Journal of Forensic and Legal Medicine 73 (2020) 101948
Available online 10 June 2020
1752-928X/© 2020 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.
Medical implications of Conducted Energy Devices in law enforcement
Richard Stevenson a
, Ian Drummond-Smith b,*
a
Emergency Medicine Consultant, Glasgow Royal Infirmary, United Kingdom
b
Police Chief Superintendent, Devon & Cornwall Police, United Kingdom
A B S T R A C T
This study examines the medical implications of Conducted Energy Devices (CEDs) in law enforcement, of which TASER® is the brand most recognised. In order to
develop understanding of TASER® use, this study undertook both a literature review and original research using data provided by a number of UK police forces.
The comprehensive review of literature identified a range of injures, including both primary and secondary complications.
Research was conducted into TASER® use in the United Kingdom using a number of data sets, including a retrospective study of some 60,000 uses of force. This
data shows TASER® was only discharged on 18% of occasions it was drawn from the holster. The injuries sustained by both subjects and Police Officers associated
with TASER® use were compared and it was found that fewer injuries, as a proportion of use, were associated with TASER® than use of Police Dogs, baton, irritant
spray or physical confrontation. The data examined 948 discharges of TASER® and recorded 159 attendances at the Emergency Department as a result. Only three
hospital admissions were identified.
The paper concludes that the use of CEDs as a police use-of-force may be associated with injury; the overwhelming majority of such are classified as minor. Death
or the more severe injuries described in the medical literature are rare and any deaths occurring within temporal proximity to the use of a CED should be investigated
thoroughly and the presentation of the individual carefully recorded.
The collection of post-incident data provides evidence to the relative operational safety of the TASER® by the UK Police; it is accepted by the police that no use-offorce
option is risk free, however data provided showed a greater incidence of injury to both the officers and subjects, as a proportion of use, when baton, irritant
spray or physical confrontation was used.
1. Introduction
This paper will explore some of the medical complications that have
been experienced as a result of police use of Conducted Energy Devices
(CEDs), of which the TASER® brand is most recognised.
TASER® was introduced in the United States to law enforcement
agencies (using nitrogen as a dart propellant) in 1999. The UK was
cautious in their adoption initially restricting use to authorised firearms
officers (AFOs) during authorised firearms operations from 2003,
expanding to AFOs in non-firearms incidents and to non-firearms officers
from 200763
, with the numbers of officers carrying the device
slowly increasing year to year.
Referred to by the police as a less-than-lethal use of force, CEDs have
evoked some concern from the public, sometimes as a result of media
reporting of the device, often quoted as “50,000 Volts” delivered to an
individual by a “stun gun”. High profile uses of the equipment whereby
the recipient of the energy delivered has died necessitate full reviews of
the device and circumstances.
Hitherto, Most of the medical literature relating to CEDs and injuries
relating to their use originates from the US. This paper will describe a
wide variety of injuries from across the globe before turning to the UK,
where a number of different police tactics for dealing with confrontation
will be studied and compared, in an attempt to understand which tactics
cause the most injuries. The paper will conclude that TASER® is not risk
free, but no use of force by the state could be considered risk free; a
significant number of police uses of force were examined, some 60,000
incidents. It will be found that fewer injuries to both officers and subjects
were associated with TASER® than with somewhat ‘traditional’ uses of
force, including baton, irritant spray and physical confrontation.
1.1. Published literature on conducted energy device related injury
Prior to formal field testing in the UK, the Defence Scientific Advisory
Council Sub-Committee on the Medical Implications of Less-lethal
Weapons (DOMILL), concluded after reviewing over eight hundred
references that “from the available evidence on the use of the device, the risk
of life-threatening or serious injuries from the M26 Advanced Taser appears
to be very low”.21
Initially trialled amongst five UK Home Office police
forces, the (then) newer model TASER® X26™ was made available to
authorised firearms officers only during authorised firearms operations
* Corresponding author
E-mail address: 15547@devonandcornwall.pnn.police.uk (I. Drummond-Smith).
Contents lists available at ScienceDirect
Journal of Forensic and Legal Medicine
journal homepage: http://www.elsevier.com/locate/yjflm
https://doi.org/10.1016/j.jflm.2020.101948
Received 1 October 2019; Received in revised form 24 March 2020; Accepted 27 March 2020
Journal of Forensic and Legal Medicine 73 (2020) 101948
2
in 2003; from 2007 the use of the TASER® X26™ was expanded to
include use by firearms officers at incidents where firearms were not
authorised.63
Also in 2007, following a further trial in ten forces, the use
of TASER® X26™ was further extended to non-firearms officers, known
as Specially Trained Officers (STOs), “where officers would be facing
violence or threats of violence of such severity that they would need to
use force to protect the public, themselves and/or the subject(s)”.91
There is a paucity of academic research with respect to the operational
deployment, success and failure of the device to achieve the
desired objective(s) within the UK. Attempts to obtain reliable and accurate
information via Freedom of Information, has proved problem­
atic.70
However, the UK Home Office publishes annual statistics
concerning Taser ‘use’ in England and Wales. In this context, the
meaning of the word ‘use’ is broad and includes a number of actions
from simply drawing the Taser out of the holster up to discharging
electricity towards the subject; types of use reported may be found in
Table 1.
Limitations to the data collected prior to 2014 are acknowledged,
citing variable reporting detail provided by Police Forces.94
Examining
the data, there has been a steady rise in the use of the TASER® X26™;
between 2015 and 2016 alone, an increase of nine per cent was recorded.
However, the total number of non-discharge uses rose by eleven per
cent, whereas total discharges had fallen by one per cent.94
While useful,
little can be inferred; similarly, the scientific literature regarding conducted
energy weapon use, efficacy (the ability to produce an effect, for
example collapse of posture), effectiveness (the ability of the device to
assist real-world scenarios, for example collapse of posture in a subject
who is intoxicated with drugs and violent), ethical issues and complications
of the device are predominantly from the United States.27
This
highlights the lack of UK jurisdiction research and comparative data to
other police use of force options to ’inform the Taser debate’. Further
gaps in academic research have been identified, with concerns raised by
clinicians that experimental conditions do not replicate real life presentations
and as such do not provide evidence of safety.82
2. Method
First, this paper examines online resources, searching for articles
relating to CED injury and deployment rates. The medical literature was
searched using the PubMed database for the terms ’conducted energy
weapon [tw] or TASER®’, which yielded 337 citations; the abstracts of
these articles were screened for references to injuries relating to CED
exposure. Once identified, the references used in these publications were
checked for any further sources of information. The criminal justice
literature was similarly searched using the Applied Social Sciences Index
& Abstracts and the National Criminal Justice Reference Service Abstracts
Database.
Upon review of the literature, utilisation of the information provided
(like any source) must be within the context of the setting; methodological
biases (often retrospective studies), voluntary reporting of CED
use, methods to identify cases46
using internet engines to search for
incidents involving CEDs and conflict of interests (employment by
manufacturers of a CED) are all legitimate concerns when examining
papers. Azadani, Tseng, Ermakov, Marcus & Lee (2011) published a
paper concluding that “studies funded by TASER® and/or written by an
author affiliated with the company are substantially more likely to
conclude that TASERs are safe”;104
however rather than a meta-analysis
this was a simple statistical test of the likelihood of a publication
reporting [CEDs are] “unlikely harmful or not harmful.” Recognition of
changes in CED technology, medical developments, numbers of CEDs
issued and changes in population characteristics (for example, the
introduction of so-called ‘legal-highs’) have all had implications for the
deployment, use and effectiveness of CEDs. A further factor confounding
literature review is that publication bias is clearly evident; only the most
serious injuries, or previously unrecognised complications following
CED exposure, are reported by clinicians.
Second, this study produces original research, as a retrospective
study, with assistance from the National Police Chiefs’ Council (NPCC)
Less Lethal Weapons Secretariat, to obtain data on TASER® use from as
many UK police forces as possible. The NPCC wrote to fifty UK based
forces, requesting anonymised and comprehensive data concerning use
of Taser, other types of force, injuries and incidents. A number of forces
replied and some 60,000 discreet uses of force have been identified and
examined in this study. This data has led to the publication of an internal
police report and there was a desire that this led to a peer reviewed
academic paper, leading us to the study you read today. The data was
anonymised and provided without conditions, indeed the original data is
available for the public to read (for which, see Ref. 63).
