Taser International's Response

ECD Event Analysis and Evidence Collection
Subject Info Event Date and Time Subject Sex Subject Age Subject Height Subject Weight (including the subjects build): e.g., Skinny, Medium Build or Fairly Large Pre-Event Behavior Physical exertion type (running, fighting, etc.) Physical exertion / duration of struggle (Y/N) Subjects influence (drugs, alcohol, EDP) Any other use of force employed and what type? Evidence Collection Photos of wounds and probe impacts with scale or drive stun marks Photos showing distance of spread (scale) Keep the original battery in the device (DO NOT REMOVE). This will keep the integrity of the internal clock. Do not discard probes and/or wire; do not let EMS place probes in sharps as information can be gathered from the probes/wires concerning the deployment Download device dataport and/or TASER CAM recording info within 48 hours of the event. Contact TASER if there are any technical issues at Jami@TASER.com or 480-905-2036. Collect 2-3 AFID tags and note their location; this is helpful if multiple devices/cartridges were deployed. TASER Deployment Circumstances What type of TASER deployment (probe or drive stun)? Deployment duration and how many cycles occurred? What was the distance the ECD was deployed from the subject? What was the probe spread between the two probes? If this was a drive stun(s) only, a drive stun follow-up, or a combination of the probes and drive stun please note the location and duration of each application when applied to the subject Where were the probes located specifically? Include top location(s) and the bottom location(s) Was the TASER device effective? TASER device effects (was there a change in behavior?)
IF DEATH OCCURRED OR AN AED or DEFIBRILLATOR WAS USED

Obtaining hair and toenail samples can be crucial for forensic and medical testing. Body Core Temperature at time of death. If death occurred, within 24 hours, brain samples must be collected for the University of Miami (UM) Brain Endowment Bank to conduct critical brain chemistry changes and dopamine reviews. Contact this organization IMMEDIATELY for further details. Provide this timely info to the Medical Examiner/Coroner at: 1-800-UM-BRAIN (1-800-862-7246) is the telephone number. Dr. Deborah Mash is the lead researcher on this matter. This is one critical act that many MEs miss out on because of delays. Its imperative to get this info to the ME as soon as possible. The time between TASER device application and pronouncement of death is crucial to document: o Was subject initially responsive (walking / talking) after exposure(s) and if so, for how long? o Approximate time that subject went into distress (or died) after TASER deployment.
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Was an AED or defibrillator used? o If so, did it shock and what was the rhythm? o Did the AED report No shock? o Is there a printout/download strips from the AED? (This will be needed for evidence) If collapse occurred, how long between the ECD exposure and time to collapse? Hospital exam information (if conducted). Medical examiners contact info or supporting info from medical attendants/ER. If the Device Did Not Perform as Expected What was the failure/challenge? Was the deployment an issue of an ineffective deployment such as a single probe hit, clothing disconnect, wire breakage, low muscle mass deployment, or short spread between the probes? Was the unit dropped/subject to a high-moisture environment? Did the unit deploy the probes? When was a successful download/spark test done? Was the dataport download saved and was the clock accurate in time or was there a slight clock drift issue (A Clock Drift Issue PDF is available on this issue) Media Info Provide the media with the following contact info: www.TASER.com o The primary MEDIA Contact is: Steve Tuttle, TASER Internationals VP of Communications o Provide the MEDIA HOTLINE for media calls: 480-444-4000 and Press@TASER.com to answer any TASER issues not related to the on-going investigation or to general safety or technical TASER related questions. Safety Info: The latest electronic control device (ECD) safety research and other related issues helpful in an investigation are listed below: http://taser.com/support/critical-event-assistance-resources http://taser.com/support/critical-event-assistance-resources/arrest-related-scenarios-field-studies http://taser.com/support/critical-event-assistance-resources/medical-safety-research http://taser.com/support/critical-event-assistance-resources/evidence-collection Additional Best contact information of the investigator to: Name Agency Phone number Email Relation to investigation MEs contact info or supporting info from attendants / ER Additional notes / info:
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BelowisemailwithattachmentsfromTasertoVSPandforwardedtome. JennieV.Duval,M.D. DeputyChiefMedicalExaminer OfficeoftheChiefMedicalExaminer 246PleasantStreetSuite218 Concord,NewHampshire03301 (603)2711235(Tel) (603)2716308(Fax) jennie.duval@doj.nh.gov > STATEMENTOFCONFIDENTIALITY > Theinformationcontainedinthiselectronicmessageandany attachmenttothismessagemaycontainconfidentialorprivilegedinformationand areintendedfortheexclusiveuseoftheaddressee(s).Pleasenotifythe AttorneyGeneral'sOfficeimmediatelyat(603)2713658orreplyto justice@doj.nh.govifyouarenottheintendedrecipientanddestroyallcopies ofthiselectronicmessageandanyattachments. > OriginalMessage From:Burnham,Lance[mailto:Lance.Burnham@state.vt.us] Sent:Thursday,June21,20122:34PM To:Duval,Jennie Cc:Nolan,Aimee Subject:FW:URGENT:VTStatePoliceArrestRelatedDeath? Importance:High DetectiveSergeantLanceBurnham VermontStatePolice 2777St.GeorgeRoad Williston,VT Ph:8028787111Ext.2020 Fax:8028782742 EMAILHASCHANGED:NEWEMAILISlance.burnham@state.vt.us OriginalMessage From:O'Donnell,Hugh Sent:Thursday,June21,20121:59PM To:Robinson,Russ;Burnham,Lance Subject:Fw:URGENT:VTStatePoliceArrestRelatedDeath? Importance:High SgtHughO'Donnell VSPBradford 1594WaitsRiverRoad Bradford,VT05033
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OriginalMessage From:SteveTuttle[mailto:Steve@taser.com] Sent:Thursday,June21,201201:56PM To:Aamodt,Michael;Busby,Justin;Danoski,Jeffrey;Decker,Lyle;Henry, Michael;Hill,Matthew;ThomasJacques<tjacques@pps.state.ut.us>;O'Donnell, Hugh;O'Donnell,Hugh;Patno,Eric;Peters,Jeremy;Smith,LarryR;Vitali,Eric; Wilkins,Todd;Young,JohnD. Subject:URGENT:VTStatePoliceArrestRelatedDeath? DearTAESRCertfiedInstructors,Iapologizesending15ofyouthismail,BUTI understandtheremayhavebeenanarrestrelateddeathinvolvingaTASERECD.Can someonetellmeifthereisaspecificpersonthatneedstogetthisinformation orwhoishandlingthisinvestigation? Iamthepointmanfortheseissuesandavailablebyphoneat4809052006to assistyouragency. Inthemeantime,Ihaveaddedseveralimportantissuestoreviewandtopass alongtoyourinvestigators. 1.TheattachedCriticalEventChecklistiscrucialinvestigativereminderabout investigativeissuesthatshouldbeaddressedsuchasAEDstripreadouts(if used),bodycoretemperature,TASERdataportdownloads,probelocations,hairand nailsamples,etc.intheeventofanARD.Pleasefeelfreetosharethe checklistwithyourinvestigatorsoranyoutsideagenciesthatmayhavetaken overtheinvestigation. 2.Theattachedsamplepressreleasesbylawenforcementagenciesonarrest relateddeathsinvolvingTASERdevices.Ialwayssuggestthatagenciesprovide themediainformationthatdoesntcompromiseanyongoinginvestigationsothat themediadoesntoperateinavacuum. 3.IfyouwouldliketohavecontactfromourMedicalDirectorDr.JeffHo,he isavailable.Dr.HoisanERphysicianataLevel1TraumaCenteratHennepin CoHospitalinMinneapolis,MN.HeisanexpertonTASERsafetyandresearch, emergencymedicine,andisatacticalsurgeonforaMNlawenforcementagency. LetmeknowandIcanhaveyouragencycontactedbyhim. 4.TheattendingmedicalexaminersshouldurgentlyknowthattheUniversityof MiamiBrainEndowmentBankisavailablewithcuttingedgeresearchcenterthat candeterminedrugabuseandlookforexciteddeliriummarkers:1800UMBRAIN (18008627246)isthetelephonenumber.Dr.DeborahMashisthelead researcheronthismatter.ThisisonecriticalactthatmanyMEsmissouton becauseofdelays.ItsimperativetogetthisinfototheMEasthebrain tissuesmustbecollectedASAP. DeborahMash ProfessorofNeurologyandMolecularandCellularJeanneC.Levey 1501NW9thAve,Room4013(D45) Miami,FL33136 (800)UMBRAIN(8008627246) Tel:(305)2436219
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Fax:(305)2433649 5.Ialsoprovidedlinksbelowonthelatestelectroniccontroldevice(ECD) safetyresearchandresourcesthatmaybehelpfulinaninvestigation. ThelinkstodownloadthesePDFsareat: http://taser.com/support/criticaleventassistanceresources http://taser.com/support/criticaleventassistanceresources/arrestrelated scenariosfieldstudies http://taser.com/support/criticaleventassistanceresources/medicalsafety research http://taser.com/support/criticaleventassistanceresources/evidence collectionkbeatt PleasecallmeifthereisanythingIcanofferfurtherassistance.PLEASElet meknowifyouwouldlikeDr.Hotocontactyouragency,too. SteveTuttle VicePresidentofCommunications TASERINTERNATIONAL,INC. 17800N85thSt Scottsdale,AZ85255 Phone:8009782737ext.2006 MediaHotline:4804444000 TASER:ProtectLife.ProtectTruth. Asoftoday,morethan89,000peoplehavebeensavedfrompotentialdeathor seriousinjuryusingTASERdevices.
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BelowisemailthreadwithVSP.
Jennie V. Duval, M.D. Deputy Chief Medical Examiner Office of the Chief Medical Examiner 246 Pleasant Street Suite 218 Concord, New Hampshire 03301 (603) 271-1235 (Tel) (603) 271-6308 (Fax) jennie.duval@doj.nh.gov STATEMENT OF CONFIDENTIALITY The information contained in this electronic message and any attachment to this message may contain confidential or privileged information and are intended for the exclusive use of the addressee(s). Please notify the Attorney General's Office immediately at (603) 271-3658 or reply to justice@doj.nh.gov if you are not the intended recipient and destroy all copies of this electronic message and any attachments. From: Duval, Jennie Sent: Tuesday, June 26, 2012 2:13 PM To: 'Burnham, Lance' Subject: RE: Taser prongs
IdontthinkitisthatcriticalLance.Takecareofyourselfandsenditwhenever. Jennie
Jennie V. Duval, M.D. Deputy Chief Medical Examiner Office of the Chief Medical Examiner 246 Pleasant Street Suite 218 Concord, New Hampshire 03301 (603) 271-1235 (Tel) (603) 271-6308 (Fax) jennie.duval@doj.nh.gov STATEMENT OF CONFIDENTIALITY The information contained in this electronic message and any attachment to this message may contain confidential or privileged information and are intended for the exclusive use of the addressee(s). Please notify the Attorney General's Office immediately at (603) 271-3658 or reply to justice@doj.nh.gov if you are not the intended recipient and destroy all copies of this electronic message and any attachments. From: Burnham, Lance [mailto:Lance.Burnham@state.vt.us] Sent: Tuesday, June 26, 2012 1:53 PM
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To: Duval, Jennie Subject: RE: Taser prongs
Dr.Duval, Iamoutoftheofficeduetoaninjury.Ihopetobebackinnextweek.Iamworkingonthereportat homewhenIcanbutitisslow.AssoonasIgetitcompletedIwillsendityourway. ThankYou, Lance DetectiveSergeantLanceBurnham VermontStatePolice 2777St.GeorgeRoad Williston,VT Ph:8028787111Ext.2020 Fax:8028782742 EMAILHASCHANGED:NEWEMAILISlance.burnham@state.vt.us
From: Duval, Jennie [mailto:Jennie.Duval@doj.nh.gov] Sent: Tuesday, June 26, 2012 11:51 AM To: Burnham, Lance Subject: RE: Taser prongs
UofMiami(ExcitedDeliriumresearchers)isrequestingacopyofthepolicereportonthisincident.Can youemailmewhatyouhave?
Jennie V. Duval, M.D. Deputy Chief Medical Examiner
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Office of the Chief Medical Examiner 246 Pleasant Street Suite 218 Concord, New Hampshire 03301 (603) 271-1235 (Tel) (603) 271-6308 (Fax) jennie.duval@doj.nh.gov STATEMENT OF CONFIDENTIALITY The information contained in this electronic message and any attachment to this message may contain confidential or privileged information and are intended for the exclusive use of the addressee(s). Please notify the Attorney General's Office immediately at (603) 271-3658 or reply to justice@doj.nh.gov if you are not the intended recipient and destroy all copies of this electronic message and any attachments. From: Duval, Jennie Sent: Monday, June 25, 2012 11:08 AM To: 'Burnham, Lance' Subject: RE: Taser prongs
Greatthanks.
Jennie V. Duval, M.D. Deputy Chief Medical Examiner Office of the Chief Medical Examiner 246 Pleasant Street Suite 218 Concord, New Hampshire 03301 (603) 271-1235 (Tel) (603) 271-6308 (Fax) jennie.duval@doj.nh.gov STATEMENT OF CONFIDENTIALITY The information contained in this electronic message and any attachment to this message may contain confidential or privileged information and are intended for the exclusive use of the addressee(s). Please notify the Attorney General's Office immediately at (603) 271-3658 or reply to justice@doj.nh.gov if you are not the intended recipient and destroy all copies of this electronic message and any attachments. From: Burnham, Lance [mailto:Lance.Burnham@state.vt.us] Sent: Monday, June 25, 2012 11:06 AM To: Duval, Jennie Subject: Re: Taser prongs
Dr.Duval, Thatwouldbefine.Theycancallthebarracksat8028787111.
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Lance
From: Duval, Jennie [mailto:Jennie.Duval@doj.nh.gov] Sent: Monday, June 25, 2012 11:03 AM To: Burnham, Lance Subject: RE: Taser prongs
Ivereceivedafewmediacallsonthiscase.CanIdirectthemtoyou?
Jennie V. Duval, M.D. Deputy Chief Medical Examiner Office of the Chief Medical Examiner 246 Pleasant Street Suite 218 Concord, New Hampshire 03301 (603) 271-1235 (Tel) (603) 271-6308 (Fax) jennie.duval@doj.nh.gov STATEMENT OF CONFIDENTIALITY The information contained in this electronic message and any attachment to this message may contain confidential or privileged information and are intended for the exclusive use of the addressee(s). Please notify the Attorney General's Office immediately at (603) 271-3658 or reply to justice@doj.nh.gov if you are not the intended recipient and destroy all copies of this electronic message and any attachments. From: Duval, Jennie Sent: Thursday, June 21, 2012 7:15 PM To: 'Burnham, Lance' Subject: RE: Taser prongs
thanks
Jennie V. Duval, M.D. Deputy Chief Medical Examiner Office of the Chief Medical Examiner 246 Pleasant Street Suite 218 Concord, New Hampshire 03301 (603) 271-1235 (Tel) (603) 271-6308 (Fax) jennie.duval@doj.nh.gov
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STATEMENT OF CONFIDENTIALITY The information contained in this electronic message and any attachment to this message may contain confidential or privileged information and are intended for the exclusive use of the addressee(s). Please notify the Attorney General's Office immediately at (603) 271-3658 or reply to justice@doj.nh.gov if you are not the intended recipient and destroy all copies of this electronic message and any attachments. From: Burnham, Lance [mailto:Lance.Burnham@state.vt.us] Sent: Thursday, June 21, 2012 7:14 PM To: Duval, Jennie Subject: Re: Taser prongs
Certainly, Iwillsenditfirstthinginthemorning. Lance
From: Duval, Jennie [mailto:Jennie.Duval@doj.nh.gov] Sent: Thursday, June 21, 2012 07:11 PM To: Burnham, Lance Subject: RE: Taser prongs
Gotthem.Thanks.Ifyouhaveachance,canyoumeasurethelengthofthebarbsorsendaphotowitha scale?
Jennie V. Duval, M.D. Deputy Chief Medical Examiner Office of the Chief Medical Examiner 246 Pleasant Street Suite 218 Concord, New Hampshire 03301 (603) 271-1235 (Tel) (603) 271-6308 (Fax) jennie.duval@doj.nh.gov STATEMENT OF CONFIDENTIALITY The information contained in this electronic message and any attachment to this message may contain confidential or privileged information and are intended for the exclusive use of the addressee(s). Please notify the Attorney General's Office immediately at (603) 271-3658 or reply to justice@doj.nh.gov if you are not the intended recipient and destroy all copies of this electronic message and any attachments. From: Burnham, Lance [mailto:Lance.Burnham@state.vt.us] Sent: Thursday, June 21, 2012 2:49 PM
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To: Duval, Jennie Subject: Taser prongs
Herearepicturesofthetaserprongsremovedfromthedecedent. DetectiveSergeantLanceBurnham VermontStatePolice 2777St.GeorgeRoad Williston,VT Ph:8028787111Ext.2020 Fax:8028782742 EMAILHASCHANGED:NEWEMAILISlance.burnham@state.vt.us v
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FSI 5715; No of Pages 7

