1. "Don't Taze me Bro!"
Jordan Barnett, MD FACEP

2. “Don’t Taze me Bro!”

3. “Don’t Taze me Bro!”
Taser is an acronym for Thomas A. Swift’s Electric Rifle. Arizona inventor Jack Cover designed and patented it in
1969. It is named after the science fiction teenage inventor and adventure character Tom Swift.
It is a battery-operated unit that resembles a handgun and fires two barbed electrodes attached to copper wires at
180 feet/sec
Wires come in various lengths ranging from 15 to 35 feet
Aimed by Laser site
The barbs attach to the subject’s skin or clothing
The current can cross up to two inches of clothing or air space.
The device’s current causes uncontrollable muscle contraction and overwhelming pain that can incapacitate a
subject if the barbs are a sufficient distance apart.
The barbs remain attached until removed

4. TASERS - The Science

5. TASERS - The Science
Deliver a lot of volts, but very few amps
A very high voltage ensures that the pulse will reach its target (Penetrating clothing and skin), and the very
low amperage keeps it from doing any permanent damage.
Basic overview of the terms voltage and amperage: Think of HIGH VOLTAGE as water under high pressure.
LOW AMPERAGE is a very low volume or stream of water. The injury inflicted by an electric shock depends on
the interaction between this "pressure", or voltage, and "flow rate", or amperage of the electricity.
Tasers differ from standard stun guns, which typically work by pressing a pair of electrodes against the skin of
a victim completing an electric circuit, in that the electrodes are tethered to long, insulated wires and can be
fired from the weapon with a burst of carbon dioxide. A standard stun gun can only be used at close range;
Tasers can shoot someone from 20 feet away.
Once the electrodes hit their target, the Taser sends a pulse with about 50,000 volts and a few milliamps. On
its standard setting, the pulse cycles for five seconds before shutting off. (The pulse continues for as long as
you hold the trigger.) The five-second shock sends intense signals through the victim's nervous system, which
causes considerable pain and triggers a contraction in all his muscles. Temporary paralysis can set in, and
most victims fall to the ground.
Tasers can also be used like regular stun guns in what's called "drive stun" mode. This causes more localized
pain and less widespread muscle contraction.

6. Volts versus Amps
Water Cannon versus high pressure water pistol

7. MECHANISM OF EFFECT
“An important concept in electrical injuries is that of the "let-go" current, defined as the
maximum current a person can tolerate as evidenced by volitional use of muscles directly
stimulated by that current. A person receiving a shock with a current exceeding the "let-go"
current threshold cannot release a hand-held conductor transmitting the current. It has been
conjectured that the Taser®delivers a current that exceeds the let-go current threshold,
resulting in the Tasered patient being unable to free himself from the device as long as the
current is delivered.”

8. Most effective where large muscle groups can
be recruited
Applying Taser shock to more sensitive parts of
the body, obviously, more painful
“Shock” is caused by muscles twitching
uncontrollably
Output voltages range 50 to 1,000 kilovolts
(usually 200-300 KV)

9. REGARDING BALLISTICS
"The initial velocity is substantially
less than that of a BB gun (91 m/s) or .38 special handgun (332 m/s). The kinetic energy delivered by the Taser® dart,
proportional to its mass x velocity, is very low. Hence the dart is ballistically a very low-velocity, low- energy weapon. The
manufacturer reports that darts fired point-blank into the bare chest of a man resulted in only the barb and needle portion of
the dart becoming imbedded in the skin.”

10. 60 Minutes Piece
What the public has seen...

12. “Tasers...we are not risk free....”

13. Deaths

15. Torture claims

16. Why would an officer taser
repeatedly? - Answer- This
is not a foolproof device

18. Deaths with Tazers

19. Deaths with Tazers
Unexpected Deaths have occurred with Taser Use By PD
“Cardiac Monitoring of Human Subjects Exposed to Taser,”
involved monitoring cardiac rhythms on healthy police (not
individuals in field who might have AICDs, Pacemakers,
under the influence,etc.). With shock of 2.2 seconds heart
rate increased in 76 subjects by 19.4 beats/minute with no
change in QRS morphology. One Individual had PVCs
Claims of “Excited Delirium” as cause of death - and not the
Taser per manufacturer and plaintiff experts

20. “Excited Delirium?”

21. “Excited Delirium?”
Not a valid medical term
Not listed in the Diagnostic and Statistical Manual of Mental
Disorders
AMA and American Psychological Association don’t
recognize this as a mental health condition

22. OK - so what is the def?

23. OK - so what is the def?
“A delirium characterized by a severe disturbance in the level
of consciousness and change in mental status over a relatively
short period of time”
Loss of clarity, awareness, focus, disoriented and may exhibit
signs of hallucinations.
Bizarre, violent behavior, public nudity, aggression,
hyperactivitiy, paranoia, hallucinations, incoherent speach,
imperviousness topain, hyperthermia

24. Bogus term?

25. Bogus term?
Panic Attacks can do some of that...
So Can Delirium Tremens
Thyroid storm
PCP
Many others......

26. “Most patients presenting to the ED have been Tasered because of violent or erratic behavior, often as a result of drug
intoxication (particularly with phencyclidine [PCP]) or as a result of a psychiatric disturbance.”