The police data allowed for an analysis of injuries to both officers and
subjects, linked to various different police tactics. An important aspect
of the data to note, is that sometimes the police use multiple tactics on
the same individual, and an injury to an officer or subject would be
recorded against each tactic; each use of force data is not mutually
exclusive. Consequently, it is impossible to calculate each individual use
of force class, however what can be calculated is the odds ratio, that will
show in interactions where TASER® was used, there was an odds of X
that injury would occur to officer and Y to subject. To calculate the
relative risk of each type of force used, a prospective study would be
required where specific data is collected and the inclusion/exclusion of
any injuries caused by each aspect of the interaction documented. Whilst
consideration was given to calculating the statistical significance of the
data, this would again require a prospective study.
2.1. Literature review
Comparisons with other countries can be illustrative of injury rates,
however due to the multitude of confounders, such exercises are of
limited benefit; with the implementation of national police use-of-force
reporting within the UK, more meaningful evaluations may be drawn –
that said, the wide demographic variation, type/rate of crime and geography
again would need to be factored into account – as described in
Table 1
Types of TASER® use report by the UK Home office.
Level of
use
Type of
use
Definition
Higher
use
Angledrive
stun
The officer fires the weapon with a live
cartridge installed. One or both probes
may attach to the subject. The officer then
holds the Taser against the subject’s body
in a different area to the probe(s), in order
to complete the electrical circuit and
deliver an incapacitating effect.
Fired The Taser is fired with a live cartridge
installed. When the trigger is pulled, the
probes are fired towards the subject with
the intention of completing an electrical
circuit and delivering an incapacitating
effect.
Discharge
Drive stun The Taser is held against the subject’s
body and the trigger is pulled with no
probes being fired. Contact with the
subject completes the electrical circuit
which causes pain but does not deliver an
incapacitating effect.
Arcing Sparking of the Taser without aiming it or
firing it.
Red-dot The weapon is not fired. Instead, the Taser
is deliberately aimed and then partially
activated so that a laser red dot is placed
onto the subject.
Non
Discharge
Aimed Deliberate aiming of the Taser at a
targeted subject.
Lower
use
Drawn Drawing of the Taser in circumstances
where any person could reasonably
perceive the action to be a use of force.
96
R. Stevenson and I. Drummond-Smith
Journal of Forensic and Legal Medicine 73 (2020) 101948
3
US studies.65
One study outside the USA5
described injury patterns
ranging from a fractured humerus to cutaneous bruising presenting for
hospital treatment. Most injuries (63%) were related to falling, with the
remainder from CED darts.
Reflective of the longer period of issue to law enforcement agencies,
the USA has a greater number of observational reports of CED use. One
paper28
studied Dallas Police Department, examining 426 cases of CED
use by officers, stating no subjects necessitated anything other than first
aid measures; there was one death attributed to cocaine intoxication and
acute behavioural disturbance. A further study reported mild/ or no
injury in criminal suspects 7
99.75% of cases, with three fatalities
deemed not as a result of CED use.
The introduction of the CED for use by UK police forces initially to
firearms officers, as a ‘less lethal use of force’ option compared to projectile
weapons, implied that by their nature, CED may still be lethal.
Much controversy arises when death occurs within temporal proximity
to police attendance, even more so when a CED has been deployed. A
2009 study51
reports that the number of deaths in US custody rose after
the introduction of CED to the study groups. However, interpretation of
results must account for the methodological limitations, with data
missing, and reliance upon figures to be returned by the respective law
enforcement agencies themselves (also problematic for UK studies. 70
In
2014, the then Independent Police Complaints Commission (IPCC)
published a review of investigations into eight UK deaths following the
use of TASER® X26™ and found that the device itself was not responsible
for the death of the individuals involved.37
However, the coroner
has attributed TASER® to three deaths in the United Kingdom: First, the
inquest concerning the death of Jordon Begley established that TASER®
did not cause cardiac arrest, however it concluded, “the use of the
TASER® and the restraint more than materially contributed to a package
of stressful factors leading to his fatal cardiac arrest".12
Another factor,
they concluded was, "Mr Begley’s intoxication at the time of the incident
and confrontation with police”. Further, the jury found that the officer,
“inappropriately and unreasonably used the stun gun for longer than
was necessary”.4
Second, in 2013 Andrew Pimlott died from multiple
burns after dousing himself with petrol; a TASER® was discharged
whilst he was allegedly holding a lit match; the petrol ignited.36
It has
since been demonstrated that CEDs have the ability to ignite petrol vapours
within a compartmented area.17
Finally, in 2017 Marc Cole died
after being subject to three separate TASER® discharges totalling 40
seconds; he had taken cocaine and jumped out of a first floor window,
going on to stab a woman in her garden and upon police arrival, cut his
own throat. The cause of death was recorded as, “use of cocaine, episode
of altered behaviour including self-harm, exertion, excitement, the use
of an x26 Taser device and restraint”.106
In contrast, between April 1, 2006 and 2017, the Independent Office
for Police Conduct (IOPC) (formally the Independent Police Complaints
Commission - IPCC) investigated 1604 deaths relating to police con­
tact38
, as described in Table 2. It seems that the significant majority of
death following police contact do not involve TASER®.
In August 2018, the IOPC were investigating seven UK deaths during
which TASER® was recorded as a factor, this does not mean TASER®
contributed to the death just that it had been recorded as a factor in the
IOPC investigation.63
When examining any death following the use of
CED, it is crucial to determine if the cause of death was due to an underlying
condition such as heart disease,83
drug and/or alcohol intoxication,
or the often contested acute behavioural disturbance (previously
referred to as ‘excited delirium’).99
The absence of any standards for
CED and arrest-related death is noteworthy.90
The time interval between
CED exposure and subsequent death is of paramount importance to
determine what, if any, contribution to the outcome it may have had.44
As with many use-of-force incidents, often multiple use of force tactics
are utilised during the event; to avoid erroneous attribution of cause and
effect to a particular use of force, the independent and summative
contribution(s) of any technique(s) must be appreciated.81
Other papers
are often contradictory: Robert Dziekanksi died during the confrontation
between a Royal Canadian Mounted Police in 2007 in which he was
subjected to CED discharges; a commission on CED usage, examining the
medical evidence, experiential and policy issues published a report with
many recommendations after a lengthy consultation process, involving
many individuals with experience of CED.10
Commissioner Braidwood
concluded that “I am satisfied that conducted energy weapons do have
the capacity (even in healthy adult subjects) to cause heart arrhythmia"
10
; this has subsequently been challenged to even go so far to say “it is
apparent that Commissioner Braidwood either did not understand the
body of scientific, medical, and technical literature, or he disregarded
it”.100
Operational safety considerations for police officers using CEDs
include risk of injury to the officers themselves, the subject or others
within the locality; One report 11
describes an officer who received a
CED probe discharge to the head when chasing a suspect and subsequently
had a seizure. Other studies from the US have reported a
reduction in officer injuries when using a CED,54,72,86
and overall injuries
to officers when equipped with a CED without incapacitant spray
issued81
; Terrill, Paoline & Ingram report a reduced incidence of officer
injuries only when CEDs were used alone compared to hands-only tac­
tics;87
contrary to these studies, a 2009 report57
found no relationship
between use of CED and officer injury. The external validity of these
studies to other agencies who use CEDs is limited with all of them
conducted within the US; common to all of the studies, the use of
retrospective data capture and analysis is fraught with the issues of
missing data, data categorisation (type of wound and severity) between
law enforcement agencies and differing departmental practices post
exposure to a CED.
The sudden contraction of muscles or loss of posture as a result of
being exposed to a CED may result in injury to the subject and falls with
subsequent head trauma may be anticipated,49
as exemplified when a
CED was used on a male in Llandudno who sustained a severe head
injury, with significant recovery.35
A 2009 report79
identifies the
(non-fatal) abdominal self-stabbing of a male holding a knife when a
CED was used. Fractures of the spine resulting from back muscle
contraction during a CED demonstration upon law enforcement officers
(whilst being supported so as not to fall) have been documented.80,101
The subject of an incident can present responding officers with
challenges; warning markers (violence, drugs and the like), age, any
mental illness and prior behaviour patterns are an invaluable aid to
officers in making their risk assessment, however such information is
often unavailable and relies on knowing the identity of the subject prior
Table 2
Investigations into death following police contact by the IPOC.