Forensic Science International xxx (2009) xxxxxx
Contents lists available at ScienceDirect
Forensic Science International

journal homepage: www.elsevier.com/locate/forsciint
Lactate and pH evaluation in exhausted humans with prolonged TASER X26 exposure or continued exertion
Jeffrey D. Ho a,*, Donald M. Dawes b, Jon B. Cole a, Julie C. Hottinger a, Kenneth G. Overton c, James R. Miner a
a b c
Department of Emergency Medicine, Hennepin County Medical Center, 701 Park Avenue South, Minneapolis, MN 55415, USA Department of Emergency Medicine, Lompoc District Hospital, 508 East Hickory Avenue, Lompoc, CA 93436, USA City of Phoenix Fire Department, 150 S. 12th Street, Phoenix, AZ 85034, USA
A R T I C L E I N F O
A B S T R A C T
Article history: Received 4 April 2009 Received in revised form 18 May 2009 Accepted 22 May 2009 Available online xxx Keywords: TASER Conducted Electrical Weapon Electronic control device Acidosis Custodial death
Objective: Safety concerns about TASER1 Conducted Electrical Weapon (CEW) use and media reports of deaths after exposure have been expressed. CEWs are sometimes used on exhausted subjects to end resistance. The alternative is often a continued struggle. It is unclear if CEW use is metabolically different than allowing a continued struggle. We sought to determine if CEW exposure on exhausted humans caused worsening acidosis when compared with continued exertion. Methods: This was a prospective study of human volunteers recruited during a CEW training course. Volunteers were from several different occupations and represented a wide range of ages and body mass index characteristics. Medical histories, baseline pH and lactate values were obtained. Patients were assigned to one of four groups: 2 control groups consisting of Exertion only and CEW Exposure only, and the 2 experimental groups that were Exertion plus CEW Exposure and Exertion plus additional Exertion. Blood sampling occurred after Exertion and after any CEW exposure. This was repeated every 2 min until 20 min after protocol completion. Descriptive statistics were used to compare the four groups. The experimental groups and the control groups were compared individually at each time point using Wilcoxon rank sum tests. Lactate and pH association was assessed using multiple linear regression. Results: Forty subjects were enrolled. There were no median pH or lactate differences between CEW Exposure groups at baseline, or between Exertion protocol groups immediately after completion. The CEW Exposure only group had higher pH and lower lactate values at all time points after exposure than the Exertion only group. After completing the Exertion protocol, there was no difference in the pH or lactate values between the continued Exertion group and the CEW Exposure group at any time points. Conclusion: Subjects who had CEW Exposure only had higher pH and lower lactate values than subjects who completed the Exertion protocol only. CEW exposure does not appear to worsen acidosis in exhausted subjects any differently than briey continued exertion. 2009 Elsevier Ireland Ltd. All rights reserved.
1. Introduction The Conducted Electrical Weapon (CEW) is currently available for law enforcement and it is designed to subdue or repel agitated or violent individuals. It has come under scrutiny by national and international media and human rights organizations because there have been unexpected deaths of persons in custody following its use [1,2]. Although most deaths in law enforcement custody occur
* Corresponding author. Tel.: +1 612 873 4904; fax: +1 612 904 4241. E-mail addresses: Jeffrey.Ho@hcmed.org (J.D. Ho), Donalddawes@gmail.com (D.M. Dawes), jonbcole@gmail.com (J.B. Cole), julie.hottinger@hcmed.org (J.C. Hottinger), kennydeanz@gmail.com (K.G. Overton), Miner015@umn.edu (J.R. Miner). 0379-0738/$ see front matter 2009 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.forsciint.2009.05.016
when no CEW has been applied (70%) [3,4], a causal association has been suggested in the lay press [5 7]. This association is largely made due to time proximity of CEW application and death. Theories about this association have included production of immediate fatal arrhythmias or some type of delayed organ system damage that manifests itself as sudden death at a later time period [8]. Previous work in this area has not demonstrated a clinically dangerous effect on human volunteers [9 14]. The CEW is often applied to subjects in the eld who have physically exerted and exhausted themselves just prior to the application and may continue to exert themselves throughout the arrest and control process. This exhaustion may be due to profound agitation, or eeing from and resisting law enforcement. Intense struggling is an activity that has been associated with sudden custodial arrest related death (ARD) [15]. Acidosis is a condition that
000013 Please cite this article in press as: J.D. Ho, et al., Lactate and pH evaluation in exhausted humans with prolonged TASER X26 exposure or continued exertion, Forensic Sci. Int. (2009), doi:10.1016/j.forsciint.2009.05.016
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2 J.D. Ho et al. / Forensic Science International xxx (2009) xxxxxx designed to invoke anaerobic exhaustion. This activity began with a 30-s timed period of push-ups. The volunteer was instructed to perform as many push-ups as they were able to during this time period. If they could not continuously perform push-ups for the 30-s duration, they were allowed to rest in the up position (arms at full extension, feet in contact with the oor) until they could continue. Immediately (dened as within 5 s) following the push-ups, the volunteer ran on a treadmill that was moving at 8.0 miles per hour at 8 degrees of elevation. They were instructed to run until they could no longer keep up with the pace of the treadmill. Subjects were instructed to step off the treadmill at that time. At this point, they were dened as being subjectively exhausted and immediately (within 45 s) underwent blood sampling from their intravenous catheter for repeat pH and lactate evaluation. Total time (minutes:seconds) of exertion was recorded for volunteers in these groups. 2.3.2. Prolonged CEW Exposure protocol (groups 1, 3) Volunteers that were selected into groups 1 and 3 received a prolonged CEW application. Group 1 volunteers received the Prolonged CEW Exposure protocol only with no prior exertion (they were in a rested state at time of CEW exposure). Group 3 volunteers received the Prolonged CEW Exposure protocol immediately after completing the Exertion protocol. The Prolonged CEW Exposure protocol consisted of a 15 s application with applied electrodes powered by a TASER X26 CEW (TASER International, Scottsdale, AZ.) The exposure consisted of manually applying electrodes to the volunteer while they were lying on a padded mat in a supine position. The electrodes were manually placed and taped into position within conductive gel instead of being red from the CEW at the subject to assure exact placement from volunteer to volunteer. The electrodes were placed on the subjects trunk in ipsilateral, anterior thorax positions to span a majority of the trunk while including trans-diaphragmatic positioning. The electrodes were always placed on the side of the thorax opposite that of the extremity that the intravenous catheter was placed in order to avoid catheter displacement in the event of upper extremity contraction during the event. Placement was always in the mid-pectoral region for the superior electrode and at the waistline for the inferior electrode in a vertical position (Fig. 1). The TASER X26 CEW internal software had a single modication that allowed the exposure duration to run for a continuous 15 s of duration with each pull of the trigger (a standard TASER X26 CEW trigger pull yields a 5 s run duration). No other modication was made to the CEW. The purpose of the software modication was to enable the CEW current application to be delivered in an objective, reproducible and controlled fashion. With the exception of this, the CEW was not altered from the factory standard. Immediately following the CEW application (within 45 s), all subjects had blood sampled by the investigators. 2.3.3. Additional Exertion Protocol (group 4) Following completion of the Exertion protocol and the subsequent blood sampling, the subjects in group 4 underwent an additional 1-min of running on the treadmill at 8 miles per hour and 8 degrees of elevation. Subjects were instructed to stop if they became too exhausted to keep up with the treadmill prior to 1 min. Upon completing this additional period of exertion, the subject immediately (within 45 s) had blood sampled and was allowed to recover in a sitting or semirecumbent position. 2.3.4. Universal protocol (all groups) All subjects in all 4 groups had an 18 or 20 gauge venous catheter placed into an upper extremity at the start of the investigation so that serial venous blood samples could be taken at various times during the study period. Intravenous cathether insertion was performed by either a certied paramedic or one of the physician investigators. After each blood sample was drawn, the specimens were labaled and analyzed immediately on a portable I-STAT1 point of care analyzer using a CG4+ analysis cartridge (Abbott Diagnostics, Abbott Park, IL). The blood samples were analyzed for pH and lactate. Blood sampling occurred universally at 2-min intervals after the nal stressor event (either nal exertion event or CEW exposure) was completed. The blood sampling continued until 20 min after the nal stressor event. Following the completion of the blood sampling, all subjects were allowed to recover in a sitting or semi-recumbent position, the intravenous catheter was removed aseptically, the area was bandaged, and the subject was offered a light snack and oral hydration. 2.4. Data analysis Data were entered in an Excel (Microsoft Excel 2008, Redmond, WA) spreadsheet for analysis. Data analysis was performed using STATA 10.0 (STATA Corp., College Station, TX). Descriptive statistics were used where appropriate. Values at time points were compared between groups 1 and 2 and between groups 3 and 4 using Wilcoxon rank sum tests. The association between pH and lactate over time within and between the exposure groups was assessed using multiple linear regression. Power analysis of the Wilcoxen rank sum test revealed that in order to detect a 10% difference between lab values at the post-exposure time point, with a signicance of 0.05 and a power of 80%, 9 subjects were required in each group.
has also been associated with death in this population [16]. It is believed that the acidosis is due to several factors including use of illicit stimulants in this population and continued eeing, ghting or resisting law enforcement authorities [17,18]. There is controversy surrounding the use of a CEW in this subject population. There is animal data to suggest that CEW exposure to rested animals under laboratory conditions can lead to worsening acidosis [19]. The effect of a CEW on pH immediately after its application has been reported but the effect over the subsequent short term period following application has not [13]. It is not known what the effect of a CEW is on an exhausted subjects metabolic physiology during this short term period after exposure. The rst objective of this study was to determine the pH and lactate changes in the 20 min after a CEW exposure, and to compare them to the effects of the Exertion protocol used in this experimental model. Determining this would allow comparison of this model to previous human studies that have not obtained short interval acidosis measurements during this time period. The next objective was to determine the metabolic effect of a prolonged CEW exposure in exhausted and rested subjects in the 20 min immediately following exposure, and to compare this to subjects who continued to exert themselves but were not exposed to a CEW. Our null hypothesis was that there would be no difference in the pH or lactate at any time point in exhausted subjects who were exposed to a CEW than in exhausted subjects who continued to exert themselves.
2. Material and methods 2.1. Study design This was a prospective study of adult volunteers recruited at a TASER International training course in August, 2008. The institutional review board of Hennepin County Medical Center approved the study. All subjects provided informed consent before enrollment. This study received partial funding from TASER International in the form of an unrestricted research grant that covered the cost of phlebotomy and laboratory services. The study sponsor had no role in designing the study, collecting the data, analyzing the data, writing the manuscript or submitting it for publication. 2.2. Study setting and population This study was performed with volunteer human subjects attending a training course. As a voluntary part of their training course, they were to receive a CEW exposure from a TASER device. All adult subjects (age > 18 years) who were going to receive this exposure were eligible for enrollment in the study. Volunteers were personnel involved in various occupations including: medicine, sales, law enforcement, corrections, public relations, public utility maintenance, long-haul transportation and political campaign management. They did not have to participate in the study as a requirement for successful course completion but declining to participate in the study did not absolve them from receiving a CEW application as part of the training course. The exclusion criteria were known pregnancy and persons with known mental illness diagnoses. Volunteers were given a TASER CEW upon successful completion of the study protocol. 2.3. Study protocol All volunteers completed a medical questionnaire that included: age, gender, occupation, body mass index (BMI) parameters, past medical history, current medication use, and history of recent heavy exertion. After completion of the study questionnaire, all volunteers had an 18 or 20 gauge intravenous catheter placed in an upper extremity and had blood drawn from this for baseline analysis of venous pH and lactate. Upon completion of the baseline blood analysis, each volunteer was randomly placed into 1 of 4 study groups. Randomization was accomplished by having volunteers present themselves for testing on a rst come, rst served basis and then cycling them through the next available testing group station. The groups were: group 1 Prolonged CEW Exposure protocol only without exertion; group 2 Exertion protocol only; group 3 Exertion protocol followed by Prolonged CEW Exposure protocol; and group 4 Exertion protocol followed by Additional Exertion Protocol. Detailed explanation of the group protocols are as follows: 2.3.1. Exertion protocol (groups 2, 3, 4) After informed consent and baseline blood sampling, volunteers that were placed into groups 24 performed a series of intense, rigorous physical activities
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J.D. Ho et al. / Forensic Science International xxx (2009) xxxxxx 3
