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Letters

Electronic control devices

Mark W. Kroll, Hugh Calkins, Richard M. Luceri, Michael A. Graham and William G. Heegaard
CMAJ August 12, 2008 179 (4) 342-343; DOI: https://doi.org/10.1503/cmaj.1080079
Mark W. Kroll PhD
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Hugh Calkins MD
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Richard M. Luceri MD
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Michael A. Graham MD
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William G. Heegaard MD MPH
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We are members of the TASER International Scientific and Medical Advisory Board, and we would like to comment on the recent CMAJ editorial on tasers.1 Essentially every implication of the editorial was either erroneous or misleading. Only 4 of the 16 references were from the medical literature; most of the rest were newspaper articles.

The implication that TASER International asserts that a TASER electronic control device has never contributed to a death is erroneous. There are at least 6 cases of deaths from head injuries resulting from falls in which an electronic control device may have contributed to the fall, and TASER International warns of this risk in its training materials. Aside from these cases, we stand by TASER International's position that electronic control devices have never directly killed anyone.

The statement that TASER International has sponsored “just about all” of the research on electronic control devices is erroneous; 12 of the 17 published peer-reviewed human studies had no funding from TASER International. (They cannot be listed here because of the CMAJ's space restrictions.)

The editorial stated that volunteers are almost never shocked in the chest or given sustained shocks. This was true in early studies but not in more recent studies.2,3

The editorial also stated that members of the TASER International Scientific and Medical Advisory Board attempt to hide their associations with TASER International. This is untrue, as demonstrated by a letter published in the Journal of the American College of Cardiology.4

The statement (referencing a newspaper article) that TASER International has sued researchers for publishing their scientific results is untrue. The newspaper article was about James Ruggieri, who claimed, not in a peer-reviewed journal but in a bulletin of a small trade group of professional expert witnesses, that there would be a 50% fatality rate with use of a TASER electronic control device, on the basis of mysterious measurements and calculations. He also suggested that patients with cardiomyopathy should not comb their hair, remove their clothing or walk across carpeting because a static shock might induce fibrillation.

TASER International and the City of Akron, Ohio, did jointly go to court under a state law that allows for independent judicial review of the opinions of medical examiners. This court case concerned an extreme situation in which the medical examiner consistently (in 3 cases) ruled that the use of an electronic control device constituted homicide, leading to criminal charges against several sheriff's deputies. After a 4-day legal proceeding in which numerous experts testified (including 3 forensic pathologists and 2 cardiac electrophysiologists), the judge ordered striking of the electronic control device as the cause of death and homicide as the manner of death.

The implication that TASER electronic control devices are a risk factor for deaths from excited delirium is erroneous. The editorialist gives no reference for this speculation nor can he, as excited delirium was recognized as a condition long before electronic control devices were invented.5–7 Even today, electronic control devices are involved in only a small minority of deaths from excited delirium.8,9

The implication that a defibrillator should be used to treat excited delirium is incorrect. When death occurs with this disorder, with or without the involvement of an electronic control device, the presenting rhythm is characteristically asystole or pulseless electrical activity.9–11 Defibrillation reverses fibrillation and therefore has no clinical indication in cases of excited delirium.

Footnotes

  • Competing interests: Mark Kroll, Richard Luceri and William Heegaard hold stock in TASER International. Mark Kroll and Michael Graham have served as consultants for TASER International. Mark Kroll has received travel assisstance from TASER International for attending medical conferences. Hugh Calkins receives a nominal fee for serving on the Scientific and Medical advisory board of TASER International. Richard Luceri is a paid board member of TASER International and has received travel assistance for attending board meetings. William Heegaard has received travel assistance to attend a scientific medical advisory board meeting and has been paid for medical advice about conducted electrical devices.

REFERENCES

  1. 1.↵
    Stanbrook MB. Tasers in medicine: an irreverent call for proposals [editorial]. CMAJ 2008;178:1401-2.
    OpenUrlFREE Full Text
  2. 2.↵
    Ho J, Dawes D, Reardon R, et al. Echocardiographic evaluation of human transcutaneous TASER(r) application along the cardiac axis. Heart Rhythm 2008;5:S97.
  3. 3.↵
    Ho JD, Dawes DM, Bultman LL, et al. Respiratory effect of prolonged electrical weapon application on human volunteers. Acad Emerg Med 2007;14:197-201.
    OpenUrlCrossRefPubMed
  4. 4.↵
    Kroll MW, Calkins H, Luceri RM. Electronic control devices and the clinical milieu. J Am Coll Cardiol 2007;49:732.
    OpenUrlCrossRefPubMed
  5. 5.↵
    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 Insanity 1849;6:97-127.
    OpenUrl
  6. 6.
    Pollanen MS, Chiasson DA, Cairns JT, et al. Unexpected death related to restraint for excited delirium: a retrospective study of deaths in police custody and in the community. CMAJ 1998;158(12):1603-7.
    OpenUrlAbstract/FREE Full Text
  7. 7.↵
    Wetli CV, Mash D, Karch SB. Cocaine-associated agitated delirium and the neuroleptic malignant syndrome. Am J Emerg Med 1996;14:425-8.
    OpenUrlCrossRefPubMed
  8. 8.↵
    Ross DL. Factors associated with excited delirium deaths in police custody. Mod Pathol 1998;11:1127-37.
    OpenUrlPubMed
  9. 9.↵
    Stratton SJ, Rogers C, Brickett K, et al. Factors associated with sudden death of individuals requiring restraint for excited delirium. Am J Emerg Med 2001;19:187-91.
    OpenUrlCrossRefPubMed
  10. 10.
    Swerdlow C, Kroll M, Williams H, et al. Presenting rhythm in sudden custodial deaths after use of TASER(r) electronic control device. Heart Rhythm 2008;5:S44.
  11. 11.↵
    DiMaio T, VJM D. Excited delirium syndrome cause of death and prevention. Boca Raton (FL): Taylor & Francis; 2006.
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Canadian Medical Association Journal: 179 (4)
CMAJ
Vol. 179, Issue 4
12 Aug 2008
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Electronic control devices
Mark W. Kroll, Hugh Calkins, Richard M. Luceri, Michael A. Graham, William G. Heegaard
CMAJ Aug 2008, 179 (4) 342-343; DOI: 10.1503/cmaj.1080079

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Electronic control devices
Mark W. Kroll, Hugh Calkins, Richard M. Luceri, Michael A. Graham, William G. Heegaard
CMAJ Aug 2008, 179 (4) 342-343; DOI: 10.1503/cmaj.1080079
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