Response to Letter Regarding Article, “TASER Electronic Control Devices and Cardiac Arrests: Coincidental or Causal?”
We thank Dr Sheridan for his interest and wish to acknowledge his contributions to the understanding of the effects of the electronic control device (ECD).1 There have, in fact, been published studies in which ECD probes were launched into the chests of volunteers. In 2 of these studies there was continuous echocardiographic monitoring to verify that there was no cardiac capture.2,3 The 63 volunteers received a total of 10 170 ECD pulses with no arrhythmias and no cardiac capture (in the 9450 with echo monitoring).
Consistent with the study coauthored by Dr Sheridan, some of us have previously published that the risk of ventricular fibrillation (VF) induction is vanishingly small, if not essentially zero. We believe that the issue of ECD-induced cardiac effects has been sufficiently studied and that the epidemiological data convincingly show how rare (if even existent) such side-effects are. The Canadian Council of Science performed an expert panel review of the literature and concluded that the reports of litigation-driven cases [Z1–Z8, our #5–12] were “particularly questionable,” “isolated and controversial,” and authored by someone with a “potential conflict of interest.” The Naunheim et al case (S.N., our #2), alleging ECD-induced VF, was correctly reported earlier by other physicians of the same hospital to have presented with asystole (consistent with the extreme alcohol intoxication and not with electric stimulation 6 minutes beforehand). That leaves 2 published cases—our #1 (K.F.) and #3 (S.F.)—and only 1 of these cases (Swerdlow et al, our #3), has not been previously questioned in the literature (our article concludes that even these 2 cases are not evidence of ECD-induced VF).
Assume arguendo that perhaps 1 or 2 of these cases actually do represent ECD-induced VF, ignore the nearly 1 400 000 officer training exposures, and consider only the ≈ 2.1 million field applications to suspects. This would yield a theoretical rate of cardiac arrest of ≤1 per million, which would make the ECD an extremely safe tool.
The relevant definition of safety is: does the tool provide more benefit than harm when compared with the alternatives? Multiple prospective studies have shown that the use of the ECD reduces suspect injury by about 2/3 compared with alternative control techniques such as pepper spray, baton strikes, and manual control.4 Eastman et al showed that 5.4% of ECD uses clearly prevented the use of lethal force.5 This suggests that ≈100 000 potentially lethal uses of force have been prevented and demonstrates that the ECD exceeds any relevant criterion for safety.
The ECD has contributed to ≈15 deaths from traumatic brain injury by causing an uncontrolled fall and ≈5 deaths from igniting a flammable substance. These deaths exceed any count of hypothesized ECD-induced VF. It is surprising that so much focus is placed on these allegations of electrocution when the ECD satisfies all relevant standards for electric safety. Because the majority of such allegations have arisen from litigation, this focus on controversial anecdotes perhaps tells us more about the present tort litigation climate than it does about ECD safety.
Mark W. Kroll, PhD
University of Minnesota
Dhanunjaya R. Lakkireddy, MD
University of Kansas Hospital
Kansas City, KS
James R. Stone, MD, PhD
Richard M. Luceri, MD
Holy Cross Hospital
Ft. Lauderdale, FL
All authors have been expert witnesses for TASER International, who funded the study. Drs Luceri and Kroll are members of their Scientific and Medical Advisory Board, and Dr Kroll is a member of their Corporate Board.
- © 2014 American Heart Association, Inc.