exposure conclusion. There was 1 volunteer in group 4 that did not complete the full minute of additional treadmill exertion at the discretion of the lead investigator due to fatigue. For this volunteer, the treadmill was shut down at 57 s upon noticing that the study subject was experiencing difculty in keeping up with the treadmill and there was a safety concern when the study subject nearly fell. There were no adverse events that occurred related to this study. Tables 2 and 3 and Figs. 2 5 display pH and lactate values at all time points. There were no differences between the groups at baseline. The CEW Exposure only group had higher values of pH and lower values of lactate at all time points after the CEW Exposure than the Exertion only group. There were no differences in groups 3 and 4 immediately after the Exertion protocol was completed. After the Exertion protocol, the Additional Exertion group showed no difference in median pH or median lactate than the CEW Exposure group at any time point. Multiple linear regression demonstrated that change in pH did not correlate with the groups over time (coefcient 0.001, 95% CI 0.0001 to 0.003, p = 0.21) but change in lactate did (coefcient 0.30, 95% CI 0.21 0.40, p < 0.001). 4. Discussion CEWs are categorized as non lethal weapons by the United States Department of Defense and offer law enforcement personnel an option for control of agitated or potentially violent persons [20]. CEWs have become increasingly popular tools of force used by law enforcement and corrections personnel and are considered by most agencies to be in a class known as an intermediate weapon. Intermediate weapons are devices that generally can induce subject compliance due to pain or incapacitation and are more than the use of empty hand control techniques but less than deadly force devices. Examples of intermediate weapons include aero solized chemical irritants, impact batons, and projectile beanbags. This project utilized the TASER brand of CEW. TASER1 is an acronym for Thomas A. Swifts Electric Rie and is a name based on a ctional series of childrens literature. Our work focused on the TASER X26 model of CEW because it is currently the most popular handheld law enforcement CEW in use and is the model most likely to be encountered in the eld. The X26 is programmed to deliver a roughly rectangular pulse of approximately 100 ms duration with about 100 mC of charge at 19 pulses per second for 5 s [21]. The peak voltage across the body is approximately 1200 2400 V but the weapon also develops an open circuit arc of 50,000 V to traverse clothing in cases where no direct contact is made. The average current is approximately 2.1 mA. It uses compressed nitrogen to re 2 metallic darts up to a maximum of 35 feet with a pre determined angled rate of spread. When it makes adequate contact and the darts are of adequate separation, it causes involuntary contractions of the regional skeletal muscles that render the subject incapable of
Fig. 1. Electrode placement example (ipsilateral, anterior thorax at mid-pectoral area and waistline on the side opposite of the IV catheter).
3. Results There were 40 subjects enrolled, 10 in each group. Subject demographics are in Table 1. All post exertion and post CEW exposure blood draws were completed within 45 s of exertion or
Table 1 Volunteer demographics. Group 1 (CEW only) Number # Females BMI (median, range) Past medical history 10 3 22.9, 16.635.4 1 asthma 1 high cholesterol 1 albuterol/advair 1 statins Group 2 (Exertion only) 10 4 28.1, 20.447.3 1 high cholesterol 1 hypertension 1 statin 2 synthroid 1 diuretic 4/10 32, 2046
Group 3 (Exertion + CEW) 10 2 27.6, 19.728.9 None
Group 4 (Exertion + Exertion) 10 1 27.1, 22.454.8 1 high cholesterol 1 left bundle branch block 2 statins
Total 40 10 26.0, 16.654.8
Medication
None
Recent exertion Median age in years (range)
2/10 38, 2254
2/10 35, 2044
4/10 36.5, 2049
12/40
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4 Table 2 pH. Group 1, CEW only (median, range) Baseline Immediately after exertion Immediately after CEW/2nd exertion 2 min after CEW/2nd exertion 4 min 6 min 8 min 10 min 12 min 14 min 16 min 18 min 20 min 7.37, 7.35, 7.33, 7.35, 7.34, 7.35, 7.37, 7.37, 7.37, 7.38, 7.38, 7.38, 7.297.40 7.307.39 7.267.39 7.277.40 7.317.41 7.327.42 7.357.40 7.347.40 7.347.39 7.347.40 7.337.40 7.367.40 Group 2, Exertion only (median, range) 7.35, 7.13, 7.07, 7.10, 7.11, 7.13, 7.14, 7.17, 7.18, 7.20, 7.22, 7.24, 7.297.40 7.037.34 7.047.15 7.067.14 7.057.30 7.077.28 7.057.30 7.007.32 7.077.33 7.097.31 7.107.32 7.137.30 Wilcoxon rank sum (group 3 vs. 4) 0.724 J.D. Ho et al. / Forensic Science International xxx (2009) xxxxxx
<0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 Wilcoxon rank sum (group 3 vs. 4) 0.774 0.653 0.791 0.495 0.437 0.596 0.910 0.567 0.624 0.689 0.682 0.790 0.967
Group 3, Exertion + CEW (median, range) Baseline Immediately after exertion Immediately after CEW/2nd exertion 2 min after CEW/2nd exertion 4 min 6 min 8 min 10 min 12 min 14 min 16 min 18 min 20 min 7.38, 7.19, 7.12, 7.11, 7.11, 7.13, 7.13, 7.16, 7.18, 7.20, 7.21, 7.22, 7.26, 7.327.41 7.057.26 7.017.23 7.017.25 7.007.25 6.997.26 7.017.28 7.227.31 7.027.34 7.057.36 7.067.36 7.107.38 7.107.36
Group 4, Exertion + Exertion (median, range) 7.36, 7.14, 7.11, 7.09, 7.10, 7.08, 7.12, 7.15, 7.17, 7.19, 7.20, 7.25, 7.25, 7.137.43 6.957.39 6.987.26 7.007.20 7.007.21 6.977.24 7.007.26 7.007.28 7.007.32 7.047.39 7.057.35 7.067.36 7.087.38
voluntary movement. If the darts are red at very close range and do not achieve adequate separation, full muscular incapacitation may not be achieved and the device is then used to encourage certain behavior through pain compliance.
Table 3 Lactate (mmol/L). Group 1, CEW only (median, range) Baseline Immediately after exertion Immediately after CEW/2nd exertion 2 min after CEW/2nd exertion 4 min 6 min 8 min 10 min 12 min 14 min 16 min 18 min 20 min 1.6, 2.1, 3.6, 4.1, 4.5, 3.4, 3.4, 3.2, 2.9, 2.7, 2.6, 2.0, 0.62.9 1.83.3 2.55.5 2.55.3 2.75.2 2.35.3 2.24.9 1.74.5 1.84.1 1.73.8 1.53.6 1.33.3
Agitated persons confronted by law enforcement have been associated with states of severe exhaustion and metabolic acidosis [16]. It is not clear whether this state of exhaustion, coupled with the application of a CEW might lead to adverse acidosis parameters
Group 2, Exertion only (median, range) 1.4, 0.73.0 13.2, 5.717.8 14.6, 10.418.3 13.0, 10.517.5 14.7, 10.018.1 14.5, 9.818.3 14.6, 8.817.9 13.2, 8.717.2 12.5, 8.116.5 12.0. 7.818.9 11.9, 7.318.6 11.3, 2.017.7 Group 4, Exertion + Exertion (median, range) 1.6, 0.73.4 10.2, 0.918.1 12.7, 8.018.2 16.0, 10.919.2 16.1, 10.019.5 15.4, 10.520.0 15.3, 10.619.3 14.6, 9.620.0 14.5, 9.120.0 14.1, 8.520.0 13.3, 7.818.9 11.9, 7.318.6 11.3, 7.017.7
Wilcoxon rank sum (group 3 vs. 4) 0.597 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 Wilcoxon rank sum (group 3 vs. 4) 0.270 0.165 0.821 0.734 0.935 0.706 0.880 0.807 0.722 0.832 1.000 0.683 0.929
Group 3, Exertion + CEW (median, range) Baseline Immediately after exertion Immediately after CEW/2nd exertion 2 min after CEW/2nd exertion 4 min 6 min 8 min 10 min 12 min 14 min 16 min 18 min 20 min 1.3, 0.91.7 9.1, 6.113.1 11.6, 7.815.0 16.0, 10.420.0 16.7, 10.320.0 16.4, 10.219.8 15.6, 9.719.1 15.3, 9.419.4 15.4, 8.218.9 19.5, 7.918.8 13.9, 7.518.3 13.0, 6.717.5 12.3, 6.117.6
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Fig. 2. Median pH of control groups.
Fig. 4. Median lactate of control groups.
shortly after application. This study was designed primarily to examine what the physiologic differences are in terms of acidosis between ending a situation with a prolonged CEW exposure versus allowing a person to continue on with their resistive behavior. It has been theorized that the application of a CEW on an already acidotic person could potentially lead to a worsening acidosis condition that causes death. Prior work in this area by Ho et al. has examined exhausted human subjects that received prolonged CEW exposures and reported biomarkers for acidosis immediately (within 1 min) following the exposures and 16 24 h after CEW exposure [13]. However, the time period following the rst minute after CEW exposure has not been specically examined. The lack of information for this short window of time partially led to a recent successful argument that CEW application likely worsened acidosis and caused an ARD within this short window of time [22]. However, our current work in this area specically attempts to address this previously unstudied time frame. We found that when applying a CEW to an acidotic subject, this short term interval is not physiologically worse with regard to acidosis parameters than allowing the subject to continue with their exertional activity. This is an important nding because law enforcement authorities in a situation requiring them to imme diately intervene generally have 1 of these 2 choices available to them (immediately stopping the resistance through incapacitation with a CEW or using time consuming control techniques that rely on pain such as pepper spray or hands on methods that allow the subject to continue to resist, ght or ee).
Because the goal of this project was to address CEW application in acidotic subjects undergoing restraint, it was important for us to attempt to reproduce the conditions of acidosis that are present in the eld during an interaction with law enforcement. We considered exercising our volunteers to 85% of maximal predicted heart rate as this exercise protocol is widely used for physical tness training but decided against this because we were not attempting to evaluate tness. We designed our Exertion protocol to induce intense anaerobic exhaustion over a short period of time, a time situation that we believe is similar to the dynamic eld conditions faced by law enforcement authorities. In this study, subjects exerted themselves to subjective exhaustion. We have used this Exertion protocol in a prior study [13]. Subjects were instructed to perform the Exertion protocol event until they perceived themselves to be exhausted. Their level of exhaustion was objectively measured by their venous pH status immediately before and after the event. We believe that this allowed us to truly test for the effect that exhaustion has when coupled with CEW application. In reality, an agitated person with delirium or intoxication is likely able to ignore their internal cues of exhaustion that our non impaired volunteers heeded. This could lead to severe anaerobic exhaustion as the subject vigorously ghts, ees and resists any efforts to attempt to control them. Anaerobic exhaustion and metabolic acidosis are generally measured by serum pH and lactate values [23]. We elected to use venous pH as a measurement of acid/base balance in the volunteers. Although arterial sampling is often thought of as
Fig. 3. Median pH of experiment groups.
Fig. 5. Median lactate of experiment groups.
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6 J.D. Ho et al. / Forensic Science International xxx (2009) xxxxxx
the gold standard for pH measurement, current literature indicates that there is good correlation for pH values between arterial and venous samples [24 26]. Electing to utilize a venous sample in this experiment allowed us to place a peripheral venous sampling catheter that was more comfortable for our volunteers instead of having to perform a more painful percutaneous arterial puncture or undergo an indwelling arterial catheter placement. We found that utilizing a CEW in this simulated study situation was no worse than allowing the subject to briey continue exerting themselves (for 1 min) from an acid/base physiology standpoint. The effect of allowing a subject to continue prolonged exertion beyond 1 min is unknown. Exposure to a CEW alone did not induce acidosis similar to exertion, and exhausted subjects did not show a difference in pH or lactate whether they exerted themselves or not for an additional minute, or were exposed to a CEW. Because exhausted subjects are associated with ARD, it may be intuitively safer to use a device such as the CEW that could quickly end a prolonged struggle instead of allowing an exertional struggle to continue unabated. It is important to note that in group 4 (Additional Exertion Protocol), the goal was to simulate what occurs in a realistic scenario when an agitated subject has a prolonged and exhaustive struggle with law enforcement authorities. We believe that the initial period of exhaustion simulated by our Exertion protocol demonstrates that a state of anaerobic exhaustion quickly occurs. The Additional Exertion Protocol was meant to simulate the continued resistive and hypermetabolic behavior that is often exhibited by subjects unless forced to stop through CEW application or chemical sedation. It is our experience and belief that in eld encounters with law enforcement ofcials, continued resistive behavior by agitated subjects generally lasts much longer than a period of 1 min. However, for the purposes of this study, 1 min was the pre determined limit to ensure the safety of the study volunteers. We believe that had the volunteers been able to continue exerting themselves beyond 1 additional minute, that our ndings would demonstrate a worsening acidosis that is different and more severe than what was demonstrated by prolonged use of a CEW. In a subsequent study by Jauchem et al., blood pH and lactate were signicantly changed after only three 5 s applications of a CEW. In that study, however, animals were also anesthetized [27]. There has been controversy about animal model studies that demonstrate CEW induced acidosis in rested swine [19,28]. CEW critics have pointed out that these studies are reasonable proof that a human being in an exhausted condition should exhibit signicantly greater acidemia after CEW application [29]. We believe these animal studies need to be interpreted with caution. Both represent relatively unrealistic eld CEW exposure durations (360 and 80 s respectively) and utilized animals that were deeply anesthetized and on life support ventilators without ability to compensate through respiratory mechanisms. In the Jauchem et al. study, complete cessation of breathing was noted during the CEW exposure time period. In the latter study, the ventilator was shut off during the exposure time period. Respiratory limitations in both studies would have articially and signicantly changed the acid/base physiology of the animal. This respiratory limitation has not been noted to occur in human research [30]. We believe Jauchems cautionary statements to be correct in that they warn readers to not draw full conclusions between his study and real law enforcement use on humans due to methodology limitations [31]. Our data would also support Jauchems statements since our ndings in humans did not mimic his in swine. The previous work by Ho et al. that demonstrates human subjects breathe above their baseline parameters during prolonged CEW application relates to our ndings [30]. This is an important conclusion relative to our ndings since continued ventilation at levels above baseline minute ventilation during CEW exposure of
