Topic: CNN story regarding a lawsuit against TASER International, Inc. (TASER) and allegations concerning TASER® Electronic Control Device (ECD) Safety

On March 4, 2010, CNN ran a story on its Web site related to the Steven Butler vs. TASER International lawsuit. The plaintiff’s attorney and one of his key experts are featured in the story making allegations against TASER about TASER ECD safety. The purpose of this document is to provide factual information about the key issues alleged by plaintiff in this news story.

Synopsis:

Mr. Butler had a pre-existing heart condition known to have high risk of cardiac arrest.

Mr. Butler had a blood alcohol level of 0.35 percent – measured at the Emergency Room after the event (this is a toxic level with known risk of death).

Mr. Butler was prescribed mental illness medication labeled with an alcohol warning and which also may exacerbate heart conditions.

Mr. Butler received three discharges to chest with TASER X26 ECD, collapsed, and was later revived with alleged brain injury.

Key facts:

• On October 7, 2006, police responded to a call of an intoxicated [blood alcohol level of 0.35 percent and THC (marijuana) in the bloodstream)] individual on a city bus. The officers encountered a seriously intoxicated male subject who they had probable cause to arrest, who refused officers’ requests to leave the bus, took a fighting stance, pulled away from officers’ attempts at handcuffing, and threatened the officers with physical assault.

• Officers tried to talk with him but he refused to cooperate. Officers tried to restrain him physically but he resisted. Officers deployed the TASER X26 ECD, which struck Mr. Butler in the chest and abdomen. There were three trigger pulls [5; 8; and 5-second cycles], which incapacitated Mr. Butler. After the final discharge, Mr. Butler became non-responsive. EMS was quickly on scene, CPR was started, and he was found to be in cardiac arrest. He was resuscitated with several drugs and several applications of a cardiac defibrillator. It is alleged that he sustained a brain injury during the time period in which he was in cardiac arrest.

• Plaintiff’s experts allege that the TASER X26 ECD was the cause of the cardiac arrest and are seeking money damages against TASER.

• There are several other key factors not included in the CNN Web site excerpt story:

1. A review of Mr. Butler’s medical records years before the incident and immediately after the incident showed that he had a pre-existing cardiac condition that places an individual at risk of sudden cardiac arrest and frequently results in having an implanted defibrillator surgically implanted to treat this high risk. The specifics of this condition cannot be publicly released at this time.
2. Mr. Butler was also prescribed and had been taking for many years the drug Zyprexa, which is not to be mixed with alcohol, and which is reported to also increase the risk of cardiac arrest.
3. At the emergency room after the event in question, Mr. Butler’s blood alcohol level was measured at 0.35 percent. This indicates that at some point during the incident, his blood alcohol level was likely even higher, approaching 0.40 percent. Blood alcohol levels in these ranges are known to have the following effects: Severe CNS depression, unconsciousness, and/or possible death. Toxicology results also showed that he had THC (marijuana) in his system.

Numerous medical professionals have closely examined this case and have concluded that Mr. Butler’s cardiac arrest was caused by his pre-existing cardiac condition, exacerbated by acute upon chronic alcohol abuse, agitated state, and other factors.

This case illustrates the challenges described in our training bulletin issued on September 30, 2009 advising a revision of the preferred target zones to avoid intentionally targeting the chest. The several “non-ECD” factors in this case that alone could have caused a cardiac arrest event are absent from the public controversy about this event.

Another allegation that needs to be addressed is that the plaintiff’s attorney alleges that a 2006 pig study “proved” that a TASER ECD can cause cardiac arrest in humans. This is false. The results of that study read as follows: “Standard NMI discharges [] did not cause VF (ventricular fibrillation) at any of the 5 locations before or after cocaine infusion.” Also, “Our study showed that VF could not be induced using the standard 5 second TASER discharge applied to a pig’s body surface even at the most sensitive area tested.”

Far from “proving” that TASER ECDs cause VF in humans, the 2006 pig study showed a significant safety margin in smaller animals than humans; animals which are more sensitive to electrically induced VF. This 2006 pig study did validate that those safety margins increase as darts are located further from the heart region, and also found that the presence of cocaine did not increase risk, rather it actually increased the overall safety margin.

