained emergency
physician using a Sonosoite M-Turbo ultrasound machine
with a 1- to 5-MHz phased-array transducer (Sonosite,
Inc., Bothell, WA). A parasternal long-axis view, including
the anterior leaﬂet of the mitral valve, was obtained
to determine heart rate and regularity of rhythm.
Ultrasonography was necessary to determine the rate
and rhythm of cardiac activity because cardiac monitoring
is insufﬁcient to determine this due to CEWcreated
electrical artifact. The two-dimensional view of
the heart was assessed in real time by the ultrasonographer
before switching to M-mode for real-time measurement
of the heart rate before, during, and after the CEW
exposure. Echocardiography was able to be obtained in
real time during CEW exposure because the conducted
electrical current does not spread outside of the area of
the CEW probe locations. Once baseline data were collected,
each volunteer received a 10-s continuous exposure
from the X2 CEW.
Vital signs and a 12-lead ECG were obtained immediately
(within 1 min) after the exposure. Real-time echocardiography
continued after the exposure until determination
of the heart rate was obtained. Venous blood sampling
occurred from the i.v. immediately after the exposure,
and was repeated every 2 min until 10 min of time post
exposure had elapsed. All venous blood samples were
analyzed in the same fashion as the initial baseline samples.
At the end of this time period, the i.v. was removed.
All volunteers returned in 24 h for their ﬁnal blood
sample evaluation, which was accomplished by standard
venipuncture.
The respiratory data were collected before, during, and
for approximately 10 min after the exposure. Breeze Suite
6.2 software (Medical Graphics, St Paul, MN) was used
to process the respiratory data. The software mean function
was utilized to determine mean values for pre, during,
and post exposure. ECGs were interpreted by a
blinded emergency physician and were interpreted as
either ‘‘normal’’ or ‘‘abnormal.’’ If abnormal, the physician
was asked to list the speciﬁc concern or abnormality.
All data was entered into an Excel spreadsheet (Microsoft
Corp, Redmond, WA) and exported into STATA 10.0
(Stata Corp, College Station, TX) for statistical analysis.
RESULTS
Ten volunteers were enrolled in this study and none were
excluded. Median age of the volunteers was 31.5 years
(range 21À44 years), median body mass index (calculated
as kg/m2
) was 29.4 (range 17.6–34.3), and 80% were
male. There were no important changes in vital signs or
measured potassium. Median increase in lactate during
the exposure was 1.2 mg/dL (range 0.6–2.8 mg/dL).
Median change in pH was À0.031 (range À0.011 to
À0.067). No subject had a positive troponin immediately
after the exposure or at 24 h after exposure. Median
change in CK at 24 h was 313 ng/mL (range À40 to
3418 ng/mL). There was no evidence of impairment of
breathing by spirometry. Baseline median minute ventilation
was 14.2 L/min, increased to 21.6 L/min during the
exposure (p = 0.05), and remained elevated at 21.6 L/
min immediately post exposure (p = 0.01).
The baseline characteristics of the volunteers are presented
in Table 1. The main results are shown in Table 2.
The pH and lactate data are summarized graphically in
Figures 3 and 4, respectively. Respiratory data are presented
in Table 3. Of the ECGs, there were two subjects
who had ‘‘normal’’ ECGs before the test and had ‘‘sinus
tachycardia’’ interpreted immediately after their exposure,
and there was one subject that had ‘‘possible right heart
strain’’ interpreted on both the pre and post-exposure
ECG. All other ECGs were interpreted as normal.
Table 1. Subject Baseline Data
Median Range IQR
Age (years) 31.5 21–44 25–39
% Body fat 22.1 12.6–31.5 20.7–26.3
BMI 29.4 17.6–34.3 26.5–30.0
Heart rate (bpm) 89 76–99 87–91
Heart rate by echo (bpm) 86 71–105 85–87
Systolic blood pressure (mm Hg) 136 122–155 135–137
Diastolic blood pressure (mm Hg) 78 74–85 76–80
Creatine kinase (ng/mL) 84.5 40–811 63–210
Potassium (mmol/L) 3.65 3.5–4.1 3.6–3.9
BMI = body mass index (calculated as kg/m2
); IQR = interquartile
range.
