Clinical communication: Adults
Two Patients Subdued with a TASER® Device: Cases and Review of Complications

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Abstract

In the United States, an increasing number of law enforcement agencies have employed the use of TASER® (TASER International Inc., Scottsdale, AZ) devices to temporarily immobilize violent subjects. There are reports in the lay press of adverse outcomes occurring in patients on whom TASER® devices have been deployed. Rhabdomyolysis has been associated with patients sustaining a TASER® shock, with a 1% incidence rate in subjects subdued with earlier versions of the device and then brought to the Emergency Department (ED). We present the cases of 2 patients who were seen in our ED after exhibiting violent behavior and receiving TASER® shocks. Both were hospitalized and received treatment for mild rhabdomyolysis. Both patients had multiple other characteristics that have been found to have an association with the development of rhabdomyolysis, in addition to the shocks they received. A review and discussion of the available medical literature on the subject follows, describing several complications that have been documented in patients after receiving TASER® shocks. Although a direct link between the TASER® and the reported adverse effects has not been established, patients who undergo restraint via this device frequently have pre-existing conditions or have exhibited behavior that places them at risk for the development of those effects. Such awareness of these possible complications is vital because the evaluation and management of patients developing adverse effects after these events will commonly occur in the ED.

Introduction

The TASER® (Thomas A Swift Electric Rifle; TASER International Inc., Scottsdale, AZ) was introduced to the market in the early 1970s, and its use among law enforcement agencies began to rapidly proliferate across the United States in the 1980s. After inspection of the early version of the gun in 1976, the U.S. Consumer Product Safety Commission concluded that the weapon was unlikely to be lethal in healthy subjects. These initial devices used 5 to 7 watts to deliver up to 50,000 volts of electricity to the subject in very short (microsecond) pulses (1). They were devised as a less-lethal alternative for immobilizing a subject, compared to the standard handguns employed by police officers, which have been found to carry an estimated mortality of 50% when used (2).

The primary manufacturer of the modern devices is an American company, TASER® International, Inc. Their current standard weapon is the Advanced TASER®, a 26-watt weapon that shoots two barbed electrodes on 21-foot copper wires at a speed of 180 feet/second. This more powerful version was developed to overcome the possibility of subjects being able to fight through the actuation of the lower pulse power. Alternatively, a direct contact mode that does not require the deployment of barbed electrodes can be applied to a subject within arms reach. The barbs can attach to either the person's skin or clothing, because the current can cross 2 inches of clothing, and can deliver up to 50,000 volts of electricity in rapid short pulses, with a peak amplitude of 18 amps at a duration of about 11 ms (3). Intensity effects are dictated by variances in the width of the placement of the barbs and whether or not both barbs strike the individual (4). Impact of the barbed electrodes leads to uncontrollable muscle contractions and overwhelming pain, thereby immobilizing the subject. The barbs remain attached, and further depression of the trigger leads to additional electrical discharges. In a phenomenon known as a “Faraday Shield,” the very high frequency of electricity generated by the TASER® tends to stay near the surface of the body in the skin and muscle, and does not seem to penetrate into internal organs, making the TASER® theoretically safer than the delivery of other types of electricity (3).

Emergency Physicians are likely to be the initial physicians providing care to patients who exhibit signs of medical complications after TASER® deployment. To increase awareness of possible complications, confounding variables, and treatment guidelines, we present the following two cases describing patients who presented to our Emergency Department (ED) and subsequently required admission to the hospital for treatment of rhabdomyolysis after they exhibited violent behavior, were involved in physical conflict, and then were subdued by force and ultimately by TASER® devices. The primary precipitant to the ED visit for each of these patients was the need for medical clearance before psychiatric disposition.

Section snippets

Case 1

The community police were summoned when a 23-year-old man with no prior medical history became severely agitated and began assaulting his mother. Upon police attempts to apprehend the patient to transfer him to a medical facility for evaluation, he became violent and was eventually subdued after receiving six TASER® shocks. He was transferred via a police vehicle to the ED.

In the ED the patient was disoriented and combative. On arrival he had an intact airway, adequate breathing, and intact

Discussion

Emergency Physicians must consider potential complications and confounding variables as they evaluate patients who have been immobilized by a TASER® device. The literature suggests a 1% incidence of mild rhabdomyolysis for these patients (2, 3). Most of these patients will, however, have other conditions or have been involved in scenarios also associated with the development of rhabdomyolysis. Two patients presented to our ED within a 10-day period with this complication. Both had evidence of

Acknowledgment

We thank Emily Heck for her expertise in manuscript preparation.

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