Two recent human studies from researchers funded by the U.S. Department of Justice found the following:

In a combined experience of 4,058 consecutively monitored CEW (Conducted Energy Weapons or ECD) field uses with an electrical shock delivered, serious injuries are clearly rare, and there are no cases in any of the reports suggesting sudden cardiac death related to the TASER ECD.1 Also, Dr. Bozeman, the author of the study has stated, “From a public health/epidemiologic perspective the use of conducted electrical weapons is similar to that of automobile air bags, which are also known to pose a small risk of serious injury and even death in rare cases, but are clearly responsible for marked overall reductions in injurie2

“CEW exposure produced no detectable dysrhythmias and a statistically significant increase in heart rate. Overall, TASER CEW exposure appears to be safe and well tolerated from a cardiovascular standpoint in this population. This study increases the cumulative human subject experience of CEW exposure with continuous ECG monitoring and includes 28 full 5-second exposures.”3

Extrapolating from pig data, another plaintiff oriented expert, Dr. John Webster, has opined that the risk of VF from a TASER ECD discharge in the field is approximately 0.0000061, which equates to a risk of 1 in 160,000 discharges. This risk is far below any documented risk with alternative use of force options.

1 Bozeman WP, Hauda WE, 2nd, Heck JJ, Graham DD, Jr., Martin BP, Winslow JE, Safety and Injury Profile of Conducted Electrical Weapons Used by Law Enforcement Officers Against Criminal Suspects, Ann Emerg Med. Jan 21 2009.

2 Bozeman, WP, Annals of Emerg Med, Nov 2009.

3 W P Bozeman, D G Barnes, Jr, J E Winslow, III, J C Johnson, III, C H Phillips, and R Alson, Immediate cardiovascular effects of the TASER X26 conducted electrical weapon, Emerg. Med. J. 2009; 26(8): p. 567-570; http://emj.bmj.com/cgi/content/abstract/26/8/567?ct=ct.

4 J M MacDonald, R J Kaminski, and M R Smith, The Effect of Less-Lethal Weapons on Injuries in Police Use-of-Force Events, American Journal of Public Health, Dec 2009 Vol 99, No 12 p. 2268-2274.

Summary: TASER ECDs are not risk free. To be clear, TASER is not claiming that the risk of inducing VF in a human is zero. Estimates are that this risk is very low, less than 1 in 100,000 applications. The extremely low risks of serious injury or death can be further reduced by avoiding firing ECDs at subjects who may fall from elevated heights and by following the preferred targeting zones per current training. Studies consistently indicate that ECDs have among the lowest risk of injury of any modern force option and field results consistently show that agencies that deploy TASER ECDs experience significant reductions in force-related injuries.

Weapons cannot be evaluated from a perspective of zero risk. Every “use of force” carries high risk of injury or death and are all considered dangerous events for both law enforcement and the people resisting arrest. All uses of force need be evaluated from a perspective of comparative risk and risk-reduction.

According to a recent study in the American Journal of Public Health, “Given the findings from this study, as well as those from previously published research, law enforcement agencies should encourage the use of OC spray or CEDs [Conducted Energy Devices] in place of impact weapons and should consider authorizing their use as a replacement for hands-on force tactics against physically resistant suspects.… Injuries from police use-of-force incidents continue to be a public health problem affecting tens of thousands of civilians and police officers in the United States each year. Our findings suggest that the incidence of these injuries can be reduced substantially when police officers use CEDs and OC spray responsibly and in lieu of physical force to control physically resistant suspects.”4

TASER remains committed to improving public safety and reducing the risks involved in use of force incidents and personal safety. We strive to continually update our products and training to provide the safest options available to protect human life.

The American Medical Association at its annual meeting earlier this month adopted new public health policies, including a resolution on TASER electronic control devices (ECDs). All in all, the resolution and accompanying report is generally positive. The AMA report finds that TASER devices, when used appropriately, can save lives during interventions that would have otherwise involved the use of deadly force. On its website, the AMA quotes Board Member Joseph Annis, M.D. as saying, “While TASERs can help law enforcement officers, proper use must be ensured through specific guidelines, rigorous training and an accountability system. There should also be a standardized approach to the medical evaluation of subjects exposed to TASERs.” We couldn’t agree more, and we look forward to working with groups like the AMA in the future.

Earlier this week, the National Institute of Health (NIH) website PubMed.com listed a key abstract on research into excited delirium syndrome which is slated for publication in Forensic Science International. The abstract “Brain biomarkers for identifying excited delirium as a cause of sudden death” describes research headed by Dr. Deborah Mash of the Department of Neurology, Miller School of Medicine, University of Miami.

The research conducted by Dr. Mash and her colleagues explored whether or not there is any physiological evidence which would make it possible to detect or prove excited delirium syndrome during an autopsy. For those that may not be familiar with this topic, the authors define excited delirium syndrome as “a serious medical condition associated with acute onset of agitated violent behavior that often culminates in a sudden unexplained death.”

In the research, Dr. Mash and her colleagues conducted an after death review of ninety excited delirium deaths and presented “results on the association of a 2-protein biomarker signature.”

