Correspondence Article Type Response to Letter Regarding Article, “TASER Electronic Control Devices and Cardiac Arrests: Coincidental or Causal?”
ECD-induced VF. It is surprising that so much focus is placed on these allegations of electrocution when the ECD satisfies all relevant standards for electric safety. Because the majority of such allegations have arisen from litigation, this focus on controversial anecdotes perhaps tells us more about the present tort litigation climate than it does about ECD safety.
We thank Dr Sheridan for his interest and wish to acknowledge his contributions to the understanding of the effects of the electronic control device (ECD).1 There have, in fact, been published studies in which ECD probes were launched into the chests of volunteers. In 2 of these studies there was continuous echocardiographic monitoring to verify that there was no cardiac capture.2,3 The 63 volunteers received a total of 10 170 ECD pulses with no arrhythmias and no cardiac capture (in the 9450 with echo monitoring). Consistent with the study coauthored by Dr Sheridan, some of us have previously published that the risk of ventricular fibrillation (VF) induction is vanishingly small, if not essentially zero. We believe that the issue of ECD-induced cardiac effects has been sufficiently studied and that the epidemiological data convincingly show how rare (if even existent) such side-effects are. The Canadian Council of Science performed an expert panel review of the literature and concluded that the reports of litigation-driven cases [Z1–Z8, our #5–12] were “particularly questionable,” “isolated and controversial,” and authored by someone with a “potential conflict of interest.” The Naunheim et al case (S.N., our #2), alleging ECD-induced VF, was correctly reported earlier by other physicians of the same hospital to have presented with asystole (consistent with the extreme alcohol intoxication and not with electric stimulation 6 minutes beforehand). That leaves 2 published cases— our #1 (K.F.) and #3 (S.F.)—and only 1 of these cases (Swerdlow et al, our #3), has not been previously questioned in the literature (our article concludes that even these 2 cases are not evidence of ECDinduced VF). Assume arguendo that perhaps 1 or 2 of these cases actually do represent ECD-induced VF, ignore the nearly 1 400 000 officer training exposures, and consider only the ≈ 2.1 million field applications to suspects. This would yield a theoretical rate of cardiac arrest of ≤1 per million, which would make the ECD an extremely safe tool. The relevant definition of safety is: does the tool provide more benefit than harm when compared with the alternatives? Multiple prospective studies have shown that the use of the ECD reduces suspect injury by about 2/3 compared with alternative control techniques such as pepper spray, baton strikes, and manual control.4 Eastman et al showed that 5.4% of ECD uses clearly prevented the use of lethal force.5 This suggests that ≈100 000 potentially lethal uses of force have been prevented and demonstrates that the ECD exceeds any relevant criterion for safety. The ECD has contributed to ≈15 deaths from traumatic brain injury by causing an uncontrolled fall and ≈5 deaths from igniting a flammable substance. These deaths exceed any count of hypothesized
Disclosures All authors have been expert witnesses for TASER International, who funded the study. Drs Luceri and Kroll are members of their Scientific and Medical Advisory Board, and Dr Kroll is a member of their Corporate Board. Mark W. Kroll, PhD University of Minnesota Minneapolis, MN Dhanunjaya R. Lakkireddy, MD University of Kansas Hospital Kansas City, KS James R. Stone, MD, PhD Harvard University Boston, MA Richard M. Luceri, MD Holy Cross Hospital Ft. Lauderdale, FL
References 1. Holden SJ, Sheridan RD, Coffey TJ, Scaramuzza RA, Diamantopoulos P. Electromagnetic modelling of current flow in the heart from TASER devices and the risk of cardiac dysrhythmias. Phys Med Biol. 2007;52:7193–7209. 2. Dawes DM, Ho JD, Reardon RF, Miner JR. Echocardiographic evaluation of TASER X26 probe deployment into the chests of human volunteers. Am J Emerg Med. 2010;28:49–55. 3. Ho JD, Dawes DM, Reardon RF, Strote SR, Kunz SN, Nelson RS, Lundin EJ, Orozco BS, Miner JR. Human cardiovascular effects of a new generation conducted electrical weapon. Forensic Sci Int. 2011;204:50–57. 4. MacDonald JM, Kaminski RJ, Smith MR. The effect of less-lethal weapons on injuries in police use-of-force events. Am J Public Health. 2009;99:2268–2274. 5. Eastman AL, Metzger JC, Pepe PE, Benitez FL, Decker J, Rinnert KJ, Field CA, Friese RS. Conductive electrical devices: a prospective, population-based study of the medical safety of law enforcement use. J Trauma. 2008;64:1567–1572.