an acidotic subject should only serve to improve an altered acid base state. The demonstration by this study that CEW application to an exhausted cohort did not demonstrably worsen their acidotic condition has ramications beyond simple acid base physiology. Our data suggests that the modern day practice of utilizing a CEW to subdue or repel an agitated, exhausted individual may be a useful control option in this type of subject. There was a signicant increase in serum lactate that occurred following the Exertion protocol. This level also increased a small but statistically signicant amount in volunteer group 3 and group 4. Lactate formation from exertion has been a classic explanation of acidosis and fatigue. However, a review by Robergs et al. demonstrates that lactate production increases only when there is an excess of cellular proton release with metabolism and its increase functions to supply the necessary nicotinamide adenine dinucleotide for glycolysis [32]. Therefore, increased lactate coincides with cell acidosis and remains a good marker for this condition but does not necessarily cause the acidosis to occur. Since lactate is a marker of exercise, exertion and metabolism, the elevations seen after exertion and after CEW exposure causing skeletal muscle activation were expected. 5. Limitations A limitation of this study is that our study population did not exactly mimic the characteristics of human subjects that tend to have custodial death events. Literature indicates that in custodial death situations, the persons who die tend to have mental illness with psychotic features or illicit stimulant abuse histories [4]. These factors were presumably not present in our volunteer population. However, we do not believe that this limit equates to a healthy population bias. The volunteers that we studied were not young, did not have exceptional levels of physical tness, and were made up of a variety of people in various occupations. They had a wide age range and some had medical problems that required controlling medication. Additionally, their average body mass index calculations place them in the overweight category by federal standards and does not suggest a superior level of tness [33]. While our study population most likely did not have a history of psychosis or chronic illicit stimulant abuse, which are common descriptors of persons who die suddenly in custody, they do appear to represent the average adult citizen of this country [34]. It should also be noted that our data may not apply to situations of longer duration CEW exposures or repetitive or numerous repetitive discharges beyond what we have studied [35,36]. An additional limitation is the possibility that the randomiza tion process did not result in an equal distribution of volunteer demographics across all 4 groups of the study. Specically, group 1 had a lower age grouping and BMI than the other 3 groups. We do not believe that this affects the results based on our prior work where we have exposed older and higher BMI subjects to a solitary CEW exposure while evaluating metabolic markers and have seen similar results [12]. 6. Conclusion Subjects who were exposed to the CEW but did not undergo the Exertion protocol had a higher pH and lower lactate than the exhaustion group at all time points after the baseline. CEW exposure does not appear to worsen acidosis in exhausted, acidotic subjects differently than continued exertion. Contributions Jeffrey Ho contributed to the study concept and design, acquisition of the data, drafting of the manuscript, critical revision
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of the manuscript for important intellectual content, obtained funding, administrative, technical, or material support, and study supervision. Donald Dawes contributed to the study concept and design, acquisition of the data, critical revision of the manuscript for important intellectual content, administrative, technical, or material support, and study supervision. Jon Cole contributed to the acquisition of the data and admin istrative, technical, or material support. Julie Hottinger contributed to the acquisition of the data and administrative, technical, or material support. Ken Overton contributed to the acquisition of the data and administrative, technical, or material support. James Miner contributed to the study concept and design, acquisition of the data, analysis and interpretation of the data, drafting of the manuscript, critical revision of the manuscript for important intellectual content, statistical expertise, and study supervision. Acknowledgments The authors would like to thank Mr. Andrew Hinz and Mr. Matthew Carver for their technical assistance. This project would not have been possible without their help. Funding sources: TASER International, Inc., Scottsdale, AZ; Dept. of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN. References
[1] American Civil Liberties Union, Citing deaths in police custody, ACLU of Colorado calls for limits on use of electroshock weapons. ACLU Library, February 26, 2004 (Accessed December 3, 2008 at http://www.aclu.org/CriminalJustice/ CriminalJustice.cfm?ID=15167&c=15). [2] Amnesty International, Excessive and lethal force? Amnesty Internationals concerns about deaths and ill-treatment involving police use of TASERs. Amnesty International Library, November 30, 2004 (Accessed December 3, 2008 at http:// web.amnesty.org/library/index/engamr511392004). [3] J.D. Ho, W.G. Heegaard, D.M. Dawes, S. Natarajan, R.F. Reardon, J.R. Miner, Unexpected arrest-related deaths in America: 12 months of open source surveillance, West J. Emerg. Med. X (2009) 6873. [4] D.L. Ross, T. Chan, Sudden Deaths in Custody, Totowa, New Jersey, 2006. [5] A. Berenson, Demands rise for tighter oversight on use of stun guns, New York Times, February 17, 2005, p. A:24. [6] R. Anglen, Taser safety claim questioned, Arizona Republic, July 18, 2004 (Accessed November 1, 2005 at http://www.azcentral.com/specials/special43/ articles/0718taser-main18.html). [7] R. Anglen, 73 cases of death following stun gun use. Arizona Republic, October 12, 2004 (Accessed November 1, 2005 at http://www.azcentral.com/specials/ special43/articles/0915taserlist16-ON.html). [8] R. Anglen, Taser shocks ruled cause of death. Arizona Republic, July 30, 2005 (Accessed June 4, 2007 at http://www.azcentral.com/arizonarepublic/news/ articles/0730taser30.html). [9] S.D. Levine, C. Sloane, T. Chan, J. Dunford, G. Vilke, Cardiac monitoring of human subjects exposed to the TASER, J. Emerg. Med. 33 (2007) 113117. [10] G. Vilke, C. Sloane, K. Bouton, F. Kolkhorst, S. Levine, T. Neuman, E. Castillo, et al., Physiological effects of a conducted electrical weapon on human subjects, Ann. Emerg. Med. 50 (2007) 569575. [11] D.M. Dawes, J.D. Ho, M.A. Johnson, E. Lundin, T.A. Janchar, J.R. Miner, 15-Second conducted electrical weapon exposure does not cause core temperature elevation in non-environmentally stressed resting adults, Forensic Sci. Int. 176 (2008) 253257.
[12] J.D. Ho, J.R. Miner, D.R. Lakireddy, L.L. Bultman, W.G. Heegaard, Cardiovascular and physiologic effects of conducted electrical weapon discharge in resting adults, Acad. Emerg. Med. 13 (2006) 589595. [13] J.D. Ho, D.M. Dawes, J.R. Miner, R.M. Moscati, T.A. Janchar, M.A. Johnson, L.L. Bultman, Prolonged TASER use on exhausted humans does not worsen markers of acidosis, Am. J. Emerg. Med. 27 (2009) 413418. [14] J.D. Ho, D.M. Dawes, W.G. Heegaard, H.G. Calkins, R.M. Moscati, J.R. Miner, Absence of electrocardiographic change following prolonged application of a conducted electrical weapon in physically exhausted adults, J. Emerg. Med., in press. [15] S.J. Stratton, C. Rogers, K. Brickett, G. Gruzinski, Factors associated with sudden death of individuals requiring restraint for excited delirium, Am. J. Emerg. Med. 21 (2001) 187191. [16] J.L. Hick, S.W. Smith, M.T. Lynch, Metabolic acidosis in restraint-associated cardiac arrest: a case series, Acad. Emerg. Med. 6 (1999) 239243. [17] R.Y. Wang, pH-dependent cocaine-induced cardiotoxicity, Am. J. Emerg. Med. 17 (1999) 364369. [18] S.A. Burchell, H.C. Ho, M. Yu, D.R. Margulies, Effects of methamphetamine on trauma patients: a cause of severe metabolic acidosis? Crit. Care Med. 28 (2000) 21122115. [19] J.R. Jauchem, C.J. Sherry, D.A. Fines, M.C. Cook, Acidosis, lactate, electrolytes, muscle enzymes and other factors in the blood of Sus scrofa following repeated TASER exposures, Forensic Sci. Int. 161 (2006) 2030. [20] Anonymous, Department of Defense Directive 3000.3 policy for nonlethal weapons. United States Department of Defense, July 9, 1996 (Accessed February 11, 2009 at http://www.dtic.mil/whs/directives/corres/pdf/300003p.pdf). [21] Anonymous, TASER training video and information disk, version 14. TASER International, August, 2008. [22] Betty Lou Heston, et al. v. City of Salinas, et al. United State District Court for the Northern District of California, Case No. C 05-03658 JW. [23] A. Hipp, R. Sinert, Metabolic Acidosis, eMedicine from Web MD, 2008. Accessed February 11, 2009 at http://www.emedicine.com/emerg/topic312.htm. [24] G. Malatesha, N.K. Singh, A. Bharija, B. Rehani, A. Goel, Comparison of arterial and venous pH, bicarbonate, pCO2 and pO2 in initial emergency department assessment, Emerg. Med. J. 24 (2007) 569571. [25] P. Middleton, A.M. Kelly, J. Brown, M. Robertson, Agreement between arterial and central venous values for pH, bicarbonate, base excess, and lactate, Emerg. Med. J. 23 (2006) 622624. [26] A.M. Kelly, R. McAlpine, E. Kyle, Venous pH can safely replace arterial pH in the initial evaluation of patients in the emergency department, Emerg. Med. J. 18 (2001) 340342. [27] J.R. Jauchem, M.C. Cook, C.W. Beason, Blood factors of Sus scrofa following a series of three TASER electronic control device exposures, Forensic Sci. Int. 175 (2008) 166170. [28] A.J. Dennis, D.J. Valentino, R.J. Walter, K.K. Nagy, J. Winners, F. Bokhari, D. Wiley, et al., Acute effects of TASER X26 discharges in a swine model, J. Trauma 63 (2007) 581590. [29] C.D. Miller, Acidosis, lactate, electrolytes, muscle enzymes, and other factors in the blood of Sus scrofa following repeated TASER exposures, Forensic Sci. Int. 168 (2007) e17e18. [30] J.D. Ho, D.M. Dawes, L.L. Bultman, J.L. Thacker, L.D. Skinner, J.M. Bahr, M.A. Johnson, et al., Respiratory effect of prolonged electrical weapon application on human volunteers, Acad. Emerg. Med. 14 (2007) 197201. [31] J.R. Jauchem, Re: Acidosis, lactate, electrolytes, muscle enzymes, and other factors in the blood of Sus scrofa following repeated TASER exposures, Forensic Sci. Int. 168 (2007) e19. [32] R.A. Robergs, F. Ghiasvand, D. Parker, Biochemistry of exercise-induced metabolic acidosis, Am. J. Physiol. Regul. Integr. Comp. Physiol. 287 (2004) R502 R516. [33] Anonymous, Standard BMI calculator, Department of Health and Human Services, National Institutes of Health (Accessed February 11, 2009 at http:// www.nhlbisupport.com/bmi/). [34] M.S. Pollanen, D.A. Chiasson, J.T. Cairns, J.G. Young, Unexpected death related to restraint for excited delirium: a retrospective study of deaths in police custody and in the community, CMAJ 158 (1998) 16031607. [35] H.E. Williams, TASER Electronic Control Devices and Sudden In-custody Death: Separating Evidence from Conjecture, Charles C. Thomas Publishers, Springeld, IL, 2008. [36] U.S. National Institute of Justice, Study of Deaths Following Electro Muscular Disruption: Interim Report. Washington, DC (Accessed May 1, 2009 at http:// www.ncjrs.gov/pdfles1/nij/222981.pdf).
BASIC INVESTIGATION
Acidosis and Catecholamine Evaluation Following Simulated Law Enforcement Use of Force Encounters
Jeffrey D. Ho, MD, Donald M. Dawes, MD, Rebecca S. Nelson, Erik J. Lundin, MS, Frank J. Ryan, PhD, Kenneth G. Overton, Adam J. Zeiders, EMT-P, and James R. Miner, MD
Abstract
Objectives: Law enforcement authorities are often charged with controlling resisting suspects. These encounters sometimes result in the sudden and unexpected death of the suspect. Drug intoxication, excited delirium syndrome, or excessive uses of force are factors that are often blamed, but sometimes the mechanism of these deaths is not fully understood. It is possible that worsening acidosis or excessive catecholamine release play a part. The objective of this study was to determine the effect on markers of acidosis and catecholamines of various tasks intended to simulate common arrest-related situations. Methods: Subjects were assigned to one of ve task groups: 1) a 150-meter sprint and wall hurdle (simulated ight from arrest); 2) 45 seconds of striking a heavy bag (simulated physical resistance); 3) a 10-second TASER X26 electronic control device exposure; 4) a eeing and resistance exercise involving a law enforcement dog (K-9); or 5) an oleoresin capsicum (OC) exposure to the face and neck. Baseline serum pH, lactate, potassium, troponin I, catecholamines, and creatine kinase (CK) were evaluated. Serum catecholamines, pH, lactate, and potassium were sampled immediately after the task and every 2 minutes for 10 minutes posttask. Vital signs were repeated immediately after the task. Serum CK and troponin I were evaluated again at 24 hours posttask. Results: Sixty-six subjects were enrolled; four did not complete their assigned task. One subject lost the intravenous (IV) access after completing the task and did not have data collected, and one subject only received a 5-second TASER device exposure and was excluded from the study, leaving 12 subjects in each task group. The greatest changes in acidosis markers occurred in the sprint and heavy bag groups. Catecholamines increased the most in the heavy bag group and the sprint group and increased to a lesser degree in the TASER, OC, and K-9 groups. Only the sprint group showed an increase in CK at 24 hours. There were no elevations in troponin I in any group, nor any clinically important changes in potassium. Conclusions: The simulations of physical resistance and eeing on foot led to the greatest changes in markers of acidosis and catecholamines. These changes may be contributing or causal mechanisms in sudden custodial arrest-related deaths (ARDs). This initial work may have implications in guiding applications of force for law enforcement authorities (LEAs) when apprehending resisting subjects. ACADEMIC EMERGENCY MEDICINE 2010; 17:E60 E68 2010 by the Society for Academic Emergency Medicine Keywords: law enforcement, restraint, physical, catecholamines, acidosis, weapons
From the Department of Emergency Medicine, Hennepin County Medical Center (JDH, RSN, JRM), Minneapolis, MN; the Department of Emergency Medicine, University of Minnesota Medical School (JDH, JRM), Minneapolis, MN; the Emergency Department, Lompoc Valley Medical Center (DMD), Lompoc, CA; the University of Louisville School of Medicine (DMD, EJL), Louisville, KY; the Laboratory Corporation of America (FJR), Burlington, NC; and the Phoenix Fire Department (KGO, AJZ), Phoenix, AZ. Received November 25, 2009; revisions received January 25 and January 28, 2010; accepted January 30, 2010. Presented at the Scientic Symposium of the American College of Emergency Physicians, September 2009, Boston, MA. TASER International, Inc., provided partial funding for the study. Disclosures: Dr. Ho serves as the contractual medical director and a medical consultant to TASER International, Inc. Dr. Dawes serves as a medical consultant to TASER International, Inc. Both personally own shares of stock in this company. Supervising Editor: Jeffrey A. Kline, MD. Address for correspondence and reprints: Jeffrey D. Ho, MD; e-mail: jeffrey.ho@hcmed.org.
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ISSN 1069 6563 PII ISSN 1069 6563583
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2010 by the Society for Academic Emergency Medicine doi: 10.1111/j.1553 2712.2010.00813.x
ACAD EMERG MED July 2010, Vol. 17, No. 7