Category 2006/7 2007/8 2008/9 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17
Road traffic incidents 35 18 33 26 24 19 23 11 13 20 28
Fatal shootings 1 4 3 2 2 2 0 0 1 3 6
Deaths in or following police custody 27 22 15 17 21 15 15 11 18 14 14
Apparent suicides following custody 47 45 56 54 46 39 65 70 71 60 55
Other deaths following police contacta
21 30 33 37 49 37 20 41 43 101b
121
38
a
Change in definition of ‘other deaths following contact’ in 2010/11 to include only cases subject to an independent investigation.
b
Expansion of IPCC investigative resource and capacity to conduct more independent investigations into serious and sensitive investigations.
R. Stevenson and I. Drummond-Smith
Journal of Forensic and Legal Medicine 73 (2020) 101948
4
to the police interaction. The use of alcohol, drugs and mental health
conditions alone or in combination, can affect a person’s ability to understand,
process and respond appropriately to an instruction or the
visual presentation of a CED such as drawing, aiming or ‘red-dotting’.
The use of CED on subjects with mental illness has been met with uneasiness,
especially those detained under mental health legislation56
; A
study conducted in the US found that those with mental illness, stimulant
use, or a combination of the two factors, statistically received more
shocks compared to those without such characteristics2
; yet in a UK case
report a CED successfully resolved an incident when standard interventions
had failed.55
One paper62
examined the use of CED by a
crisis intervention team, comprising of police officers with additional
training in mental illness; there were thirty-five incidents where a CED
was used within the first eighteen months (ten featured the possession of
a weapon, most commonly a knife), with no serious harm to the individual
subject to electrical discharge. Similarly, a retrospective study
over three years reported an 85% success rate with no serious injury or
death when an CED was used for incidents involving emotionally
disturbed persons.98
A New Zealand study67
reported that CED
discharge is statistically more likely in mental health emergencies than
criminal incidents. The increased number of discharges to individuals
under the influence of stimulants, or experiencing mental health emergencies,
may be indicative of the higher pain tolerance under these
conditions, and/or an altered mental status with a subsequent reduced
efficacy of CEDs in subduing dangerous behaviours.
2.2. Injuries associated with conducted energy device use
2.2.1. Primary complications
The induction of potentially fatal cardiac arrhythmias (ventricular
tachycardia and ventricular fibrillation) secondary to exposure to a CED
electrical discharge has been contested both within the literature and US
courts43,47,64,85,102,103
; the attribution of a CED to induce these arrhythmias
is obfuscated by the rapid deterioration of such rhythms to
asystole (no electrical activity of the heart) and the many other factors
that may precipitate the generation of fatal ventricular rhythms.
The DOMILL21
report noted that the technological evolution of CEDs
resulted in a reduction in the ability to induce extra ventricular beats (in
isolated heart tissue): “the risk of a life-threatening event arising from the
direct interaction of the currents of the X26 Taser with the heart, is less than
the already low risk of such an event from the M26 Advanced Taser”. A
statement later released 23
made specific reference to the increased
vulnerability of children and those of small stature due to smaller body
weights, extrapolating from data on the body weight of pigs.
Extreme physiological exertion, with an overload of circulating
adrenaline may lead to sudden death (c.f. acute behavioural disturbance);
underlying genetic risk factors, structural heart abnormalities
and stimulant drug use may all contribute to an increased risk of fatal
arrhythmia generation.22
Acute stress-related cardiomyopathy (Takotsubo’s
cardiomyopathy) resulting from severe emotional distress and
raised adrenaline levels is a recognised phenomenon characterised by a
‘dilated pocket’ of heart muscle, postulated as a cause of death in
arrest-related deaths after CED exposure.14
A published a case report 61
featuring a sixteen-year-old who was found to have the heart rhythm
atrial fibrillation (often referred to as an ‘irregular heart beat’) after the
use of an earlier generation M26 CED. Myocardial infarction (in a
twenty-year-old anabolic steroid user) has been reported one-and-a-half
hours after being subdued with a CED.3
Whilst arrest-related cardiac
arrest is normally a fatal event, a 2009 report77
describes the successful
resuscitation of a seventeen year-old male who was found to have no
cardiac electrical activity (asystole) for 20 min when emergency medical
services arrived.
For persons who have a pacemaker or implantable cardioverterdefibrillator,
concerns have been raised by medical professionals that
the device may be damaged by or detect the CED electrical current as an
abnormality requiring (inappropriate) activation. The few case reports
on this subject have not found this to be the case.13,32
Paninski and
Marshall69
report electrical stimulation of the heart measured by a
pacemaker but caution whether this was a property of the CED per se, or
only in association with cardiac devices in situ. A case report25
stated
awareness of a single incident in which a seizure was trigged in a person
with epilepsy and a death secondary to severe coronary artery disease
after exposure to a CED. A single report of a stroke occurring in a
32-year-old male with schizoaffective and bipolar disorder after CED
discharge was reported 6
; a persisting speech abnormality and
right-sided weakness was noted and a work-up for the common risk
factors for stroke were negative other than a history of smoking.
An 60
often cited case report of miscarriage following CED exposure
in the United States, describes a female heroin user who was eight-to-ten
weeks pregnant when a CED was used on her for failing to undress in
front of male guards; she began spotting blood the day after, with a
resulting miscarriage fourteen days later.
A medical 31
report cites rhabdomyolysis (muscle breakdown) and
subsequent kidney failure in a subject who was combative, agitated and
subsequently subdued with a CED. Whilst an electrical ‘shock’ may lead
to muscle death, an alternative cause could be the acute behavioural
disturbance leading to the outcomes reported; at the lesser end of the
spectrum this has been reported in two patients with psychosis who
were agitated.75
As with attributing any agent to an outcome in humans, simple
temporal association does not necessarily imply causation; rigorous
evaluation of all contributory factors involved is necessary to avoid
inappropriate, or even incorrect attribution of police actions leading to a
deleterious event. Jauchem39
describes in his narrative paper various
sources of misconceptions, with exaggeration or over statement of the
incapacitating effects and association of CED with deaths.
2.2.2. Secondary complications
The darts of CEDs are designed to penetrate the skin or clothing of an
individual to allow the delivery of the electrical current; of the 3.3
million darts that have penetrated human skin, none have resulted in
any reported infections.48
Designed to tether within the skin layer,
complications may arise from the inadvertent probe impact onto an area
of the body other than the primary target areas. Due to the often highly
emotive and agitated state of the subject relative to the police officer,
recall of events, timings, verbal communications and actions of those
present can be impaired, thus when reviewing such injuries this must be
taken into account; the use of body-worn cameras are invaluable in
providing additional evidence to the officer’s subjective experience.
Injuries to the head and face from the probes may result in fractures
to the often paper-thin bones19
; penetration of the skull bones has been
demonstrated [15
,41
,50
,52
,74
] with no long-term complications reported.
The eye is particularly vulnerable to damage from the probes with
permanent visual impairment or blindness33,53,76
or even removal of the
eye necessary73,88
; although with advanced surgical techniques penetration
of eye may not necessarily lead to blindness.16,40,66
In one case
report 78
cataract formation with a linear burn across the eyelid was
associated with a CED exposure.
Puncture of the throat,1
trachea – resulting in air within the chest
cavity,58
and chest wall – with subsequent lung collapse34
are more
likely to occur in very thin individuals.
