Technical Report
TR-01-2006

Review of Conducted Energy Devices

August 22,2005

Prepared by
Drazen Manojlovic , Christine Hall, Darren Laur, Shawna Goodkey, Chris
Lawrence, Rick Shaw, Sylvain St-Amour, Annik Neufeld, Steve Palmer
For the
Canadian Association of Chiefs of Police

©HER MAJESTY THE QUEEN IN RIGHT OF CANADA (2005)
As represented by the Solicitor General of Canada

This report is a publication of the Canadian Police Research Centre.
For additional copies or further information contact:

Canadian Police Research Centre (CPRC)
Building M-55, 1200 Montreal Road
Ottawa, ON K1A 0R6
Telephone: (613) 990-8577
Fax: (613) 949-3056
www.cprc.org

Centre canadien de recherches policières
(CCRP)
Édifice M-55, 1200, chemin de Montréal
Ottawa (Ontario) K1A 0R6
Téléphone : (613) 990-8577
Télécopieur : (613) 949-3056
www.cprc.org

Canadian Police Research Centre
Review of Conducted Energy Devices
Executive Summary
As a result of a number of deaths associated with the use of Conductive Energy
Devices (CEDs), and growing concern within the public and the law enforcement
communities in Canada, the Canadian Association of Chiefs of Police (CACP)
approached the Canadian Police Research Centre (CPRC) in August 2004, to
conduct a comprehensive review of the existing scientific research and data and
provide a national perspective on the safety and use of CEDs.
CPRC closely collaborated with representatives from the Victoria Police Department
who were concurrently studying CEDs on behalf of the BC Office of the Police
Complaints Commissioner (BCOPCC). This horizontal collaboration enabled the
optimization of resources and brought about mutual benefits with regards to
information sharing. Moreover, this report complements the existing BCOPCC
reports, which were published respectively in December 2004 and June 2005. At
the same time, CPRC and BCPOCC consulted with their UK and US counterparts
who were also reviewing the use of CEDs.
In Canada, the use of CEDs are limited to police officers and guided by policies
established by the responsible agencies be they at the federal, provincial or
municipal level. In turn, the agencies are guided by the National Use of Force
Framework (NUFF), which was established in 2000, by the CACP. It is the intent of
this report to provide guidance and assistance to the Canadian police community in
reviewing the current operational use of CEDs and the development of future
training programs, governing policies and procedures.
To guide its activities and to ensure appropriate representation from the community,
CPRC established a Steering Committee.
Membership included medical
professionals, police officers, police trainers, policy analysts and stakeholder
representatives from across Canada.
The CPRC’s review of CEDs focused on three areas: the medical safety of CEDs,
the policy considerations for Police CED operations and the analysis of the medical
condition excited delirium. The term “Conducted Energy Device” has been used
throughout the report rather than the trademarked term “TASER”. This more
inclusive term recognizes that there are other products, which may be entering the
market. Only the TASER® M26 and X 26 were reviewed for this report.

Section 1 - Medical Safety of CEDs
This section focuses primarily on the medical effects of the devices. The research
and/or opinions (15 in total) were categorized as vendor-sponsored, independent, or
on-going. Based on the existing research into the medical safety of CEDs, the
CPRC team has concluded the following:
•
•
•
•

Definitive research or evidence does not exist that implicates a causal
relationship between the use of CEDs and death.
Existing studies indicate that the risk of cardiac harm to subjects from a CED is
very low.
Excited Delirium (ED), although not a universally recognized medical condition,
is gaining increasing acceptance as a main contributor to deaths proximal to
CED use.
The issue related to multiple CED applications and its impact on respiration, pH
levels, and other associated physical effects, offers a plausible theory on the
possible connection between deaths, CED use, and people exhibiting the
symptoms of ED.

The contributors to this CPRC report believe that CEDs are effective law
enforcement tools that are safe in the vast majority of cases.
Section 2 – Policy Considerations for Police CED Operations
During the course of reviewing the existing research on CEDs, information has been
collected that can substantially improve the knowledge that law enforcement
agencies possess about the use of CEDs. Section 2 addresses issues relating to
operational use, training, policy and accountability.
It has become evident that the emergence of CEDs as a use of force option for
police services has been a substantial benefit. Proper training and use of CEDs
have reduced the risk of harm to both police officers and suspects. Several positive
aspects of CED usage are referred to in reports across North America, namely:
•
•
•
•

Less injuries to police officers while completing arrests
Less injuries to persons who are resisting arrest
Less use of lethal force
Less use of other force options

Originally, the CEDs were developed in an effort to provide “less-lethal” use of force
options to police when faced with incidents that may otherwise require a lethal use
of force option. At the time, this is also how the devices were marketed to the
public, the media, civilian oversight bodies, government, and “watchdog” groups –
as replacements for lethal force. There is no question that the use of CEDs can,
and have, saved many lives, however, it is a common misconception that CEDs are

ii

only used when an incident would require lethal force, and/or before lethal force is
actually used in such situations.
Based on the existing research, the CPRC team puts forth the following policy
considerations:
•
•
•
•
•
•

The use of CEDs are related to a decrease in the use of lethal force in some
jurisdictions and are also related to substantial decreases in police officer and
subject arrest-related injuries.
Although each use of force incident needs to be judged separately, for the most
part the increased use of CEDs in non-lethal incidents is appropriate.
Originally marketed and accepted as an alternative to lethal force, usage has
grown to include incidents where intermediate (but not lethal) weapons should
be used
Police services and their governing bodies and agencies should give thoughtful
consideration to developing CED usage reporting procedures, forms, or
databases.
It would be unwise and counter-productive for any police service or government
body to develop policies and procedures that explicitly speciffiesy in what kinds
of circumstances a CED may or may not be used.
Notwithstanding the above point, police officers need to be aware of the adverse
effects of multiple, consecutive cycles of a CED on a subject; deploying a CED
on a subject’s head, neck, or genitalia; deploying a CED where a person can fall
from a height; and deploying a CED on a subject where it is known to the officer
that the subject has flammable substances on their clothing or on their person,
or are standing in or near obvious flammable/explosive substances conditions
such as a puddle of gasoline or a natural gas leak.

Section 3: Excited Delirium (ED)
Given the attention surrounding the deaths proximal to CED use, Section 3 provides
with a more thorough explanation of ED and its relationship to CEDs and the
individuals who have died. The CPRC team believes strongly that this section
sheds noteworthy light on the possible significant factors in these deaths.
To appreciate the complexity of ED, consider the following scenario:
Police are dispatched to intervene when a male subject (rarely is a
female the subject in excited delirium), often inappropriately dressed
for the environment, is acting in a violent and irrational manner in a
public or residential space. There is seemingly purposeless, constant
activity and violence. Attempts to intervene by bystanders have been
unsuccessful, the violent rampage continues and there is concern for
personal safety or the protection of property. On arrival of the police
service, the subject is apparently incoherent, is often continuously
screaming unintelligible words or sounds, does not recognize that
iii

police are present and appears to be suffering from either some sort
of psychosis, or a severe drug induced “high”. The disruptive situation
continues or escalates and the officers attempt to take the subject into
custody. Upon physical contact, the subject immediately begins to
fight aggressively with police resulting in a protracted physical
encounter requiring multiple officer participation and varying methods
of restraint. During the struggle, the subject is apparently impervious
to pain and appears to have near superhuman strength, out of
proportion with physical characteristics. Often officers note that the
skin of the subject is extremely hot to the touch and the subject may
(or may not) be sweating profusely. At the conclusion of the
protracted struggle, the subject is finally taken under some semblance
of control and handcuffed; everyone, including the subject, is
exhausted. What is the diagnosis?
In fact, there is no unifying diagnosis; rather, a set of signs and symptoms forming a
condition that may be associated with sudden death proximal to restraint. That
cluster of signs and symptoms collectively forms a condition known to some as
excited delirium, also known as agitated delirium or delirium agité. When the
subject has a fatal outcome following presentation in excited delirium, previous
literature has called that specific clinical course “in custody death syndrome”.
Whether as a result of illicit drugs, psychiatric illness or other metabolic
derangements, the cause of the excited delirium is initially irrelevant since it can
neither be investigated nor treated until the subject is contained. No therapeutic
relationship can be entered with an individual who is incoherent, violent and
resistive.
Not only is the commencement of therapy or the protection of public good in order, it
may be harmful to allow the delirious state to continue. Usually, police engagement
is requested as a result of property damage concerns, dangerous or threatening
behaviours and commonly, real concerns about the imminent danger to the subjects
themselves. Risks to these individuals are not necessarily mitigated by containing
them in a large space until such time as exhaustion sets in. Not only are property
owners not content to watch police allow a subject to continue to destroy property,
there is some medical evidence that suggests that progression to a state of
exhaustion is, in itself, dangerous.
Current attentions are focused on the use of CEDs as causative in the deaths
through a variety of proposed but unproven mechanisms. Section 1 of this report
deals specifically with the current level of medical research into conducted energy
weapons and sudden death proximal to police restraint. Prospective investigation in
the population of interest is still lacking and all causative theories are, at present,
speculative.

iv

Recent discussions surrounding the need for further scientific data for the
population of interest during the situation of interest have prompted the
development of a national protocol for the epidemiologic study of subjects resisting
arrest with specific interest in features of excited delirium and the incidence of
sudden in custody death.
Interest in further defining physiologic mechanisms potentially placing subjects
suffering excited delirium at risk have lead to other scientific protocols investigating
acid base balance and the influence of pH changes with and without various
methods of restraint.
Evidence for the multifactorial nature of the deaths is further supplied by
observations that subjects dying in police custody are not always restrained prone
nor are all the characteristics replicated in all cases. Collection of data around all
features of subjects resisting arrest and dying in police custody remains necessary
to fully understand these events.
Based on the existing research on excited delirium, the CPRC team recommends
the following:
•

Police officers should recognize that acutely agitated persons are suffering from
a medical emergency, and that emergency medical services (EMS) involvement
is warranted as early as possible in the restraint process.

•

Notification of EMS for dispatch prior to actual physical engagement with the
subject may be the most rational policy

Conclusions
This report summarizes the efforts of the CPRC team in researching, analyzing, and
communicating the vast array of complex issues associated with CEDs. The CPRC
team believes that the following global statements will assist and guide the policing
community in Canada establishing best practices for the safe use of CEDs:
•

Definitive research or evidence does not exist that implicates a causal
relationship between the use of CEDs and death.

•

Existing studies indicate that the risk of cardiac harm to subjects from a CED is
very low.
Police officers need to be aware of the adverse effects of multiple, consecutive
CED cycles
The issue related to multiple CED applications and its impact on respiration, pH
levels, and other associated physical effects, offers a plausible theory on the
possible connection between deaths, CED use, and people exhibiting the

•
•

v

•
•

symptoms of ED.
It would be unwise and counter-productive for any police service or government
body to develop policies and procedures that explicitly specify in what kinds of
circumstances a CED may or may not be used.
The application of best practices relating to the safe use of CEDs should lead to
an increase in public confidence in CEDs as appropriate law enforcement tools.

Future Directions
The team has identified areas for future work beyond the scope of this study.
It has become apparent to the CPRC team that there is no known, scientifically
tested, independently verified, and, globally accepted CED safety parameters. This
is problematic for a couple of reasons.
•

Police services and authorizing agencies are completely reliant on manufacturer
claims regarding the safety of their products. By comparison there are many
policing tools and equipment that have an accepted range of safety parameters
such as body armour, OC spray concentrations, and police vehicle
specifications. In terms of CEDs what is known is limited to testing of the
TASER® M26 and X26. If a new CED were to be introduced, police services
and authorizing agencies could only rely on manufacturer claims.

•

Because of this lack of known safety parameters relating to CED, authorizing
agencies are ill-equipped to respond quickly to advances in technology that may
be immediately beneficial to police and, eventually, community safety. At least
in the context of a few Canadian examples, some authorizing jurisdictions have
little independent information to form decisions and policy – with the end result
being an unnecessarily bureaucratic process, devoid of leadership, that serves
few stakeholders. This is a tangible “gap” in the complete understanding of
CEDs that needs to be filled.

There is a lack of scientific information on death proximal to restraint.
•

There is a need for a national epidemiological study of individuals resisting
arrest to gather data around all features of these subjects and those dying in
police custody to fully understand these events.

There is also great interest in gaining more information about what happens
physiologically in subjects suffering excited delirium:
•

Scientists are planning to investigate acid base balance and the influence of pH
changes with and without various methods of restraint.

•

In addition there is a need, at a national level, to develop research that can study
the existence and nature of ED and how people suffering from this condition can
be best subdued by police in order to expedite medical treatment.
vi

Acknowledgements
The Canadian Police Research Centre would like to thank all those who contributed
to the success of this study. Over a twelve month period, thousands of pages of
information were reviewed, dozens of meetings held and countless telephone calls
and e-mails exchanged nationally and internationally.
While there are far too many people and organizations to name individually we
would like list a few who played key roles in this report,:
•
•
•
•

•
•

Office of the Police Complaints Commissioner, British Columbia, Mr Dirk
Ryneveld, Commissioner
CPRC Conducted Energy Device Steering Committee, (Appendix A)
CPRC Team (Appendix B)
Organizations who seconded staff and resources to the study: The BC Public
Safety and Solicitor General, the Victoria Police Department, the Delta BC
Police Department, l’École Nationale de Police de Québec, Service de Police
de la ville de Montréal, the Edmonton Police Services, the National Research
Council, the Ontario Police College, Ontario Ministry of Community Safety
and Correctional Services, the Royal Canadian Mounted Police and
Correctional Service Canada.
Members of the Canadian Association of Chiefs of Police
International organizations with whom we shared information such as: The
National Institute of Justice (USA), The Police Executive Research Forum
(USA), The Department of Defence, Human Effects Centre of Excellence,
(USA), International Association of Chiefs of Police (USA), Home Office
Scientific Development Branch (UK)

vii

Recommendation from the Conducted Energy Device
Steering Committee
To the CPRC Advisory Board:

The Canadian Association of Chiefs of Police asked the Canadian Police Research
Centre in August 2004, “to conduct a comprehensive review of the existing scientific
research and data and provide a national perspective on the safety and use of CED
in police work in Canada and around the world”
The Conducted Energy Device Steering Committee was established to provide
advice and guidance to the Canadian Police Research Centre (CPRC) Advisory
Board and Executive Director in the conduct of the CPRC Conducted Energy
Device Study. The Steering Committee reports to the CPRC Advisory Board.
To address the request of the CACP, the CPRC worked in collaboration with the
research community, end users and other stakeholders to review the medical safety
of Conducted Energy Devices (CEDs), the policy considerations for police CED
operations and the analysis of the medical condition excited delirium.
The CPRC team has conducted a thorough review of the existing research and
presented the results in an objective manner. CPRC has encouraged open and
frank discussion in an effort to separate opinion from the research regarding the use
and safety of Conducted Energy Devices.
During the course of the study, the Committee reviewed and discussed the work in
progress and the outcomes of the study.
On August 10, 2005 the Steering Committee approved the final report. In our
opinion the findings in the CPRC report, TR-01-2006 “Review of Conducted Energy
Devices”, are a fair representation of the current state of research regarding safety
and use of the Conducted Energy Devices.
We recommend acceptance of the report by the Advisory Board of the Canadian
Police Research Centre. We further recommend that CPRC communicate the
findings to the Canadian public.
Yours Respectfully

Conducted Energy Device Project Steering Committee

viii

Table of Contents
EXECUTIVE SUMMARY

I

ACKNOWLEDGEMENTS

VII

RECOMMENDATION FROM THE CONDUCTED ENERGY DEVICE STEERING
COMMITTEE
VIII
TABLE OF CONTENTS

IX

INTRODUCTION

1

SECTION 1 - MEDICAL SAFETY OF CONDUCTED ENERGY DEVICES (CED)

