Medical Safety Update Less Lethal Weapons / Conducted Energy Devices (CED) William P. Bozeman, MD, FACEP, FAAEM Tactical Physician Assoc Director of Research Department of Emergency Medicine Wake Forest University NCSTL, November 2006

WPB Background Emergency Physician Trauma / Critical Care subspecialty Tactical Physician, >6 yrs Academic / Researcher –animal & human studies –PI, national LLW Study

LLW – general profile Law enforcement experience: –Operationally effective tools –Decrease use of lethal force –Decrease injuries in suspects and officers Medical experience: –LLW do cause injuries –Most are minor –Rare major injuries & deaths

Medical Effects of Less Lethal Weapons

Less Lethal Weapons

Medical effects…

Conducted Energy Devices Fire 2 probes Series of electrical pulses –pain –involuntary muscle contractions 5 second duration –may terminate early –may repeat

CED Concerns Secondary injuries –Falls  blunt trauma Probe striking eyes or vessels –~¼ inch max. penetration Cardiac Affects (??)...

Cardiac Safety VFib Threshold: joules Medical Therapy: joules Taser output: 1.76 joules (M26) 0.36 joules (X26)

Recent Advances in CED Medical Research (Highlights)

Relative Risk of Force Options UK Data Includes all police UOF incidents –Taser M26 –CS spray –Canine –Baton (Excellent review of prev. literature too) Jenkinson, J Forensic Science, 2006

Cardiac Monitoring During Taser Use in Humans 2 studies – CA, NC –104 patients (officers) –151 shocks No rhythm problems Increases heart rate, BP Bozeman, Annals Emerg Med, Oct 2006 Levine, Acad Emerg Med, May 2006

VFib threshold (pig studies) In General: –Need times Taser output to induce VFib Cocaine increases this threshold –50% – 100% above baseline resistance Lakkireddy, J Am Coll Cardiol, Aug 2006 McDaniel, PACE, Jan 2005

Electrical Capture During Shock (pig studies) Standard Taser discharge may cause abnormal heart beats –Not detected by normal EKG due to noise –Applicable to humans? –Significance? Nanthakumar, J Am Coll Cardiol, Aug 2006

Ongoing Research – the NIJ LLW Study “Injuries Produced by Law Enforcement Use of Less Lethal Weapons: A Prospective Multicenter Trial”

LLW Study Prospective, multicenter, “real world" trial 12 LE agencies nationwide –Vary in size, location, population, policies (i.e. representative sample with good external validity) Tracks 100% of LLW uses via UOF reporting –Kinetic impact projectiles –CED / Taser

After LLW use: UOF investigation documents events & injuries –includes retrieval of medical records by LE agency –HIPAA has specific provision for this Tactical physician reviews all LLW UOF reports & materials –determines injury type & severity (a priori definitions) –None / Mild / Moderate / Severe

Current Status Approx 500 real-world LLW cases to date –Almost all are Taser uses First Interim analysis 300 pts)  –Minority of cases have some injury – all mild –No significant injuries Study completion this summer, report in fall

Summary – Medical Safety Any force option, including CED, can cause injuries –Most are mild, but can be severe –Specific risk still not determined Current data support safety of CED –At least as safe as CS spray, canine, or baton More questions under investigation…

Questions?