Forensic Sci Med Pathol (2015) 11:53-64 DOI 10.1007/sl2024-014-9640-x
REVIEW
TASER conducted electrical weapons: misconceptions in the scientific/medical and other literature
James R. Jauchem
Accepted: 24 November 2014/Published online: 31 December 2014 © Springer Science+Business Media New York 2014
Abstract TASER® conducted electrical weapons (CEWs) have become an important law-enforcement tool. Controversial questions are often raised during discussion of some incidents in which the devices have been used. The main purpose of this paper is to point out some misconceptions about CEWs that have been published in the scientific/medical and other literature. This is a narrative review, using a multidisciplinary approach of analyzing reports from scientific/medical and other literature sources. In previous reports, durations of incapacitating effects and possible associations of CEWs with deaths-in-custody have often been overstated or exaggerated. Comparisons of CEW effects with "electrocution" are misleading. Clarification of these misconceptions may be important during policymaker decisions, practitioner operations, expert witness testimonies, and court proceedings. Despite misconceptions in the literature, CEWs can still be a valuable tool for law enforcement activities. Scientists, medical professionals, legal advisors, and investigators of police tactics should be aware of these misconceptions.
Keywords   TASER • Conducted electrical weapon • Conducted energy weapon • Electronic control device • Electro-muscular incapacitation • Non-lethal
Introduction
TASER® conducted electrical weapons (CEWs) have become an important non-lethal law-enforcement tool ["TASER" is a registered trademark of TASER International, Inc.
J. R. Jauchem (El)
Forensic Pathophysiology, LLC, 999 E Basse Rd Suite 180,
San Antonio, TX 78209, USA
e-mail: jrj @ forensicpathophysiology.com
(Scottsdale, AZ)]. The controversial nature of this topic has been reflected in the discussion of some incidents in which the devices have been used. Some misconceptions may result in a lack of public confidence in police and a lack of perceived legitimacy of using CEWs and other non-lethal weapons.
The purposes of this paper are (a) to review possible misconceptions about CEWs that have been published in the scientific/medical and other literature, and (b) to present the current and other authors' perspectives regarding these issues. Details regarding some of these misconceptions may be important during policymaker decisions, practitioner operations, expert witness testimonies, and court proceedings.
This is a narrative review, using a multidisciplinary approach of analyzing reports from recent scientific/medical and other literature sources (including legal, sociological, police-science, news-media, and popular literature). Some of the topics covered in this review are in the form of questions that may be asked of researchers and policymakers. Policies regarding rules of engagement and risk/ benefit analyses are beyond the scope of this review.
Historical notes
Wolf and De Angelis [1] stated that "rapid proliferation of" CEWs "became possible only after" (a) "an intensive corporate search for new ways of profiting from heightened consumer fear of crime" and (b) "an institutional incentive for law enforcement to adopt less visibly violent control technologies". In addition to these two points, as CEWs became more effective they were then more widely adopted. Early models of CEWs were essentially ineffective. The 1991 "Rodney King incident" is one recognized failure of these earlier versions [2]. In one experimental study of a conscious animal model, the "Advanced TASER M26"
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CEW was the only device (out of five models that were evaluated) to effectively cause incapacitation [3]. A number of newer models have become available in recent years (including, most notably, the "TASER X26" device). Emerging new technology, sometimes known as "Smart Weapons" by TASER International, include the "X26P" and "X2" CEW models, which will replace the earlier devices. Even though TASER International has been accused of "aggressive marketing/lobbying... for the acceptance of its products" [4], the devices have been regarded as useful for law enforcement by police departments in many countries.
General concepts regarding CEWs and "electricity"
Although CEW technology has been written about by numerous authors and perceived authoritative bodies in the scientific literature, many have erroneously portrayed how these weapons work and what they are (and more importantly, what they are not) capable of. In some cases, an association of the concept of "electricity" with CEWs may result in increased apprehension and bias against the devices [5]. Hehir [6] stated that the devices "incapacitate subjects by passing 50,000 volts of electricity into the body...". As Williams [7] noted, however, although the main capacitor of the X26 device has a peak open circuit with 50,000 V, only 1,200 V may actually be delivered to the body (in comparison, a relatively strong static electric shock may exceed 30,000 V [7]).
