Can there be truth about TASERs?

W hat is the real truth about the TASER conducted electrical weapon (CEW)? The problem with debating this topic is that it has very polarized opinions that are generally based on emotion or anecdote. Either you love it for the technological advances it brings to the practice of human restraint or you hate it for the potential it brings for misuse. Both approaches incorporate rhetoric and underlying agendas when it comes to talking about these devices, and the majority of people will obtain their information about this topic in some type of sensationalized format such as media publications, personal Web blogs, or conspiracy Web sites. These sources, unfortunately, are prone to errors and personal opinions and do not present objective data with full explanation. Luckily, there also exists scientific literature on the subject, but this is more difficult to search out, can be costly to access, and requires some understanding of statistics and scientific principles to interpret. The publication of the TASER CEW papers by Vilke et al. and Swerdlow et al. in this issue of Academic Emergency Medicine add significantly to the growing body of human research on this topic. Critics of the existing scientific literature have maintained that research in this field is primarily funded by the device manufacturer, TASER International, Inc. (Scottsdale, AZ), or that work has been performed with inadequate methodology yielding inaccurate results. There is little doubt that this type of criticism will also emerge since Swerdlow is a member of the TASER International Scientific and Medical Advisory Board, and the study by Vilke et al. did not use subjects who were drug intoxicated, deliriously agitated, or mentally ill (conditions commonly presenting in persons who have bad outcomes following interactions with law enforcement). However, as work in this area continues to grow, those arguments become academically weak. Also, it is important to remember that unexpected sudden death shortly after interaction with law enforcement is not a new phenomenon; there are cases of similar custodial deaths dating back long before the invention of the CEW. The CEW is, perhaps, the most intensely studied and vetted law enforcement tool in existence, and the majority of the human work in this area is supportive of its safety profile. Considering what the CEW is designed to be used for, and that the alternatives available to law enforcement personnel likely involve a blunt impact weapon or a firearm, it becomes easier to understand why the TASER CEW should be associated with protecting life instead of contributing to taking it. The paper by Vilke et al. explores the important variable of exercise in combination with CEW exposure. In 2006, a study led by myself examined a number of physiologic measurements in humans following CEW exposure and did not find a clinically significant change in the measured parameters. This work was criticized for using rested subjects because it is uncommon for rested subjects to be involved in a CEW-mediated altercation with law enforcement (these altercations are usually precipitated by significant physical resistance or an exertional foot chase). Because of this, factoring in the component of exercise is an important one. Vilke’s group has demonstrated no clinically significant changes in ventilatory and blood parameters of physiologic stress following a 5-second CEW exposure. This dovetails nicely with recent work by our group that also examined a heavily exerted population following a 15-second CEW exposure and concluded that there was no evidence of worsening acidosis or cardiac troponin measurement. The work by Vilke et al. is also notable because it adds support for use of CEWs by law enforcement when interacting with dangerous individuals in compromised physiologic circumstances. Let’s be honest: law enforcement authorities are in the difficult position of having to take control of significantly resistive persons while under intense scrutiny with the public expectation of a perfect outcome. And while training, updated tools, and improved tactics allow for this in a majority of cases, anything less than an excellent outcome creates a situation of potential public outrage. Academically, we can probably all agree that law enforcement personnel have a difficult job to do, and any time a CEW is legitimately used during the course of this work, the stakes are going to be high. This work by Vilke’s group adds to the literature on this topic and offers yet another demonstration of the reasonable safety profile of the CEW. Additionally, the fact that this study was not sponsored by industry limits the popular argument of preconclusion bias. Although the prospective model of Vilke et al. was limited by the artificiality of the laboratory environment and the relative healthy population selection bias, one