There are those who attribute these deaths to the actions applied by the police, including restraint techniques, neckholds, OC spray (oleoresin capsicum, or pepper, spray), or more recently by TASERs. This has even led some to refer to TASER-associated deaths as death by tasercution. Research has disproved oleoresin capsicum, neckholds, and restraint techniques as contributors to these sudden deaths, and more commonly, as Dr. Roberts noted, it is the presence of excited delirium in the subjects that likely leads to untoward outcomes.
Nevertheless, it is interesting to note that the TASER and other devices of its kind were approved for use on the streets against humans, based on theoretical calculations submitted to the U.S. Consumer Product Safety Commission. It is not until the past few years that meaningful studies designed to objectively evaluate the actual medical effects of these devices have begun to appear. These studies are split among animal models, mostly pigs and dogs, and some human studies on healthy human volunteers. They are all an important step toward understanding the effects of these devices.
The animal studies all come with the criticism that they use an artificial situation: an anesthetized, sedated animal with breathing controlled by a ventilator, one that has its drawbacks when compared with the chronic cocaine-abusing individual with occult heart disease who dies in a struggle with police. The human studies are criticized for not replicating field conditions because they are healthy subjects not in a state of excited delirium or intoxicated on stimulant drugs. Studies that replicate field situations encountered by police cannot be done due to ethical limitations, but the currently published human studies do begin to lay the foundation for understanding the device's effects and safety.
For those of us asked to evaluate these patients, the research allows us to begin to draw some conclusions. Much like Dr. James Robert's own department (see this month's InFocus), in our ED there was some confusion about what sort of evaluation these subjects required after being tased. Most importantly, the sort of person who sustains the application of one of these devices is de facto a high-risk individual for complications, as are many suffering from excited delirium. For us, these patients represent a medical emergency, and we are aggressive in managing the underlying condition. We have recommended to our local law enforcement agencies that they strongly consider activating EMS prior to the use of the device in such altered individuals so that medical intervention can occur as rapidly as possible to minimize the risk of sudden death.
For the person who simply made a poor decision, sustained a hit from a TASER, and is subsequently compliant, who has normal vital signs, no signs of excited delirium, and was not hit by the probe in a sensitive part of the anatomy, we simply pull the darts and discharge the patient directly from triage.
There are, however, other groups that warrant caution. There are simply no medical data available on the effects of the TASER when used in children, the elderly, and pregnant women. Though some have proposed that the uterus acts as a shield of sorts from the effects of electricity, the so-called Faraday shield, we have taken the approach of suggesting fetal monitoring for those past the age of viability.
Cardiac pacemakers also are an area of controversy. Though the studies that exist with pacemakers suggest no ill effects to the pacemaker, we approach these patients with caution. Physicians should all consider possible secondary injuries; we have seen three cases of vertebral compression fracture after TASER activation and also managed a patient in whom a TASER dart penetrated his skull.
Having taken a “ride” on the TASER ourselves, we can attest to its effectiveness and immediate resolution of its incapacitating effects. While tasercution actually may be a fair word to describe the sensation of the device while being under its activation, the current data on the TASER appears to show a positive safety profile.© 2008 Lippincott Williams & Wilkins, Inc.