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udden and unexpected deaths have occurred in custodial situations for centuries.1 The mechanisms of many of these deaths remain unclear. These types of deaths in modern-day society are most often associated with violent and resistive encounters with law enforcement authorities (LEAs) attempting a custodial arrest. These arrest-related deaths (ARDs) tend to yield scrutiny of the LEAs tools and tactics used in the encounter. There has been speculation about the mechanisms responsible for ARD. While drug intoxication, excited delirium syndrome, or LEA excessive force practices have been implicated, the possible mechanisms leading to ARD have not been well studied. Worsening acidosis and a hyperadrenergic state are two possible mechanisms.2,3 In this study, we examined these parameters within the context of commonly used tools, tactics, and suspect behaviors to establish a better understanding of the physiologic state of a person at the time of ARD. The objective of this study was to determine the effect on markers of acidosis and catecholamines of various tasks intended to simulate common arrest-related situations. METHODS Study Design This was a prospective, experimental study of human subjects. All subjects provided informed consent. The institutional review board at Hennepin County Medical Center approved the study. Study Setting and Population The study was conducted at the Thomas A. Hontz Police and Fire Training Facility (Scottsdale, AZ) in the context of a LEA training environment. Data gathering took place in March 2009 during daylight hours. Daily outdoor temperatures ranged from 43.3 to 76.5 F over the 3 days of testing. The participants were a convenience sample of law enforcement and corrections ofcers, non-LEA public safety personnel, TASER International, Inc., employees, and academic researchers participating in a training event sponsored by TASER International, Inc. (Scottsdale, AZ). Attendees at the training event were notied of the research and instructed to contact the investigators if interested. All participants were aware that they were participating in training that could subject them to various uses of force, including a TASER device exposure. All of the training conditions used in this research are common situations used in the training of police and corrections ofcers and were familiar to persons at this event. This training event was chosen as a recruitment site because participants had familiarity with the events in each arm of the study, allowing them to make informed decisions about enrollment in the study. Each subject was asked to complete one of ve tasks meant to simulate various custodial arrest-related conditions. Each subject then completed a medical screening questionnaire describing medical history, current medications, and recent exercise, which was reviewed by a study physician. Inclusion criteria were the ability
to participate in vigorous physical exercise. Known pregnancy was the only exclusionary criteria. Each subject was given a TASER device as compensation for participation at the completion of the study. Study Protocol Each subject was prospectively assigned to one of ve tasks that were meant to simulate suspect behaviors that commonly occur or the LEA use of tools and tactics that are commonly used during custodial arrest situations of a resisting subject: 1) 150-meter sprint and wall hurdle, simulating ight on foot from LEAs; 2) 45 seconds of hitting and kicking a heavy bag, simulating the physical exertion of resisting arrest by LEAs; 3) 10-second continuous TASER X26 device exposure; 4) an LEA-trained dog (K-9) resistance exercise simulating eeing on foot from and resisting a K-9; or 5) an oleoresin capsicum (OC) foam exposure to the face neck. Subjects assigned to the K-9 resistance task group were screened rst for prior K-9 training or handling experience. Subjects who had prior K-9 training or handling experience were not eligible for the K-9 resistance task and were assigned the next available task. All subjects were asked not to engage in any physical exercise regimens for 48 hours prior to testing and until their nal blood draw 24 hours after the task. Details of the Task Groups Task Group 1 (150-meter Sprint and Wall Hurdle). The subject sprinted 150 meters in a straight line on a blacktop covered level surface. The subject had 10 yards at the end of the sprint to slow and prepare for a wall hurdle. The wall hurdle required the subject to jump climb over a 44-inch wall. The time to complete the task was recorded. The subject was encouraged verbally during the event. Task Group 2 (45 Seconds of Heavy Bag Physical Resistance). The subject was required to keep a suspended heavy bag away from him- or herself by any means possible. This included punching, kicking, head butting, and throwing knees and elbows offensively at the bag. The subject had the option to use any or all of these methods. The subject wore athletic shoes, had hands wrapped with protective athletic tape during the task, and was encouraged verbally during the event. Task Group 3 (10-second TASER X26 Device Exposure). The subject was exposed to a 10-second continuous TASER X26 electronic control device discharge to the back with deployed probes. The probes were deployed with the subject in the prone position on a protective mat from a distance of approximately 7 feet; the operator red from an elevated position on a stepladder. The probes and the TASER device were standard products from the manufacturer. The spread between the probes was measured to indicate the area of the subject exposed to the current. Task Group 4 (K-9 Fleeing and Physical Resistance Exercise). The subject wore a protective suit. The two K-9s used in this task were both on active police duty.
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Their handlers were with them during the entire task. The subject sprinted 160 feet in front of and away from the K-9. Near the completion of the sprint, the K-9 was released to chase the subject. The subject was instructed to present an arm for the K-9 to bite when nearing the completion of the sprint. The K-9 stayed on the bite for 20 seconds and the subject had been instructed to attempt to resist the K-9 during this time by pulling away and trying to stay on his or her feet. The K-9 handler provided verbal commands to the K-9 and the subject, simulating an arrest situation. The total task time was approximately 30 seconds. Task Group 5 (OC Pepper Spray). The subject was sprayed with 10% OC foam (Sabre Red, Security Equipment Corp, Fenton, MO) for a period long enough in duration to cover the face and the anterior portion of the neck (approximately 23 seconds). The subject was sprayed with eyes and mouth closed and was allowed to rinse the foam off with water after 10 seconds of exposure time. The subject was allowed access to continuous fresh air, running water, and a cooling fan if desired following the exposure. Measures Each participant had an 18- or 20-gauge intravenous (IV) catheter placed in the left or right antecubital fossa by a physician or paramedic prior to the test. Baseline automated blood pressure and heart rate were recorded by a Nonin 2120 device (Nonin Medical, Inc., Plymouth, MN). Baseline venous blood specimens for measurement of serum catecholamines (epinephrine, norepinephrine, dopamine, and total), pH, lactate, potassium, troponin I, and creatine kinase (CK) were obtained through the IV catheter. Each subject then participated in his or her assigned task. Catecholamines, pH, lactate, and potassium were drawn immediately (within 30 seconds) after the task and every 2 minutes until 10 minutes posttask. Vital signs were repeated immediately (within 30 seconds to 1 minute) after the task. CK and troponin I were obtained again at 24 hours. All samples for fractionated catecholamines, potassium, troponin, and CK were centrifuged and held on ice for off-site analysis and determination (LabCorp, Inc., Phoenix, AZ). Venous pH and lactate were determined on-site, using the i-STAT system and CG4+ cartridges (Abbott Point-of-Care, East Windsor, NJ). Data Analysis On-site data were compiled in an Excel spreadsheet (Microsoft Corporation, Redmond, WA). Data were exported into STATA 10.0 (StataCorp, College Station, TX) for analysis and SigmaPlot 11 (Systat Software, Inc., San Jose, CA) for graphical presentation. Descriptive statistics were used where appropriate. Data were not normally distributed and are reported as medians and ranges. Proportions describing subject characteristics were compared using chi-square tests. Values at each time point were compared between groups using the Kruskal-Wallis equality of populations rank test. Within each group, the baseline value was compared to subsequent values using Wilcoxon signed-rank tests.
Catecholamine values were reported as means with standard errors of the mean. To detect a 5% difference in the pH value between the groups at any time point, assuming a standard deviation (SD) of 5%, with a signicance of 0.05, and a power of 90%, 11 subjects were needed in each group. RESULTS Sixty-six subjects were enrolled. Three subjects were disqualied secondary to an inability to obtain IV access, and one of them had vasovagal syncope associated with multiple attempts to place an IV catheter. One subject was excluded secondary to refusal to participate in the prospectively assigned group. This subject had signicant anxiety leading to vasovagal syncope when told that he or she was being assigned to the OC foam exposure-task group. Sixty-two subjects completed the assigned tasks. Two of these subjects had their data excluded: one subject assigned to the heavy bag group had an IV catheter failure after the task, and further attempts at catheter placement were unsuccessful. The other subject was in the TASER X26 exposure group and had a 5-second continuous exposure instead of a 10-second exposure due to operator error. Data from both of these subjects were excluded from the group analysis (Table 1). There were 12 subjects in each of the task groups for the nal analysis. The subject characteristics and vital signs are presented in Table 2. There was no difference between the groups in age (p = 0.31), sex (p = 0.10), or body mass index (BMI; p = 0.10). Health histories included anxiety (n = 1), hypertension (n = 5), high cholesterol (n = 3), asthma (n = 1), chronic back pain (n = 1), gastroesophageal reux disease (n = 1), depression (n = 3), Hashimotos disease (n = 1), and hypothyroidism (n = 1). One subject had prior sexreconstructive surgery, one had recent hand surgery, and one listed low blood pressure as a current medical condition. The median sprint task group time was 25.6 seconds (range 22.031.6 seconds). The median TASER X26 probe spread was 12 inches (range 613 inches). One subject reported musculoskeletal shoulder pain after the TASER X26 device exposure that persisted, but was improved at 24 hours. On later telephone follow-up with this subject, there were no further complaints, and the issue had resolved. One subject in the TASER X26 device exposure task group had an apparent vasovagal syncopal episode after the completion of the exposure, but became responsive within 5 seconds with gentle stimulation and had no complaints upon recovery. Five of the heavy bag subjects had abrasions to the knuckles after the task. In addition, ve of these subjects became nearly syncopal and vomited after the task and had to be placed supine to recover. One sprint group subject had a syncopal episode 8 minutes after his task (he had been lightheaded and nauseated since completing the task). No other adverse events were reported. All subjects recovered and felt as at baseline prior to releasing them from the testing site. The pH and lactate values are presented in Tables 3 and 4. The groups were not different at baseline.
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Table 1 Results From Excluded Subjects Subject; Reason Heavy bag #8; IV catheter failure a) b) c) d) e) f) a) b) c) d) e) f) Pre 299 7.32 2.04 580 4 <0.2 590 7.367 1.65 106 3.9 <0.2 Post a) b) c) d) e) f) a) b) c) d) e) f) 1,359 7.11 16.96 X 3.8 X 727 7.334 1.33 X 3.4 X 2 Minutes a) b) c) d) e) f) a) b) c) d) e) f) X X X X X X 697 7.331 1.46 X 3.8 X 4 Minutes a) b) c) d) e) f) a) b) c) d) e) f) X X X X X X 616 7.340 1.56 X 3.7 X 6 Minutes a) b) c) d) e) f) a) b) c) d) e) f) X X X X X X 621 7.335 1.73 X 3.7 X 8 Minutes a) b) c) d) e) f) a) b) c) d) e) f) X X X X X X 597 7.387 1.69 X 3.9 X 10 Minutes a) b) c) d) e) f) a) b) c) d) e) f) X X X X X X 630 7.387 1.69 X 3.9 X 24 Hours a) b) c) d) e) f) a) b) c) d) e) f) X X X X X X X X X 129 X <0.2
TASER #1; 5 second exposure only
a) Total catecholamines (pg mL); b) pH; c) lactate (mmol L); d) CK (U L); e) K (mmol L); f) troponin I (ng mL); X = not obtained.
Table 2 Subject Characteristics and Vital Signs Group Sprint Age, yr Male sex, % Median BMI Pretest BP, mm Hg Posttest BP, mm Hg Comparison to baseline Pretest HR, beats min Posttest HR, beats min Comparison to baseline 36.5 (24 49) 91.7 26.2 (20.9 31.9) 128 73 (119 61 152 100) 151 82 (87 65 198 100) 0.011 72 (62 98) 130 (88 170) 0.002 OC 40 (21 48) 75.0 30.0 (26.2 39.3) 148 98 (121 74 184 123) 170 90 (106 85 202 130) 0.013 91 (69 110) 88 (53 110) 0.266 TASER 34 (24 67) 92.3 26.5 (22.1 36.9) 139 88 (126 71 175 101) 141 84 (122 87 178 86) 0.564 92 (60 109) 96 (66 115) 0.889 Heavy Bag 36 (24 50) 100 28.2 (21.7 44.1) 141 92 (118 73 191 117) 168 71 (108 95 202 111) 0.035 74 (64 117) 146 (115 181) 0.002 K9 26 (19 47) 66.7 25.8 (19.1 42.8) 129 85 (105 67 171 100) 166 90 (133 92 192 100) 0.004 80 (60 100) 122 (71 141) 0.002
Values reported are median (range) unless otherwise noted. BP = blood pressure; BMI = body mass index; HR = heart rate; OC= oleoresin capsicum.
Table 3 Median pH (Range) 10 minute Post 7.22 7.37 7.36 7.06 (7.16 (7.32 (7.34 (6.99 7.32) 7.48) 7.39) 7.15)
Group Sprint OC TASER Heavy bag K9 p value*
Baseline 7.32 7.36 7.37 7.36 (7.30 (7.33 (7.32 (7.28 7.44) 7.39) 7.43) 7.39)
Immediate Post 7.16 7.37 7.29 7.04 (7.05 (7.33 (7.24 (6.95 7.31) 7.40) 7.35) 7.18)
2 minute Post 7.17 7.37 7.29 7.01 (7.09 (7.32 (7.25 (6.91 7.31) 7.47) 7.33) 7.09)
4 minute Post 7.18 7.39 7.32 7.01 (7.11 (7.36 (7.28 (6.91 7.28) 7.45) 7.35) 7.09)
6 minute Post 7.19 7.37 7.33 7.06 (7.12 (7.34 (7.31 (6.94 7.29) 7.48) 7.36) 7.11)
8 minute Post 7.21 7.36 7.34 7.05 (7.13 (7.34 (7.31 (6.96 7.31) 7.48) 7.39) 7.13)
7.34 (7.30 7.40) 7.26 (7.14 7.36) 0.07 <0.001
7.25 (7.17 7.35) <0.001
7.26 (7.17 7.34) <0.001
7.27 (7.18 7.35) <0.001
7.27 (7.20 7.35) 7.31 (7.22 7.38) <0.001 <0.001
OC = oleoresin capsicum. *Kruskal Wallis test.
The pH and lactate (normal pH values 7.35 to 7.45 and lactate 12 mmol L) changed from baseline at every time point for all groups (p < 0.001 for each, Wilcoxon signed-rank test). There were no differences in potassium (normal 3.5 to 5.0 meq L) between the groups at baseline (median 4.0 meq L, range 3.64.6 meq L; p = 0.755). The sprint group and TASER group had a
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decrease in potassium at all time points (p < 0.01). The maximum decrease from baseline for the sprint group was 0.2 meq L (from 3.9 to 3.7 meq L), and for the TASER group was 0.3 meq L (from 4.0 to 3.7). The heavy bag group had a decreased potassium at the rst four time points (p < 0.01; maximum decrease from baseline 0.4 meq L, from 4.0 to 3.6 meq L), no difference from
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Table 4 Median Lactate, mmol L (Range)