28. SO....Surprised?
Cardiovascular disease
I"icit Drugs
Stimulants....

30. Real World versus Lab
A major concern is fibrillatory current - the current that produces ventricular fibrillation. For externally applied current,
the fibrillatory current in human beings is believed to be a function of the duration, frequency, and magnitude of the
current, as well as the patient's body weight The threshold of ventricular fibrillation for men (for an externally applied,
60-Hz current) has been proposed to be 500 mA for shocks of less than 200 ms du- ration and 50 mA for shocks of more
than two seconds
The current produced by the Taser ® appears to be under the proposed fibrillatory threshold and under the theorized
asphyxia threshold. Therefore, if these estimations are correct, it appears unlikely that a Tasered victim with normal car-
diopulmonary function will develop ventricular fibrillation or paralysis of respiratory muscles. The effects of the device
on individuals with coronary artery disease, conduction defects (eg, sick sinus syndrome), Wolff Parkinson- White
syndrome, or preexisting arrhythmias, or on patients under the influence of alcohol or other drugs is not well studied.

31. The manufacturer's own product warnings caution that CEWs "have not
been scientifically tested on at-risk 'susceptible populations,' " such as
"frail, elderly, pregnant, small children, and individuals with low
body mass indexes

35. Typical sudden death

36. Typical sudden death
Violent subject requiring multiple officers to restrain
continues to struggle in custody
suddenly goes quiet
Often due to respiratory arrest
Treat as for any other respiratory arrest

37. Literature and Lawyers

38. Follow the Money
Manufacturer wants to sell units
Police would like to have alternative unit than gun or club
Some physicians have compromised ethics or present skewed
views when hired as expert witnesses for trial

39. EMS Response

40. EMS Response
Scene Safety
Listen to police orders
Patients can remain agitated
Sudden cardiac arrests can occur despite rapid transport and
top-notch care
Majority of deaths minutes to hours after application

41. If still agitated...

42. If still agitated...
Bring to the Emergency Department
Most officers will be willing to comply
You may need to be a patient advocate
Be wary of hyperthermia, tachycardia, volume depletion,
rhabdomyolysis, metabolic acidosis - may need ALS!

43. General Principles

44. General Principles
All Tasered patients should be assessed with Full Head to Toe
Physical Exam
Patients can fall if they were standing! Think Head and Neck
injuries!
Pregnant patients need evaluation following Taser

45. Removal Of Taser Barbs

47. Many Agencies Allow Barb removal in
Certain Circumstances (follow local
protocols)
Barb is a straight fishhook, with barb length
4mm with overall length 9.53 mm
An XP barb exists for “extra penetration” and
is 13.33 mm in length

49. Recommended by AEM
One of three methods may be used to remove It is unknown if any particular method of ex-
Taser®barbs from the skin per Annals of Emergency traction results in a higher rate of wound infection.
Medicine. In descending order of ease they are: Patients typically are not placed on antibiotic
prophylaxis for these minor wounds
1) grasping the wire connected to the dart and
firmly pulling it away from the skin; - The disadvantage is
the production of more irregular wound margins
2) placing a 16-gauge needle over the barb portion
of the dart and gently backing the dart out of the
skin; -produce a wound margin with sharper edges and, hence, better healing
and cosmesis.
3) prepping the skin, infiltrating locally with
lidocaine, cutting down to the barb with a sterile
scalpel, and removing the barb through the
incision. -produce a wound margin with sharper edges and, hence, better
healing and cosmesis.

51. Stabilize barb with one hand and pull directly
out
If patient cannot tolerate removal, treat as
impaled object and transport to ED. Per
literature, area around barb insensate
Minimal bleeding because of local “Cautery “
effect of the electric current

52. Treat any barbs embedded in major vascular
structures as impaled objects!

54. Theoretical risk to neck vasculature and
genitalia
Eye injury possible - often requiring surgical
repair
Pneumothorax possible

62. Clinical management of a penetration of the eye should consist of leaving the dart in place, placement of a protective
metal eye shield, and immediate ophthalmologic consultation. In addition, as with any penetration of the body surface by
the dart, appropriate tetanus immunization should be given.

63. Other injuries include Skull Penetration
(Range of firing possible culprit - Also, who
remembers the movie “Unbreakable?”
Osteogenesis Imperfecta)
Seizures
Spinal Fractures due to severe muscle spasm

72. Bottom Line
Projectiles being fired at people
Projectiles can penetrate and cause injuries
Be Safe - follow police instructions
Be an advocate for the patient
Follow your training in regards to trauma and
cardiopulmonary arrest management

74. Personal Statement: Despite the dangers, if
I or my family members were police
officers, I would want them to have a
Taser.

75. ?