Testicular penetration by a dart with associated haemorrhage has
been recorded89
or torsion68
; whilst impaction into the finger may
necessitate surgical excision and tendon repair.20,26
Given the nature of incapacitation, it is to be expected that falls from
standing height may be associated with head injury; retained probe tip,
facial fractures and brain haemorrhage may result from such falls.59
It
appears the use of a CED presents a small increased risk of fatal traumatic
brain injury, with increased age an independent risk factor for
fatal brain injury.49
Finally, ingestion of the probe post CED discharge has not shown to
result in harm.45
R. Stevenson and I. Drummond-Smith
Journal of Forensic and Legal Medicine 73 (2020) 101948
5
3. UK police data
Evaluating the effectiveness of CED by the police requires consideration
of many factors; the operational implementation of the device itself
(determined by the design, reliability and so forth) may be
considered an independent control factor within the UK (that is when
comparing different success and failure rates at incidents in differing
forces), as the only model supplied to all police forces until 2017 was the
TASER® X26™. The Taser XREP™ model, a shotgun style self-contained
projectile was used once by Northumbria Police during the stand-off
with Raoul Moat in 2010, which was supplied direct to Northumbria
Police, not to the UK Home Office and was never approved for use in the
UK.31
The newer TASER® X2™ was authorised for use by the Home
Office in March 201795
and most forces have now converted to this new
device.
Drawing on data published by the UK Home Office,92,93,97
Fig. 1
shows 22,637 uses of TASER® from 27 police forces, separated into
non-discharge and discharge uses. This indicates that the majority of
TASER® use by these forces did not lead to the discharge of electricity
but were simply drawing, aiming or activating the red dot from the
device. This might suggest that these actions can be sufficient to deescalate
a violent encounter and the non-discharge use of TASER® can
prevent other, potentially more injurious, types of force being used, such
as a police baton, irritant spray or physical confrontation. This data
shows TASER® was only discharged to a subject on 18% of occasions it
was ‘used’.
This data is very useful, as most countries do not routinely report
non-discharge use of TASER®; whilst this makes comparison with other
countries difficult, it also provides a useful insight into how TASER® is
actually used on the street, at least in the UK.
The NPCC wrote to fifty UK Police forces requesting data concerning
use of TASER® and injuries to both officers and subjects. This led to the
creation of several data sets, as different forces presented different data,
from 2016 to 2017 and therefore relates to the X26™ model of TASER®.
First, it was possible to determine the effectiveness of various police
tactics in these cases. When completing the use of force data, officers are
asked to report if the tactics used were ’effective’. This is an inherently
subjective measure, however the police have given the following guidance
to their officers to measure effectiveness of tactics: “whether the
technique achieved its tactical aim - or were further tactics necessary to
achieve this outcome?“.63
For example, if a violent subject was hit with a
baton but this did not change their behaviour, the use of baton would be
considered ineffective.
Twenty forces shared data concerning 59,401 uses of force, which
were analysed for reported effectiveness of each tactic, which is summarised
in Table 3.
The data shows that firearms were the most effective tactics at 97%.
Irritant spray was the least effective at 54%. The effectiveness of
TASER® was reported as 68%, more effective than baton (by only 1%)
and irritant spray.
In England & Wales, once a police officer uses force, they should
record details of the incident using a national ‘Use of Force Form’.63
This
form collects data on the various tactics used by the officers and any
injuries received by officers and subjects. This data is somewhat limited:
The form does not record how injuries were caused and in some incidents
multiple tactics are used; there is therefore an association between
types of force used and injuries and no direct link can be inferred.
Furthermore, our data covers all injuries and this would range from
minor to life changing injuries; the injury may have been caused before,
during or after the use of force.63
Twenty forces provided injury data from 2017 relating to police officers
and the corresponding tactics used during the incident, a total of
38,355 uses of force. This data, summaised in Table 4, includes where
devices, such as irritant spray or TASER® are simply drawn and not
discharged.
The data includes use of the ‘Attenuating Energy Projectile’ (AEP)
system, which is a less-lethal impact round system carried by all Armed
Response Vehicles.63
It shows the tactic associated with the greatest
proportion of injuries to officers was irritant spray (16%), the lowest
being firearms (0.5%) and AEP (nil). Firearms potentially provide the
greatest stand-off distance and firearms operations are typically well
resourced.63
The data shows fewer injuries to officers associated with
TASER® (4%) compared to other common uses of force, including irritant
spray, baton, physical confrontation or police dog. Using this data,
we were able to calculate the odds ratio for officers being injured.
Examining the odds ratios for the various use of force options (Fig. 2)
demonstrates that police dogs, firearms and TASER® results are less
than 1.0 (indicative of reduced odds of officer injury, and with narrow
confidence intervals, this is a relatively precise estimate for TASER® and
firearms.) The NPCC report63
states TASER® also gives officers a greater
stand-off distance from the subject than many of the other commonly
available tactics. Greater stand-off distance may be associated with a
reduction in the odds of injury, however the answer is most likely
multi-factorial and would necessitate prospective study methods to
identify.
Eighteen forces provided data from 2017 concerning injuries to
subjects and the associated tactics, a total of 34,217 uses of force. This
may be found in Table 5. Again, this data relates to the entire range of
injuries, from minor to significant and would include injuries from the
darts. It does not record when the injury was caused, so again may have
been suffered prior, during or after the use of force by the police. As with
previous data, multiple tactics are sometimes used during an incident;
where multiple tactics were used, the same injury would be recorded
against every tactic, so each use of force is not mutually exclusive. For
example, if a subject was injured with a baton then later a TASER® was
Fig. 1. Proportion of TASER® discharge vs non-discharge.63
Table 3
Effectiveness of use of force by tactic.
Type of force (includes drawing/aiming
equipment)
Effective Ineffective %
Effective
Firearms 2634 93 97
Police Dog 472 91 84
Physical confrontation 31,406 6202 84
AEP 67 20 77
Taser 8639 4007 68
Baton 1453 711 67
Irritant Spray 1963 1643 54
Total 46,634 12,767 79
63
R. Stevenson and I. Drummond-Smith
Journal of Forensic and Legal Medicine 73 (2020) 101948
6
discharged at them, an injury sustained by the baton would be reported
against both the baton and the TASER®.63
This is a significant flaw in
the data and we will recommend that the police enhance their recording
of the cause of injuries. Finally, this data includes where devices such as
police dogs, baton or TASER® are ‘drawn’ not discharged.
The recording of dart punctures to the skin following the use of CEDs
is currently documented by UK police forces; the classification of such
marks as an injury or not has been the subject of academic debate87
:
Terrill and Paolne are of the opinion that dart punctures to the skin are
injuries and should be analysed as such; consequently the outcome of
their study found that the use of CEDs resulted in an increased probability
of subject injury compared to no use (although 58.4% of cases did
not result in any injury). The inclusion of dart punctures as injuries
secondary to police use of force is argued against by Kaminski et al.42
; in
their study, they concluded that when dart punctures are excluded, injuries
to suspects are benign or reduced. The injury data used in our
study does include injuries from the darts.
Counterintuitively, firearms and AEP were associated with the least
proportion of injuries to the subject, the NPCC63
state the British Police
rarely discharge firearms and the analysis includes incidents where
firearms and AEPs were merely drawn from holsters. Placing firearms
and AEP aside, as a proportion of use, TASER® was associated with
fewer injuries to subjects than other, perhaps more traditional use of
force tactics by the police, such as physical confrontation, baton, irritant
spray and police dog. Calculating the odds ratio for subjects to be injured
by the use of force, TASER® and firearms were associated with a lower
odds for the subject, as was AEP use; perhaps unsurprisingly, use of
police dogs and irritant spray were much more likely to result in injury
to the subject (Fig. 3).
Within the UK, until 2017, the police categorised injuries in association
with the deployment of a CED into three categories:
� Primary – Possibly caused by the direct effect of current flow.
� Secondary – as a result of an indirect delivery, such as from the barbs
or falls;
� Co-incidental – Injuries received in the incident not directly related
to Taser use, e.g. self-inflicted wounds, gunshot wounds, dog bites.63
Our study examined X26™ TASER® use forms provided by twenty
forces, concerning 5,839 uses of TASER® during 2016, which were
scrutinised for qualitative data. On each form, officers were asked to
record primary, secondary or coincidental injuries and provide a free
text explanation of each injury. It was not possible to compare this data
with other tactics, as physical confrontation, baton and irritant spray
were not subject to this level of scrutiny at that time.63
Of the 5,839 occasions that TASER® was used, the forms recorded
discharge of TASER® on 948 occasions (16%); 159 attended Emergency
Departments (ED) (3% of total use, or 17% of discharges). Examples
include where barbs were bent upon falling as well as other injuries from
the fall, rapid pulse rate and one ‘seizure’.63
Whilst all forces recorded
injuries and hospital visits, only sixteen forces recorded when the subject
was admitted to hospital as an inpatient. These forces used TASER®
on 417 occasions, of which TASER® was discharged on 61 occasions. Of
these sixteen forces, only three hospital admissions were noted, one for a
primary injury and two for a secondary injury. This represents 0.7% of
Table 4
Injuries to officers and associated tactics used during the incident.