2

Independent Research

2

Vendor-Sponsored Research

9

Ongoing Research

12

Summary of Medical Concerns and CED

12

CED Probe Removal

16

Deaths Proximal to CED Use

16

Section 1 - Summary

18

SECTION 2 – POLICY CONSIDERATIONS FOR POLICE CED OPERATIONS 20
Cincinnati Police Department

20

Orange County (Florida) Sheriff’s Office (OCSO)

20

Madison (Wisconsin) Police Department (MPD)

21

Toronto Police Service (TPS) X26 TASER® Pilot Study

22

The Canadian National Use of Force Framework

23

CED Accountability

28

Police Exposure to CED during Training

29

ix

Implications for Police CED Operational Use

31

Section 2 - Summary

33

Section 2 -Future Directions

34

SECTION 3 - EXCITED DELIRIUM

35

The Scenario

35

Delirium

35

Identification of a state of excited delirium

37

Death in custody

39

Theories on the etiology of death in excited delirium in the setting of police restraint 40
Interventions to potentially lessen the risk of death

43

Section 3 - Future directions

43

REFERENCES

45

GLOSSARY OF TERMS

51

APPENDICES

52

A -Conductive Energy Device Steering Committee

53

B- Conductive Energy Device Working Group

54

C- British Columbia Office of the Police Complaints Commissioner Final report

55

D-British Columbia Office of the Police Complaints Commissioner Interim report

55

x

Introduction
As a result of a number of deaths associated with the use of Conductive Energy
Devices (CEDs), and growing concern within the public and the law enforcement
communities in Canada, the Canadian Association of Chiefs of Police (CACP)
approached the Canadian Police Research Centre (CPRC) in August 2004, to
conduct a comprehensive review of the existing scientific research and data and
provide a national perspective on the safety and use of CEDs.
CPRC closely collaborated with representatives from the Victoria Police Department
who were concurrently studying CEDs on behalf of the BC Office of the Police
Complaints Commissioner (BCOPCC). This horizontal collaboration enabled the
optimization of resources and brought about mutual benefits with regards to
information sharing. Moreover, this report complements the existing BCOPCC
reports, which were published respectively in December 2004 and June 2005. At
the same time, CPRC and BCPOCC consulted with their UK and US counterparts
who were also reviewing the use of CEDs.
In Canada, the use of CEDs are limited to police officers and guided by policies
established by the responsible agencies be they at the federal, provincial or
municipal level. In turn, the agencies are guided by the National Use of Force
Framework (NUFF), which was established in 2000, by the CACP. It is the intent of
this report to provide guidance and assistance to the Canadian police community in
reviewing the current operational use of CEDs and the development of future
training programs, governing policies and procedures.
To guide its activities and to ensure appropriate representation from the community,
CPRC established a Steering Committee.
Membership included medical
professionals, police officers, police trainers, policy analysts and stakeholder
representatives from across Canada.
The CPRC’s review of CEDs focused on three areas: the medical safety of CEDs,
the policy considerations for Police CED operations and the analysis of the medical
condition excited delirium. The term “Conducted Energy Device” has been used
throughout the report rather than the trademarked term “TASER”. This more
inclusive term recognizes that there are other products, which may be entering the
market. Only the TASER® M26 and X 26 were reviewed for this report.

Section 1 - Medical Safety of Conducted Energy Devices
(CEDs)
The Canadian Police Research Centre’s (CPRC) review of CEDs research focuses
primarily on the medical effects of the devices. The CPRC has closely collaborated
with the team from the Victoria Police Department (VPD) that studied CEDs on
behalf of the British Columbia Office of the Police Complaints Commissioner
(BCOPCC). The BCOPCC released an interim report in September of 2004 and the
final report was released in June of 2005. In clear recognition and acknowledgment
of the substantial work that culminated in the two BCOPCC reports, and in an effort
to reduce unnecessary and unproductive duplication of efforts, this CPRC report
(and in particular this section) summarizes the findings of the BCOPCC reports.
Note that only one study listed below did not come from either of the BCOPCC
reports (Saul D. Levine, Christian Sloane, Theodore Chan, Gary Vilke and James
Dunford, University of California, San Diego (UCSD), 2005).
The BCOPCC reports reviewed either research that employed scientific
methodology or opinions offered by medical professionals. This research or
opinions are categorized as vendor-sponsored, independent, or on-going. The
following summarizes the details of each research/opinion and states their
conclusion (for further details please refer to the BCOPCC reports). The
research/opinions are listed in chronological order, however for brevity and
consistency, please note that the individual(s) or organization(s) that conducted the
scientific research or provided the professional opinion is labeled as “Researcher”:

Independent Research
Researcher: Sgt. Scott Grenfell, Victoria (Australia) Police, 2003. (A-1;A-2,A-3)
Focus:

The Alfred Hospital in Melbourne, Australia conducted an electrical
safety analysis of the M26 and X26 TASER®.

Conclusion: “The M26 TASER® output is less than 2% of the normalized current
likely to produce ventricular fibrillation. The X26 improves this figure
even more to less than 1% of normalized current likely to cause
ventricular fibrillation.” They also conclude that “the advanced
TASER® appears from the manufacturer’s data file to be a relatively
safe device for immobilizing non-violent offenders. However, these
subjects are exposed to a number of immediate risks/potentially fatal
dangers operating either just before or just after being apprehended
with the aid of a TASER®.

2

Researcher: Portland Bureau of Police, Portland, Oregon, 2003. (B)
Focus:

Reviewed 227 TASER® M26 usages and the corresponding emergency
medical services care reports for the period between June 2002 and July
2003.

Conclusion: “Of the 227 successful TASER® deployments. 96 (42%) of the incidents had
EMS reports. Median patient age was 36 years: 92% were male and 64%
were white. 31 (32%) patients received a "Dry stun" when 65 (68%) were
shot with the TASER®. There were no documented deaths, dysrhythmias, or
cardiac complaints. 60 (63%) of the patients had no documented injury,
while 27 (28%) sustained minor secondary injuries (hematomas, lacerations
and contusions) and 9 (9%) sustained self-inflicted or unrelated injuries.”

They conclude “the M26 appears to be a safe and effective non lethal
weapon in this case series. No deaths were reported, however, a
higher incidence of minor injury was observed than was noted in
previous manufacturers’ reports. A prospective trial of its use to better
define a risk-benefit relationship is justified.”
Researcher: Joseph Heck, Casualty Care Research Centre, Henderson, Nevada,
2004. (C)
Focus:

Examined the medical implications of CED use from the perspective of
emergency care providers.

Conclusion: “The electrical impulse delivered by either the stun or EMD
(electromuscular disruption) device is well below the level established
as “safe” by the federal government and International European
standards in approving such devices as electrified cattle fence, and
the risk of cardiac complications is low. Sudden death has been
reported proximate to electrical impulse device use. However in all
reported cases the cause of death was attributed to other factors,
primarily drug intoxication, and there has been no direct link to the use
of the device.”
Researcher: Dr. Charles Butler, 2004. (D)
Focus:

Dr. Butler was commissioned by the Kalamazoo County (Michigan)
Sheriff’s Department to assess the scientific and medical data
evaluating the safety and efficacy of the TASER®.

Conclusion: Dr. Butler came to four main conclusions:
Up to the present there is no proven connection between the use of
the TASER® and the occurrence of in-custody deaths;
There is no evidence of long-term harm from electric current in
survivors of the TASER®;
The electrophysiological literature indicates that the M26 TASER®
does not exceed published electrical current limits;

3

Use of the TASER® reduces injuries compared to all alternative
methods studied.
Researcher: Orange County (Florida) Sheriff’s Office, 2004. (E)
Focus:

A panel of four medical professionals reviewed the literature and
provided opinions in a public forum. The forum was held July 28,
2004, in response to several highly publicized incidents of death
associated to TASER® use by police. This was the single most
accessible document we located that canvassed the issues in a
fashion readily understandable to a layperson.

Conclusion: Four members of the medical panel offered their opinions and they are
as follows:
•

Dr. Aurelio Duran, a cardiac-electro-physiologist of the Orlando Heart Center,
stated, “In the real world, the individuals that I read who have problems tend to
be people who have problems minutes or hours after being TASER®ED. If a
device was able to cause a bad heart rhythm - if I by mistake was fixing one of
these outlets here and got electrocuted and it caused a bad rhythm - you would
see me immediately collapse and I wouldn't get up and start walking around and
talking to you. I would collapse and wouldn't come back to life unless a
paramedic came and shocked me out of death.”

•

Dr. Daniel Brennan, an emergency room physician at the Orlando Regional
Medical Center, stated, “It’s very hard to shock people's hearts. We use
defibrillators with big paddles and high energy because of that resistance of air.
So the TASER®, in contrast even though it is high voltage, it has very low
current, very low amperage, and a very short duration as well. It does use
repetitive cycles, 5-30 cycles per second. That's how we're actually able to
immobilize the person we're trying to immobilize with the TASER®, I suppose,
because it's not just one quick jolt where your body would give just a jerk, but it's
several cycles, over several seconds, to immobilize the person. The energy
used is about 1.6J, where as the exo-defibrillator we use in the EMS and the
emergency fire unit is a minimum of 50-360J. So again, it's a very minimal
amount of energy.”

•

Dr. Bob Vandervoort, a pharmacologist, then discussed the role of cocaine and
the relationship between consumption and psychosis. He stated “In a study of
55 patients admitted into a hospital for cocaine help, these are people who
actually sought treatment 53 percent this is over half the people who were
regular cocaine users, had features of psychosis. It's not like five, ten percent of
people. We used to think, back in the 70's, that the number was eighteen
percent. But that was when it was the entry nasal form that everybody was
using. When I looked up the different forms of ingestion, entry nasal form only
had four percent incidence of psychosis. In that same study, the crack users had
52 percent very similar to this number. Of those people who had psychosis,
ninety percent had delusions, 96 percent hallucinated, and look at the last one;

4

48 percent of people, half the people who had psychotic effects, said they had it
every time they used the drug.”
•

Dr. Jan Garavaglia, the Chief Medical Examiner for Orlando, provided a
summary of information relating to in-custody death. He stated “When I first got
here, I had a TASER® death right away. The first thing I asked was what he did
after he got shot with the TASER®. And they said he did this and this and this.
Well, I know that the TASER® didn't kill him. You're not going to have a delayed
effect with the electricity. So the common factor in the deaths reported seems to
be the excited state of the individual being shot by the TASER®. The timeline of
Excited Delirium deaths - that's what we call the deaths of people very excitedwas first reported out of Miami in 1985. It was reported by a doctor there, who
had seven cases, all showing bizarre psychotic behaviour. They all had
hyperthermia, meaning elevated body temperature, and we're talking up to 107108. They were all very hyperactive and had experienced extreme exertion while
fleeing or being pursued by the police. And then they had sudden deaths,
sudden death usually after being restrained by the police. 1985 is probably a
very important date, because that's the date when crack cocaine started being
actively marketed in Miami.
•

Excited Delirium Syndrome is found to be different than acute cocaine
intoxication deaths. We see cocaine intoxication deaths a lot, because the
mechanisms are usually heart weakness, seizures, and that can happen with
your first time use. You can die from cocaine with your first time use and I've
had some well-documented cases of that. This is a totally different syndrome.
With Excited Delirium deaths, usually the cocaine is present in low levels.
Sometimes you find them with the metabolite present. They always have a
history of chronic cocaine use. They tend to be crack users. They are also IV
cocaine users; you hardly ever see it with the nasal. They have very bizarre,
excited behaviour, they have hyperthermia, and they tend to have a much
lower instance of seizures than in acute cocaine death.

•

It is my belief that TASER® use is now associated with Excited Delirium,
because it’s associated; that’s how they’re bringing them down, but there’s
really no evidence that they’re causing any of the deaths. Actually, according
to the National Association of Medical Examiners, the physician paper, this
cocaine Excited Delirium is now a fatal disease, whether the police interact or
not. These are people with elevated temperatures (107-108F) and its
chronic cocaine use; you don’t ever see it with a first episode use. Thus I
believe these individuals would have died with or without being shot with a
TASER®.”

Researcher: Defence Scientific Advisory Council (DSAC) of the United Kingdom,
2004. (F-1,F-2,F-3,F-4,F-5)

5

Focus:

DSAC created a sub-committee to advise the Secretary of State for
the Home Department with medical advice on various less-lethal
weapons systems including the TASER® M26.

Conclusion: The DSAC sub-committee found a cardiac safety threshold of “70 fold”
for the M26. They state, “the results from the study, together with
evidence gleaned from the literature, suggest that some frequently
abused drugs have the potential to contribute to any cardiacrelated morbidity or mortality that may arise in the context of
TASER® use. Furthermore, it seems reasonable to assume that
this conclusion could be generalized to other emotionally
charged and possibly violent confrontations with law
enforcement personnel. The adverse cardiac effects produced
by any individual drug are likely to be dependent on several risk
factors, including dose consumed, co-use with other drugs
(including pharmaceutical drugs and ethanol) and pre-existing
heart disease. This complex interplay of multiple risk factors
could conceivably contribute to any cardiac-related morbidity or
mortality associated with TASER® use against drug-intoxicated
persons. Officers should be aware that the risk of any adverse
response in the aftermath of TASER® deployment may be higher in
drug-impaired individuals, and accordingly, they should be vigilant of
any unusual behaviour displayed by the apprehended person that may
signal the need for early medical intervention.” The sub-committee’s
overall conclusion was that “the risk oflife- life-threatening or serious
injuries from the TASER® M26 is very low.”
Researcher: HECOE, (partnership of the U.S. Air Force Research Laboratory and
the Joint Non-Lethal Weapons Program), 2004. (G)
Focus:

To assess the effectiveness and risk characterization of the M26 and
X26 TASER® based on existing data.

Conclusion: “Overall, the results indicate that the use of the TASER® M26 and
X26, as intended, will generally be effective in inducing the desired
temporarily incapacitating effect without presenting a significant risk of
unintended severe effects. Although likely to be uncommon, some
severe unintended effects might occur.
The occurrence of in-custody deaths has been reported in conjunction
with use of TASER® devices. However, there are several arguments
against any predominant role of EMI (Electromuscular Incapacitation)
in arrest-related deaths. In previous epidemiological reports, deaths
were often attributed to illicit drug intoxication in suspects. Although
these reports address incidents involving EMI waveforms different
from those of the M26 and X26, drug intoxication has been associated
with in-custody deaths under a number of circumstances, regardless

6

of how the subjects were subdued. Contemporary medical opinion
supports the view that the drug intoxication itself causes or
predisposes one to underlying vulnerability. Based on the
documentation and research reviewed, this report concludes that EMI
is likely not the primary causative factor in reported fatalities.”
On the issue of cardiac effects the study states “ventricular fibrillation
was not expected to occur in otherwise healthy adult populations,
although data are too limited to evaluate probabilities for potentially
sensitive populations or for alternative patterns of exposure.”
Researcher: Dr. James Jauchem, Senior Research Physiologist, Human
effectiveness Directorate, U.S. Air Force Research Laboratory, 2004.
(H)
Focus:

To test the effectiveness of CED systems and extrapolate the potential
risk to human subjects based on effects observed in pigs subjected to
the effects of the X26 TASER®. Dr. Jauchem’s work has been
released in peer literature.