430 J. D. Ho et al.
Unfortunately, there was variable compliance with the
pre andpost-exposure exercise/exertionrestriction request.
We contacted all subjects with CK values > 500 ng/mL. No
subjects had clinical complaints of rhabdomyolysis (e.g.,
dark urine, fever, ﬂank pain, unusual muscle pain or weakness).
All subjects with CK values > 500 ng/mL admitted
to disregarding the exercise restriction and engaged in
strenuous muscular exertion (i.e., intentional workouts at
a gym) within 24 h of attending the training course.
DISCUSSION
Cardiac
We did not ﬁnd a demonstrably harmful cardiac effect in
our study. Studies by several authors have shown no
changes in surface ECG or serum troponin, a measure
of heart muscle damage, after an exposure to a TASER
X26 CEW, from 1 to 15 s, and with and without exertion
(4,6,8À10,14,15). In addition, human studies involving
chest exposures with an X26 CEW have not demonstrated
direct cardiac capture, even with prolonged or
repetitive exposures, in rested and exhausted volunteers
(7,12,16À19).
There has been a single report of a cardiac capture
event in a human with an experimental CEW that was
not released for ﬁeld use (19). In that case, exposure
was to the chest immediately adjacent to the sternum
and the dart tip to heart distance was 16.7 mm (with a
slight pectus excavatum of the chest). The subject had a
real-time echocardiographically viewed capture rate of
240 beats/min but had no clinical complaint, had a normal
post-exposure ECG, and had a negative troponin at 24 h.
Ideker and Dosdall estimated that the current from a
TASER X26 CEW was 2.63 standard deviations less
than the current needed to stimulate an ectopic beat,
and that only 0.4% of individuals would have a paced
beat from a TASER X26 pulse at the most sensitive position
on the chest (20). We did not demonstrate any evidence
of cardiac capture in this study, although our
targeting was below the chest and was consistent with
the preferred target zone as recommended by the CEW
manufacturer. This target zone is low center mass and is
consistent with the recommended target zones for other
projectile intermediate weapons, such as ﬁred beanbag
or baton rounds. It is expected that shots within this target
zone would have a near zero chance of inducing a cardiac
effect.
Respiratory
Our study showed an increase in minute ventilation during
the X2 CEW exposure. This was achieved primarily
through a signiﬁcant increase in respiratory rate. We
believe that this phenomenon is likely due to the breathing
pattern exhibited by people under acute pain or stress
Table 2. Subject Post-CEW Exposure Data
Median Range IQR
Cardiac echo during exposure
(bpm)
120 107–136 115–125
Cardiac echo 10 min post
exposure (bpm)
93 73–120 81–105
Heart rate post exposure (bpm) 99.5 73–113 87–110
Systolic BP post exposure
(mm Hg)
135 116–166 133–143
Diastolic BP post exposure
(mm Hg)
79 60–106 73–82
CK post exposure (ng/mL) 84.5 40–822 63–210
CK 24 h post exposure (ng/mL) 84 40–800 77–199
Potassium post exposure
(mmol/L)
3.9 3.4–4.7 3.5–4.1
Potassium 24 h post exposure
(mmol/L)
3.75 3.4–4.7 3.5–3.8
BP = blood pressure; CK = creatine kinase; IQR = interquartile
range.
Figure 3. Median pH over time.
Figure 4. Median lactate (mg/dL) over time.
New Generation CEW 431
situations. This ﬁnding is also consistent with the results
from prior X26 CEW respiratory studies. In those studies,
no clinically important effects on respiration were found
with single device discharges, including durations up to
30 s continuously (4,6,18,21). There was no evidence of
induced apnea in our data.
Venous pH
The pH is important in the discussion of CEW effect on
physiology. CEWs are often used on persons in acidotic
states. This acidotic state might be due to stimulant intoxication,
physical resistance to LEOs, excited delirium
syndrome, or a combination of all three. The discussion
of acidÀbase balance is important because there is literature
to support that when persons die suddenly and unexpectedly
while in custody, they are often profoundly
acidotic (22). Because CEWs are often used to control
persons in these situations, it is important to know
whether or not new technology CEWs could signiﬁcantly
contribute to this condition.