Milne [8] claimed that TASER CEWs produce relatively "high current". In fact, very little electric current would be delivered via a CEW to a subject. One author speculated that in one particular case of CEW use, "only one prong [probe] attached, so that 50,000 V entered" the subject's body, "but never left..." [9]. The speculation that such voltage would be deposited into the body and "never leave" is erroneous. If one probe does not make contact (whether directly to the body or indirectly via some other contact surface), a circuit is not completed. A TASER X26 CEW has a peak electrical current of only 3 A if a circuit is completed, while a strong static shock may have a peak electrical current of 30 A [10].
The 2013 release of the International Classification of Diseases, Tenth Revision, Clinical Modification [11] included a code of "Electrocution from electroshock gun (taser)". The use of such terminology may result in confusion regarding effects of CEWs. The principal cause of death during electrocution is "ventricular fibrillation caused by a direct effect of the electric current" [12]. The unfounded assumption of "electrocution" in deaths after use of a CEW has been discussed previously (e.g. [13]). Statements referring to CEWs as causing "uncontrollable
spasm of the heart muscles" [14] are also misleading. There is a lack of evidence for such a direct effect.
Lee et al. [15], using a mathematical model, suggested that "safety" during CEW exposure was directly related to current density near the dart closest to the heart. The degree of overall muscle contractions within the body, however, may be more important than direct effects on the heart, since such contractions may result in potentially hazardous physiological sequelae such as primary metabolic acidosis [16]. Such effects, however, might only occur during repeated or long-duration exposures to CEWs.
Equating effects of CEWs with accidents involving domestic power sources (e.g. [17]), and with electroconvulsive therapy (e.g. [18]), is misleading since properties of each type of exposure are vastly different. Kroll [19] graphically summed up the differences between power sources and CEWs.
Incapacitating effects of CEWs: How long do they last?
Humans must perform continuous muscle activity (especially in the legs) to maintain an upright standing posture. For humans or animals to maintain a fixed posture to oppose gravity, agonistic-antagonistic muscle coupling is required for a stable contraction of muscles to occur [20]. A certain degree of ankle torque is required to counter what may be referred to as "gravity toppling torque" [21]. Ho et al. [22] described the primary effects of CEWs related to incapacitation. In some cases, there may be essentially "board-like rigidity" [23]. Behavioral responses to pain may also play a role.
There have been misstatements regarding incapacitating effects of CEWs. One group of authors [24] indicated that a 3-5 s exposure to a "stun weapon" (seemingly including devices manufactured by TASER International) would commonly leave a subject "incapacitated, left dazed and weak for at least five, perhaps, fifteen minutes". Rejali [25] stated the "technology incapacitates the whole body for several minutes". Layman [26] suggested an individual would be "rendered...physically incapacitated... for up to 10 min". In contrast to these assertions, there have been no confirmed reports of such long-lasting effects. In fact, Criscione and Kroll [27] reported that reaction times were normal in subjects immediately (within ~ 1 s) after cessation of a 5 s exposure from a TASER X26 CEW.
To imply that CEW applications regularly result in "falling while unconscious" [14] will lead to further confusion. Although some cases of "loss of consciousness" have been presumed to be due to CEWs [28], head injuries due to falling onto a hard surface may be more likely than any direct effects of a CEW exposure. Nonetheless, there have been cases reported of CEW shots involving the
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cranium with loss of consciousness probably unrelated to impact with the ground [29-31]. A seizure, similar to that induced by electroconvulsive therapy, may be provoked directly by such a CEW exposure [31].