Conclusion: Dr. Jauchem exposed pigs to repeated cycles from an X26 TASER®
using five seconds of application followed by five seconds of rest for a
period of three minutes. This meant the animals were TASER®ed 18
times within that three-minute period. After a delay of one hour, a
second three-minute exposure period, identical to the first, was added.
Dr. Jauchem made a number of observations relating to blood
chemistry. With respect to pH, he noted that blood became more
acidic after the three-minute application, returning toward normal
levels one hour after exposure. Blood carbon dioxide levels also rose
immediately following the TASER application, returning to normal over
a sixty-minute period.
Dr. Jauchem reached a number of conclusions, the first being that the
X26 TASER® was successful in producing the desired effect incapacitation. Using an experimental device that allowed greater
power levels than the X26, he found that varying the pulse amplitude
and duration over several orders of magnitude resulted in increased
muscle contraction. He also found that maximum contraction occurred
with a minimum probe spacing of 20 cm (8 in). In relation to the blood
chemistry changes, Dr. Jauchem concluded that “some medical
monitoring of subjects may be required.”

7

The issue is the extent to which Dr. Jauchem's work can be usefully
extrapolated to law enforcement scenarios, which are highly unlikely
to involve such a prolonged series of shocks. Nonetheless, we believe
this work is very valuable and supports investigation of a number of
preliminary hypotheses about the role of blood pH, respiratory
impairment, and sudden in-custody death.
Researcher: James Ruggieri, 2005. (I-1)
Focus:

Presentation titled “Lethality of TASER®s” delivered at the Annual Meeting
of the American Academy of Forensic Sciences.

Conclusion: Mr. Ruggieri asserted in his presentation that a review of available
documents had led him to conclude that there were critical technical
errors made by TASER® International (TI) in their assessment of
electrical risk. He went on to express the opinion that the devices were
indeed capable of killing people and that the electrical charge from the
M26 fell into the zone that the International Electrical Commission
standards described as causing ventricular fibrillation 50% of the time.
Mr. Ruggieri went on to hypothesize that delayed ventricular fibrillation
(VF) may be the cause of some TASER®-related deaths, arguing that
the myocardium is capable of acting as an electrical sink that
subsequently depolarizes into VF at a time point delayed from the
initial shock. This argument is in direct contrast with the wide medical
opinion that VF as a result of electrical shock must be
instantaneous/simultaneous with the application of that shock.
In his presentation Mr. Ruggieri made a number of references to J.
Reilly and his book Applied Bioelectricity. Mr. Reilly was contacted to
seek his comments on the Ruggieri presentation. Mr. Reilly (I-2)
stated, “it appears that some inappropriate conclusions have been
circulated relative to the information in Mr. Ruggieri's slides.” Mr.
Reilly, it should be noted, was a participant in the HECOE study,
which had concluded that the risk of VF in a healthy population was
very low.
Mr. Reilly concludes, “in view of these facts, neither the M26 nor X26
TASER® is expected to produce a VF hazard when applied to the
thorax of healthy human adults. I am not aware of scientific
investigations of TASER® safety in potentially sensitive people (e.g.
the ill or under the influence of drugs).”
Relevant to Mr. Ruggieri's assertions with respect to delayed VF was
an opinion obtained by Dr. J. Cairns, the Deputy Chief Coroner for
Ontario. Dr. Cairns asked Dr. Joel Kirsh, Staff Cardiologist at the

8

Hospital for Sick Children in Toronto and an Assistant Professor of
Pediatrics, University of Toronto, for his opinion on the cardiac safety
of the TASER®. Dr. Kirsh (I-3) specifically addresses the concept of
VF occurring sometime after exposure to electrical current:
“The time course of deaths reported as being possibly related to
TASER® use is not typical of the usual clinical picture that
experienced cardiac electrophysiologists have observed over several
decades of proactive testing for ventricular arrhythmias. During such
tests, the ventricle is incrementally paced with progressively shorter
extrastimuli until such time as tissue refractoriness is reached, or an
arrhythmia is induced. Such experimentally induced arrhythmias are
observed as occurring immediately with extrastimuli and there is no
known electrophysiologic mechanism to explain any delayed induction
of ventricular arrhythmias, whether minutes or hours following the
extrastimuli.” Dr. Kirsh also concluded “the time course of deaths
reported as being possibly related to TASER® use is not typical of the
usual clinical picture that experienced cardiac electrophysiologists
have observed over several decades of provocative testing for
ventricular arrhythmias.
Researcher: Saul D. Levine, Christian Sloane, Theodore Chan, Gary Vilke and
James Dunford, University of California , San Diego (UCSD), 2005. (J)
Focus:

Abstract titled “Cardiac Monitoring of Subjects Exposed to the TASER®”,
published in the supplemental edition of Academic Emergency Medicine.

Conclusion: Twenty police officers volunteered to be TASER®ed while the team
from UCSD “evaluated cardiac changes utilizing monitoring during
deployment of the TASER®.” The researchers concluded “in this pilot
study we found no significant cardiac dysrythmias in healthy human
subjects immediately after receiving a TASER® shock. In addition,
there were no morphologic, rhythm, or interval changes other than a
small decrease in PR interval and an increase in heart rate.” The
team’s complete study was presented at the Society of Academic
Emergency Medicine’s Annual Meeting in New York City, May 2005.

Vendor-Sponsored Research
Researcher: Dr. Richard Stratbucker, Medical Advisor to TI, 1996.(K)
Focus:

Test the safety of the Air TASER®, a predecessor to the M26.

Conclusion: In 1996 Dr. Stratbucker conducted experiments to test the safety of
the Air TASER®, a predecessor to the M26. Part of the research

9

involved applying electrical currents several times more powerful than
those generated by the Air TASER® to an anaesthetized pig while the
animal's heart function was monitored. Stratbucker reported the
following results: “Of the more than 48 discharges of five seconds
duration, there was no case in which the animal revealed any cardiac
ectopy or myocardial injury. The cardiac tissue proved resistant to
stimulation despite progressively increased skeletal muscle effects
noted as the storage capacitors and battery output were increased by
several hundred percent.”
A more recent study conducted by Dr. Stratbucker utilized both the Air
TASER® and the Advanced TASER® in a study designed to
determine whether the devices could induce ventricular fibrillation
when they were applied to the chest areas of anaesthetized dogs. The
protocol involved the administration of 236 shock discharges via
probes placed on the thorax area. No episodes of ventricular
fibrillation were noted during these tests. Dr. Stratbucker concluded
from these tests that the risk of inducing ventricular fibrillation by
normal use of the TASER® in healthy humans is “very small.”
Researcher: Dr. Anthony Bleetman, Consultant in Accident and Emergency
Medicine, and Dr. Richard Steyn, Consultant in Thoracic Surgery,
Birmingham (UK) Heartlands Hospital, 2003. (L)
Focus:

TI funded study focusing on the injury potential of the M26 TASER®.

Conclusion: Dr. Bleetman and Steyn concluded:
•

The medical risks of electronic weaponry compare favourably with
those of more conventional methods of controlling non-compliant
and violent subjects. It has been impossible to accurately calculate
how much electrical energy the Advanced TASER® delivers into
the human body.

•

There exists no convincing evidence directly implicating TASER®
weaponry in deaths of subjects in over 25 years' experience in
America.

•

Risk factors for death in "TASER®ed" subjects appear to be no
different from known risk factors for death in custody (drugs,
exhaustion, bizarre behaviour leading to arrest etc.).

•

The risk of harm might well be higher for using these devices on
patients with pre-existing heart and neurological diseases. These
risks are largely theoretical and have not been demonstrated in
field application or laboratory testing to date.

•

The risk to patients with implanted pacemakers and defibrillators
are probably quite small.

10

•

The potential for significant injury exists for TASER® barbs striking
the eye, open mouth, neck, genital, and large blood vessels in the
groin.

•

The TASER® delivers electricity that incapacitates the subject and
ends the physical, (and likely the psychological), resistance to
arrest. It causes a degree of stunning. Much useful data has been
gained from over 800 volunteers. More work is required to record
the effects of the TASER® on physiological variables and ECG
tracings.

•

The TASER® is most unlikely to cause any permanent physical
problems in healthy individuals.

Researcher: Dr. Wayne McDaniel, University of Missouri-Columbia, 2005. (M)
Focus:

Dr. McDaniel published a peer-reviewed supplement entitled “Cardiac
Safety of Neuromuscular Incapacitating Defensive Devices” in the
January 2005 edition of Pacing and Clinical Electrophysiology (the
official journal of the International Cardiac Pacing and
Electrophysiology Society).

Conclusion: This study was focused on the issue of VF and the hypothesis of the
researchers was that “the induction of VF would require significantly
greater discharge levels than delivered by electrical NMI
(neuromuscular incapacitation) devices fielded by law enforcement
agencies.”
This study utilized adult domestic pigs chosen to simulate human
bodyweights of between 30 kg (66Ib) and 120 kg (265Ib).
Researchers used a device that provided the same waveform and
pulse duration as the X26 TASER®, but which could be adjusted to
provide increasing levels of electrical charge, far beyond that which
can be produced by the X26. Power levels were increased until VF
could be reliably induced, and the results recorded.
This study “confirmed the cardiac safety of an experimental NMI
device emulating the performance of commercially used devices. An
NMI discharge that could induce VF required 15-42 times the charge
of the standard NMI discharge. Furthermore, this study demonstrated
a safety index strongly correlated with increasing weight. In addition,
the observation of the hemodynamic stability of the animals suggests
that these devices may be safely applied multiple times if needed.
Discharge levels output by fielded NMI devices has an extremely low
probability of inducing VF.”

11

Ongoing Research
Researcher: Dr. William Bozeman, Wake Forest University. (N)
Focus:

Sponsored by the National Institute of Justice (NIJ), this study is a
multi-centre trial that will record the number and severity of injuries
produced by law enforcement officers using lower lethality devices
such as TASER®s, rubber bullets and beanbag projectiles. The Wake
Forest University Baptist Medical Center is receiving $140,000.00
from the NIJ for the study, led by Dr. William Bozeman.
The study is utilizing twelve different cities as study sites, where
emergency room physicians will assess and report on injuries related
to lower lethality weapons deployment. The researchers anticipate
between 750 and 900 individuals will be examined in the course of the
study, the first injury epidemiology study of its kind. This study should
provide valuable insight into how tactical choices relating to the
deployment of lower lethality weapons affect injury rates.

Researcher: Dr. J. G. Webster University of Wisconsin. (O)
Focus:

Also sponsored by the NIJ, this study is the one most immediately
relevant to CED. This study is utilizing live animals (swine) and is
focusing on mapping the path of TASER® current in the body. Using
models that will most closely simulate field applications, this study
should provide definitive answers about how much, if any, electrical
energy is able to reach the heart and the possible effects. This study
will also examine issues such as fibrillation thresholds, the impact of a
variety of stimulant drugs, including cocaine and methamphetamine,
and changes in blood chemistry.

Summary of Medical Concerns and CED
The previous listing of scientific research and professional opinion can possibly be
overwhelming to the layperson, as the listing briefly summarizes relatively complex
conclusions. In recognition of this, the following sub-section attempts to further
summarize these conclusions into categories directly affecting a person’s medical
well-being:

12

•

Electrocardiophysiology

During the course of this review of existing research into the physical safety of
CED, it became apparent that most of the studies reviewed focused on the
cardiac safety of CED. Based on these studies’ findings, it is reasonable to
conclude that the risk of danger to the heart, from VF or any other aspect of
electrocardiophysiology, as a result of the use of a CED, is very low in healthy
subjects. The research does call for a greater understanding of CED effects on
vulnerable subjects, such as those that are intrinsically and/or extrinsically
compromised (such as substance abuse and/or mentally ill), but that the use of
CED should not be limited or suspended until this understanding is obtained.
There is little research that makes any conclusions about the safety of using a
CED on a subject who has an implanted pacemaker/defibrillator (AICD). A
recent case in BC involved such an incident. A person with an AICD with was
subdued with a CED. During the CED application, the AICD recorded no
interruption in heart rhythm and no extrasystoles in a subject known to have
unstable dysrhythmias requiring an AICD. The current applied did interfere
transiently with the AICD's ability to discharge itself appropriately, which
normalized when the CED discharge was stopped.

•

Respiratory Impairment/pH Changes in Multiple Applications

Depending on probe location in the upper torso, it appears likely that the
muscular tetany produced by a TASER® deployment could impair a subject's
respiration. TI acknowledges this in their most recent instructor-level teaching
material. Whether such impairment would occur in a push stun deployment to a
limb is a matter of speculation. If breathing is stopped or impaired during the
five-second cycle, this could affect both CO2 and pH levels. If the TASER® is
cycled continuously for 15-20 seconds, the effects could be expected to
increase.
The issue of respiratory impairment due to restraint appears to play a role in
some of the deaths proximal to the use of CED, although no hypothesis has yet
been verified. Respiratory impairment becomes particularly crucial when the
weapon is used or restraint is applied during, or at the end of, a prolonged
physical struggle. The ability to breathe freely is critical as the body tries to
return to homeostasis and compensate for the metabolic acidosis incurred
during periods of prolonged anaerobic activity, such as that incurred during a
prolonged struggle. During such struggle, rapid breathing allows the body to
eliminate CO2, allowing pH to remain constant; suppression of effective
respiration may inhibit the body’s ability to compensate.

13

Based on Dr. Jauchem's research (H), it would appear that prolonged TASER®
applications (three minutes of five seconds on - five seconds off cycling) can
produce significant lowering of pH levels in pigs. This may be the interaction of
respiratory interruption along with high levels of muscular contraction.
Evidence for low pH as a factor in the deaths of these subjects was presented in
a paper by Hick et al (19) in Academic Emergency Medicine, in which Dr. Hick
describes a case series of consecutive patients with sudden cardiac death while
in a state of ED. Promptly done arterial blood gases demonstrated severe
acidemia in each case. If the starting pH was extremely low in an individual,
then repetitive hypoventilation secondary to repeated TASER® strikes could be
contributory. Unfortunately, no prospective data regarding the presence of
acidemia in acutely agitated subjects exists making it difficult to anticipate the
effect of further lowering pH.
There will be situations, particularly in areas where back-up officers may be
distant or unavailable, where multiple applications are necessary to control
violent subjects. Training protocols, however, should reflect that multiple
applications, particularly continuous cycling of the TASER® for periods
exceeding 15-20 seconds, may increase the risk to the subject and should be
avoided where practical. Conventional use-of-force theory dictates that officers
abandon any particular tactic after it has been employed several times without
achieving the desired result (i.e. control of the subject). If multiple TASER®
applications have not succeeded in gaining control, the officer should reassess
and consider another force option or disengagement.
Conversely, recognizing that prolonged struggle heightens the risk to both the
officer and the subject, it may be appropriate to use a TASER® as soon as it
becomes clear that the subject’s active resistant or assaultive behaviour will
justify physical control, and that negotiation is unlikely to succeed. A single
TASER® application made before the subject has been exhausted, followed by
a restraint technique that does not impair respiration may provide the optimum
outcome.

•

Pregnancy

There is currently no peer-reviewed research on the effects of CED current to a
pregnant woman and her fetus. The only report located specific to pregnancy
was a 1992 medical report regarding a woman, 12 weeks pregnant, who began
to miscarry seven days after being exposed to an early model TASER®.
TI's medical staff has theorized that the womb and amniotic fluid provide a
"Faraday shield" effect that would prevent electrical current from reaching the
14

fetus, and they have conducted one unpublished animal study that found the
X26 TASER® did not induce miscarriage in two pregnant pigs. There have been
several out-of-court settlements involving pregnant women, but these have not
produced any independent research outcomes.
Pregnancy is another situational risk factor that has to be evaluated in the entire
context of a use-of-force event. A TASER® is clearly preferable to a firearm, if
the situation warrants deadly force, but more difficult decisions have to be made
where physical force is necessary to resolve a situation that does not require a
firearm. The risk from secondary injuries, such as falling, obviously takes on
more significance when dealing with a pregnant subject.