Group Sprint OC TASER Heavy bag K9 p value * Baseline 1.19 1.01 1.30 1.44 (0.67 (0.76 (0.81 (0.73 3.55) 2.03) 1.93) 2.61) Immediate Post 10.98 1.39 5.49 15.46 (3.25 14.60) (0.6 2.39) (1.33 7.18) (8.85 18.65) 2 minute Post 12.74 1.45 5.52 17.22 (6.17 16.72) (0.61 2.40) (1.46 6.66) (15.14 20.0) 4 minute Post 13.26 1.50 5.31 17.88 (6.50 16.47) (1.07 2.15) (1.56 6.16) (15 01 20.0) 6 minute Post 13.93 1.49 4.76 17.09 (8.49 16.66) (0.65 2.13) (1.73 5.67) (13.81 20.0) 8 minute Post 13.02 1.34 4.60 18.26 10 minute Post
(8.55 16.56) 11.47 (7.61 15.77) (0.65 2.10) 1.50 (0.72 2.67) (1.69 5.29) 4.06 (1.69 4.78) (13.67 20.0) 17.33 (13.88 20.0) 5.90 (2.42 9.87) <0.001
1.05 (0.61 1.45) 0.066
5.01 (1.54 9.58) <0.001
5.76 (2.30 10.16) <0.001
6.13 (2.87 11.0) <0.001
6.53 (2.81 10.55) <0.001
6.34 (2.85 10.41) <0.001
OC = oleoresin capsicum. *Kruskal Wallis test.
Table 5 Creatinine Kinase, U L Group Sprint OC TASER Heavy bag K9 p value 144.8 215.3 184.4 303.8 137.4 Baseline (55.4) 57 231 (145.8) 98 597 (155.3) 42 576 (221.8) 99 758 (137.4) 58 366 0.038 196.8 214.1 241.1 351.6 174.8 24 hour Post (91.6) 57 440 (139.9) 69 508 (133.5) 59 447 (285.3) 109 1161 (170.5) 57 536 0.157 Difference From Baseline (Range) 30.5 5.5 26 74 3 ( ( ( ( ( 19 to 205) 120 to 92) 205 to 329) 160 to 403) 32 to 322) 0.70 p value* 0.006 1.000 0.25 0.31 0.57
Values are reported as mean (SD) range unless otherwise noted. OC = oleoresin capsicum. *Wilcoxon signed rank test. Kruskal Wallis test.
baseline at the 8-minute time point (p = 0.475), and an increase of 0.3 meq L at the 10-minute time point (from 4.0 to 4.3 meq L, p = 0.002). There were no positive troponin I values (normal < 0.4 ng mL). CK data are presented in Table 5. No subjects had rhabdomyolysis based on a CK value greater than 5,000 U L (normal 60 to 400 U L). The highest CK value was 1,161 U L in a heavy bag subject (his baseline value was elevated prior to the task at 758 U L). Catecholamine data are presented in Figure 1. Due to dilution-related difculties, fully quantied values for catecholamines were not available for several subjects with very high levels. These were only reported as greater than the last value obtained before the quantity was not sufcient for further dilution. This limitation affected the sprint task group primarily (n = 6), but also affected the K-9 resistance task group (n = 5) and the heavy bag task group (n = 4). It did not affect the TASER group or OC group. For total catecholamines, there was no difference between the groups at baseline (p = 0.769). The values increased from baseline in all groups at all time points (p < 0.002 for all groups by Wilcoxon signed-rank test). For norepinephrine, there was no difference among the groups at baseline. The values increased from baseline in all groups at all time points (p < 0.002 for all groups by Wilcoxon signedrank test). For epinephrine, there was a difference at baseline in epinephrine, which was noted to be highest in the TASER device exposure and the heavy bag groups. All groups had increases from baseline at time
point 2 (p < 0.001); by time point 3 the TASER group was no longer increased from baseline (p = 0.21), but the other groups were (p < 0.01). By time point 4, the K-9 resistance (p = 0.67) and TASER device (p = 0.78) exposure groups were no longer increased from baseline, while the other groups were (p < 0.01); by time point 5 the OC exposure (p = 0.31), TASER device exposure (p = 0.35), and K-9 resistance (p = 0.72) groups were not changed from baseline. These groups remained unchanged from baseline at subsequent time points. The sprint and heavy bag groups remained increased from baseline at all time points (p < 0.001). For dopamine, there was no difference among the groups at baseline but there was a difference at all groups at each subsequent time point (p < 0.02). DISCUSSION Metabolic acidosis can cause autonomic instability, depressed myocardial function, arrhythmias, and cardiovascular collapse. There is literature to support metabolic acidosis as a possible mechanism of ARDs. Hick et al.4 reported a series of ve patients who sustained cardiac arrest temporally associated with LEA custodial arrest. The subjects had a pH range of 6.25 to 6.81. Four of the subjects died despite aggressive management. Gass et al.5 found that lactate peaked at the sixth minute of inactive recovery in subjects completing a maximum exercise regimen on a motor-driven treadmill. The mean peak lactate was 14.2 mmol L. Allsop
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Figure 1. Catecholamines (pg mL) mean value (error bar = SEM). OC = oleoresin capsicum.
et al.6 found that venous pH decreased from 7.39 to 7.04 after a 30-second maximal sprint. The pH was 7.29 at 30 minutes. Lactate peaked at 15.76 mmol L 5 minutes after the completion of the sprint, declining to 10.30 mmol L at 30 minutes.6 In our study, we found decreases in pH after tasks designed to simulate common subject behaviors and tools and tactics used on resistive subjects by LEAs during a custodial arrest situation. The pH was lowest and the lactate was highest in the heavy bag resistance task group, followed by the sprint group. The phenomenon of ARD is often associated with behaviors that can contribute to inducing or worsening acidosis. These factors include illicit stimulant abuse, agitated behavior, excited delirium syndrome, and heavy physical resistance to LEA or health care person-
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nel attempting to control a person in this condition to render aid.2,3,7 Our study demonstrates that physical resistance and eeing may be signicant contributors to acidosis. Based on this, the intuitively dangerous concepts of running from and resisting LEAs or LEA K-9s appear to be true at a metabolic level. The important implications of this are that of the actions studied, the top three that appear to worsen acidosis are under the control of the subject and not the LEAs. We believe that our data support the concept that LEAs should attempt to limit the length of time that a suspect is allowed to vigorously or violently resist restraint, and that once restrained, continued resistance should be viewed as potentially harmful and may require emergent medical intervention. Our study indicates that continued vigorous exertion that may be
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typically displayed by an agitated, intoxicated, and delirious suspect may worsen acidosis and play a role in ARD. There is also literature supporting a direct correlation between worsening acidosis and increasing catecholamine levels. A study by Goldsmith et al.8 showed that for a given level of exercise, acidosis signicantly correlates with an increasing rise of systemic catecholamines. Dimsdale et al.9 noted increases in catecholamines in the period immediately after the cessation of exercise and hypothesized this as a mechanism for the increased risk of cardiac arrhythmias and ischemia in the period immediately after strenuous exercise. This hypothesis may be a factor in the sudden and unexpected nature of ARDs, which often involves cardiovascular collapse in the period just after the subject is restrained following signicant physical exertion such as resistance and eeing.10,11 Some authors have hypothesized that this is related to a hypersympathetic state and an acute stress cardiomyopathy.1214 The phenomenon of acute stress cardiomyopathy has been referred to as tako-tsubo cardiomyopathy in Japan and has also been reported in the United States.15 However, acute stress cardiomyopathy is not regularly described as progressing to sudden death. Another theory linking catecholamines and ARDs suggests that the postexercise period might pose a risk because of the peripheral arteriolar dilation associated with exercise.16 The vasodilation, coupled with a sudden decrease in venous return from the termination of muscular activity, may reduce cardiac output suddenly and reduce coronary artery perfusion at a time when the heart rate and oxygen demand are elevated due to high catecholamine levels.17,18 A prior study by Dawes et al.19 used salivary amylase and cortisol as measures of the sympathetic-adrenalmedulla (SAM) axis and hypothalamus-pituitary-adrenal (HPA) axis responses to a prolonged TASER X26 device exposure, OC exposure, a defensive tactics drill, and the cold pressor task. This study demonstrated that OC exposure and physical exertion activated the SAM and HPA axes, similar to our ndings. Increases in plasma catecholamines following physical exertion have been found previously by Allsop et al.6 as well, who found larger changes than those detected in our study. According to Karch,20 under normal exercise conditions (not described as maximal), epinephrine levels are 700 pg mL, and norepinephrine 299300 pg mL. In heart failure, they are 3575 and 500800 pg mL; in cocaine use, 3040 pg mL and 10002000 pg mL; and in cardiac arrest, 10,000100,000 pg mL and 500600 pg mL. However, Karchs data are based on only a single-time-point analysis. There is also evidence of elevations in catecholamines with animal-based restraint stress models (300%600% increase) and with exercise stress combined with cocaine exposure (200%-500% increase), similar to the heavy bag group (600% increase in total catecholamines after the task) found here.21,22 It is possible that catecholamine excess, when combined with exertional stress during restraint, may decrease electrical cardiac stability making the myocardium more sensitive to arrhythmogenic drugs.23 This may have important implications, because the majority
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of subjects in ARDs test positive for stimulant drugs in their system at time of autopsy.11,2426 However, Lakkireddy et al.27 showed a 50% to 100% increase in the ventricular brillation threshold to a TASER device electrical shock in the setting of cocaine intoxication in a swine model. We evaluated CK because rhabdomyolysis is a common complication of heavy exertion.28,29 Heavy exertion from agitation, delirium, and custodial resistance is often described as a feature associated with ARDs. It has also been theorized that because a TASER works by causing skeletal muscle activation it might also cause signicant rhabomyolysis. In a 2006 study by Ho et al.,30 the mean change in CK at 24 hours was 57.2 U L with a 5-second TASER X26 device-deployed probe exposure to the back. In our current study, the highest value was 1,161 U L in a heavy bag subject. The highest median change from baseline in CK occurred with the heavy bag group followed by the sprint group, but only the sprint group change was signicant. Our data suggest that rhabdomyolysis that is present in association with a resistive LEA interaction is likely due to volitional eeing and resistance rather than LEA tools and tactics. Hypokalemia in the period immediately after the cessation of exercise has been proposed as a possible contributory factor in ARDs. This potential period of peril has been thought to occur when exertion ceases because catecholamine-induced potassium absorption by cells continues.2 The potassium changes we found, however, were not clinically signicant. Our data do not suggest that hypokalemia plays a role in the mechanism of ARDs. Our results for the TASER device exposure group were consistent with prior studies that showed minimal serum pH, lactate, and potassium changes and no associated troponin I elevations.3032 Our pH and lactate changes were more pronounced than those that Vilke et al.31 found for the TASER, but we sampled pH values almost immediately after the exposure and used a longer exposure time. Prior research has shown that in exhausted subjects, TASER exposures are not associated with worsening acidosis differently than continued exertion.33,34 Oleoresin capsicum exposure appeared to cause continued rising catecholamine levels. This may be important because this effect could continue long after the subject was restrained. In addition, OC exerts its primary effect by pain and disorientation (due to an inability to open the eyes) and can also cause brief laryngospasm and bronchospasm.35 This effect may cause even more release of catecholamines in a subject in a noncontrolled setting, especially in a subject with agitated delirium, already exhibiting paranoid behavior. Finally, it is theoretically likely that OC application in a eld situation could result in a subject eeing due to pain, further exposing him or her to the physiologic responses we saw in our Task Group 1 (sprint). In ARD studies, death has usually been preceded by signicant physical exertion and restraint.4,10,11,13 Our data suggest that the most deleterious factor in LEA subject encounters is physical resistance (heavy bag group) followed by eeing on foot (sprint group).
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These simulations resulted in the highest catecholamine levels and the greatest change in pH, lactate, and CK. In studies that have reviewed initial cardiac rhythms following collapse in ARD situations, the vast majority are pulseless electrical activity or asystole.4,11,36 These terminal rhythms are consistent with severe acidosis that could occur in a prolonged or intense struggle. LEAs are often challenged with protecting the public from agitated, violent subjects. The results of our study may be important in considering the best methods to ensure safety in custodial arrest situations and prevention of ARDs. We believe that our study demonstrates subject physiology during these encounters. These encounters cannot be without risk. When LEAs are called to deal with resistive subjects, the risk for injury and death to both the subject and the LEAs is elevated. The TASER device, K-9, and OC groups show that LEA intervention with these tactics and tools may have less negative consequences for acidosis and catecholamine levels than physical resistance or allowing the subject to ee and may be safer approaches to restraint. LIMITATIONS The volunteers were assigned to task groups based on testing station availability, and volunteers with prior signicant LEA K-9 experience did not participate in the K-9 resistance task, introducing selection bias. Also, the number of volunteers was not large, limiting our ability to detect differences between groups. The number of volunteers in the study was kept to a minimum due to the logistical difculties in carrying out the ve tasks. Although the numbers are small, we believe that our data show consistent and important differences between groups. We encourage further investigation in this area. Many of the subjects with very high catecholamine levels did not have fully quantied results. This affected the sprint, K-9 resistance, and heavy bag task groups, but not the TASER device exposure or OC exposure task groups. Because a true maximum quantication could not be performed for these three groups, we have underestimated the catecholamine levels in these three groups and limited our ability to nd a difference. Therefore, we used nonparametric statistics robust to the variation in values higher than the median. The K-9 resistance task group may have had a blunted response because the volunteers were not blinded to the fact that they were wearing a protective bite suit and only experienced pressure or pinching from the bite. Additionally, several of the study subjects complained when they were not assigned to the dog bite task (they were looking forward to trying that task). We believe that this may have also yielded an underestimation of the true effects that would occur in a real LEA K-9 custodial arrest interaction (since eld situations would more likely involve fear). The time limit chosen for the heavy bag resistance task group in the study was felt to be a conservative estimate of the time to physically restrain a combative subject. In situations in which the LEAs and suspects are not evenly matched, or in cases of supranormal ability to offer resistance (e.g., drug intoxication or