In a study by Vilke et al. using 5-s exposures from the
TASER X26, the pH dropped from a mean baseline of
7.45 to 7.42 at 1 min and returned to 7.43 at 10 min
(23). Lactate rose from a baseline of 1.4 mg/dL to
2.8 mg/dL at 1 min and 2.4 mg/dL at 10 min. A study
by Ho et al., examined the effect of a 15-s TASER X26
discharge on already ‘‘exhausted’’ and acidotic adults,
and found that the discharge did not signiﬁcantly affect
pH or lactate. Median pH after the exertion regimen but
before the exposure was 7.23. After the exposure, the median
was 7.22. Median lactate after the exertion regimen
was 8.39 mg/dL, rising to 9.85 mg/dL after the exposure
(24). In a follow-up study by Ho et al., a 15-s TASER X26
exposure was compared with an exertion regimen, and
then to an exertion regimen followed by a 15-s exposure,
and an exertion regimen followed by an additional 1 min
of exertion (11). Exertion alone in this study produced
profound pH drops at 2 min post-exertion. The study
found no statistical difference between the TASER exposure
and the additional brief exertion in the groups that
had the initial exertion regimen. In another study with
10-s exposures, the pH dropped from 7.4 to 7.35 at
4 min, and the lactate rose from 1.3 mg/dL to 4.57 mg/
dL at 6 min (21). In a study of 30-s durations, the pH dropped
from 7.36 to 7.27, with lactate rising from 1.46 mg/
dL to 5.63 mg/dL (18). In a use of force comparison study,
the median pH changed from 7.36 to 7.01 within 2 min
after a 45-s heavy-bag resistance drill (punch and kick
at maximal effort) (25). A 10-s TASER X26 exposure
in comparison resulted in a median pH drop that was
much less signiﬁcant, from 7.37 to 7.29. This comparative
study found that other arrest-related scenarios
(ﬁghting and ﬂeeing) and typical uses of force are likely
to produce more profound deleterious metabolic effects
in a human than a CEW. The pH results in our current
study with 10-s CEW exposures yielded results that
were similar to this prior pH work described.
Electrolytes
Earlier CEW human studies have not demonstrated clinically
important effects on electrolytes such as potassium
(4,6). Our current study results are consistent with these
ﬁndings for older-generation CEW technology. This is
important to the discussion about sudden custodial deaths
in which a CEW has been used temporally proximate to
that death, often after a signiﬁcant exertional struggle
with LEOs has occurred. It has been theorized that a
mechanism of acute intracellular potassium release under
circumstances of extreme exertion followed by acute
hypokalemia during recovery can pose a risk of sudden
cardiac dysrhythmia due to sudden shifts in plasma potassium
(26À28). Our study does not support a CEW
contributing to this theory.
CK
Because CEWs are designed to stimulate skeletal muscle
tissue, there is interest in knowing if they can induce clinically
signiﬁcant rhabdomyolysis. Rhabdomyolysis is
clinically measured by CK and is important because
massive rises in CK can lead acutely to hyperkalemia
and renal failure (29).
In the seminal human CEW work by Ho et al., the
baseline median CK was 185.1 U/L (range of 71À479
U/L). Median CK at 24 h after a 5-s X26 exposure was
242.3 U/L (range 52À909 U/L) (4). In a study by Dawes
et al. examining the effects of two to three simultaneous
5-s discharges, the CK rises were higher, with a mean
Table 3. Subject Respiratory Data
Pre Exposure During Exposure Post Exposure
Median Range Median Range Median Range
Respiratory rate (breaths/min) 14.5 6–24 29 8–58 20 8–22
Tidal volume (L) 0.96 0.74–1.68 0.68 0.44–1.71 1.25 1.21–1.66
Minute ventilation (L/min) 14.2 10.6–19.8 21.6 13.5–40.3 21.6 13.9–29.4
432 J. D. Ho et al.
CK at 24 h of 508 U/L for two simultaneous discharges
and 1016 U/L for three simultaneous discharges (17). In
a study by Dawes et al. with 30-s durations, median CK
at baseline was 140 U/L, rising to only 187 U/L at 24 h
(18). A meta-analysis by Dawes et al. showed a correlation
between number of contact points (devices or circuits)
and rise in CK, but no such relationship for
duration (13). Our study on the newer-generation CEW
indicates that the expected effect with regard to CK is
similar to what has been found with previous technology.