White et al. [32] reported statistically significant decreases in the ability to perform on several tests of cognitive functioning in police recruits after exposure to a CEW. Dawes et al. [33], however, found that other arrest-related stressors during use-of-force scenarios resulted in a similar decline in neurocognitive performance. The result was transient and performance returned to baseline within 1 h post-scenario.
Sussman [34] claimed that CEWs are "even potentially equipping the subject with 'superhuman' strength". This claim was erroneously linked to a warning [35] that: (a) did not include any such causal relationship, and (b) simply included discussion of excited delirium (a syndrome that may occur independently of CEW exposures and may include superhuman strength as one of its characteristics). In another article, it was noted that, during CEW exposures, "the mental state may change and even develop to an excited delirium" [36]. Such changes, however, could be independent of any effects of CEW applications.
Feeney et al. [37] stated that "potential complications" of exposure to the TASER X26 CEW included "hyperthermia". The articles cited for this assertion, however (e.g. [38]), again simply included discussion of excited delirium (of which hyperthermia may be one characteristic). Hyperthermia would not be caused by limited CEW exposures [39, 40]. Dawes et al. [41] responded to Feeney et al. and disputed any causal relationship between CEW exposure and an agitated delirious state. Eliades et al. [42] stated that thyroid storm (a disorder characterized by an exaggeration of the natural physiologic response to an overactive thyroid gland) was "induced by electrical shock delivered by a Taser gun". There was, however, no evidence of a causal relationship with the CEW exposure.
Rappert [43] seemed to suggest that CEWs were "designed to cause as much pain as feasible". In addition, in a medical newsletter it was reported that CEWs "work by causing extreme pain" [44]. Rather, most CEWs (other than in "drive stun" mode) have been designed to incapacitate via loss of muscle control.
Severity of injuries associated with CEW usage compared with other non-lethal force
For a full assessment of CEW hazards, one must compare them with effects of other non-lethal weapons. Kirchmaier [45] stated that a military working dog's "injurious effects are relatively minor compared to those of other available non-lethal weapons like the M26 taser...". This idea, however,
seems incorrect on the basis of data collected by other investigators, who noted a high potential for serious injury due to canines used in law enforcement [46] (in some police departments, application of a CEW, and deployment of a canine are considered to be at the same level of force [46]). Alpert et al. [47], referring to a survey of non-lethal weapon use, reported "the use of a canine posed, by far, the greatest injury risk to suspects, increasing injury odds by almost 40 fold". With the commonly used "bite-and-hold" technique, injury is practically inevitable [48]. Although there may be differences between rules of engagement for military versus civilian law-enforcement use of canines, it would seem that effects of bites would be similar in both situations. Trained law-enforcement dogs can exert tremendous bite forces (about ten times what would be expected from untrained German shepherds), with a high number of fractures [48].
Giil et al. [49] noted that psychological effects of injuries from dog bites could be permanent. Injuries from canines may be evaluated with "a somewhat higher suspicion for significant injury" [50]. Sloggett and Ches-terman [51] suggested that use of a CEW is "often the less injurious solution" when compared with alternatives such as batons, police dogs, or conventional firearms.
Is CEW usage causally associated with deaths?
Reports in the news media are often focused on possible causation rather than simply a non-causative association or correlation of CEW events with in-custody deaths. Potential confounding factors involved in cases of deaths that occur at approximately the same time as CEW usage have been summarized previously [52-54]. Despite these factors, causality with the CEW is often assumed, as in the following statement: "...a suspect who was Tasered by law enforcement has died as a result" [55]. Other authors have argued, "...in some cases" of CEW applications, "...even death can result" [56] and "stun guns are capable of causing death" [57]. Even with a temporal relationship between CEW exposures and deaths, however, one cannot automatically presume a causal association. In addition, whether any particular factor is a contributory cause of death versus an irrelevant factor [58] would be dependent on details of the situation. Laima et al. [59] suggested that CEWs had a "dangerous effect on the heart muscle that caused fatal arrhythmias" but concluded that "overt cardiac pathology" and "stress" would be more important in cases of deaths-in-custody.