•

Body Weight and Size

Scientific literature has long recognized that body mass directly impacts on the
effects of electrical current on an individual. The PACE Study (M) is the most
recent confirmation that those with a lower body weight, such as children, have
lowered margins of safety when exposed to an electrical current. It found that a
30 kg (66 Ib) pig had a safety ratio of 15:1 (with respect to ventricular fibrillation)
when exposed to X26 TASER® current. A pig with a body mass of 117 kg (258
Ib) had a safety ratio of 42:1 before fibrillation could be induced.
However, public concern about the use of TASER®s against children and the
elderly does not rest solely on the issue of electrical safety. Because, as we
have discussed, blanket prohibitions against TASER® use on specific groups
can be counterproductive, the test in every case remains one of
reasonableness.

•

Seizures

The HECOE (G) study suggests that both the M26 and X26 TASER® have
electrical outputs that exceed the seizure threshold. However the probability
that this would occur is very low, given that at least one, if not both of the probes
would have to hit a subject’s head. Furthermore, even if this situation were to
occur, HECOE estimates that the probability that a seizure were to be induced is
0.7%.
Standard police training in CED does not recommend probes be fired at a
subject’s head, but it is possible that a subject may physically move before the
probes strike their intended target, and strike the head instead. However, there
are two incidents during CED training in the US where subjects suffered
seizures after being struck in the head by probes.

15

•

Long-Term Superficial Damage to Skin

Depending upon the time, duration, and skin type of the individual, seconddegree burns are likely from a CED application. Research indicates that longterm superficial damage to skin (i.e. permanent scars, short-term burn marks) is
possible, and this is more prevalent in dark-skinned individuals. Also, it appears
that skin damage is greater when the push stun mode is used compared to the
entry burn marks seen when the probes are deployed. This last point is
particularly true of light-skinned individuals in the first 24 hours after being
subject to a push stun.
It appears that none of this skin damage would have a significant health risk to
the subject. However the psychological and emotional impact on the subject
must be respected.

CED Probe Removal
When used in “probe mode”, meaning that when a CED fires its probes into a
person or their clothing, it becomes necessary for the probes to be removed.
Manufacturer training guidelines recommend that the removal of the probes from
a person’s skin is generally not difficult and can be readily performed by police
officers.
To minimize the risk of injury occurring as a result of probe entry into the body,
officers are trained not to aim at the head, neck, or genitalia. Some agencies
provide training in the removal of the probes from a person’s skin while others
require medical personnel to perform the removal. Police officers are also
trained to seek medical attention when the removal of the probes is difficult, in a
sensitive location, or further injury occurs after the probes have been removed
(i.e. excess bleeding). In short, injuries to subjects as a result of probe removal
have not been a significant issue.

Deaths Proximal to CED Use
This section of the report summarizes the research that is currently available
and on-going that touches on the physical safety of a subject who is undergoing
the experience of a CED. However, a significant factor in the decision behind the
CACP’s request for the CPRC to review existing CED research was the deaths
in Canada that are proximal to the use of CED. To date, (August 10, 2005)

16

there have been 151 deaths associated with CED use in North America, 13 in
Canada. Consequently, it only stands to reason that any discussion on the
physical effects of CED must eventually consider what, if any, connection there
is between the use of the CED and the death of the subject.
The investigative team that authored the BCOPCC reports recognized this need.
As such they formed a medical review panel that consisted of the following
individuals:
•

Dr. J. Butt (Forensic Pathologist)

•

Dr. D. Docherty (Exercise Physiologist)

•

Dr. R. Leather (Cardiologist)

•

Dr. S. Lohrasbe (Forensic Psychiatrist)

•

Dr. A. MacPherson (Vice Chief of Emergency Medicine)

•

Dr. V. Sweeney (Neurologist)

•

Mr. C. Lawrence (Trainer with the Ontario Police College)

•

Mr. P. Leslie (District Superintendent for the BC Ambulance Service)

•

Mr. S. Palmer (Executive Director of the Canadian Police Research Centre)

•

Mr. M. Rutledge (Advanced Life Support Paramedic)

There was consensus on the issue that sudden and unexpected death proximal
to the use of CED and eventual restraint is caused by a variety of factors, not a
single precipitating issue. Risk factors identified included significant amounts of
acidosis, which affect cardiac contractility, respiratory muscle impairment,
rhabdomyolysis (the destruction of skeletal muscle tissue from traumatic injury,
substance abuse, some prescription medication, and/or excessive exertion) that
is accompanied by the release of muscle cell contents into the bloodstream)
hypoglycaemia, and high levels of adrenaline.
With respect to ED, it was observed that this is not a single entity, but rather a
"symptom cluster" that also occurs in hospital settings. It was also noted that
cocaine and methamphetamine abuse overlap with mental disorders and
produce paranoia and control over-ride, where the subject feels a loss of control
over their thoughts and actions. Because these drugs can over stimulate already
delirious patients, increased fatality rates are seen in hospitals without the
presence of CED or other lower lethality weapons.
Both doctors and ambulance personnel identified that the period immediately
following successful restraint of an individual in the field is the appropriate

17

interval in which to involve prehospital care practitioners. Acutely agitated
persons are to be recognized as suffering from a medical emergency; therefore,
EMS involvement is warranted as early as possible in the restraint process.
Intramuscular chemical restraint in the field is felt to be potentially beneficial in
limiting further struggle and thereby potentially decreasing injuries to subjects,
police officers and EMS personnel. However, it should be cautioned that
chemical restraint is not a guarantee of life preservation as there have been
multiple anecdotal cases of subjects dying immediately following chemical
restraint with benzodiazepines, major tranquilizers or combination therapy.
Utilization and choice of chemical restraint agents is left to the discretion of the
appropriate EMS medical director. It was noted that paramedics in Calgary, AB
and Toronto, ON employ chemical restraint on a regular basis and that a
prospective study on this is being proposed. The committee has currently no
evidence on which to suggest changes in ALS treatment protocols or the
implementation of attempts at prehospital biochemical analysis such as blood
gas measurement.
It was clear from the discussion that the development of new medical protocols
for dealing with ED hinges on research that will confirm a number of the existing
hypotheses. It was agreed that a national or international standard of evaluation
and information gathering would be the preferred method for obtaining this data.
Based on this, the investigative team moved forward to propose the inclusion of
blood gas monitoring in the University of Wisconsin research project to provide
further comprehensive data on acidosis, CO2, and other factors. As discussed,
members of the investigative team will continue to support the CPRC-sponsored
epidemiological study of ED across Canada.

Section 1 - Summary
Based on the existing research, the CPRC team can conclude the following main
points:
•

Definitive research or evidence does not exist that implicates a causal
relationship between the use of CEDs and death.

•

Existing studies indicate that the risk of cardiac harm to subjects from a CED is
very low.

•

ED, although not a universally recognized medical condition, is gaining
increasing acceptance as a main contributor to deaths proximal to CED use.

•

The issue related to multiple CED applications and its impact on respiration, pH
levels, and other associated physical effects, offers a plausible theory on the
possible connection between deaths, CED use, and people exhibiting the
symptoms of ED.
18

The contributors to this CPRC report believe that CEDs are effective law
enforcement tools with a low risk of harm to the subject. Other developments have
come to light that should have an effect on police CED training and operational use
that will further mitigate an already minimal risk. These will be discussed in Section
2.Section3.

19

Section 2 – Policy Considerations for Police CED
Operations
During the course of reviewing the existing research on CEDs, information has been
collected that can substantially improve the knowledge that law enforcement
agencies possess about the use of CEDs. This information can address themes
related to operational use, training, & policy, and accountability.
Prior to a discussion of these four categories, it may be useful to consider the
impact that CEDs have had on law enforcement across North America. For
example:

Cincinnati Police Department
Cincinnati PD reported in July 2004, that in the first six months of that year, that
there have been “over 300 deployments of the TASER®. Arrest related injuries to
officers have dropped 70%. Suspect injuries have dropped 40% and the use of
force by other traditional means has dropped 50%. The number of citizen
complaints arising from the use of force by officers has seen a similar reduction.”

Orange County (Florida) Sheriff’s Office (OCSO)
OCSO and the Florida Gulf Coast University collaborated to identify the
effectiveness of various lower lethality options employed by police and examining
the potential for force escalation. The OCSO Study found that lower lethality
munitions such as the bean-bag round produced injuries in 80% of the instances
where they were deployed; the majority being bruises or abrasions from the
projectile. They reported eight deaths in 373 deployments. Conventional impact
weapons like batons also produced blunt trauma injuries, and had a very high
potential for escalation of subject resistance if they were not immediately effective.
Chemical agents had a very low associated injury rate, and the OCSO Study found
them to have a lower failure rate (12%) than other studies. Conventional defensive
tactics-officers using hand-to-hand techniques to subdue subjects were ineffective
29% of the time and resulted in the largest number of subject and officer injuries.
OCSO found the TASER® to be effective in 77-95% of the cases studied, with the
effectiveness varying greatly between divisions. Specialized units had much lower
failure rates (11 %) than patrol (22%). The study's authors speculated this may
have been the result of specialized units deploying the TASER® much earlier in an
event where there was an expectation of resistance, and
thus providing less opportunity for the subject to move out of the 21-foot range.
20

Most significantly, the study found that the TASER® had the highest level of deescalation (subjects were less likely to fight harder against arrest) and provided a
substantial deterrent effect even when not used. In a 3-year period OCSO reported
a decrease in worker’s compensation claims of 50% from “arrest injuries”. OCSO
documented one death associated to the TASER in 870 deployments studied. They
have received only 50 excessive force complaints in “approximately 1,000 uses of
the TASER®.”
The OCSO Study identified 18 instances in a one-year period where subjects were
subdued with a TASER® in circumstances when deadly force was warranted. Using
the figure of $100,000.00 as the cost for deadly force litigation (not including any
damages that may be awarded), OCSO estimated that this had saved $1.8 million
in legal costs.
The OCSO Study may be most valuable for highlighting that many of the lower
lethality options available to police have high potential for causing blunt force
trauma and do not necessarily terminate the physical confrontation. This may be
why these tools are used so infrequently in a Canadian context.

Madison (Wisconsin) Police Department (MPD)
The MPD concluded a pilot program that saw TASER®s introduced into their
inventory in the summer of 2003. They found that in 92 TASER® deployments the
device was successful in producing incapacitation 77% of the time. This is in line
with similar studies across North America. This study also documented six cases
where the TASER® was used to subdue suspects whose actions would have
justified the use of deadly force.
The Madison report documents two significant secondary injuries as a result of
suspects falling with one individual requiring seven stitches to close a laceration. It
also noted a reduction in officer injuries during physical confrontations, although
with the caveat that this reduction could not be entirely attributed to the TASER®
alone.
The key findings in the report were summarized as follows:
•

MPD deployment of the TASER® has reduced injuries to officers and suspects
resulting

•

from use-of-force encounters;

•

MPD deployment of the TASER® has reduced MPD officers' utilization of deadly
force;

21

•

The TASER® has proven to be a safe and effective use-of-force tool;

•

MPD officers are deploying the TASER® in an appropriate manner.

Toronto Police Service (TPS) X26 TASER® Pilot Study
The TPS undertook a pilot study of the X26 TASER® from April 1 to September 30,
2004. Officers of the TPS’ Emergency Task Force (ETF) were trained and issued
with the X26 and data was recorded for each incident that required TASER®
presence. Prior to this pilot study, TPS ETF units were equipped with the M26
TASER®.
The results of the pilot test were:
•

The X26 was activated in 92 incidents by the TPS during the six-month period of
the study. The weapon was used in 32 of these 92 incidents; thus in 65% of all
incidents the presence of the X26 contributed to a successful resolution of the
incident without the weapon being used. As an example, officers only had to
display the TASER® to gain compliance from a man who had previously injured
an officer and required cell extraction.

•

The X26 was effective in 28 incidents (or 88% completely effective of incidents
where the X26 was used), semi-effective in two incidents (6%) and ineffective in
two incidents (6%).

•

Thirteen of these incidents (or 40% of all incidents where the X26 was used)
involved an intoxicated or mentally/emotionally disturbed person (3 of whom
were suicidal), while eleven incidents (34%) involved a subject armed with a
weapon (7 knives, 2 hammers, 1 axe, and 1 ice pick).

•

In 47% of the incidents, officers required only one cartridge shot or “drive-stun”
to resolve the incident. In only one incident did the subject suffer any injury (an
abrasion) that was not self-inflicted.

Due significantly to the successful field-testing of the X26 by the TPS, Ontario’s
Ministry of Community Safety and Correctional Services approved the X26
TASER® for use by Ontario police services in January 2005.
The results from these four police agencies typify the positive aspects of CED
usage that are frequently reported across North America, namely:
•

Less injuries to police officers while completed arrests

•

Less injuries to persons who are resisting arrest

22

•

Less use of lethal force

•

Less use of other force options

It has become evident that the emergence of CEDs as a use of force option for
police services has been a substantial benefit. Proper training and use of CED has
demonstrated to reduce the risk of harm to both police officers and suspects.
However, a more thorough understanding of what is meant by “proper training and
use” requires a brief description on police use of force in Canada.

The Canadian National Use of Force Framework
In 2000, the CACP endorsed the National Use of Force Framework (NUFF). It was
the intent of the CACP that the NUFF bring together the best theory, research and
practice about officer use of force. The NUFF would also be dynamic, support
officer training, and facilitate professional and public understanding of officer use of
force. The NUFF was drafted in a manner that would apply to any common law
country such as Canada, USA, UK, and Australia. The NUFF is also consistent with
two standards produced through the United Nations Office of the High
Commissioner for Human Rights. The standards are the Code of Conduct for Law
Enforcement Officials and the Basic Principles on the Use of Force and Firearms by
Law Enforcement Officials.
With the provision of policing being a provincial responsibility, since the 1980’s
many provinces and the Royal Canadian Mounted Police (RCMP) have developed
their own use of force models which pre-date and certainly helped develop the
NUFF.
Six basic principles underlie the NUFF:
1)

The primary responsibility of a peace officer is to preserve and protect life.

2)

The primary objective of any use of force is to ensure public safety.

3)

Police officer safety is essential to public safety.

4)

The NUFF does not replace or augment the law; the law speaks for itself.

5)

The NUFF was constructed in consideration of (federal) statute law and
current case law.

6)

The NUFF is not intended to dictate policy.

It is not necessary here to expand on all of the details of the NUFF, but it suffices to
conclude that the framework takes into account the situation, subject behaviours,
and an officer’s perception/tactical considerations which eventually guide the

23

officer’s decision-making about if, when, and how much force may be required to
use on a subject in any given incident.

NUFF and CED
Understanding the NUFF is important in the context of this review of CEDs for two
reasons: 1) it helps shed some light on the original policing need for the
development of CEDs and, 2) it explains the increasing use of CEDs beyond this
original need.
Originally, the development of CEDs occurred in an effort to provide “less-lethal”
use of force options to police when faced with incidents that may otherwise require
a lethal use of force option. Such incidents are frequent and can best be
understood by the following recent incident in Toronto:
Police were called to a scene where a man, apparently distraught over a
domestic dispute with his spouse, was found in the middle of his residential
street brandishing a large kitchen knife. The man was shirtless despite the
fact that the time of year was in the all.
At least three TPS patrol units were dispatched to the scene, where officers
attempted to calm the man down and instructed him to put down his knife.
The man ignored these instructions and began walking slowly towards the
officers.
The officers had parked their vehicles in a semi-circle pattern and were able
to keep at least one vehicle between themselves and the man. All of the
officers had their firearms drawn while continuing to dialogue with the man.
For approximately ten minutes the officers kept pacing away from the man
while always keeping a vehicle between themselves and the distraught man.
The responding officers were able to contain the incident and patiently wait
for the TPS’ Emergency Task Force (ETF) to arrive who were equipped with
a M26 TASER®. ETF eventually arrived, deployed the TASER®, and the
man was arrested without further harm to himself, the officers or any
bystanders.
The above incident demonstrates precisely what the development of CEDs were
intended for. This was a situation where, instead of walking slowly, had the
distraught man , ran towards, jumped, or lunged at the officers, it would have been
reasonable to expect that the officers would have resorted to a lethal use of force
option for fear of grievous bodily harm or death from the man.