The conclusion — “When combined with descriptions of the decedents’ behavior prior to death, a 2-protein biomarker signature can serve as a reliable forensic tool for identifying the excited delirium syndrome at autopsy.”

Pretty heady stuff; but what does it mean? It means that Dr. Mash and her colleagues found there is physiological evidence that is reliable in identifying excited delirium syndrome, which may be linked to malfunctioning chemical receptors in the brain that could lead to dangerous and violent behaviors.

Finally, this week a groundbreaking medical study, Cataecholamines in Simulated Arrest Scenarios, was presented at the Australia College of Emergency Medicine (ACEM) Winter Symposium 2009 in Darwin, Northern Territory, Australia. The research led by Dr. Jeffrey D. Ho of the Department of Emergency Medicine, Hennepin County Medical Center, looked at the human physiology involved in common subject behavior, as well as police tools and tactics in arrest-related scenarios.

From the data obtained in the study, the researchers concluded that TASER devices or ECDs were “one of the least activating of catecholamines while the simulated combat was one of the most activating.” Also, that simulated physical struggle lowered the blood pH the most of all the simulated police encounters — in fact causing subjects to become acidotic to a degree that posed significant health risks from just 45 seconds of heavy fighting-type exertion.

More heady stuff. So what does this mean?

Mark Kroll, PhD, FACC, Adjunct Professor of Biomedical Engineering at the University of Minnesota and Chairman of the TASER International Scientific and Medical Advisory Board offers his insight:

“Catecholamines are the bodies ‘hyper-hormones’ and include the well-known adrenaline. They are an indicator of the amount of stress felt by the body. This study is one of the first to look at the human physiology in common arrest-related situations with various police tools and tactics. The research is groundbreaking in that it clearly shows that the use of a TASER device does not significantly lead to the increase of catecholamines in the human body. However, struggling or running from police causes dramatic increases which can begin to cascade toward sudden death.”

A picture is emerging from this data — fighting with police or running from law enforcement officers can be more detrimental to your health than modern police tactics such as pepper spray and ECDs.

Certainly it has been a busy couple of weeks for the medical and scientific communities with regard to TASER devices and related issues. While to some, TASER brand devices remain controversial, there are now more than 280 scientific, medical or governmental studies on electronic control devices. This includes a growing body of more than 120 scientific and medical studies involving human subjects. Hopefully soon the vast evidence of the medical and scientific research will outweigh the conjectures and emotionally-based opinions. We then may be able to focus on all the good the law enforcement community and ECDs are doing in reducing injuries and saving lives.

Today, TASER brand electronic control devices (ECDs) are used by more than 14,000 law enforcement agencies in more than 45 countries worldwide. During the past decade, more than 1.5 million people have been hit with a TASER brand ECD, including an estimated 760,000 people in actual arrest proceedings by law enforcement. While a completely accurate number is hard to come by, it further is estimated that more than 50,000 people have avoided injury or had their lives saved because a TASER brand ECD was available and used by law enforcement.  

Despite the broad acceptance and amazing success of the TASER ECDs in reducing injuries and violence, there are still a number of critics and skeptics who are willing to ignore the data, ignore the scientific studies and ignore anecdotal evidence while calling for a moratorium on the use of TASER devices by law enforcement. Most commonly, these naysayers inaccurately site a “lack of independent” scientific and medical studies into the safety of TASER technology and TASER ECDs.

I have to believe that those making such a claim are just uninformed. Arguably, TASER brand ECDs and TASER technology is the most studied law enforcement tool ever. To date, and to the best of our knowledge, there have been more than 275 scientific, medical or governmental studies on ECDs. This includes a growing body of more than 120 scientific and medical studies involving human subjects. In all, approximately 70 percent of these studies are “independent” — having been performed without funding from TASER International.  

Some of the most recent studies to be presented at major medical conferences such as CardioRythm 2009 and in leading medical journals such as the American Journal of Emergency Medicine and the Annals of Emergency Medicine include groundbreaking work on the effects of prolonged or multiple exposures to a TASER device. The following is a sample of recent studies:

Can Prolonged TASER X26 Exposure or Continued Exertion Contribute to Sudden Cardiac Death Through Worsening Acidosis?

Ho, J.D., et al CardioRhythm, Hong Kong: Dept. of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN Dept. of Emergency Medicine, Lompoc Valley Medical Center, Lompoc, CA.

Conclusion: Acidosis is worse from continued exertion when compared to an ECD application. This does not support an association between TASER device applications and sudden death due to worsening acidosis. It does support a worsening acidosis from continued exertion.