Lee et al. [60] studied CEW deployment among law-enforcement departments. The authors concluded that usage was associated with a significant increase in deaths-in-custody in the early deployment period. Exposures to CEWs, however, were not verified. There was a low
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response rate from agencies queried and "every single one of the top ten cities refused to give" data to the investigators [61]. Kaminski [62] also criticized the study, stating that the authors' "speculation is implausible on its face".
Casey-Maslen [63] stated, "these weapons have been marketed as 'non-lethal', 'less lethal', 'sub-lethal',...although the use of some of these devices has already resulted in significant numbers of deaths and serious injuries". Significant numbers, however, generally have not been directly linked solely to use of the devices. In an example of one study [64], deaths reported after CEW applications occurred overwhelmingly in subjects who exhibited (a) pre-existing cardiovascular disease, (b) an agitated state and long struggles with police officers, or (c) illicit stimulant use. In death-in-custody cases, an assumption that "it was the taser that pushed him off the cliff" [65] cannot be proven. Barua and Vaughn [66] said that CEWs "have caused death when used on individuals with existing or potential health problems". A causal effect directly linked to the CEW device itself, however, was not proven. White and Ready [67] noted that, even though subjects exposed to CEWs were "disproportionately from a vulnerable population that many argue are at higher risk for suffering serious physiological side effects," there was "no evidence of serious injury or death..." (other more recent studies that are similar have been cited previously [54]).
Oriola et al. [68] cited a case in which a subject supposedly "had his heart weakened" in an initial incident that included CEW application and subsequently died after another law-enforcement episode with a CEW being used. The first incident, however, occurred two years prior to the fatal incident. No mechanism for such "weakening of the heart" is apparent.
Langevin [69] claimed that long QT syndrome (a disorder characterized by sudden rapid heartbeats) could be the sole reason for in-custody deaths due to CEW exposures. There is no basis for such a conclusion. In fact, long QT syndrome has been reported during excited delirium (which may occur independently from CEW applications) [70]. The syndrome is often considered to be inherited and can be diagnosed via genetic testing [71].
In one business-news item, the headline was, "Tasers can kill, says American Heart Association" [72]. In fact, results of the cited study [28, 73] simply appeared in a journal published by the association. The entire organization did not review and accept the article. In the article, eight cases of purported atrial fibrillation, myocardial infarction, and death were listed as being due to CEW exposures. Kroll et al. [74], however, noted that potential confounding factors (not related to CEWs) were not accounted for. Other drawbacks to the article have been mentioned previously [54]. For example, it is likely that one of the deaths was due to strenuous exertion combined
with the sickle cell trait (without any contribution of CEW applications). Graham [75] also supported this idea.
Omalu [76] seemed to suggest that CEWs themselves could cause death due to "nervous system pathologies such as... status epilepticus... repetitive concussive brain injury, etc.". In contrast, such pathologies could be confounding factors during incidents involving use of the weapons (rather than caused by the weapons themselves).
Langsjoen et al. [77] presented a case with use of a CEW purportedly associated with cardiac arrest and anoxic brain injury. Rather than a causal association with the CEW, the syndrome of excited delirium must be considered. In other literature, on the basis of the small number of cases in which a temporal relationship between CEW applications and fatal cardiac arrhythmias was found, a clear causal link can neither be confirmed nor excluded [78]. Kenny and Bovbjerg [79] noted, since there is no appropriate comparison group for epidemiological studies, it is not possible to determine "even whether there are risk factors" for death among those exposed to CEWs.
Why use the term "non-lethal" to refer to CEWs?