24

It is similar situations, where officers may be faced with lethal force options that
prompted the need for CEDs. It is also how the devices have been marketed and
accepted by the public, the media, civilian oversight bodies, government, and
“watchdog” groups – as replacements for lethal force.

However what is under-appreciated is the benefit to individual police officers that
are placed in these situations. The use of lethal force can have profound adversely
stressful effects on the officer’s emotional and psychological health, including that of
the officer’s family, no matter how justified the use of lethal force may have been.
Richard Parent quantified these effects in his Master’s Thesis titled “Aspects of
Police Use of Deadly Force In British Columbia: The Phenomenon Of VictimPrecipitated Homicide.” (Q) In his study Mr. Parent notes that “three of the twenty
police officers (15%), who were directly involved in a fatal shooting incident, have
since left policing to pursue other interests.”
In summary, although trained and
prepared to use lethal force where lawfully justified, it is accurate to state that the
overwhelming majority of officers hope to never resort to lethal force.
There is no question that the use of CEDs can and has saved many lives.
However, it is a common misconception of the CED’s benefits that assumes they
should only be used when an incident would require lethal force, and/or before
lethal force is actually used in such situations. The most successful interventions
using a CED in lethal force incidents frequently reveal circumstances where officers
are able to contain the scene, and that back-up lethal force is present if the CED
should fail in resolving the incident. It is not reasonable for anyone to expect
officers, a great many of which patrol remote regions all over Canada, to
automatically use a CED in the face of a lethal or grievous bodily harm threat, when
the safeguards of containment and back-up are not present or when the situation
escalates rapidly.
This discussion is important, because many of the individuals who have died
proximal to the use of a CED were not armed with weapons that could deliver
grievous bodily harm or death to an officer (beyond the person’s own physical
strength). Consequently some observers have questioned why a CED would be
used in these incidents.
Because it is reasonable to assume that the use of a CED will likely not cause death
to a person (unlike a firearm), CEDs are considered intermediate weapons in the
North American, law enforcement, use of force vernacular. Other intermediate
weapons commonly include oleoresin capsicum (OC) spray, batons, and other
weapons also described as less lethal (such as bean bag projectiles or rubber
bullets). The concept of intermediate weapons is best explained as the use of

25

force tool options available to officers when their presence, communication skills,
instructions/commands, or direct physical attempts at control without using a
weapon, are not adhered to, are unsuccessful during an incident, or inappropriate
for the type of threat. The label of “intermediate” implies that these tools are distinct
between non-weapon application of force and lethal force on the use of force
spectrum.
As previously mentioned a person’s behaviour at an incident is one of the key
components assessed by officers as part of their use of force decision-making. The
NUFF categorizes and explains these behaviours:
•

Co-operative - the subject responds appropriately to the officer’s presence,
direction and control.

•

Resistant (Passive) - the subject refused, with little or no physical action, to
cooperate with the officer’s lawful direction. This can assume the form of a
verbal refusal or consciously contrived physical inactivity.

•

Resistant (Active) – the subject uses non-assaultive physical action to resist, or
while resisting an officer’s lawful direction. Examples would include pulling away
to prevent or escape control, or overt movements such as walking toward, or
away from an officer. Running away is another example of active resistance.

•

Assaultive – the subject attempts to apply, or applies force to any person;
attempts or threatens by an act or gesture, to apply force to another person, if
he/she has, or causes that other person to believe upon reasonable grounds
that he/she has, present ability to effect his/her purpose. Examples include
kicking and punching, but may also include aggressive body language that
signals the intent to assault.

•

Grievous Bodily Harm or Death – the subject exhibits actions that the officer
reasonably believes are intended to, or likely to cause grievous bodily harm or
death to any person. Examples include assaults with a knife, stick, or firearm, or
actions that would result in serious injury to an officer or member of the public.

In practice, police in Canada can utilize some form of intermediate weapon when
dealing with subjects that demonstrates Active Resistant, Assaultive, or Grievous
Bodily Harm or Death behaviours. Ultimately each individual incident where an
officer uses force is accountable to the existing laws and administrative “checks and
balances” that ensures public trust and confidence in police use of force. With this
system in place, it is reasonable to conclude that police equipped with CEDs may
use it instead of another intermediate weapon in a non-grievous bodily harm or
death incident.
Consequently, the increased deployment of CEDs in incidents requiring such force
is an indicator of this reality. Police officers now have the option of using a CED
26

instead of OC spray or a baton strike. There are some “schools of thought” which
imply that the use of a CED is more pervasive to the subject and should be used
minimally, while others think that the CED is a more humane force option that
reduces the risk of injury to the subject and the officer. Indeed there are reports that
quantify and lend credence to the latter. Neither of these opinions is inherently
more correct over the other; the final judgment can only be made on a case-by-case
basis that examines the totality of events in a particular incident.
Thus, it is correct that many of the deaths proximal to CED use involved subjects
who were not behaving in a manner that would be consistent with grievous bodily
harm or death. However, it is highly probable that they were actively resistant, if not
assaultive, requiring police intervention and use of force. The police were required
to make a decision on if, when, and how much force to use and what, if any,
weapons can assist in their intervention. Often the use of the CED might be the
most effective option and it is likely that the use of any other force option would not
have changed the unfortunate outcomes witnessed.
The BCOPCC Final report states “the variety and complexity of the circumstances
that may confront an officer make it impossible for any policy to encompass every
possible scenario.” The contributors of this CPRC report agree and believe that it
would be unwise and counter-counter-productive for any police service or
government body to develop policies and procedures that explicitly specifies
in what kinds of circumstances a CED may or may not be used. For example,
many law enforcement agencies in the United States have developed procedures
that prohibit the use of a CED on handcuffed individuals, pregnant women, the
elderly, or youth/children. It is very difficult for police officers to envision an incident
where they may have to lawfully use a CED on one of these groups of people – in
fact the idea may be abhorrent to them.
However, cases exist where CEDs were used in similar circumstances and the use
of the CED was the best alternative. For example in Ontario, a large, aggressive
handcuffed individual refused to be placed in the back of a police vehicle while a
large unruly crowd was gathering.
Contrary to a common misconception,
handcuffing a person does not prevent them from escape or make them incapable
of offering significant resistance to an officer’s control efforts. In this incident,
although already restrained by police the handcuffed person was still being actively
resistant. One arresting officer chose to push stun him in the back of the leg, which
then allowed the officers to place him in the vehicle as the arrested person’s knees
buckled. Had those officers been prohibited to use a CED on a restrained person,
they likely would have resorted to a possibly more harmful force option (e.g. baton
strikes).
Similarly, it would not take much to envision a pregnant woman, a youth/child, or an
elderly person being armed with a weapon that could bring an incident into the
27

realm of lethal use of force. The Victoria Police Department (VPD) in British
Columbia (BC) used a TASER® to subdue a man in his 80s who was armed with a
weapon that could have easily brought grievous bodily harm or death to the officers
or other bystanders at the scene. What would a prohibition on using a CED on an
elderly person have contributed in this case? It would likely have resulted in the
lawful use of lethal force by those officers.
There will be some incidents where, through improved training and common sense,
an officer will not use a CED. An example would be a situation where a person may
fall from a height after being subjected to the CED, or if it is known to the officer that
the subject has doused themselves with a flammable substance (e.g. gasoline). It
is important that officers are aware of these rare, unintended, but serious
consequences.

CED Accountability
The BCOPCC Final Report recommends that the Government of British Columbia
fill the position of Provincial Use of Force Coordinator as is specified in their use of
force regulations. Comparatively, Ontario has developed a regulation on police use
of force that does not require a similar position; however depending on the level of
force used and the circumstances of the specific incident police officers in Ontario
must complete a mandatory, provincial use-of-force report form. The local police
service maintains these completed forms for training purposes and presents results
to their police services board on at least an annual basis.
Police services and their governing bodies and agencies should give thoughtful
consideration to developing CED usage reporting procedures, forms, or databases.
Given the increasing use of CEDs, it would be a prudent, transparent step to assure
Canadians that police services and governments are responsible and capable of
managing the growth in the use of CEDs and improving our knowledge. Such
reporting can form the basis of a database that eventually could be applied
nationally, in order to better understand the use of CEDs.
Current models of TASER®s provide police with the capability to test the chargelevel of the battery of the weapon before it is taken out on patrol. This provides the
officer with the comfort that the weapon is adequately charged and will likely be
effective. It would be ideal for officers to be able to calibrate their CEDs, to ensure
that the amount of conducted energy sent to a subject meets the manufacturer’s
specifications. Please note that no evidence exists to suggest that this is a problem
at all, however, much like mobile radar installed in police vehicles, it would be an
ideal precautionary step.

28

Similarly, some are of the minds that, in order to further ensure accountability, after
use each CED be delivered to a firm capable of electrical testing to determine if the
specifications were met. In BC only one firm has that capability at a cost of $4,000
per test. The ability to test a CED post-use would also be ideal, however one could
argue that these costs are prohibitive. Consideration should be given to such a test
if a subject suffers serious injury or death proximal to CED use.
Information has been received that there may be data corruption issues in certain
versions of the software that captures TASER® use in the X26 model. Any version
lower than software version 15 for the X26, can cause dataport problems. Most
agencies should have TI upgrade their software to version 15. As for the M26, TI
has been using version 585 software since the M26's inception. They do not do
upgrades to the software or the programming of the M26. The only upgrades would
be to the lifespan of the unit itself, such as improving the epoxy used inside the unit.
That being said, there are some issues with the dataport in the M26 as they have a
tendency to time "creep", what is meant by that is the dataport time can move
forward or back by a couple minutes in a month. This “time-creep”; could really add
up if the TASER® is not downloaded on a regular basis and the time corrected.
The worse case scenario is a dataport that is out by hours. Police services or
approving government agencies should consider contacting TI or their distributors to
ensure that these software issues are resolved.
Lastly, in an unscientific experiment conducted by use of force trainers at the
Edmonton Police Service (EPS), one trainer volunteered to be push stunned in the
side of her torso by her colleagues, to determine the effects of the push stun on her
skin. Upon being push stunned, her natural reaction was to get away from the
burning sensation of the device, while the deploying officer continued to push stun
her for a few seconds. The volunteer officer took photographs of her torso to
demonstrate the immediate skin markings resulting from push stuns. Within a week
most of the marks had disappeared, but the initial amount of skin-redness and
pigmentation was significant – to the point where one could reasonably assume that
she had been push stunned repeatedly. The point is that she had endured only a
couple of push stuns and it was her natural inclination to move away from the
current and cause an arc that caused the amount of immediate skin changes
visible. Although not scientific this is a powerful anecdote that could assist in
resolving police complaints. In fact the BCOPCC Final Report states that the vast
majority of complaints related to the use of CEDs is in relation to push stuns.

Police Exposure to CED during Training
One of the first areas that must be discussed is the need for police officers to
experience the effects of a CED while undergoing training and the possibility of
injury. In training officers to use a CED, it has been common for instructors to

29

expose all the trainees to a short period of exposure. Typically officers are shocked
for a period of one to two seconds, rather than the full five-second cycle. TI's
original training material made experiencing the abbreviated shock mandatory for
users, but this was subsequently changed from a mandatory requirement to one
that was "strongly recommended". This mirrored previous experiences with OC
sprays, where direct exposure to the spray was a requirement for user certification.
That requirement was subsequently removed in BC, at least in part because of
concerns raised by the Workers Compensation Board of British Columbia.
Most CED trainers were aware of the potential for secondary injuries, particularly to
the head, during this exposure and positioned officers around the trainee,
supporting their weight, and preventing them from falling. What is now emerging,
however, suggests there may be a potential for musculoskeletal injuries caused by
the powerful muscular contraction when a CED is applied.
In December 2004, the Arizona Republic reported the case of a Maricopa County
sheriff's deputy who was suing TI claiming that he had sustained a compression
fracture of his spine during such a training exposure. A doctor who examined the
deputy found he had pre-existing osteoporosis; a condition that leaves people at
increased risk of bone fractures. Other officers have come forward reporting training
injuries that include shoulder dislocations and chipped teeth; the majority caused by
falls after being shocked. Phoenix Police Department, one of the first major
American agencies to equip all of its line officers with TASER®s, now prohibits
training exposures.
In consultation with the lead CED instructor for the Edmonton Police Service (EPS),
she advised that they have experienced three hamstring injuries as a result of CED
applications during training. These injuries were believed to have been caused by
muscular contraction when the probes were placed on the quadriceps and upper
chest of trainees. The contraction of the quadriceps caused a pull in the hamstring.
The VPD has not experienced any significant injuries during TASER® training,
although there are occasional anecdotal reports of transient muscle soreness
following exposure and one report of vertigo lasting for approximately three hours
after a five second X26 TASER® probe exposure.
Recently during a CED exposure in a training session, a Saskatoon Police
Department officer suffered a lower back injury that may limit his police duties for
the remainder of his career. The officer did not have any medical issues that
concerned him prior to the exposure to the CED.
To place these events in some context, it is relevant to note that physical training in
arrest and control techniques, either at the Justice Institute of British Columbia
(JIBC) for recruits, or in-house for serving members, has routinely resulted in

30

broken bones, bruises and ligament tears. Hard, realistic training inevitably results
in some level of injury to the participants; however, this type of training ensures that
officers are both physically and mentally prepared to deal with real-world
challenges.
Given the information currently available, it is foreseeable that musculoskeletal
injuries may occur during CED training and thus agencies need to revisit the issue
of mandatory exposure. This also suggests that subjects exposed to a CED in a
field usage may also be at risk from similar injuries, particularly if they have some
underlying pre-disposing condition that makes them especially vulnerable.
The most common secondary injuries related to a probe deployment from a CED
are the minor lacerations and electrical burns at the site where the probes have
penetrated the skin. Seen immediately after deployment, the probe sites are
typically surrounded by small circular areas of reddened skin. Little attention has
been paid to the issue of permanent scarring as a result of CED use. The BCOPCC
Final Report notes of a civil suit launched in Alaska where an individual who was
TASER®ed was successful in collecting damages for permanent scarring. We have
also observed cases where law enforcement trainers who have been subjected to
probe deployments have sustained permanent scarring, albeit minor in nature. The
degree of scarring will be dependent upon both skin type and probe penetration and
is impossible to predict prior to the event.
The risks of musculoskeletal injuries and scarring must be weighed against the
benefits of CED exposure by agencies and individual trainees. In order to make an
informed decision, officers should be provided with accurate information as to
possible unintended consequences.

Implications for Police CED Operational Use
As previously acknowledged, the CPRC has collaborated with the authors of the
BCOPCC reports to produce this document, which may be considered as a “best
practice” document that combines the efforts of all involved (again the majority of
which is courtesy of the BCOPCC team). Additional information, feedback,
reference material, and formatting have been provided by all of the contributors of
the CPRC working group.
With that in mind the following summarizes what else we have learned in relation to
the most proper use of CEDs:

31

•

Personnel must complete agency approved CED training carried out by a
certified instructor and meet minimum standards on all CED tests. CED trainers
may wish to alter their current curriculum on CEDs to reflect this new information
and consider incorporating issues of ED and restraint.