(Circulation. 2014;130:e168.) © 2014 American Heart Association, Inc. Circulation is available at http://circ.ahajournals.org
DOI: 10.1161/CIRCULATIONAHA.114.010923
e168
Copyright of Circulation is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
ECD-induced VF. It is surprising that so much focus is placed on these allegations of electrocution when the ECD satisfies all relevant standards for electric safety. Because the majority of such allegations have arisen from litigation, this focus on controversial anecdotes perhaps tells us more about the present tort litigation climate than it does about ECD safety.
We thank Dr Sheridan for his interest and wish to acknowledge his contributions to the understanding of the effects of the electronic control device (ECD).1 There have, in fact, been published studies in which ECD probes were launched into the chests of volunteers. In 2 of these studies there was continuous echocardiographic monitoring to verify that there was no cardiac capture.2,3 The 63 volunteers received a total of 10 170 ECD pulses with no arrhythmias and no cardiac capture (in the 9450 with echo monitoring). Consistent with the study coauthored by Dr Sheridan, some of us have previously published that the risk of ventricular fibrillation (VF) induction is vanishingly small, if not essentially zero. We believe that the issue of ECD-induced cardiac effects has been sufficiently studied and that the epidemiological data convincingly show how rare (if even existent) such side-effects are. The Canadian Council of Science performed an expert panel review of the literature and concluded that the reports of litigation-driven cases [Z1–Z8, our #5–12] were “particularly questionable,” “isolated and controversial,” and authored by someone with a “potential conflict of interest.” The Naunheim et al case (S.N., our #2), alleging ECD-induced VF, was correctly reported earlier by other physicians of the same hospital to have presented with asystole (consistent with the extreme alcohol intoxication and not with electric stimulation 6 minutes beforehand). That leaves 2 published cases— our #1 (K.F.) and #3 (S.F.)—and only 1 of these cases (Swerdlow et al, our #3), has not been previously questioned in the literature (our article concludes that even these 2 cases are not evidence of ECDinduced VF). Assume arguendo that perhaps 1 or 2 of these cases actually do represent ECD-induced VF, ignore the nearly 1 400 000 officer training exposures, and consider only the ≈ 2.1 million field applications to suspects. This would yield a theoretical rate of cardiac arrest of ≤1 per million, which would make the ECD an extremely safe tool. The relevant definition of safety is: does the tool provide more benefit than harm when compared with the alternatives? Multiple prospective studies have shown that the use of the ECD reduces suspect injury by about 2/3 compared with alternative control techniques such as pepper spray, baton strikes, and manual control.4 Eastman et al showed that 5.4% of ECD uses clearly prevented the use of lethal force.5 This suggests that ≈100 000 potentially lethal uses of force have been prevented and demonstrates that the ECD exceeds any relevant criterion for safety. The ECD has contributed to ≈15 deaths from traumatic brain injury by causing an uncontrolled fall and ≈5 deaths from igniting a flammable substance. These deaths exceed any count of hypothesized
Disclosures All authors have been expert witnesses for TASER International, who funded the study. Drs Luceri and Kroll are members of their Scientific and Medical Advisory Board, and Dr Kroll is a member of their Corporate Board. Mark W. Kroll, PhD University of Minnesota Minneapolis, MN Dhanunjaya R. Lakkireddy, MD University of Kansas Hospital Kansas City, KS James R. Stone, MD, PhD Harvard University Boston, MA Richard M. Luceri, MD Holy Cross Hospital Ft. Lauderdale, FL
References 1. Holden SJ, Sheridan RD, Coffey TJ, Scaramuzza RA, Diamantopoulos P. Electromagnetic modelling of current flow in the heart from TASER devices and the risk of cardiac dysrhythmias. Phys Med Biol. 2007;52:7193–7209. 2. Dawes DM, Ho JD, Reardon RF, Miner JR. Echocardiographic evaluation of TASER X26 probe deployment into the chests of human volunteers. Am J Emerg Med. 2010;28:49–55. 3. Ho JD, Dawes DM, Reardon RF, Strote SR, Kunz SN, Nelson RS, Lundin EJ, Orozco BS, Miner JR. Human cardiovascular effects of a new generation conducted electrical weapon. Forensic Sci Int. 2011;204:50–57. 4. MacDonald JM, Kaminski RJ, Smith MR. The effect of less-lethal weapons on injuries in police use-of-force events. Am J Public Health. 2009;99:2268–2274. 5. Eastman AL, Metzger JC, Pepe PE, Benitez FL, Decker J, Rinnert KJ, Field CA, Friese RS. Conductive electrical devices: a prospective, population-based study of the medical safety of law enforcement use. J Trauma. 2008;64:1567–1572.
(Circulation. 2014;130:e168.) © 2014 American Heart Association, Inc. Circulation is available at http://circ.ahajournals.org
DOI: 10.1161/CIRCULATIONAHA.114.010923
e168
Copyright of Circulation is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