The terms "non-lethal weapons" and "less-lethal weapons" (which include CEWs) have been considered by some authors to be "rather euphemistic" [80]. Wright [81] was concerned about a "vexed issue of when is a non-lethal weapon a non-lethal weapon if it isn't really non-lethal". Wright [81] also commented, "...since a submachine gun wounds statistically more often than it kills—is it therefore a non-lethal weapon?". Upton [82] suggested, "Non-lethal implies that TASERs are not capable of lethality...". These statements and related questions can be addressed by referring to Burrows and Cooper [83], who explained that such devices are "weapons, devices or tactics designed and intended" to operate "without substantial risk of serious or permanent injury or death" (italics for emphasis are mine). The US Department of Defense [84] noted, more recently, that non-lethal weapons "are intended to... minimize risk of fatalities, permanent injuries...however, they shall not be required to have a zero probability of producing these effects". Upton [82] was correct to warn that, if not properly interpreted, use of the term "non-lethal" may result in police officers applying "unnecessary, repeated deployment of TASERs on a suspect". Such deployments should be avoided. It should be noted, however, that other types of forces intended to be non-lethal could result in a lethal outcome (e.g. repeated heavy striking with a flashlight or baton) (also see the section titled "What would constitute excessive use of a CEW?" below).
TASER International [85] has stated "CEW exposure causes certain effects, including physiologic and metabolic
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changes" and, "in some individuals, the risk of death or serious injury may increase with cumulative CEW exposure". Such effects, however, would not be expected during short-duration exposures.
Is there unusual bias among the experts who study TASER CEWs?
Controversy regarding different funding sources
Azadani et al. [86] compared funding sources and author affiliations with conclusions regarding whether TASER CEWs were a) "harmful", b) "probably harmful", c) "unlikely harmful", and d) "not harmful" (as identified by "two independent reviewers"). Whether an analysis of any given study would result in such specific conclusions, however, is difficult to determine and open to interpretation [87]. In addition, it would be problematic to use such simple classifications, without considering different durations of exposure and other aspects of methodology [88]. Although a table listing details of classification of each study might be cumbersome (as argued by Azadani et al. [89]), a reader would not be able to reach any reasonable conclusions without such details.
In some cases, once an investigator has received supported from TASER International, one may mistakenly presume that the company also supports any future work by that investigator even if the work is independent [90]. I myself have been guilty of this misconception [53].
If experts arrive at different conclusions, is there unwarranted bias?
Expert witnesses often have differing opinions regarding details of cases related to CEW usage. Some would question how such opinions could be different, and would assume that unwarranted "bias" must be present. Beran [91] argued against this idea and noted, "each expert will have an opinion and often that expert will be known to hold a particular view within the context of comparable scenarios... so long as that expert sincerely ascribes to the view for valid reasons, then it is inappropriate to label that expert a 'hired gun'". Since an expert's opinion regarding cause of death will be based partly on "experiences... and just plain personal intuition" [92], it should not be surprising that differing opinions may be presented during courtroom testimony. In addition, the law profession realizes that "scientific conclusions are subject to perpetual revision" [93].
Some bias relating to effects of CEWs "could be the result of the framing or shaping of the actual research questions, which may be more likely to lead to certain conclusions even if the integrity of the research is sound"
[94]. In many cases, a court will decide whether an expert's testimony is based on scientific knowledge [95]. In addition, a change of opinion by an expert may be entirely logical as scientific theories evolve [96]. Hope et al. [97] noted that, in cases of "innocent contamination" inadvertent false consistency can lead to allegations of "willful collusion or a cover-up" when none has intentionally taken place.
Cases of oversimplification and exaggeration
Oversimplification of the title of a journal article
Dawes and Ho [98] pointed out a misleading title in a medical article ("Myocardial infarction after TASER exposure"), in a case that included a physical altercation and use of an over-the-counter weightlifting supplement [99]. Two of the authors [100] responded that the title was "factually correct" even if misleading. This is just one example of how titles (often the only part of a scientific paper that some readers will see) are sometimes oversimplified.