Type of force (includes drawing/aiming
equipment)
Uses of
force
Officer
injured
%
injured
Irritant Spray 2465 403 16
Baton 1274 135 11
Physical confrontation 27,077 2761 10
Police Dog 374 19 5
Taser 5619 225 4
Firearms 1470 7 0.5
AEP 76 0 0
Total 38,355 3550
63
Fig. 2. Odds ratios for officer injury when use of force is employed.
Table 5
Injuries to subjects and associated tactics used during the incident.
Type of force (includes drawing/aiming
equipment)
Uses of
force
Subject
injured
%
injured
Police Dog 369 112 30
Irritant Spray 2145 362 17
Baton 1228 162 13
Physical confrontation 23,510 2693 11
TASER® 5444 485 9
Firearms 1445 21 1
AEP 76 1 1
Total 34,217 3836
63
R. Stevenson and I. Drummond-Smith
Journal of Forensic and Legal Medicine 73 (2020) 101948
7
all TASER® use and 4.9% of discharge.
The Royal College of Physicians Faculty of Forensic and Legal
Medicine advise that, “All persons subjected to TASER® discharge must
ultimately be examined and assessed by a registered medical practitioner
– a doctor,"71
This is adopted by the College of Policing Approved
Professional Practice, essentially the rule book to which the UK police
work, which states, “All arrested persons who have been subjected to
CED discharge must be examined by a forensic medical examiner (FME)
[a doctor] as soon as practicable after arrival at the custody suite”.18
The
recommendation that detainees are examined only by a doctor, when
nurses or paramedics are often employed in UK custody suites, can be
problematic to the police, who must then attend the Emergency
Department. This policy may confound our analysis and is perhaps why
the data showed some subjects taken to hospital with apparently no
injuries. Considering the relatively low number of admissions to hospital
following TASER® discharge found in this study and the relatively low
number of injuries associated with TASER® use, the Faculty of Forensic
and Legal Medicine might wish to consider broadening their advice to
include appropriately trained nurses and paramedics. This may have an
incidental benefit of revealing pressure on Emergency Departments.
A retrospective analysis 84
of CED use within Seattle, noted that
26.8% of subjects were seen in Emergency Departments within 24 h, of
whom one quarter of which had an altered mental state; a stark contrast
to the much lower requirement for hospital attendance noted in the UK
police data.
In 2012, a review of CED against one hundred subjects aged 13 to 17
reported no significant injuries other than 20 probe-related minor
wounds.8
Gardner, Hauda & Bozeman30
published their retrospective
review of 1,201 subjects who had been exposed to an CED, classifying
99.75% as having no injuries and 0.25% sustaining head injuries as a
result of falls and one case of rhabdomyolysis; two deaths occurred
associated with prolonged combative behaviour. The most recent reported
study used a prospective multi-centre observational method9
,
finding after 504 CED uses there were no significant injuries reported.
4. Discussion
Bringing the evidence together, it is apparent that the use of CEDs by
police may be associated with injury; the overwhelming majority of such
are classed as minor. The inclusion of probe puncture wounds or contact
superficial burns is accepted by the police as being of a high likelihood
with the discharge of a CED. Death or the more severe injuries described
in the medical literature are rare, given the number of CED deployments.
With the advent of dual laser targeting in the TASER® X2™ to assist
officers, injuries might be reduced. Deaths occurring within temporal
proximity to the use of a CED should be investigated thoroughly and the
presentation of the individual carefully recorded; there is no direct evidence
of a CED leading to a death during an episode of acute behavioural
disturbance, a condition in itself that has an appreciable mortality when
unrecognised. However, the increased physiological stress experienced
by a person after being exposed to a CED should be appreciated; that
said, given the lack of any current prehospital recognised strategy for the
management of such a condition, the use of a CED should not be precluded
should the risk-threat assessment prove necessary for management
of the situation.
What is clearly absent from any of the literature, and indded our
project, is a post-event study examining the subject’s ‘lived experience’
of the event and a CED being deployed. Work of this nature may alleviate
concerns regarding the use of CEDs and may allow comparison to
other police use-of-force outcomes.
The collection of post-incident data provides evidence to the relative
operational safety of the TASER® by the UK Police; it is accepted by the
police that no use-of-force option is risk free, however data provided
showed a greater incidence of injury to both the officers and subject, as a
proportion of use, when baton, irritant spray or physical confrontation
was used. As part of a governance structure for UK police, the open
publication of anonymous and standardised data regarding the use of
CEDs (and other use-of-force options) can only help strengthen public
(and officer) confidence with such strategies. Whilst the body of literature
referred to earlier is representative of rare and severe injuries, the
operational evidence indicates the overall relative safety of CEDs.
Our study of UK data examined 22,637 discreet uses of force, finding
that TASER® was only discharged in 18% of occasions it was drawn
from the holster; on other occasions it was drawn, aimed, red doted or
the warning arc was activated as a deterrent. Effectiveness of various use
of force tactics was measured across 59,401 uses for force: firearms were
found to be the most effective tactic at 97%, TASER® was reported to be
effective on 68% of occasions it was used, more effective than baton (by
only 1%) and irritant spray, the latter being the most ineffective tactic at
54%.
Injuries to officers were examined across 38,355 uses of force and it
was found that injuries associated with the TASER® tactic were noted on
Fig. 3. Odds ratios for use of force and subject injury.
R. Stevenson and I. Drummond-Smith
Journal of Forensic and Legal Medicine 73 (2020) 101948
8
4% of occasions TASER® was used; this was lower than irritant spray
(16%), baton (11%), physical confrontation (10%) and police dog (5%).
It was calculated that the odds ratio of an officer being injured where
TASER® was used was less than 0.5, whereas irritant spray provided the
greatest odds of injury, being around 2.
In a similar way, injuries to subjects associated with 34,217 different
police tactics were examined; injuries were associated with 9% of use of
TASER®, compared to police dogs (30%), irritant spray (17%), baton
(13%) and physical confrontation (11%). The odds ratios calculated
showed that the odds of a subject being injured when a TASER® was
used was less than 1, while both police dog and irritant spray were
greater than 3. Further data from 2016 examined 5,839 uses of TASER®
and found that 159 subjects attended Emergency Departments (ED) (3%
of total use, or 17% of discharges). Three hospital admissions were
noted.
The UK data confirms our findings that whilst use of TASER® can
cause injury in subjects, it is more often than not a minor injury and only
found in a small percentage of use of the device; rarely does it lead to a
hospital visit and even less frequently is the subject admitted to hospital.
It would be fair to conclude from the data provided, that TASER® is
associated with fewer injuries, as a proportion of use, than somewhat
traditional police tactics, such as the use of irritant spray, baton or police
dogs.
Analysis of TASER® use continues to be difficult as recording practices
vary from country to country, however it was noted that arguably
the UK has the most comprehensive and transparent recording mechanism
of TASER® use in the world. However, this study identified some
challenges in the UK police data and we recommend the national Use of
Force reporting programme seek to identify the specific tactics that
cause reported injuries in each case, by amending the post-incident
questionairre completed by officers.
Further, we considered the advice from the Faculty of Forensic and
Legal Medicine that all persons subjected to TASER® discharge must be
examined by a doctor. Considering the relatively low number of admissions
to hospital following TASER® discharge and the relatively low
number of injuries associated with TASER® use, the faculty might wish
to consider broadening their advice to include appropriately trained
nurses and paramedics.
Declaration of competing interest
Dr Richard Stevenson is a reviewer for the Journal of Forensic and
Legal Medicine.
Mr Ian Drummond-Smith is a Police Officer. He has been employed
as a Police Officer for twenty two years and is currently the TASER® lead
for his force.