Overall
Our study demonstrated that the physiologic effects of the
new-generation TASER X2 are similar to the effects of
previous-generation devices. Familiarity with effects
from CEW exposures is important for the clinician. Laboratory
values, vital signs, or clinical ﬁndings outside of
the expected range should prompt the clinician to look for
causes other than the CEW (such as intoxication, metabolic
abnormality, etc.) The X2 CEW shows a reasonable
safety proﬁle with the duration of exposure tested. This is
especially true when considering the context in which a
CEW is used in society. The risk-to-beneﬁt ratio balances
society’s need for controlling violent individuals from
further harmful behavior with using a reasonable amount
of force to do so. Although nothing can guarantee a zerorisk
potential when violent behavior occurs and is met
with use of reasonable force, the X2 CEW appears to
have an acceptable physiologic safety proﬁle if used per
the manufacturer’s recommendations. This assessment
is supported by epidemiologic literature that indicates a
decrease in injuries to LEOs and suspects and a low suspect
injury rate with ﬁeld use (30,31).
Limitations
Our study is limited by the relatively small number of
subjects studied. The number studied was limited by
the amount of time that it took to complete the entire evaluation
of each volunteer. We believe, however, that our
ﬁndings in these volunteers mimic the ﬁndings of earlier
CEW human research.
Our study population might also be somewhat limiting
because they were relatively healthy persons and not under
the inﬂuence of illicit drugs or in the throes of a
mental illness crisis, as many persons are that interact
with LEOs and subsequently require a CEW application
for behavior control. However, it was our goal to determine
the basic, comprehensive effect of an X2 CEW on
human physiology and we believe we accomplished that.
We acknowledge that we also had some noncompliance
in our volunteers with the ‘‘no exertion/no exercise’’
instruction during the post-exposure period before their
24-h evaluation. We believe, however, that this would
have led to artiﬁcially worse results in biomarkers such
as CK or pH. If anything, this would cause us to be overly
conservative in stating our conclusions.
CONCLUSIONS
In our study, there was no evidence of dangerous physiology
found with any of our measured parameters. We
conclude that the human physiologic effects of the X2
CEW are similar to previously studied older-generation
CEWs. We recommend further study of emerging CEW
technology to validate these results.
Acknowledgments—The study authors would like to acknowledge
Mr. Andrew Hinz and Mr. Matt Carver for their assistance
on this project.
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434 J. D. Ho et al.
ARTICLE SUMMARY
1. Why is this topic important?
Human physiology effects have been studied for older
generation CEW technology. As older generation CEWs
are replaced with newer CEW technology, it is important
for medical professionals to know whether the new generation
CEWs with different circuit speciﬁcations produce
human physiologic effects that are different.
2. What does this study attempt to show?
This study is the ﬁrst to examine the human physiologic
effects of new generation CEWs with newer technology.
3. What are the key ﬁndings?
A 10-second frontal exposure with a new generation
CEW in a manufacturer-recommended target zone did
not demonstrate measurable harmful physiologic changes
in human subjects. This is consistent with results from
prior studies of older technology CEWs.
4. How is patient care impacted?
The ﬁndings from this study should guide clinicians
caring for patients after a CEW exposure. The study results
support the recommendationsin prior literature that
provides guidelines for post-CEW exposure evaluations
and treatment. (Vilke GM, Bozeman WP and TC Chan.
Emergency department evaluation after conducted energy
weapon use: review of the literature for the clinician.
J Emerg Med 2011;40:598-604.)
New Generation CEW 435