Far-reaching conclusions based on incomplete information
It has been assumed by some that results of one CEW study (performed by me and my colleagues [101]) were "leaked to CBS News, fueling controversy about levels of acidosis and troponin T..." [102] (troponin T is a heart-muscle injury marker). Results of the study, however, were not "leaked," but rather were publicly released before any news reports. In a related news story on CBS News [103], a cardiologist stated, "initial impression would be that there'd been some heart muscle damage, threat of a heart attack". More recently, Hibberd [104] also claimed CEW exposures, as performed in the study, caused heart damage. After CEW exposures in our animal-model study, however, there were no statistically significant differences in serum cardiac troponin T from baseline. As explained in the full paper relating to the research [105], since the detection limit of the troponin assay had not been determined, values listed as "zero" at baseline may simply have been below the detection limit (with recent analytical improvements, lower levels of cardiac troponin can be measured more accurately [106]). Even if the troponin concentrations in our study had been statistically significantly increased after CEW exposures, such changes would not necessarily be clinically significant. Muscle contractions during physical exercise can result in increased cardiac troponin in the blood [107]. The cause for the increase is not known.
Wolf and De Angelis [108] contended that college students and "non-resisting political protestors" are more
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"vulnerable" to the effects of CEWs than the general population. There is no basis for this assertion. A case report of a 15-year-old combative male who was "subdued via taser" and exhibited a "pattern of deficits observed in children who have experienced an anoxic event secondary to cardiac arrest" was presented as illustrating particular vulnerability of adolescents [109]. There is also no basis for this assertion. Gardner et al. [110] reported no significant injuries in 100 consecutive CEW uses against suspects who ranged from 13 to 17 years in age.
Gross et al. [Ill] presented a case report of an incident in which a CEW was deployed against a 51-year-old 350-pound man. The authors stated "...it seems clear that the use of the TASER played a significant role in his early rhabdomyolysis and renal failure". The patient exhibited markedly elevated creatine phosphokinase (CPK) levels (which can be associated with skeletal muscle damage). It was assumed that the CPK levels "can only be explained in the context of his exposure to the shocks he received from being TASERed" [111]. The subject, however, was so combative that he was administered haloperidol and lora-zepam and was placed in four-point restraints. The high levels of CPK seen in the case report were more consistent with cases of excited delirium (e.g. [112]) than with CEW exposures.
Bell et al. [113] presented a case report of a 32-year-old male with a cerebrovascular accident after head exposure to a TASER CEW during an altercation with police. The case was classified as an "isolated electrical neurovascular injury," in part due to the temporal relationship with the CEW application. The authors cited several previous reports of neurological injuries associated with electrical exposures. Any relevance of those cases to CEW exposures, however, is not obvious. For example, one case that was cited [114] was related to use of a high-voltage arc welder. Such equipment operates from 220 to 440 volt alternating current [115], a situation quite different from CEWs. In addition, Bell et al. [113] also suggested that "thermal injury, caused by large quantities of heat produced by the flowing current" might have been involved in their case report. The strength of current passing through the body is a crucial factor in electrical injuries [116]. Such a current, however, does not flow during CEW exposures. A cerebrovascular accident coincident with CEW application may be more likely due to head trauma (which could occur during falling to the ground) than due to any electrical properties of the CEW itself.
Ghaheri et al. [117] suggested that cases of Raynaud's syndrome in two "users" and two "sellers" of CEWs might have been associated with vibration from the CEWs. Evidence for such an association is lacking. Dawes and Brave [118] noted that only minimal vibration would be perceived during CEW applications.
What would constitute excessive use of a CEW?
Are some uses of CEWs automatically "excessive"?
Upton [82] analyzed 113 cases of "TASER use of force" (as reported in news articles) and identified 19 of those cases as resulting in death (notwithstanding the lack of a causal association). The author suggested that the remaining cases "involved use of TASER force that may be in question for police misconduct". Another author reported that all deaths in Canada that occurred during incidents of CEW applications were "due to their inappropriate, excessive... use" [119]. Although, in some cases, use of a CEW may truly be excessive [120], not all uses would be considered disproportionate. "Determining whether the force used by police is excessive is a fact-laden inquiry" [121] that is a difficult task. Police-science literature related to excessive use of force may not even specifically include cases of justified force [122] or "avoidance of force" [123] for comparison. The ambiguous and nebulous term "appropriate force" "is often defined in hindsight by the courts" [123].