References
1. Al-Jarabah M, Coulston J, Hewin D. Pharyngeal perforation secondary to electrical
shock from a taser gun. Emerg Med J : Eng Manag J. 2008;25(6):378. https://doi.
org/10.1136/emj.2007.056416.
2. Bailey CA, Smock WS, Melendez AM, El-Mallakh RS. Conducted-energy device
(taser) usage in subjects with mental illness. J. Am. Acad. Psychiatr. 2016;44(2):
213–217, 44/2/213.
3. Baldwin DE, Nagarakanti R, Hardy SP, Jain N, Borne DM, England AR, Glancy DL.
Myocardial infarction after taser exposure. J La State Med Soc : Off. Org. Louisiana
State Med. Soc. 2010;162(5):294–295, 291-2.
4. BBC News. Jordon Begley Inquest: Taser and Restraint ’contributed’ to Death; 2015,
23rd
June 2018 https://www.bbc.co.uk/news/uk-england-manchester-33373531.
5. Becour B. Conducted electrical weapons or stun guns: a review of 46 cases
examined in casualty. Am J Forensic Med Pathol. 2013;34(2):142–146. https://doi.
org/10.1097/PAF.0b013e31828873d6.
6. Bell N, Moon M, Dross P. Cerebrovascular accident (CVA) in association with a
taser-induced electrical injury. Emerg Radiol. 2014;21(2):211–213. https://doi.
org/10.1007/s10140-013-1180-2.
7. Bozeman WP, Hauda WE, 2nd Heck JJ, Graham Jr DD, Martin BP, Winslow JE.
Safety and injury profile of conducted electrical weapons used by law enforcement
officers against criminal suspects. Ann Emerg Med. 2009;53(4):480–489. https://
doi.org/10.1016/j.annemergmed.2008.11.021.
8. Bozeman WP, Teacher E, Winslow JE. Transcardiac conducted electrical weapon
(TASER) probe deployments: incidence and outcomes. J. Emerg. Med. 2012;43(6):
970–975. https://doi.org/10.1016/j.jemermed.2012.03.022.
9. Bozeman WP, Stopyra JP, Klinger DA, Martin BP, Graham DD, Johnson JC,
Mahoney-Tesoriero K, Vail SJ. Injuries associated with police use of force.
J Trauma Acute Care Surg. 2018;84:466–472.
10. Braidwood Commission. In: Restoring Public Confidence. Restricting the Use of
Conducted Energy Weapons in British Columbia. 2009.
11. Bui ET, Sourkes M, Wennberg R. Generalized tonic-clonic seizure after a taser shot
to the head. CMAJ (Can Med Assoc J) : Canadian Med Assoc J. 2009;180(6):
625–626. https://doi.org/10.1503/cmaj.081364.
12. Bunyan N. Police Taser Shooting Contributed to Man’s Death, Jury Finds. The
Guardian; 2015, 28th
February 2018 www.theguardian.com/world/2015/jul/06
/police-taser-shooting-contributed-to-mans-death-jury-finds.
13. Cao M, Shinbane JS, Gillberg JM, Saxon LA, Swerdlow CD. Taser-induced rapid
ventricular myocardial capture demonstrated by pacemaker intracardiac
electrograms. J Cardiovasc Electrophysiol. 2007;18(8):876–879. JCE881.
14. Cevik C, Otahbachi M, Miller E, Bagdure S, Nugent KM. Acute stress
cardiomyopathy and deaths associated with electronic weapons. Int J Cardiol.
2009;132(3):312–317. https://doi.org/10.1016/j.ijcard.2008.12.006.
15. Chandler J, Martin BP, Graham Jr DD. TASER((R)) injury to the forehead. J. Emerg.
Med. 2013;44(1):e67–e68. https://doi.org/10.1016/j.jemermed.2011.06.009.
16. Chen SL, Richard CK, Murthy RC, Lauer AK. Perforating ocular injury by taser. Clin
Exp Ophthalmol. 2006;34(4):378–380. CEO.
17. Clarke C, Andrews SP. The ignitability of petrol vapours and potential for vapour
phase explosion by use of TASER(R) law enforcement electronic control device. Sci
Justice : J Forensic Sci Soc. 2014;54(6):412–420. https://doi.org/10.1016/j.
scijus.2014.04.004.
18. College of Policing. Conducted energy devices (taser) . Retrieved from College of
policing. https://www.app.college.police.
uk/app-content/armed-policing/conducted-energy-devices-taser/#aftercare;
2020, March 21.
19. de Runz A, Minetti C, Brix M, Simon E. New TASER injuries: lacrimal canaliculus
laceration and ethmoid bone fracture. Int J Oral Maxillofac Surg. 2014;43(6):
722–724. https://doi.org/10.1016/j.ijom.2013.12.006.
20. Dearing M, Lewis TJ. Foreign body lodged in distal phalanx of left index fingertaser
dart. Emerg Radiol. 2005;11(6):364–365. https://doi.org/10.1007/s10140-
005-0428-x.
21. Defence Scientific Advisory Council Sub-Committee on the Medical Implications of
Less-lethal Weapons (Domill) (2002). Annex: First DOMILL Statement on the Medical
Implications of the Use of the M26 Advanced Taser. December; 2002.
22. Defence Scientific Advisory Council Sub-Committee on the Medical Implications of
Less-lethal Weapons (Domill). Statement on the Comparative Medical Implications of
Use of the X26 Taser and the M26 Advanced Taser. 2005.
23. Defence Scientific Advisory Council Sub-Committee on the Medical Implications of
Less-lethal Weapons (Domill). Statement on the Medical Implications of M26 and X26
Taser Use at Incidents where Firearms Authority Has Not Been Granted. 2007.
25. Defence Scientific Advisory Council Sub-Committee on the Medical Implications of
Less-lethal Weapons (Domill). Statement on the Medical Implications of the Taser X26
and M26 Less-Lethal Systems on Children and Vulnerable Adults. 2011.
26. Dunet B, Erbland A, Abi-Chahla ML, Tournier C, Fabre T. The TASERed finger: a
new entity. case report and review of literature. Chir Main. 2015;34(3):145–148.
https://doi.org/10.1016/j.main.2015.04.001.
27. Dymond A. ^a€~The flaw in the taser debate is the taser debate^a€™: what do we
know about taser in the UK, and how significant are the gaps in our knowledge?1.
Policing: J Pol Pract. 2014;8(2):165. https://doi.org/10.1093/police/pau011.
28. Eastman AL, Metzger JC, Pepe PE, Benitez FL, Decker J, Rinnert KJ, Friese RS.
Conductive electrical devices: a prospective, population-based study of the medical
safety of law enforcement use. J Trauma. 2008;64(6):1567–1572. https://doi.org/
10.1097/TA.0b013e31817113b9.
30. Gardner AR, Hauda WE, 2nd, Bozeman WP. Conducted electrical weapon (TASER)
use against minors: a shocking analysis. Pediatr Emerg Care. 2012;28(9):873–877.
https://doi.org/10.1097/PEC.0b013e31826763d1.
31. Gleason JB, Ahmad I. TASER((R)) electronic control device-induced
rhabdomyolysis and renal failure: a case report. J Clin Diagn Res : J Clin Diagn Res.
2015;9(10):HD01–2. https://doi.org/10.7860/JCDR/2015/15465.6608.
32. Haegeli LM, Sterns LD, Adam DC, Leather RA. Effect of a taser shot to the chest of a
patient with an implantable defibrillator. Heart Rhythm. 2006;3(3):339–341.
S1547-5271(05)02466-5.
33. Han JS, Chopra A, Carr D. Ophthalmic injuries from a TASER. Cjem. 2009;11(1):
90–93, 0566600dca854e7a9b84b211d6ed90a8.
34. Hinchey PR, Subramaniam G. Pneumothorax as a complication after TASER
activation. Prehosp Emerg Care : Off J Nat Assoc EMS Phys Nat Assoc State EMS Dir.
2009;13(4):532–535. https://doi.org/10.1080/10903120903144890.
35. Ipcc, Independent Police Complaints Commission, 11th
November 2017 www.ipcc.
gov.uk; 2017.
36. Ipcc, Independent Police Complaints Commission. Andrew Pimlott. Death Following
Taser Discharge. 2014.