•

CEDs should be carried by officers in agency-approved holsters on the nondominate/support side of the body. There have been a few incidents where
officers mistook their firearm for their CEDs and shot a subject that they
intended to use a CED on. By placing the CED on the side of the duty belt
opposite the side of their firearm (e.g. support side), these tragic errors will
hopefully be minimized.

•

Officers should ensure the CED is in proper working order and record the serial
number of the CED prior to start of shift.

•

Officers need to be aware that multiple, consecutive cycles of a CED on a
subject may have adverse effects on respiration as well as other physiological
effects. There may be times where such consecutive cycles are appropriate, but
officers should allow some time for the subject to comply with the officer’s
instructions before another lawfully justifiable cycle is deployed. Officers need to
be aware that it is possible that the subject cannot hear the officer during the
CED exposure, or after the exposure the subject may be momentarily “dazed”
and will appear to be ignoring the instructions. During the initial cycling of a
CED on a subject, officers are encouraged to consider their options once the
cycling has concluded whether the subject is compliant or not.

•

Officers should consider telling the subject that they have been subjected to a
CED after the first cycle. Often subjects think they have been shot with a firearm
and knowing that it was a CED may help calm them and encourage them to
comply.

•

Officers should avoid using a CED on a person’s head, neck, and genitals,
unless such intended usage occurs in an incident where lethal force is justifiable.

•

Officers should avoid, where practical, deploying a CED on a subject who is at
risk of falling from a significant height and suffering injuries as a result of the fall.

•

Officers should avoid, where practical, deploying a CED on a subject who they
know, or suspect, has flammable or ignitable substances on their clothing or on
their skin. It is important to stress that this probably will not be readily apparent
to the officer. The obvious example is if the subject was standing in a pool of
gasoline, but there has been a case where an officer was fatally injured when he
deployed a CED in an area of a natural gas leak, causing an explosion. This is
particularly noteworthy in relation to some OC sprays. In 2004, the Dallas Police
Department replaced 1,800 canisters of OC spray that had an alcohol base,
after a subject’s long hair became flammable as a result being sprayed and then
a CED being deployed. It would be prudent for authorizing bodies to ensure that
approved OC spray does not have a flammable base. Furthermore, concerns
have been raised by a First Nations Police Service in Ontario, which
unfortunately responds to violent subjects who have become intoxicated on

32

inhalants on a regular basis. These inhalants are often gasoline or lacquer,
which my or may not be on their clothing.
•

Related to this issue is the statement from the United Kingdom Police Scientific
Development Branch (PSDB), which concludes “it is clear from these tests that
there is a risk of ignition if the TASER® is fired at a target with a flammable
solvent on their clothing. On at least two occasions when TASER®s have been
used operationally in other countries, the TASER® has ignited subjects who
were soaked in a flammable liquid. There will also be a risk of ignition when
there are flammable vapours present in the environment. It should be noted that
the solvent for PAVA is 50% ethanol, 50% water which means that it is also
flammable, although less so than MIBK. The flames produced from this
ethanol/water mix will be blue and quite small, compared to the larger orange
flames produced from, for instance, petrol or MIBK. This could mean that the
former are more difficult to see which may cause a delay in extinguishing them.
It is strongly recommended that the TASER® is not used against a subject who
has already been sprayed with either CS or PAVA, both of which are currently
contained within a flammable solvent, if it is possible to avoid doing so. Extreme
caution must also be exercised when using it on a subject who is suspected of
being covered in any other flammable solvent, such as strong alcohol (e.g.
undiluted spirits) or petroleum spirit, or in a dangerous environment, such as a
petrol station.”

Section 2 - Summary
Based on the existing research, the CPRC team can conclude the following main
points:
•

The use of CEDs is related to a decrease in the use of lethal force in some
jurisdictions and it is also related to substantial decreases in police officer and
subject arrest-related injuries.

•

While originally marketed and accepted as an alternative to lethal force, the use
of CEDs have grown to include incidents where intermediate (but not lethal)
weapons should be used.

•

Although each use of force incident needs to be judged separately, for the most
part the increased use of CEDs in non-lethal incidents is appropriate.

•

Police services and their governing bodies and agencies should give thoughtful
consideration to developing CED usage reporting procedures, forms, or
databases.

•

It would be unwise and counter-productive for any police service or government
body to develop policies and procedures that explicitly specify in what kinds of
circumstances a CED may or may not be used.

33

•

Notwithstanding the above point, police officers need to be aware of the adverse
effects of multiple, consecutive cycles of a CED on a subject; deploying a CED
on a subject’s head, neck, or genitalia; deploying a CED where a person can fall
from a height; and deploying a CED on a subject where it is known to the officer
that the subject has flammable substances on their clothing or on their person,
or are standing in or near obvious flammable/explosive substances conditions
such as a puddle of gasoline or a natural gas leak.

Section 2 -Future Directions
It has become apparent to the CPRC team that there is no known, scientifically
tested, independently verified, and, globally accepted CED safety parameters. This
is problematic for a couple of reasons.
•

Police services and authorizing agencies are completely reliant on manufacturer
claims regarding the safety of their products. By comparison there are many
policing tools and equipment that have an accepted range of safety parameters
such as body armour, OC spray concentrations, and police vehicle
specifications. In terms of CEDs what is known is limited to testing of the
TASER® M26 and X26. If a new CED were to be introduced, police services
and authorizing agencies could only rely on manufacturer claims.

•

Because of this lack of known safety parameters relating to CED, authorizing
agencies are ill-equipped to respond quickly to advances in technology that may
be immediately beneficial to police and, eventually, community safety. At least
in the context of a few Canadian examples, some authorizing jurisdictions have
little independent information to form decisions and policy – with the end result
being an unnecessarily bureaucratic process, devoid of leadership, that serves
few stakeholders. This is a tangible “gap” in the complete understanding of
CEDs that needs to be filled.

This concludes the section on Policy Considerations for Police CED Operations and
Training. However, given the attention surrounding the deaths proximal to CED
use, Section 3 follows with a more thorough explanation of ED and its relationship
to CED and the individuals who have died. The CPRC team believes strongly that
this next section sheds noteworthy light on the possible significant factors in these
deaths.

34

Section 3 - Excited Delirium
Christine A. Hall, MSc MD FRCPC

The Scenario
The details are startlingly similar between cases. Police are dispatched to intervene
when a male subject (rarely is a female the subject in excited delirium), often
inappropriately dressed for the environment, is acting in a violent and irrational
manner in a public or residential space. The subject displays seemingly
purposeless, constant activity and violence. Attempts to intervene by bystanders
have been unsuccessful, the violent rampage continues and there is concern for
personal safety or the protection of property. On arrival of the police service, the
subject is apparently incoherent, is often continuously screaming unintelligible
words or sounds, does not recognize that police are present and appears to be
suffering from either some sort of psychosis, or a severe drug induced “high”. The
disruptive situation continues or escalates as the officers attempt to take the subject
into custody. Upon physical contact, the subject immediately begins to fight
aggressively with police resulting in a protracted physical encounter that requires
multiple officer participation and varying methods of restraint. During the struggle,
the subject is apparently impervious to pain and appears to have near superhuman
strength, out of proportion with his physical characteristics. Often officers note that
the skin of the subject is extremely hot to the touch and the subject may (or may
not) be sweating profusely. At the conclusion of the protracted struggle, the subject
is finally taken under some semblance of control and handcuffed; everyone,
including the subject, is exhausted. What is the diagnosis?
In fact, there is no unifying diagnosis; rather, a set of signs and symptoms forming a
condition that may be associated with sudden death proximal to restraint. That
cluster of signs and symptoms collectively forms a condition known to some as
excited delirium, also known as agitated delirium or delirium agité.(1-4) When the
subject has a fatal outcome following presentation in excited delirium, previous
literature has called that specific clinical course “in custody death syndrome”.(5;6)

Delirium
Delirious states are familiar to medical practitioners and are known to be associated
with a wide variety of medical conditions that result in the common endpoint of an
altered level of consciousness with loss of both cognition and perception (7). In
medicine, delirium is recognized not as a specific diagnosis of its own but rather a
clinical state for which the list of potential differential diagnoses is broad.
Determining the specific etiology often requires extensive medical investigation; the
cause is often not readily apparent at first contact with the individual.

35

Some delirious states, such as those associated with fevers and hospital use of
sedatives and analgesics, are characterized by the loss of cognition and perception
but have little or no increase in motor activity. Physiologic excitement in these cases
is sometimes seen by virtue of an elevated temperature, heart rate and/or breathing
rate. Persons suffering these kinds of delirium are often visualized by lay persons
as lying semi conscious, moaning in a hospital bed of tangled sheets. However,
other kinds of delirious states can be generated by illicit drug use, acute psychosis
or mania, or a combination of psychiatric illness and illicit drug use.(8;9) These
delirious states are also defined by a loss of cognition and perception but they are
most identifiable by profound increases in motor activity leading to the subject being
described as extremely agitated or in a state of extreme excitation. Physiologic
excitement in terms of elevated temperature, heart rate, blood pressure and/or
breathing rate may also be detected once physical examination is possible.
There are many potential causes for the combination of extreme physical exertion
and a delirious state that leads medical practitioners to describe a subject’s
presentation on the whole as consistent with “Excited Delirium”. This large number
of potential causes generates some variation in the symptom cluster, which makes
it difficult to establish a consistent definition. However, Morrison and Sadler have
recently defined excited delirium as “a state of extreme mental and physiological
excitement, characterized by extreme agitation, hyperthermia, epiphoria, hostility,
exceptional strength and endurance without apparent fatigue”. (10) Other
practitioners prefer a more general description of “an altered level of consciousness
combined with extreme physical exertion”, which allows for some variation in the
symptom cluster but does not address the physiologic derangement which is
occurring simultaneously.(11-20)
The concept of excited delirium is not new. In 1849, Bell first described a “peculiar
form” of delirium that was fatal in at least three quarters of those suffering it.(21)
However, much of the current interest in excited delirium began in 1995 when San
Francisco medical examiner Steven Karch outlined his concerns with the need to
clarify whether excited delirium as well as positional asphyxia were both processes
at work in the sudden death of individuals restrained by police. (3;14;22-27)
Cocaine induced excited delirium (also often called cocaine excited delirium) is a
type of excited delirium which has received academic scrutiny and first came to the
attention of physicians in the early 1980’s as the cocaine epidemic gained
momentum in the United Sates. (4;25;28-33) Death of the agitated individual
suffering cocaine excited delirium has often occurred while the subject is in police
custody after being restrained to protect public interests. (8;9;34-36) Whether death
from excited delirium can be extrapolated to include methamphetamine induced
excited delirium is unknown, although the extreme stimulant response in a subject is
similar following methamphetamine abuse. (4;37;38) The exact pathogenesis of

36

excited delirium and cocaine excited delirium is unknown at this time.(4;13;39)
While no specifically toxic level of cocaine exists, it has been documented that
cocaine levels in those thought to have succumbed to excited delirium are similar to
levels measured in recreational users and lower than those who actually died from
known cocaine intoxication. (8)
Whether excited delirium occurs as a result of illicit drugs, psychiatric illness or
other metabolic derangements, the cause is initially irrelevant since it can neither be
investigated nor treated until the subject is contained. No therapeutic relationship
can be entered with an individual who is incoherent, violent and resistive.
Not only is it desirable to commence therapy and the protection of public good in
order, it may be harmful to allow the delirious state to continue. While it is tempting
to suggest that persons suffering from excited delirium simply be allowed to “wind
down”, there are good reasons not to allow the subject to continue to run rampant.
Usually, police engagement is requested to prevent property damage, dangerous or
threatening behaviours and commonly, overt harm to the subjects themselves.
Containing an individual in a large space until such time as exhaustion sets in does
not necessarily mitigate risk to the individual. There is some medical evidence that
suggests that progression to a state of exhaustion is, in itself, dangerous.(27) Prior
to the development of effective treatment for the acute phase of mania or psychosis,
death as a consequence of exhaustion in psychiatric patients was reported. In 1952,
Bellak et al described that “sustained motor and mental excitement with continued
activity for a period of time” was a risk factor for sudden death due to excited
delirium.
Delirious states, particularly those associated with extreme physical exertion need
to be recognized as true medical emergencies with plans to institute treatment as
soon as possible after containment. (10;16;19;20;40;41) Excited delirium can
progress rapidly to cardiopulmonary arrest and death in individuals who are
struggling violently and are then subdued either in the prehospital or hospital
setting. Thus, recognition of the symptom cluster – not ascertainment of a cause
may- may be the most important initial intervention, with mobilization of medical
resources as early as possible in the restraint process.(19;20;40;42)

Identification of a state of excited delirium
It is difficult for police officers to anticipate a condition for which the incidence and
characteristic features have not been published in summary. The condition of
excited delirium is not a clinical entity of its own, but a constellation of symptoms
from a varied and severe underlying process.

37

While there is currently no prospective scientific evaluation outlining historical
features of excited delirium and retrospective reviews are fraught with selection and
reporting bias, a review of a large number of published series, case studies and
anecdotal reports suggests the following guidelines to identify a potentially high risk
situation. (3;4;8;14;19;26;28;31;32;35;36;39;43-45) Police officers can look for
three types of information: pre-encounter descriptions from witnesses, features
visible at a distance and those experienced on direct physical contact with the
individual.
Occasionally, information is available prior to the police encounter that suggests
that excited delirium may be present, particularly if the call is in response to a
violent outburst/activity. That information may include any, all or none of the
following:
•

known history of schizophrenia, psychosis or mania

•

previous similar presentation(s) in an acute agitated state

•

known or suspected history of illicit substance abuse

•

known or suspected history of ethanol abuse

•

police dispatched for violent disturbance, destruction of property, disruption of
traffic

Once the officer is on the scene, any or all of the following may be observed:
•

bizarre, purposeless and violent behavior

•

attraction to glass and other inanimate objects

•

hyperactivity

•

incoherent shouting/screaming/animal like noises

•

failure to recognize police presence

•

extreme aggression

•

paranoia

On direct physical contact, the officer may note any or all of the following:
•

unbelievable strength that may be out of keeping with physical characteristics of
the subject

•

subject apparently impervious to pain including injuries sustained during violent
outburst. No response to pain mediated methods of restraint i.e.) “limb holds”

•

able to offer effective resistance against multiple officers

•

very hot skin

•

sweating profusely or skin extremely dry for level of exertion

38

Unlike other medical conditions, there is no published set of major and minor criteria
for establishing a diagnosis of excited delirium, and currently no ability to predict
what number of symptoms and signs alone, or in combination, is predictive of a
poor outcome. There is no published series that has prospectively documented the
incidence of excited delirium in persons undergoing the arrest process or in those
resisting arrest in any way. However, the above signs represent a list of factors
often associated with an acutely delirious state which should prompt police officers
to treat the situation as a medical emergency.