Multiple Simultaneous Exposures of the TASER X26 in Human Volunteers

Ho, J.D., D.M. Dawes, and J.R. Miner 2009, CardioRhythm, Hong Kong: Dept. of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN Dept. of Emergency Medicine, Lompoc Valley Medical Center, Lompoc, CA.

Conclusions: Five second multiple (2-3), simultaneous exposures to an ECD device do not appear to have significant deleterious effects on the heart.

Presenting Rhythm in Sudden Deaths Temporally Proximate to Discharge of TASER Conducted Electrical Weapons (CEW)

Swerdlow C, Fishbein M, Chaman L, Lakkireddy D, Tchou P. Society for Academic Emergency Medicine. May 2009;16:1‐13.

Conclusions: In sudden deaths proximate to CEW discharge, immediate collapse is unusual, and ventricular fibrillation (VF) is an uncommon VF presenting rhythm. Within study limitations, including selection bias and the possibility that VF terminated before the presenting rhythm was recorded, these data do not support electrically induced VF as a common mechanism of these sudden deaths.

Prolonged TASER Use on Exhausted Humans Does Not Worsen Markers of Acidosis

Ho J, Dawes D, Bultman L, Moscati R, Janchar T, Miner J. American Journal of Emergency Medicine. 2009;27(4):413‐418.

Conclusion: Prolonged CEW application on exhausted humans was not associated with worsening change in pH or troponin. Decreases in pCO2 and potassium and a small increase in lactate were found. Worsening acidosis theories due to CEW use in this population are not supported by these data.

Safety and Injury Profile of Conducted Electrical Weapons Used by Law Enforcement Officers Against Criminal Suspects

William P. Bozeman, MD Annals of Emergency Medicine Jan 2009

Conclusion: To our knowledge, these findings represent the first large, independent, multicenter study of conducted electrical weapon injury epidemiology and suggest that more than 99 percent of subjects do not experience significant injuries after conducted electrical weapon use.

The Neuroendocrine Effects of the TASER X26®: A Brief Report 

Forensic Science International , Volume 183 , Issue 1 – 3 , Pages 14 – 19 D . Dawes , J . Ho , J . Miner

Conclusions: Our preliminary data suggests that physical exertion during custodial arrest may be the most activating of the human stress response, particularly the sympathetic–adrenal–medulla axis. This may suggest that techniques to limit the duration of this exertion may be the safest means to apprehend subjects, particularly those at high-risk for in-custody death. Conducted electrical weapons were not more activating of the human stress response than other uses of force.

A complete index of all known medical, scientific and governmental studies is available on the TASER International web site here.

I understand that there will probably always be some debate over the need and proper use of TASER electronic control devices. I believe such a debate to be healthy and valuable, but only if there is an acknowledgement of the vast body of scientific data and evidence that has been produced regarding the TASER technology.

Generally, each Chiefs Course includes the following components, although the presenters vary depending on region and availability: an update on legal issues pertaining to the use of TASER devices, an update on the latest medical research on TASER technology, a session on media relations and data tracking, a discussion on the potential civil rights issues surrounding the deployment of TASER devices, and an update on suggested training requirement for TASER devices.  

As Vice President of Communications at TASER for 15 years, I know a thing or two about TASER and TASER devices, but each time I present at one of these courses, I am humbled by my co-presenters and honored to be speaking from the same podium.  

Why are the presenters so impressive?  Let’s take, as an example, the person who gave the medical research update today.  Dr. Jeffrey Ho, is a board-certified emergency medicine physician, a Fellow of the American College of Emergency Physicians and the American Academy of Emergency Medicine. He is a licensed deputy sheriff in the state of Minnesota and currently serves with the Meeker County Sheriff’s Office.  He also is an independent, expert medical consultant to TASER, where he leads a cadre of research in studying human physiologic effects of electronic control devices (ECDs).  

And he’s a nice guy to boot.

My presentation today covered media relations and data tracking, including a look at media messaging, and more importantly, net field results for TASER device usage in agencies big and small around the United States.  The agency field results statistics always generate a lot of interest.  They provide the quantitative proof that TASER devices are reducing injuries and saving lives in every community where they are deployed.  I believe it’s so powerful to see a graphical representation of the benefits TASER devices provide to agencies — such as a reduction in officer and suspect injuries, a reduction in suspect shootings, and a reduction in lawsuits and worker’s comp claims — and today’s audience seemed to agree.

It’s been a busy day, getting up early, flying in and out of Minneapolis, but it’s completely worth it.  I make every effort to be present at these meetings because I believe that they are the lifeblood of sustaining good TASER programs in law enforcement agencies around the country.