excited delirium syndrome), it would likely take much longer than 45 seconds to physically restrain the subject. It appeared that the heavy bag task group was fatigued after 30 seconds. We may have underestimated the true physiologic burden of a real eld encounter in the heavy bag group. CONCLUSIONS We believe that this is the rst study to evaluate the human acid base and catecholamine response of a resisting subject during a simulated law enforcement authority custodial arrest encounter. This physiology may be important in understanding the root cause of arrest-related death events. The actions of physically resisting and eeing appear to be the most harmful with respect to acid base and catecholamine physiology. This suggests that tactics and tools that limit this type of activity may be important in limiting the effect of the custodial arrest process on suspects.
The study authors acknowledge the following for their assistance in this project: Mr. Andrew Hinz (technical assistance), Mr. Matt Carver (technical assistance), Ms. Victoria Gronkowski (data entry), Ms. Jennifer Knowles (LabCorp technician), and Ms. Wendy Holmes (Lab Corp technician). The authors especially recognize the contributions of Sgt. Doug Dirren and the City of Scottsdale (AZ) Police Department. This project would not have been possible without their help and assistance.
References 1. Bell L. On a form of disease resembling some advanced stages of mania and fever, but so contradistinguished from any ordinary observed or described combination of symptoms as to render it probable that it may be overlooked and hitherto unrecorded malady. Am J Insan. 1849; 6:97127. 2. Di Maio TG, Di Maio VJ. Excited Delirium Syndrome Cause of Death and Prevention. 1st ed. Boca Raton, FL: Taylor & Francis Group, 2006. 3. Ross DL, Chan TC (eds.). Forensic Science and Medicine: Sudden Deaths in Custody. Totowa, NJ: Humana Press, 2006. 4. Hick JL, Smith SW, Lynch MT. Metabolic acidosis in restraint-associated cardiac arrest: a case series. Acad Emerg Med. 1999; 6:23943. 5. Gass GC, Rogers S, Mitchell R. Blood lactate concentration following maximum exercise in trained subjects. Br J Sports Med. 1981; 15:1726. 6. Allsop P, Cheetham M, Brooks S, Hall GM, Williams C. Continuous intramuscular pH measurement during the recovery from brief, maximal exercise in man. Eur J Appl Physiol. 1990; 59:465 70. 7. Stevens DC, Campbell JP, Carter JE, Watson W. Acid-base abnormalities associated with cocaine toxicity in emergency department patients. Clin Toxicol. 1994; 32:319. 8. Goldsmith SR, Iber C, McArthur CD, Davies SF. Inuence of acid-base status on plasma catecholamines during exercise in normal humans. Am J Physiol. 1990; 258:R141116.
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9. Dimsdale JE, Hartley LH, Guiney T, Ruskin JN, Greenblatt D. Postexercise peril: plasma catecholamines and exercise. JAMA. 1984; 251:6302. 10. OHalloran RL, Frank JG. Asphyxial death during prone restraint revisited: a report of 21 cases. Am J Forensic Med Pathol. 2000; 21:3952. 11. Stratton S, Rogers C, Brickett K, Grunzinski G. Factors associated with sudden death of individuals requiring restraint for excited delirium. Am J Emerg Med. 2001; 19:18791. 12. Cevik C, Otahbachi M, Miller E, Bagdure S, Nugent K. Acute stress cardiomyopathy and deaths associated with electronic weapons. Int J Cardiol. 2009; 132:3127. 13. Lee B, Vittinghoff E, Whiteman D, Park M, Lau L, Tseng Z. Relation of TASER (electrical stun gun) deployment to increase in in-custody sudden deaths. Am J Cardiol. 2009; 103:87780. 14. Wetli C, Mash D, Karch S. Cocaine-associated agitated delirium and the neuroleptic malignant syndrome. Am J Emerg Med. 1996; 14:4258. 15. Sharkey SW, Lesser JR, Zenovich AG, et al. Acute and reversible cardiomyopathy provoked by stress in women from the United States. Circulation. 2005; 111:4729. 16. Halliwill JR, Taylor JA, Eckberg DL. Impaired sympathetic vascular regulation in humans after acute dynamic exercise. J Physiol. 1996; 495:27988. 17. Fletcher GF, Balady GJ, Amsterdam EA, et al. Exercise standards for testing and training: a statement for healthcare professionals from the American Heart Association. Circulation. 2001; 104:1694740. 18. Goodman JM, Busato GM, Frey E, Sasson Z. Left ventricular contractile function is preserved during prolonged exercise in middle-aged men. J Appl Physiol. 2009; 106:4949. 19. Dawes D, Ho J, Miner J. The neuroendocrine effects of the TASER X26: a brief report. Forensic Sci Int. 2009; 183:149. 20. Karch SB. Karchs Pathology of Drug Abuse. 4th ed. Boca Raton, FL: Taylor & Francis Group CRC Press, 2009. 21. Buhler HU, Da Prada M, Haefely W, Picotti GB. Plasma adrenaline, noradrenaline, and dopamine in man and different animal species. J Physiol. 1978; 276:31120. 22. Han DH, Kelly KP, Fellingham GW, Conlee RK. Cocaine and exercise: temporal changes in plasma levels of catecholamines, lactate, glucose, and cocaine. Am J Physiol Endocrinol Metab. 1996; 270:E43844.
23. Sun AY, Li DX, Wang YL, Li QP. Restraint stress changes heart sensitivity to arrhythmogenic drugs. Acta Pharmacol Sin. 1995; 16:4559. 24. Ho JD, Heegaard WG, Dawes DM, Natarajan S, Reardon RF, Miner JR. Unexpected arrest-related deaths in America: 12 months of open source surveillance. West J Emerg Med. 2009; 10:6873. 25. Strote J, Hutson HR. TASER use in restraint-related deaths. Prehosp Emerg Care. 2006; 10:44750. 26. Grant JR, Southhall PE, Mealey J, Scott SR, Fowler DR. Excited delirium deaths in custody: past and present. Am J Forensic Med Pathol. 2009; 30:15. 27. Lakkireddy D, Wallick D, Ryschon K, et al. Effects of cocaine intoxication on the threshold for stun gun induction of ventricular brillation. J Am Coll Cardiol. 2006; 48:80511. 28. Sinert R, Kohl L, Reinone T, Scalea T. Exerciseinduced rhabdomyolysis. Ann Emerg Med. 1994; 23:13016. 29. Lin AC, Lin CM, Wang TL, Leu JG. Rhabdomyolysis in 119 students after repetitive exercise [abstract]. Br J Sports Med. 2005; 39:e3. 30. Ho JD, Miner JR, Lakireddy DR, Bultman LL, Heegaard WG. Cardiovascular and physiologic effects of conducted electrical weapon discharge in resting adults. Acad Emerg Med. 2006; 13:58995. 31. Vilke G, Sloane C, Bouton K, et al. Physiological effects of a conducted electrical weapon on human subjects. Ann Emerg Med. 2007; 50:56975. 32. Sloane C, Chan T, Levine S, Dunford J, Neuman T, Vilke G. Serum troponin I measurement of subjects exposed to the TASER X-26. J Emerg Med. 2008; 35:2932. 33. Ho JD, Dawes DM, Bultman LL, Moscati RM, Janchar TA, Miner JR. Prolonged TASER use on exhausted humans does not worsen markers of acidosis. Am J Emerg Med. 2009; 27:4138. 34. Ho JD, Dawes DM, Cole JB, Hottinger JC, Overton KG, Miner JR. Lactate and pH evaluation in exhausted humans with prolonged TASER X26 exposure or continued exertion. Forensic Sci Int. 2009; 190:806. 35. Steffee CH, Lantz PE, Flannagan LM, Thompson RL, Jason DR. Oleoresin capsicum (pepper) spray and in-custody deaths. Am J Forensic Med Pathol. 1995; 16:18592. 36. 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. 2009; 16:72639.
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Calculation of the TASER X26 Internal Time Circuit Drift for Event Reconstruction
AndrewHinzTASERInternational
Abstract: The TASER X26 system has quickly become the electronic control device of choice for law enforcement, military, and civilian organizations, with over 12,000 law enforcement agencies currently deploying the TASER X26. The X26 device has the ability to record the last 1500 trigger pulls, providing a time record of how the device was fired, as well as how long the device was activated. A TASER devices ability to accurately record when the device was activated is of a great benefit when reconstructing an event. The X26 has an internal timing circuit powered by the microprocessor with a clock running in Greenwich Mean Time (GMT). All timing circuits are subject to clock drift, which is inherent to all electronic devices that have an internal timing mechanism. Keeping the time record as accurate as possible can sometimes be critical in event reconstruction and also important when multiple devices are involved in an event. A TASER X26 devices internal timing circuit will drift a maximum of minus 3 minutes 00 seconds per month under average temperature ranges. From temperatures of 20 C to +50 C, those time ranges can vary up to 2 minutes 33 seconds in colder environments and up to 3 minutes 41 seconds in warmer environments. By using this formula, we can determine a time range window of when a device was activated in real time for the reconstruction of events.
Key Words: TASER, X26, Internal Clock, Time Drift, Stun, Conducted Energy Weapon, Electronic Control Device (ECD) A TASER X26 has a small amount of internal clock drift compared to other computer devices (timing crystal of personal computers, digital watches, alarm clocks,, etc) Normal clocks such as clocks at home and wristwatches will drift compared to the actual time. That is why one must reset their time periodically. Clocks often drift differently depending on their quality, the exact power they get from the battery, the surrounding temperature, and so on. Thus the same clock can have different clock drift rates at different occasions. Accuracy (the closeness of computer time to UTC in our case) is the systematic (not random) error in the time offset. When your average computer clock is left free running, the major causes of its inaccuracy are the initial time offset error (the outside source to which we are setting our clock), and the average frequency offset error, (drift) causing time to move away from the true time at a variable rate. When the computer clock is disciplined to an external reference (a time standard that everyone can agree on, for example), the accuracy is orders of magnitude better and is determined by the accuracy of the external reference, by the offsets introduced by the time dissemination technique used (e.g. network delays or latencies in the interface to the attached reference clock), and by the ability of the software to properly adjust the computer clock. Depending on the time scale one has in mind, slow fluctuations in frequency of the computer clock oscillator can be counted as a contributor to imprecision or the inaccuracy of the computer clock. The drift for the TASER X26 is not a constant for each device and can vary in the degree of drift from month to month for each device. If the device is not synchronized to an outside source after a period of time, the device may be of inaccurate significantly compared to real time (hours, maybe even days in some cases were a device has been in service for years without being synchronized). When the device is downloaded , The TASER X26 will only alert the user of a time synchronization error if the device time is 10 minutes difference from the indicated system time (Figure 1).
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difference compared to the time reported by the download station. The user can manually synchronize the time if desired. Dataport download software displays a firing record in Greenwich Mean Time as well as local time determined by what time zone the download station is reporting. A TASER X26 device should be periodically downloaded for maintenance purposes. TASER International recommends that a TASER device be downloaded every 90120 days to verify accurate data recording. The recommendation of the 90-120 days was determined by predicting the most likely time period of when a Time Synchronization Warning would occur by calculating the internal timing circuit drift.
(Figure 1)
Once the device time is synchronized, the user will then be able to view the firing records from the device. With the current version of X26 Dataport Download software the user is able to see the difference in device time compared to time as reported by the download station. (Figure 2)
To determine the exact drift this test was performed over a one-week period using six production TASER X26 devices. The six X26 devices had never been used in the field and were in out-of-box condition. All devices used the X26 digital power magazine (DPM) registering 99% at the time of the test. Each device, after being removed from the chamber, was fired three times for 5-second durations each time to verify proper time recording. The temperature points used were 20 C, 20 C, and 50 C. An environmental chamber preconditioned to the test temperature was used. Each device was placed into the chamber for a 24-hour period (Figure 3).
(Figure 2)
For example in Figure 2 above, the X26s internal clock was a oneminute, five-second positive
(Figure 3)
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The device internal timing circuit variation was determined by firing the unit before and after placing the unit in an Esqec ESX-3C temperature chamber and noting the time from the National Institute of Standards and Technology website at http://nist.time.gov/timezone.cgi?Mountain/s/7/java (Technology, 2007)(Figure 4)
synchronized pre-chamber. There was no pre-drift to calculate (all units were 0.00 seconds). 4. The units exposed to 20 C lost a total average 6.83 seconds over a 24-hour time period. The range was -4 to -10 seconds. The units were all time synchronized pre-chamber. There was no pre-drift to calculate (all units were 0.00 seconds). If a unit is losing an average of 6.00 seconds per day, then we can estimate an average loss of 3 minutes 00 seconds per month (6 seconds per day X 30-day month). In colder climates, we can expect to see a maximum of 4.67 seconds per 24 hours (2 minutes 33 seconds per month). Warmer climates will have an average maximum loss of 6.83 seconds per 24 hours (3 minutes 41 seconds per month). No Positive time drift (accelerating) clock times were observed during testing. A TASER X26 Electronic Control Devices internal timing circuit drift can be determined for event reconstruction if a device has not been synchronized for a extended period of time or to line up multiple devices to one time reference for accurate event reconstruction. An X26 should be downloaded within 48 hours of an event so the exact internal clock reference point can be determined. Law enforcement agencies that deploy the TASER X26 devices should have a program in place for maintenance downloads every 90120 days to ensure that an X26 devices internal clock is as accurate as possible as this will ensure the most accurate times being recorded in the firing log.
(Figure 4)
Time synchronization was performed for each device before each temperature point so internal clock time and real time were matched with a difference of 0 seconds. The X26 internal timing circuit operates in seconds, not in milliseconds, as is the case of a modern desktop computer. Because the timing circuit is part of the microprocessor, power for the internal clock is supplied via the Digital Power Magazine (DPM), which consists of two 1.5-volt lithium power cells. Results 1. The average time lost over all the temperature ranges for all units pre- and post-chamber was that the units lost 6.0 seconds in a 24-hour period. 2. The units exposed to 20 C lost a total average of 4.67 seconds over a 24-hour period. The range was -4 to -5 seconds. The units were all time synchronized prechamber. There was no pre-drift to calculate (all units were 0.00 seconds). 3. The units exposed to 50 C lost a total average of 6.83 seconds over a 24 hour time period. The range was -4 to -10 seconds. The units were all time
Technology, N. I. (2007, July 23). Retrieved from http://nist.time.gov/timezone.cgi?Mountain/s/-7/java AIR TASER, M26, and X26 are trademarks of TASER International, Inc. TASER and ADVANCEDTASER are registered trademarks of TASER International, Inc.
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For further information please contact: Andrew Hinz TASER International Technical Programs mamanger 17800 North 85 St Scottsdale, AZ 85255 andrew@taser.com 1/800-978-2737
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ECD Event Analysis and Evidence Collection