Death in custody
In anecdotal cases of death associated with features of excited delirium reported
from the prehospital setting, persons of police interest who have required restraint
have progressed from extreme violence and agitation to death in a matter of
minutes, with or without presence of emergency medical personnel. (8;23;35;36;4649) The true pathogenesis for sudden death of subjects undergoing restraint in a
state of excited delirium state remains unknown. While one study attempted to
determine risk factors for death due to excited delirium, cases reported were not
chosen in a way that allows generalization of the findings.(8) The incidence of death
in persons exhibiting characteristics of excited delirium prior to or during the arrest
process is not known, nor is the relative risk of death in persons exhibiting excited
delirium features as compared to those simply resisting arrest.
While Ross et al did hypothesize that the state of excited delirium had more to do
with the sudden death than the nature of the restraint process, further papers to that
effect have not been forthcoming and the controversy continues.(50) Part of the
problem is that it is difficult to study the effects of custody and restraint in the actual
persons suffering the condition, especially because excited delirium has historically
not been recognized until death ensued. All previous investigators have attempted
to simulate the rigors of the resisting arrest and restraint process in normal healthy
individuals in order to determine the biochemical processes leading to death.(51-55)
However, most true reported cases of sudden and unexpected death proximal to
restraint seem to involve young men in an “excited” state or one of “agitated
delirium” as a result of psychiatric illness or intoxication from illegal drugs; a state
far removed from the normal healthy volunteer being strenuously active. These
individuals are combative, violent, and often struggle past the point of exhaustion,
sometimes sustaining traumatic injuries during the confrontation with law
enforcement before being subdued.(28) However, no author has prospectively
documented how often any set of situational features or subject characteristics
suggestive of excited delirium exist in the prehospital arrest scenario, or whether
their presence is associated with sudden death. Lack of such information has
prevented adequate planning of investigational or interventional strategies.

39

Attempts to define risk factors for death have been undertaken in a retrospective
manner, again subject to the selection bias in defining that excited delirium existed.
In 1998, the Ontario Coroner’s Office published a retrospective study of 21 cases of
unexpected death in people with Excited Delirium that occurred between 1988 and
1995 within the province of Ontario.(8) Of the cases reported, 18 deaths occurred
while the subject was in police custody. In all 21 cases, Dr Pollanen found that
“many deaths related to Excited Delirium are associated with restraint in the prone
position” and that all of the subjects who died had lapsed into “tranquility” shortly
after being restrained. Nearly 50% of subjects had undergone multiple forms of
restraint and engaged in struggle with 1-5 people.
Other studies demonstrate the wide variation in the circumstances of subjects dying
in an excited delirium state proximal to police restraint. For example, in Stratton’s
study of 18 deaths in 216 arrests associated with excited delirium, 198 subjects who
were subject to the position of maximal restraint did not die suddenly and survived
the arrest and restraint process, 18 succumbed. (35) Multiple force options have
been implicated. There are many causes for the state of excited delirium although
stimulant drugs are common and the deaths occur suddenly and
unexpectedly.(9;35;36;56) In all studies to date cardiopulmonary arrests were
unanticipated and preceded by a short period (an estimate of 5 minutes or less)
during which the victim ceased in struggling against restraints and developed a
labored or shallow breathing pattern.

Theories on the etiology of death in excited delirium in the setting of police
restraint
Asphyxia
Currently no study has demonstrated a clear causal link between any risk factor or
physiologic derangement and sudden death proximal to police restraint.
Pathologists have proposed many possibilities as they struggled to determine a
cause of death for persons suddenly expiring while in police custody. In the 1980s,
positional asphyxia or inadvertent death by suffocation was the theory with medical
examiners and practitioners suggesting that chest compression invoked by prone
position, maximal restraint position or multiple officers’ weight on the subject caused
inadvertent asphyxiation and death due to oxygen deprivation. (14;31;32;32;45;4749;51;57;58) Inconsistencies in the data led to much controversy and investigation
of other potential mechanisms/risk factors for the deaths.(18;50;52;53;59-61)
It is possible that rather than oxygen deprivation, proning precludes effective
ventilation and respiration. In this scenario, a subject who has just undergone
minutes to hours of extreme physical exertion and is breathing at a very rapid rate,
becomes restrained in a prone position, inhibiting his ability to breathe fast enough
to compensate for the recent metabolic excitation. (18-20;42) While the subject is

40

certainly breathing, the rate of breathing may be insufficient, leading the subject to
have relative hypoventilation. This theory makes intuitive sense but has not been
explored in these subjects.
Until the process of proning subjects can be more fully examined and clearly found
not to be directly associated with death, it is recommended that long term proning
be avoided and subjects be placed lying on their side or sitting at the earliest
possible opportunity. It is understood that in order to apply handcuffs, subjects may
have to be in a prone position at least once (and often more than once) during the
process of gaining control.

Cardiac dysrhythmia
Illicit drugs, especially stimulant agents such as cocaine and methamphetamine,
may make subjects more likely to have unusual heart rhythms. (37;62) Long term
use of cocaine markedly increases circulating norepinephrine (the precursor to
adrenaline) as the receptors that usually take up excess norepinephrine fail
because of chronic exposure to the drug. This excess of adrenaline and its
precursors potentially puts cocaine abusers at risk of life threatening arrhythmia.(37)
During violent activity and struggle, adrenaline release is increased as part of the
normal nervous system response to a perceived threat or a struggle. Release of
more adrenaline into a system that cannot uptake the excess safely may sensitize
the heart and promote rhythm disturbances. The combination of adrenaline and
cocaine can then enhance the toxicity of cocaine which can lead to seizures,
respiratory arrest, and cardiac arrest. (37)
Some members of the population are genetically susceptible to arrhythmia through
certain medical conditions.(63-65) These are rare conditions which cannot be
anticipated by police officers since even the affected individuals may be unaware of
their own condition. Other congenital and acquired cardiac conditions such as
Wolfe-Parkinson-White syndrome and left ventricular enlargement may predispose
subjects to arrhythmia but police officers cannot anticipate this information either.

Dopaminergic dysfunction
Chronic cocaine use prevents clearance of cerebral dopamine resulting in delirium
and potential increases in body temperature (hyperthermia).(11-13;66)
Hyperthermia may also result when a subject is engaged in extensive muscular
activity in a warm and/or humid environment (summer months or even hot rooms
with poor ventilation). Increased ambient temperature and high levels of muscle
activity may combine with a person’s inability to regulate body temperature to result
in extreme and potentially fatal elevations of core body temperature.(14;15;26)

41

Rhabdomyolysis
Rhabdomyolysis is an overwhelming breakdown of muscle tissue that can be
caused by severe over exertion of the muscle (such as struggling with police or
continued struggle against restraint once in custody) or other physiologic
derangement. It can also be caused by many drugs of abuse. (4;14;39) Long term
cocaine use and untreated persons with schizophrenia have elevations in serum
creatine kinase suggestive of muscle breakdown. This finding lends support to the
theory that chronic alterations in how dopamine works in the body can also affect
skeletal muscle physiology. Whether rhabdomyolysis has any role in sudden
cardiac death proximal to restraint remains unclear.

Metabolic acidosis
Hick et al studied five consecutive cases of sudden cardiac arrest proximal to police
restraint in individuals with features of excited delirium, all of whom were found to
have initial pH measurements far below 7.00. (19) At this pH level, enzyme
mechanisms and physiologic function become deranged. The authors postulated
that cocaine and other stimulants exacerbate the effects of exercise induced lactic
acidosis through sympathetic induced vasoconstriction. Delirium alters cognition
and perception, thereby altering pain sensation and allowing for physical exertion
far beyond normal physiological limits. In other words, the subject does not respond
to the burning of muscles that limits more aware individuals’ activity. The unaware
subject continues to exert himself which can lead in turn to a severe acidosis for
which the body must immediately compensate. Hick et al found that when severe
metabolic acidosis, stimulant drug use (notably cocaine) and exertion are all
combined, the subsequent profound changes in pH can contribute to cardiovascular
collapse. (19;42;67) Changes in pH may be made worse through continued
increase in metabolic activity or through failed compensation such as
hypoventilation. Since their publication, Hick et al have changed their practice such
that they have adapted their treatment of agitated patients to include measuring
blood pH and administration of aggressive fluids and sodium bicarbonate. After this
practice change, five subsequent patients had their acidosis resolved and all five
survived.(19;42)
Similarly, in 2001, Allam and Noble submitted a letter to the editor of “Anaethesia”
describing an anecdotal case of a subject with cocaine induced excited delirium and
extreme acidosis who survived following treatment with hyperventilation, sodium
bicarbonate and dantrolene sodium .(68)
However, relative hypoventilation with its resultant elevation in blood carbon dioxide
levels and metabolic acidosis remain theories for deaths proximal to police restraint
in subjects suffering from excited delirium that need to be validated in prospective
studies of the subjects in question rather than healthy volunteers or small case
series.
42

Conducted energy weapons
The use of conducted energy devices like the Taser ® is currently being examined
as a possible cause of death through a variety of proposed but unproven
mechanisms. A previous section of this entire report deals specifically with the level
of medical research to date into conducted energy weapons and sudden death
proximal to police restraint. Prospective investigation in the population of interest is
still lacking and all causative theories are, at present, speculative.

Interventions to potentially lessen the risk of death
Because there is no effective medical treatment that can be administered from a
distance, physicians and prehospital care personnel have suggested that the period
immediately after successful physical restraint of an individual in the field is the best
time to involve prehospital care practitioners in an attempt to mitigate subject risk.
(69-72) Police officers should be trained to recognize that acutely agitated persons
are suffering from a medical emergency, and that EMS involvement is warranted as
early as possible in the restraint process. Notification of EMS for dispatch prior to
actual physical engagement with the subject may be the most rational policy.
While sedative injections by EMS in the field may be beneficial in limiting further
struggle and thereby potentially decreasing injuries to subjects, police officers and
EMS personnel, it must be cautioned that such chemical restraint is not a guarantee
of preservation of life.(69;72) There have been multiple anecdotal cases of subjects
dying immediately following chemical restraint with benzodiazepines, major
tranquilizers or combination therapy. There is currently no evidence to support or
reject using any specific drug or combination of drugs to sedate persons suspected
of suffering excited delirium and undergoing police restraint in the field. Therefore,
utilization and choice of chemical restraint agents is left to the discretion of the
appropriate EMS medical director. Similarly, there is no evidence on which to
suggest changes in advanced life support treatment protocols or attempts at
prehospital biochemical analysis such as blood gas measurement.

Section 3 - Future directions
•

Recent discussions surrounding the need for further scientific data in the
subjects of interest during the situation of interest have prompted the
development of a national protocol for the epidemiologic study of subjects
resisting arrest with specific interest in features of excited delirium and the
incidence of sudden in custody death.

43

•

There is also great interest in gaining more information about what happens
physiologically in subjects suffering excited delirium. Scientists are planning to
investigate acid base balance and the influence of pH changes with and without
various methods of restraint.

•

The many factors surrounding the deaths are evident from observations that
subjects dying in police custody are not always restrained prone, nor are all the
characteristics replicated in all cases. (8;73) There is a need to gather data
around all features of subjects resisting arrest and dying in police custody to fully
understand sudden and unexpected death proximal to police restraint as well as
excited delirium as a condition and its role in these deaths.

44

References
(A-1) Grenfell, Scott (Sgt), Victoria Australia, 2003
(A-2) Advanced Taser M-26 Safety Analysis, Melbourne, Australia,22 September
2003
(A-3) Taser X-26 Safety Analysis, The Alfred Hospital, Melbourne Vic, Australia, 29
June 2004
(B)

Portland Bureau of Police, Review of 227 Taser® M26 Usages, Portland
Oregon, 2003

(C)

Heck, Joseph, Casualty Care Research Centre, Henderson, Nevada, 2004 –
Medical Implications of CED use from the perspective of the emergency care
providers

(D)

Butler, Charles, Safety and efficacy of the Taser®, Kalamazoo County
Sheriff’s Department, 2004.

(E)

Orange County Sheriff’s Office, “ Taser Deployments and Injuries: Analysis
of Current and Emerging Trends”, 29 December 2004

(F-1) UK Defence Scientific Advisory Council (DSAC), DSAC Sub-committee on
the Medical Implications of Less-lethal Weapons (DOMILL) Statement in the
comparative medical implications of use of the X26 Taser® and the M-26
Advanced Taser®, 2005
(F-2) Patten Report “Recommendations 69 and 70 Relating to Public Order
Equipment”, Northern Ireland Office, January 2004
(F-3) Donnelly T, “Less Lethal Technologies, Initial Prioritisation and Evaluation”,
Police Scientific Development Branch, Home Office, United Kingdom,
Publication 12/01, 2001
(F-4) Donnelly T, Douse K, Gardner M, Wilkinson D, “PSDB Evaluation of Taser
Devices”, Police Scientific Development Branch, Home Office, United
Kingdom, Publication 9/02, 2002
(F-5) Wilkinson D, “PSDB Further Evaluation of Taser Devices”, Police Scientific
Development Branch, Home Office, United Kingdom, Publication 19/05, 2005
(G)

United States Department of Defense, Human Effects Center of Excellence,
Human “Effectiveness and Risk Characterization of electromuscular
incapacitation devices” October 18, 2004

(H)

Jauchem, Dr. James, Human Effectiveness Directorate, US Air Force
Research Laboratory “Effectiveness and Health Effects of Electromuscular
Incapacitating Devices”, 16 November 2004.

(I-1)

Ruggieri, James, Presentation titled “Lethality of TASER®s”, Annual Meeting
of the American Academy of Forensic Sciences, 25 February 2005

45

(I-2)

Reilly, Patrick, “Comments on Lethality of TASER® presented by J.A.
Ruggieri, 25 February 2005”, Letter dated 4 March 2005

(I-3)

Kirsh, Dr J, “Opinion on cardiac safety of the TASER weapon”, Letter dated 8
February 2005

(J)

Saul D. Levine, Christian Sloane, Theodore Chan, Gary Vilke and James
Dunford, University of California , San Diego (UCSD), “Cardiac Monitoring of
Subjects Exposed to the TASER®”, Academic Emergency Medicine,
Volume12, Number 5, Supplement 1 71, 2005.

(K)

Stratbucker, Dr. Richard, Study of Air Taser®

(L)

Bleetman, Dr, Anthony and Steyn, Dr. Richard, “The Advanced Taser: A
Medical Review”, Birmingham Heartlands Hospital, UK, 27 April 2003

(M)

McDaniel, Dr. Wayne, University if Missouri-Columbia, “Cardiac Safety of
Neuromuscular Incapacitating Defensive Devices”, 2005 Edition of Pacing
and Clinical Electrophysiology.

(N)

Bozeman, Dr. William, Multi-centre trial to assess and report on injuries
related to lower lethality weapons deployment, Wake Forest University and
National Institute of Justice.

(O)

Webster Dr J G, University of Wisconsin, Mapping the path of Taser current
in the body, University of Wisconsin and the National Institute of Justice.

(P)

McBide DK, Tedder NB, “Efficacy and Safety of Electrical Stun Devices”,
Potomac Institute for Public Studies Report, 29 March 2005
Parent, Richard, “Aspects of Police Use of Deadly Force In British Columbia:
The Phenomenon Of Victim-Precipitated Homicide”. Burnaby, BC: Simon
Fraser University. (Master’s Thesis). 1996

(Q)

Section –3 References
(1)

Stewart J. Excited Delerium. cbs 3 A.D. Jan 12.

(2)

Vilke GM, Chan TC. Agitated delirium and sudden death. Prehosp Emerg
Care 2002; 6(2):259-260.

(3)

Karch SB, Wetli CV. Agitated delirium versus positional asphyxia. Ann Emerg
Med 1995; 26(6):760-761.

(4)

Ruttenber AJ, Lawler-Heavner J, Yin M, Wetli CV, Hearn WL, Mash DC.
Fatal excited delirium following cocaine use: epidemiologic findings provide
new evidence for mechanisms of cocaine toxicity. J Forensic Sci 1997;
42(1):25-31.

(5)

Conner MG. In custody death: excited delirium, restraint asphyxia, positional
asphyxia and in custody death syndromes: controversial theories that may
explain why some children in treatment programs die when restrained.
46

(6)

Jenkins D. Death in police custody. Acta Med Leg Soc (Liege) 1985;
35(2):31-34.