The acceptability, in the public's view, of even equipping the police with CEWs will be dependent on the context in which the weapons are deployed [124, 125]. Use of the device to protect an officer from being assaulted may result in fewer objections from the public than use as a "riot-control weapon" to suppress dissention within a group of protestors.
Robinson [126] hypothesized that increasing efficiency of non-lethal weapons, when combined with legal proportionality requirements, may lead to an increase use of such weapons "in situations where no force would be used today". Since a CEW is relatively easy to deploy, some may argue that police officers are going to be tempted to use it "just to show who is boss" [127]. Bourne [128] suggested that acceptance of CEWs will lower the threshold for use of force. In contrast, in one study of a metropolitan police department, officers equipped with CEWs used the weapons only when encountering physical resistance (and not in response to simply passive resistance from subjects) [129]. Taylor et al. [130] explained how, despite an increase in the general availability of CEWs to some officers, the actual use of CEWs stayed relatively constant.
The John Howard Society of Alberta [131] considered "the use of tasers by police forces and guards in penal institutions" to be "officially sanctioned excessive use of force". The authors seemed to presume that all use of CEWs in a prison setting is excessive. In particular specific prison settings, however, CEWs may be more useful and effective than large tactical teams using shields and batons [132].
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If an individual is asked to describe use-of-force incidents in terms of dichotomous variables (e.g. "justified" versus "unjustified," "legal" versus "illegal," "excessive" versus "not excessive"), the person must choose between one extreme position and another [133]. As Flanagan and Vaughn [134] noted, however, the term "excessive use of force" includes a continuum of interactions between police and the public (a full discussion of the placement of CEWs on the use-of-force continuum is beyond the scope of this review). Simply because a death occurred after use of a CEW, unreasonable or excessive force should not be inferred [135].
Police departments have the ability to implement a variety of improvements in their operations to decrease complaints of excessive force, including specifically for CEW usage. Policies need to be clear regarding what is required of law-enforcement personnel in different situations [136]. In general, the use of CEWs is not usually associated with a greater number of liability claims of excessive force against police departments, at least in the US [137].
Is all use of CEWs "torture"?
CEWs have been referred to as a "refinement" of "electro-torture" [138] and as having origins "in Argentina in the early twentieth century" for use in "torture and interrogation of human subjects by police" [139]. These beliefs, however, are in contrast with the original intent of the development of the weapons as a non-lethal alternative to other uses of force. Langevin [63] indicated that any use of a CEW is automatically in breach of a treaty of the United Nations Committee against Torture. The committee, however, did not intend for the term "torture" to be applied to lawful actions [140]. An act of torture only occurs when "severe pain or suffering... is intentionally inflicted on a person for such purposes as obtaining... information or a confession, punishing... or intimidating or coercing..." [140]. Some uses of CEWs could be inappropriate (such as to simply obtain compliance in some situations, e.g. [141] or "repeated drive stuns without justification" [142]). Although psychiatric sequelae after CEW exposures [143] may be similar in some respects to effects of torture (including post-traumatic stress disorder [144]), use of the devices during most law-enforcement activities would not fit within a description of "torture."
Cusac [145] suggested that CEWs are used more often for "torture and abuse rather than as a substitute for lethal force". Empirical data for such a claim are lacking. Actually, any object can be used as a torture device. Haberland [146] noted, considering the wide variety of practices that may be used for torture, "it seems slightly unfair to simply brand [non-lethal weapons] as potential torture instruments".
Wright [81] complained, "no one calls these products torture technologies. Instead... Orwellian euphemisms are used, such as e.g. electro muscular disruption technology". Such a description of the technology, however, is more reasonable than use of the term "torture."
Should CEWs be used only as an alternative to deadly force?