IF DEATH OCCURRED OR AN AED or DEFIBRILLATOR WAS USED

To: Duval, Jennie Subject: RE: Taser prongs

Certainly, Iwillsenditfirstthinginthemorning. Lance

To: Duval, Jennie Subject: Taser prongs

Herearepicturesofthetaserprongsremovedfromthedecedent. DetectiveSergeantLanceBurnham VermontStatePolice 2777St.GeorgeRoad Williston,VT Ph:8028787111Ext.2020 Fax:8028782742 EMAILHASCHANGED:NEWEMAILISlance.burnham@state.vt.us v

FSI 5715; No of Pages 7

Contents lists available at ScienceDirect

Forensic Science International

FSI 5715; No of Pages 7

FSI 5715; No of Pages 7

Group 3 (Exertion + CEW) 10 2 27.6, 19.728.9 None

Total 40 10 26.0, 16.654.8

Recent exertion Median age in years (range)

2/10 38, 2254

2/10 35, 2044

4/10 36.5, 2049

FSI 5715; No of Pages 7

FSI 5715; No of Pages 7

Fig. 2. Median pH of control groups.

Fig. 4. Median lactate of control groups.

Fig. 3. Median pH of experiment groups.

Fig. 5. Median lactate of experiment groups.

FSI 5715; No of Pages 7

FSI 5715; No of Pages 7

ISSN 1069 6563 PII ISSN 1069 6563583

ACAD EMERG MED July 2010, Vol. 17, No. 7

USE OF FORCE PHYSIOLOGY

ACAD EMERG MED July 2010, Vol. 17, No. 7

TASER #1; 5 second exposure only

Group Sprint OC TASER Heavy bag K9 p value*

7.34 (7.30 7.40) 7.26 (7.14 7.36) 0.07 <0.001

7.25 (7.17 7.35) <0.001

7.26 (7.17 7.34) <0.001

7.27 (7.18 7.35) <0.001

7.27 (7.20 7.35) 7.31 (7.22 7.38) <0.001 <0.001

OC = oleoresin capsicum. *Kruskal Wallis test.

USE OF FORCE PHYSIOLOGY

Table 4 Median Lactate, mmol L (Range)

1.05 (0.61 1.45) 0.066

5.01 (1.54 9.58) <0.001

5.76 (2.30 10.16) <0.001

6.13 (2.87 11.0) <0.001

6.53 (2.81 10.55) <0.001

6.34 (2.85 10.41) <0.001

OC = oleoresin capsicum. *Kruskal Wallis test.

ACAD EMERG MED July 2010, Vol. 17, No. 7

Total Catecholamines pg/ml

USE OF FORCE PHYSIOLOGY

ACAD EMERG MED July 2010, Vol. 17, No. 7

USE OF FORCE PHYSIOLOGY

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Taser International's Response

Taser International's Response