(7)

Rosen P, Barkin R. Emergency Medicine: Concepts and Clinical Practice;
4th edition. Rosen P, Barkin R, editors. 4. 1998. St Louis, Missouri, Mosby.

(8)

Pollanen MS, Chiasson DA, Cairns JT, Young JG. Unexpected death related
to restraint for excited delirium: a retrospective study of deaths in police
custody and in the community. CMAJ 1998; 158(12):1603-1607.

(9)

O'Halloran RL, Frank JG. Asphyxial death during prone restraint revisited: a
report of 21 cases. Am J Forensic Med Pathol 2000; 21(1):39-52.

(10)

Morrison A, Sadler D. Death of a psychiatric patient during physical restraint.
Excited delirium--a case report. Med Sci Law 2001; 41(1):46-50.

(11)

Mash DC, Ouyang Q, Pablo J, Basile M, Izenwasser S, Lieberman A et al.
Cocaine abusers have an overexpression of alpha-synuclein in dopamine
neurons. J Neurosci 2003; 23(7):2564-2571.

(12)

Mash DC, Pablo J, Ouyang Q, Hearn WL, Izenwasser S. Dopamine transport
function is elevated in cocaine users. J Neurochem 2002; 81(2):292-300.

(13)

Mash DC, Staley JK, Izenwasser S, Basile M, Ruttenber AJ. Serotonin
transporters upregulate with chronic cocaine use. J Chem Neuroanat 2000;
20(3-4):271-280.

(14)

Wetli CV, Mash D, Karch SB. Cocaine-associated agitated delirium and the
neuroleptic malignant syndrome. Am J Emerg Med 1996; 14(4):425-428.

(15)

Henry JA. Metabolic consequences of drug misuse. Br J Anesthesia 2000;
85(1):136-142.

(16)

Farnham FR, Kennedy HG. Acute excited states and sudden death. BMJ
1997; 315(7116):1107-1108.

(17)

Fineschi V, Wetli CV, Di Paolo M, Baroldi G. Myocardial necrosis and
cocaine. A quantitative morphologic study in 26 cocaine-associated deaths.
Int J Legal Med 1997; 110(4):193-198.

(18)

Chan TC, Neuman T, Vilke GM, Clausen J, Clark RF. Metabolic acidosis in
restraint-associated cardiac arrest. Acad Emerg Med 1999; 6(10):1075-1076.

(19)

Hick JL, Smith SW, Lynch MT. Metabolic acidosis in restraint-associated
cardiac arrest: a case series. Acad Emerg Med 1999; 6(3):239-243.

(20)

Hick JL, Smith SW, Lynch MT. Metabolic acidosis in restraint-associated
cardiac arrest: A case series. Academic Emergency Medicine 1999;
6(3):239-243.

(21)

Bell L. On a form of disease resembling some adnaced stages of mania and
fever. American Journal of Insanity 1849; 6:97-127.

(22)

Karch SB, Stephens BG. Acute excited states and sudden death. Acute
excited states are not caused by high blood concentrations of cocaine. BMJ
1998; 316(7138):1171.

47

(23)

Karch SB, Stephens BG. Drug abusers who die during arrest or in custody. J
R Soc Med 1999; 92(3):110-113.

(24)

Karch SB, Stephens B, Ho CH. Relating cocaine blood concentrations to
toxicity--an autopsy study of 99 cases. J Forensic Sci 1998; 43(1):41-45.

(25)

Karch SB, Stephens BS. When is cocaine the cause of death? Am J
Forensic Med Pathol 1991; 12(1):1-2.

(26)

Stephens BG, Jentzen JM, Karch S, Wetli CV, Mash DC. National
Association of Medical Examiners position paper on the certification of
cocaine-related deaths. Am J Forensic Med Pathol 2004; 25(1):11-13.

(27)

Paterson B, Bradley P, Stark C, Saddler D, Leadbetter D, Allen D. Deaths
associated with restraint use in health and social care in the UK. The results
of a preliminary survey. J Psychiatr Ment Health Nurs 2003; 10(1):3-15.

(28)

Mirchandani HG, Rorke LB, Sekula-Perlman A, Hood IC. Cocaine-induced
agitated delirium, forceful struggle, and minor head injury. A further definition
of sudden death during restraint. Am J Forensic Med Pathol 1994; 15(2):9599.

(29)

Budd RD. Cocaine abuse and violent death. Am J Drug Alcohol Abuse 1989;
15(4):375-382.

(30)

Escobedo LG, Ruttenber AJ, Agocs MM, Anda RF, Wetli CV. Emerging
patterns of cocaine use and the epidemic of cocaine overdose deaths in
Dade County, Florida. Arch Pathol Lab Med 1991; 115(9):900-905.

(31)

Fishbain DA, Wetli CV. Cocaine intoxication, delirium, and death in a body
packer. Ann Emerg Med 1981; 10(10):531-532.

(32)

Wetli CV, Fishbain DA. Cocaine-induced psychosis and sudden death in
recreational cocaine users. J Forensic Sci 1985; 30(3):873-880.

(33)

Garber MW, Flaherty D. Cocaine and sudden death. Am Fam Physician
1987; 36(4):227-230.

(34)

O'Halloran RL, Lewman LV. Restraint asphyxiation in excited delirium. Am J
Forensic Med Pathol 1993; 14(4):289-295.

(35)

Stratton SJ, Rogers C, Brickett K, Gruzinski G. Factors associated with
sudden death of individuals requiring restraint for excited delirium. Am J
Emerg Med 2001; 19(3):187-191.

(36)

Stratton SJ, Rogers C, Green K. Sudden death in individuals in hobble
restraints during paramedic transport. Ann Emerg Med 1995; 25(5):710-712.

(37)

Lange RA, Hillis LD. Cardiovascular complications of cocaine use. N.Engl.J
Med 345[5], 351-358. 8-2-2001.

(38)

Pestaner JP, Southall PE. Sudden death during arrest and phencyclidine
intoxication. Am J Forensic Med Pathol 2003; 24(2):119-122.

(39)

Ruttenber AJ, McAnally HB, Wetli CV. Cocaine-associated rhabdomyolysis
and excited delirium: different stages of the same syndrome. Am J Forensic
Med Pathol 1999; 20(2):120-127.
48

(40)

Hick JL, Mahoney BD, Lappe M. Prehospital sedation with intramuscular
droperidol: a one year pilot study. Prehosp.Emerg Care 5, 391-394. 1991.

(41)

Pounder D. Acute excited states and sudden death. Death after restraint can
be avoided. BMJ 1998; 316(7138):1171.

(42)

Hick JL, Smith SW, Lynch MT. Reply Letter. Academic Emergency Medicine
1999; 6(10).

(43)

Mittleman RE, Wetli CV. Death caused by recreational cocaine use. An
update. JAMA 1984; 252(14):1889-1893.

(44)

Ruttenber AJ, Sweeney PA, Mendlein JM, Wetli CV. Preliminary findings of
an epidemiologic study of cocaine-related deaths, Dade County, Florida,
1978-85. NIDA Res Monogr 1991; 110:95-112.:95-112.

(45)

Wetli CV, Wright RK. Death caused by recreational cocaine use. JAMA 1979;
241(23):2519-2522.

(46)

Reay DT. Death in custody. Clin Lab Med 1998; 18(1):1-22.

(47)

Reay DT. Positional asphyxia during law enforcement transport. Am J
Forensic Med Pathol 1993; 14(2):170-171.

(48)

Reay DT, Hazelwood RR. Death in military police custody and confinement.
Mil Med 1970; 135(9):765-771.

(49)

Reay DT, Fligner CL, Stilwell AD, Arnold J. Positional asphyxia during law
enforcement transport. Am J Forensic Med Pathol 1992; 13(2):90-97.

(50)

Ross DL. Factors associated with excited delirium deaths in police custody.
Mod Pathol 1998; 11(11):1127-1137.

(51)

Reay DT, Huber J, Fligner CL, Watson WA. Effects of positional restraint on
oxygen saturation and heart rate following exercise. Am J Forensic Med
Pathol. 9[1], 16. 1988.

(52)

Chan TC, Vilke GM, Neuman T. Reexamination of custody restraint position
and positional asphyxia. Am J Forensic Med Pathol 1998; 19(3):201-205.

(53)

Chan TC, Vilke GM, Neuman T. Restraint position and positional asphyxia.
Am J Forensic Med Pathol 2000; 21(1):93.

(54)

Haouzi P, Chenuel B, Chalon B. Effects of body position on the ventilatory
response following an impulse exercise in humans. J Appl Physiol 2002;
92(4):1423-1433.

(55)

Wilson LD, Shelat C. Electrophysiologic and hemodynamic effects of sodium
bicarbonate in a canine model of severe cocaine intoxication. J Toxicol Clin
Toxicol 2003; 41(6):777-788.

(56)

Gruszecki AC, McGwin G, Robinson A, Davis GG. Unexplained Sudden
Death and the Likelihood of Drug Abuse. J Forensic Sci. 50[2], 1-4. 2005.

(57)

Reay DT, Eisele JW. Death from law enforcement neck holds. Am J Forensic
Med Pathol. 3, 253-258. 1982.

49

(58)

Reay DT, Eisele JW. Law Enforcement Neck Holds. Am J Forensic Med
Pathol. 7, 177. 1986.

(59)

Chan TC, Vilke GM, Neuman T, Clausen JL. Restraint position and positional
asphyxia. Ann Emerg Med 1997; 30(5):578-586.

(60)

Ross LB. An analysis of in-custody deaths and positional asphyxiation.
Police Marksman Mar/Apr. 3-2-1996.

(61)

Schmidt P, Snowden T. The effects of positional restraint on heart rate and
oxygen saturation. J Emerg Med 1999; 17(5):777-782.

(62)

Straus SM, Bleumink GS, Dieleman JP, van der LJ, 't Jong GW, Kingma JH
et al. Antipsychotics and the risk of sudden cardiac death. Arch Intern Med
2004; 164(12):1293-1297.

(63)

Priori SG, Napolitano C. Genetics of cardiac arrhythmias and sudden cardiac
death. Ann N Y Acad Sci 2004; 1015:96-110.:96-110.

(64)

Vos MA, Paulussen AD. Genetic basis of drug-induced arrhythmias. Ann
Med 2004; 36 Suppl 1:35-40.:35-40.

(65)

Laitinen PJ, Swan H, Piippo K, Viitasalo M, Toivonen L, Kontula K. Genes,
exercise and sudden death: molecular basis of familial catecholaminergic
polymorphic ventricular tachycardia. Ann Med 2004; 36 Suppl 1:81-6.:81-86.

(66)

Mash DC, Staley JK. D3 dopamine and kappa opioid receptor alterations in
human brain of cocaine-overdose victims. Ann N Y Acad Sci 1999; 877:50722.:507-522.

(67)

Ortega-Carnicer J, Bertos-Polo J, Gutierrez-Tirado C. Aborted sudden death,
transient Brugada pattern, and wide QRS dysrrhythmias after massive
cocaine ingestion. J Electrocardiol 2001; 34(4):345-349.

(68)

Allam S, Noble JS. Cocaine excited delirium and severe acidosis.
Anaesthesia 2001; 56(4):385.

(69)

Martel M, Miner J, Fringer R, Sufka K, Miamen A, Ho J et al. Discontinuation
of Droperidol for the Control of Acutely Agitated Out-of-Hospital Patients.
Prehosp.Emerg Care 9[1], 44-48. 2005.

(70)

Rosen CN, Ratcliff AF, Wolfe RE. The efficacy of intravenous droperidol in
the prehospital setting. et al, editor. J Emerg Med 15, 133-137. 1997.

(71)

Naik P, Lawton J. Assessment and management of individuals under the
influence of alcohol in police custody. J Clin Forensic Med 1996; 3(1):37-44.

(72)

Thomas H, Schwartz E, Petrelli R. Droperidol vs haloperidol for chemical
restraint of agitated and combative patients. Ann Emerg Med 21, 407-413.
1992.

(73)

Park KS, Korn CS, Henderson SO. Agitated delirium and sudden death: two
case reports. Prehosp Emerg Care 2001; 5(2):214-216.

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Glossary of Terms
BCOPCC

British Columbia Office of the Police Complaints Commissioner

CED:

Conducted Energy Device

CPRC:

Canadian Police Research Centre

DSAC:

Defence Scientific Advisory Council

DSTL:

Defence Sciences Technology Laboratory

ED:

Excited Delirium

EMI:

Electro-Muscular Incapacitation

EMS:

Emergency Medical Service

ETF:

Emergency Task Force

HECOE:

Human Effects Centre of Excellence

ISTAT:

A medical tool which measures blood gas levels

NMI:

Neuro-Muscular Incapacitation

NIJ:

National Institute of Justice: the research and evaluation branch
of the U.S. Department of Justice
National Use of Force Framework

NUFF:
OC

Oleoresin Capsicum spray (commonly referred to as Pepper
Spray)

OSCO:

Orange County Sheriff’s Office

PACE:

Pacing and Clinical Electrophysiology

TASER:

Trademark of Taser International Inc, (Thomas A. Swift Electric
Rifle),

TI

Taser International Inc

VF:

Ventricular Fibrillation

VPD:

Victoria Police Department

51

Appendices
A. Conducted Energy Device Steering Committee
B. Conducted Energy Device Working Group
C. British Columbia Office of the Police Complaints Commissioner Final report
o http://www.opcc.bc.ca
D. British Columbia Office of the Police Complaints Commissioner Interim report
o http://www.opcc.bc.ca

52

A -Conductive Energy Device Steering Committee
Tony Burbridge
Halifax Regional Police

Chair

Ronald Bélanger
École nationale de police du Québec
Allan Bonner
Toronto,
Pierre Brassard
Ecole nationale de police Québec
Christine Hall MD FRCPC
Calgary Health Region, Department of Emergency Medicine
Dale Kinnear
Canadian Professional Police Association
Bill Naughton
Victoria Police Department
George Nickel
Correctional Services Canada
Jeffrey E. Pfeifer
University of Regina
Emile Therien
Canada Safety Council
Leah Young / Joan Montgomery
Schizophrenia Society of Canada
Rosie Wartecker
Tourettes Syndrome Foundation of Canada
Steve Palmer
Canadian Police Research Center

53

B- Conductive Energy Device Working Group
1. Tony Burbridge
Halifax Regional Police
Halifax, Nova Scotia

(Chair)

2. Chris Lawrence
Ontario Police College
3. Christine Hall MD FRCPC
Calgary Health Region, Department of Emergency Medicine
Calgary, Alberta
4. Drazen Manojlovic,
Ontario Ministry of Community Safety and Correctional Services
Toronto, Ontario
5. Darren Laur
Victoria Police Department / Seconded to CPRC
Victoria, British Columbia
6. Shawna Goodkey
Edmonton Police Service, Edmonton, Alberta
7. Rick Shaw,
Royal Canadian Mounted Police, Ottawa, Ontario
8. Sylvain St-Amour,
Service Police Ville Montreal, Montreal, Quebec
9. Annik Neufeld
Service Police Ville Montreal, Montreal, Quebec
10. Sharlene Brooks
Delta Police Service, Delta, British Columbia
11. Sheldon Dickie
Royal Canadian Mounted Police, Ottawa, Ontario

54

C- British Columbia Office of the Police Complaints Commissioner Final
report
o Available on line at http://www.opcc.bc.ca or
http://www.cprc.org/docs/bcopcc_final.pdf

D-British Columbia Office of the Police Complaints Commissioner Interim
report
o Available on line at http://www.opcc.bc.ca or
http://www.cprc.org/docs/bcopcc_interm.pdf

55