Some have suggested that CEWs are designed for "replacement of firearms" [147]. A CEW, however, is usually not intended to "replace" a firearm [148]. In one police department, although the chief stated that CEW use was, in essence, "an alternative to deadly force," the department's general orders included a statement that CEWs were "not a substitute for lethal force" [149]. Ijames [150] explained how describing a CEW as an alternative to deadly force is inaccurate when law-enforcement officers face impending deadly jeopardy. Instead, a CEW is simply one type of non-lethal weapon; there should be no intent to use it in situations where deadly force is necessary.
Individual police officers have, at times, been justified (ethically and legally) to use deadly force, but did not [151]. The availability of a CEW may have been a factor in some of these decisions. Conversely, if use of a CEW is initially ineffective, in some situations officers are subsequently justified in employing lethal weapons [152]. Scott [153] noted that a CEW is "not a replacement for existing means of managing conflict situations, but is an option to be considered alongside all other available tactics". If CEWs were to be banned, law-enforcement officers may instead rely on other forms of physical force that could result in injuries. In addition, Ho et al. [154] noted that escalation to deadly force might be avoided in many confrontations with mentally-ill patients (or suicidal situations) simply by the presence of a CEW.
Should all police officers that are certified to carry a CEW be exposed themselves?
When officers are trained in the use of CEWs, it has been common for instructors to allow trainees to experience a short period of exposure [102]. Martinelli and Staton [155] stated that a law-enforcement officer cannot "convince the general public and/or a plaintiff attorney that" CEWs are "safe and effective... when you refuse to be exposed yourself". This may be a commendable attempt to facilitate acceptance of the use of CEWs. Other personnel, however, usually physically support the volunteers to prevent them from falling down (or the volunteers are provided with a padded area to fall onto). After this experience, officers in
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the field may not actively focus on the fact that severe traumatic head injuries can result from subjects falling to the ground after a CEW application (separate from any "direct" effects of the devices). Kleinig [156] explained the psychosocial difference between experiencing a CEW exposure as part of a training exercise and as part of a use-of-force situation in the field. In a survey of one county in the US, Gerhardstein [142] reported that one-third of police departments did not specifically instruct their officers to consider any risk of impact to subjects falling off an elevated surface subsequent to CEW use. This lack of consideration may be reinforced during the training-exercise CEW exposures.
After a claim of a compression fracture of the thoracic spine, some police departments prohibited such training exposures [102]. Such fractures, though very rare during CEW training exposures, have been reported at thoracic vertebrae 6, 7, and 8 [157, 158]. Another trainee exhibited vertebral body compression fractures at T8 and T9, and bony contusion of the T7 and T10 superior endplates, after a CEW application to the ventral part of the body [159]. A scapular fracture was reported in another police officer [160]. An unusual case was mentioned (in a news article) of a subject "breaking the humerus bones, in his upper arms, dislocating his shoulders, and fracturing his shoulder sockets" purportedly caused by "muscles convulsing the bones" during a CEW exposure [161]. Although fractures occurring after common household electric shock are usually the result of falling onto a hard surface, very rare cases of the electricity itself causing enough tetanus to produce a fracture have been reported [162]. Fractures of the humerus were the most frequent. In addition, older volunteers may suffer fractured hips [163], and any loss of bone mineral density would increase the risk for fracture.
Key points
1. The scientific/medical and other literature contains many misconceptions regarding the use of conducted electrical weapons (CEWs) during law-enforcement operations.
2. Durations of incapacitating effects and possible associations of CEWs with deaths-in-custody have often been overstated or exaggerated.
3. Assumptions that all uses of CEWs constitute excessive force or torture are misleading and unwarranted.
4. Clarification of these and other misconceptions may be important during policymaker decisions, practitioner operations, expert witness testimonies, and court proceedings. Scientists, medical professionals, legal advisors, and investigators of police tactics should be aware of these misconceptions.
Conflict of interest The author has not had any relationship with any manufacturers of conducted energy weapons, including employment, consultancies, stock ownership, honoraria, paid expert testimony, patent applications/registrations and grants or other funding.
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