37. Ipcc, Independent Police Complaints Commission. IPCC Review of Taser Complaints
and Incidents 2004-2013. 2014.
38. Iopc, Independent Office for Police Conduct, 23rd
June 2018 https://policeconduc
t.gov.uk/sites/default/files/Documents/statistics/deaths_during_following_police
_contact_201617.pdf; 2017.
39. Jauchem JR. TASER(R) conducted electrical weapons: misconceptions in the
scientific/medical and other literature. Forensic Sci Med Pathol. 2015;11(1):53–64.
https://doi.org/10.1007/s12024-014-9640-x.
R. Stevenson and I. Drummond-Smith
Journal of Forensic and Legal Medicine 73 (2020) 101948
9
40. Jey A, Hull P, Kravchuk V, Carillo B, Martel JB. Emergent diagnosis and
management of TASER penetrating ocular injury. Am J Emerg Med. 2016;34(8):
1740. https://doi.org/10.1016/j.ajem.2016.01.005. .e3-1740.e5.
41. Kaloostian P, Tran H. Intracranial taser dart penetration: literature review and
surgical management. J Surg Case Rep. 2012;(6):10. https://doi.org/10.1093/jscr/
2012.6.10.
42. Kaminski RJ, Engel RS, Rojek J, Smith MR, Alpert G. A quantum of force: the
consequences of counting conducted energy weapon punctures as injuries. Justice
Q JQ. 2015;32(4):598–625. https://doi.org/10.1080/07418825.2013.788729.
43. Kim PJ, Franklin WH. Ventricular fibrillation after stun-gun discharge. N Engl J
Med. 2005;353(9):958–959, 353/9/958 [pii].
44. Kornblum RN, Reddy SK. Effects of the taser in fatalities involving police
confrontation. J Forensic Sci. 1991;36(2):434–438.
45. Koscove EM. Taser dart ingestion. J. Emerg. Med. 1987;5(6):493–498.
46. Kroll MW, Adamec J, Wetli CV, Williams HE. Fatal traumatic brain injury with
electrical weapon falls. J Forensic Legal Med. 2016;43:12–19. https://doi.org/
10.1016/j.jflm.2016.07.001.
47. Kroll MW, Lakkireddy DR, Stone JR, Luceri RM. TASER electronic control devices
and cardiac arrests: coincidental or causal? Circulation. 2014;129(1):93–100.
https://doi.org/10.1161/CIRCULATIONAHA.113.004401.
48. Kroll MW, Luceri RM, Lakireddy D, Calkins H. Do TASER electrical weapons
actually electrocute? Can J Cardiol. 2016;32(10):1261. S0828-282X(15)01701-8.
49. Kroll MW, Ritter MB, Guilbault RA, Panescu D. Infection risk from conducted
electrical weapon probes: what do we know? J Forensic Sci. 2016;61(6):
1556–1562. https://doi.org/10.1111/1556-4029.13148.
50. Le Blanc-Louvry I, Gricourt C, Toure E, Papin F, Proust B. A brain penetration after
taser injury: controversies regarding taser gun safety. Forensic Sci Int. 2012;221(1-
3):e7–11. https://doi.org/10.1016/j.forsciint.2012.03.027.
51. Lee BK, Vittinghoff E, Whiteman D, Park M, Lau LL, Tseng ZH. Relation of taser
(electrical stun gun) deployment to increase in in-custody sudden deaths. Am J
Cardiol. 2009;103(6):877–880. https://doi.org/10.1016/j.amjcard.2008.11.046.
52. Lewis MC, Lewis DE. Frontal sinus TASER dart injury. J. Emerg. Med. 2016;50(3):
490–492. https://doi.org/10.1016/j.jemermed.2015.09.024.
53. Li JY, Hamill MB. Catastrophic globe disruption as a result of a TASER injury.
J. Emerg. Med. 2013;44(1):65–67. https://doi.org/10.1016/j.
jemermed.2011.03.010.
54. Lin Y, Jones TR. Electronic control devices and use of force outcomes. Incidence
and severity of use of force, and frequency of injuries to arrestees and police
officers. Polic An Int J Police Strategies Manag. 2009;33(1):152–178. https://doi.
org/10.1108/13639511011020647.
55. Little J, Burt M. Tasers and psychiatry: the use of a taser on a low secure unit.
J Psychiatr Intensive Care. 2013;9(1):56–58. https://doi.org/10.1017/
S1742646412000106.
56. MacAttram M. Tasers Have No Place in Mental Health Care. The Guardian; 2016.
57. MacDonald JM, Kaminski RJ, Smith MR. The effect of less-lethal weapons on
injuries in police use-of-force events. Am J Publ Health. 2009;99(12):2268–2274.
https://doi.org/10.2105/AJPH.2009.159616.
58. Maher PJ, Beck N, Strote J. Pneumomediastinum and pulmonary interstitial
emphysema after tracheal taser injury. Emerg Med J : Eng Manag J. 2015;32(1):
90–2013. https://doi.org/10.1136/emermed-2013-203160. -203160. Epub 2013
Sep. 20.
59. Mangus BE, Shen LY, Helmer SD, Maher J, Smith RS. Taser and taser associated
injuries: a case series. Am Surg. 2008;74(9):862–865.
60. Mehl LE. Electrical injury from tasering and miscarriage. Acta Obstet Gynecol Scand.
1992;71(2):118–123.
61. Multerer S, Berkenbosch JW, Das B, Johnsrude C. Atrial fibrillation after taser
exposure in a previously healthy adolescent. Pediatr Emerg Care. 2009;25(12):
851–853. https://doi.org/10.1097/PEC.0b013e3181c399a9.
62. Munetz MR, Fitzgerald A, Woody M. Police use of the taser with people with
mental illness in crisis. Psychiatr Serv. 2006;57(6):883, 57/6/883.
63. Npcc. In: Taser: Fifteen Tears on. Worcester: National Police Chiefs’ Council Less
Lethal Weapons Secretariat; 2019.
64. Naunheim RS, Treaster M, Aubin C. Ventricular fibrillation in a man shot with a
taser. Emerg Med J : Eng Manag J. 2010;27(8):645–646. https://doi.org/10.1136/
emj.2009.088468.
65. Neuscheler J, Freidlin A. Report on Electronic Control Weapons (ECWs) Submitted to
the City of Berkeley. Stanford: Standford Criminal Justice Centre; 2015.
66. Ng W, Chehade M. Taser penetrating ocular injury. Am J Ophthalmol. 2005;139(4):
713–715. S0002-9394(04)01402-3.
67. O’Brien AJ, McKenna BG, Thom K, Diesfeld K, Simpson AI. Use of tasers on people
with mental illness A New Zealand database study. Int J Law Psychiatr. 2011;34(1):
39–43. https://doi.org/10.1016/j.ijlp.2010.11.006.
68. Ordog GJ, Wasserberger J, Schlater T, Balasubramanium S. Electronic gun (taser)
injuries. Ann Emerg Med. 1987;16(1):73–78.
69. Paninski RJ, Marshall ME, Link MS. ICD oversensing caused by TASER.
J Cardiovasc Electrophysiol. 2013;24(1):101. https://doi.org/10.1111/jce.12046.
70. Payne-James JJ, Rivers E, Green P, Johnston A. Trends in less-lethal use of force
techniques by police services within england and wales: 2007-2011. Forensic Sci
Med Pathol. 2014;10(1):50–55. https://doi.org/10.1007/s12024-013-9492-9.
71. Payne-James J, Sheridan B. TASER® : Clinical Effects and Management. London:
Royal College of Physicians: The Faculty of Forensic & Legal Medicine; 2017.
72. PERF. Comparing Safety Outcomes in Police Use-Of-Force Cases for Law Enforcement
Agencies that Have Deployed Conducted Energy Devices and a Matched Comparison
Group that Have Not: A Quasi-Experimental Evaluation. 2009.
73. Rafailov L, Temnogorod J, Tsai FF, Shinder R. Impaled orbital TASER probe injury
requiring primary enucleation. Ophthalmic Plast Reconstr Surg. 2015. https://doi.
org/10.1097/IOP.0000000000000486.
74. Rehman TU, Yonas H, Marinaro J. Intracranial penetration of a TASER dart. Am J
Emerg Med. 2007;25(6):733. S0735-6757(06)00479-7.
75. Sanford JM, Jacobs GJ, Roe EJ, Terndrup TE. Two patients subdued with a TASER
(R) device: cases and review of complications. J. Emerg. Med. 2011;40(1):28–32.
https://doi.org/10.1016/j.jemermed.2007.10.059.
76. Sayegh RR, Madsen KA, Adler JD, Johnson MA, Mathews MK. Diffuse retinal injury
from a non-penetrating TASER dart. Doc Ophthalmol Adv Ophthalmol. 2011;123(2):
135–139. https://doi.org/10.1007/s10633-011-9287-9.
77. Schwarz ES, Barra M, Liao MM. Successful resuscitation of a patient in asystole
after a TASER injury using a hypothermia protocol. Am J Emerg Med. 2009;27(4).
https://doi.org/10.1016/j.ajem.2008.07.042, 515.e1-515.e2.
78. Seth RK, Abedi G, Daccache AJ, Tsai JC. Cataract secondary to electrical shock
from a taser gun. J Cataract Refract Surg. 2007;33(9):1664–1665. S0886-3350(07)
00900-5.
79. Sharma A, Theivacumar NS, Souka HM. Tasers–less than lethal!. Ann R Coll Surg
Engl. 2009;91(4):W20–W21. https://doi.org/10.1308/147870809X400958.
80. Sloane CM, Chan TC, Vilke GM. Thoracic spine compression fracture after TASER
activation. J. Emerg. Med. 2008;34(3):283–285. https://doi.org/10.1016/j.
jemermed.2007.06.034.
81. Smith MR, Kaminski RJ, Rojek J, Alpert GP, Mathis J. The impact of conducted
energy devices and other types of force and resistance on officer and suspect
injuries. Policing. 2007;30(3):423–446. https://doi.org/10.1108/
13639510710778822.
82. Strote J, Hutson HR. TASER study results do not reflect real-life restraint situations.
Am J Emerg Med. 2009;27(6):747. https://doi.org/10.1016/j.ajem.2009.05.017.
author reply 747-9.
83. Strote J, Range Hutson H. Taser use in restraint-related deaths. Prehosp Emerg Care
: Off J Nat Assoc EMS Phys Nat Assoc State EMS Dir. 2006;10(4):447–450.
M73266N077X5L628.
84. Strote J, Walsh M, Angelidis M, Basta A, Hutson HR. Conducted electrical weapon
use by law enforcement: an evaluation of safety and injury. J Trauma. 2010;68(5):
1239–1246. https://doi.org/10.1097/TA.0b013e3181b28b78.
85. Swerdlow CD, Fishbein MC, Chaman L, Lakkireddy DR, Tchou P. Presenting
rhythm in sudden deaths temporally proximate to discharge of TASER conducted
electrical weapons. Acad Emerg Med : Off J Soc Acad Emerg Med. 2009;16(8):
726–739. https://doi.org/10.1111/j.1553-2712.2009.00432.x.
86. Taylor B, Woods DJ. Injuries to officers and suspects in police use-of-force cases: a
quasi-experimental evaluation. Police Q. 2010;13(3):260–289. https://doi.org/
10.1177/1098611110373994.
87. Terrill W, Paoline EA. Conducted energy devices (CEDs) and citizen injuries: the
shocking empirical reality. Justice Q JQ. 2012;29(2):153–182. https://doi.org/
10.1080/07418825.2010.549834.
88. Teymoorian S, San Filippo AN, Poulose AK, Lyon DB. Perforating globe injury from
taser trauma. Ophthalmic Plast Reconstr Surg. 2010;26(4):306–308. https://doi.org/
10.1097/IOP.0b013e3181c15c36.
89. Theisen K, Slater R, Hale N. Taser-related testicular trauma. Urology. 2016;88:e5.
https://doi.org/10.1016/j.urology.2015.11.011.
90. Todak NE, Cesar GT, Louton B. Forensic reporting of TASER exposure: an
examination of situational and exposure characteristics. J Forensic Legal Med. 2015;
35:4–8. https://doi.org/10.1016/j.jflm.2015.06.010.
91. Police Use of Taser Statistics, England and Wales, 2009 to 2011. United Kingdom
Home Office; 2013.
92. United Kingdom Home Office. Police Use of Taser Statistics. uk: England and Wales;
2015, 2014. Retrieved January 11, 2019, from Gov https://www.gov.uk/governm
ent/publications/police-use-of-taser-statistics-england-and-wales-1-january-to-31-
december-2014/police-use-of-taser-statistics-england-and-wales-2014.
93. United Kingdom Home Office. Police Use of Taser Statistics. uk: England and Wales;
2016, 2015. Retrieved January 11, 2019, from Gov https://www.gov.uk/governm
ent/publications/police-use-of-taser-statistics-england-and-wales-1-january-to-31-
december-2015/police-use-of-taser-statistics-england-and-wales-2015.
94. Police Use of Taser X26 Conducted Energy Device Statistics. England and Wales 1st
January to 31st December 2016. 2017.
95. United Kingdom Home Office. New Transparency Measures for Taser Use Announced
by Home Secretary; 2017. Retrieved 25 September 2017 from https://www.gov.
uk/government/news/new-transparency-measures-for-taser-use-announced-
by-home-secretary.
96. United Kingdom Home Office. User Guide to ‘Police Use of TASER ® X26 Conducted
Energy Devices Statistics, England and Wales’. London: Home Office; 2017. Retrieved
January 11, 2019, from https://assets.publishing.service.gov.uk/government/u
ploads/system/uploads/attachment_data/file/608032/police-use-of-conducted-e
nergy-devices-2016-user-guide.pdf.
97. United Kingdom Home Office. Police Use of TASER ® X26 Conducted Energy Devices
Statistics, England and Wales, 1 January to 31 December 2016; 2017, April 13.
Retrieved from Gov.uk https://www.gov.uk/government/publications/police-use
-of-taser-x26-conducted-energy-devices-statistics-england-and-wales-1-january-t
o-31-december-2016/police-use-of-taser-x26-conducted-energy-devices-statistic
s-england-and-wales-1-january-to-31-december-2.
98. White MD, Ready J. The TASER as a less lethal force alternative. Police Q. 2007;10
(2):170–191.
99. White MD, Ready J, Riggs C, Dawes DM, Hinz A, Ho JD. An incident-level profile of
TASER device deployments in arrest-related deaths. Police Q. 2013;16(1):85–112.
https://doi.org/10.1177/1098611112457358.
R. Stevenson and I. Drummond-Smith
Journal of Forensic and Legal Medicine 73 (2020) 101948
10
100. Williams HE. The Braidwood Commission reports on TASER use in Canada: an
evidence-based policy review. Polic An Int J Police Strategies Manag. 2011;35(2):
356–381. https://doi.org/10.1108/13639511211230101.
101. Winslow JE, Bozeman WP, Fortner MC, Alson RL. Thoracic compression fractures
as a result of shock from a conducted energy weapon: a case report. Ann Emerg
Med. 2007;50(5):584–586. S0196-0644(07)00724-X.
102. Zipes DP. Sudden cardiac arrest and death following application of shocks from a
TASER electronic control device. Circulation. 2012;125(20):2417–2422. https://
doi.org/10.1161/CIRCULATIONAHA.112.097584.
103. Zipes DP. TASER electronic control devices can cause cardiac arrest in humans.
Circulation. 2014;129(1):101–111. https://doi.org/10.1161/
CIRCULATIONAHA.113.005504.
104. Azadani P, Tseng Z, Ermakov S, Marcus G, Lee B. Funding source and author
affiliation in TASER research are strongly associated with a conclusion of device
safety. American Heart Journal. 2011;162(3):533–537. https://www.sciencedirect.
com/science/article/abs/pii/S0002870311004194.
106. Deardon L. Police Taser deaths will rise in UK unless action taken, coroner warns.
Independent; 2020. https://www.independent.co.uk/news/uk/home-news/police
-taser-deaths-uk-marc-cole-cornwall-coroner-a9477026.html.
R. Stevenson and I. Drummond-Smith