REPORT 6 OF THE COUNCIL ON SCIENCE AND PUBLIC HEALTH (A-09)
Use of Tasers® by Law Enforcement Agencies
(Reference Committee D)
EXECUTIVE SUMMARY
Objective: To review the technology of conducted electrical devices (CEDs) such as Tasers®, the
evidence on their direct physiological effects, and existing data on the morbidity and mortality
associated with their use by law enforcement personnel. General guidelines on use-of-force
policies and the role played by CEDs also are noted, and their relevance to public health and the
health care system is discussed.
Methods: English-language reports on studies using human or animal subjects were selected from
a PubMed search of the literature from 1985 to March 2009 using the text terms “taser,” or
“conducted electrical device” or the MeSH terms “law enforcement/methods” or “weapons,” in
combination with “electric injuries,” and “diagnosis,” “etiology,” “physiopathology,” “prevention
and control,” “mortality,” or “forensic medicine.” Additional articles were identified by manual
review of the references cited in these publications. Web sites of Taser International, the U.S
Department of Justice, the Canadian House of Commons, Amnesty International, and the
International Association of Police Chiefs also were searched for relevant resources.
Results: The design of CEDs has evolved over the last 20 years. Tasers® are the primary CEDs
used by law enforcement. Despite the designation of the Taser® as a less lethal or less-than-lethal
weapon, Amnesty International has catalogued a temporal association between the use of CEDs
and more than 330 in-custody sudden deaths in North America between June 2001 and August
2008, all involving M-26 or X-26 Tasers®. Swine models have demonstrated the ability of
Tasers® to induce ventricular arrhythmias. Limited Taser® discharges applied to healthy human
volunteers generally appear to be safe. Such studies cannot fully evaluate the responses of
individuals who are confrontational, have taken drugs, or are desperate for escape, highly agitated,
and combative.
Higher risk situations for restraint-related fatalities seem to be associated with pre-existing
cardiovascular disease in individuals who have taken psychostimulants or other drugs and engage
in a struggle against law enforcement personnel and then are subjected to restraint maneuvers (with
or without Taser® use). The sudden in-custody deaths of individuals who are combative and in a
highly agitated state have been attributed to the presence of “excited delirium.” The latter is not a
validated diagnostic entity in either the International Classification of Diseases or the Diagnostic
and Statistical Manual of Mental Disorders, but is a more generally accepted entity in forensic
pathology.
Conclusion: Concerns about the use of CEDs fall into three general areas: (1) they are used too
frequently and at lower levels on the use-of-force continuum than indicated; (2) appropriate
training and supervision of CED use is lacking in some jurisdictions; and (3) CEDs may contribute
to the death of suspects, either directly or indirectly. Arrest-related deaths are not new and predate
the deployment of CEDs. Most studies undertaken by law enforcement agencies (and others)
indicate that deploying CEDs relative to other use-of-force options, such as pepper spray, physical
force, police dogs, and batons, reduces injuries to officers and suspects and reduces the use of
lethal force. If deployed according to an appropriate use-of-force policy, and used in conjunction
with a medically driven quality assurance process, Taser® use by law enforcement officers appears
to be a safe and effective tool to place uncooperative or combative subjects into custody.

REPORT OF THE COUNCIL ON SCIENCE AND PUBLIC HEALTH
CSAPH Report 6-A-09

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Subject:

Use of Tasers® by Law Enforcement Agencies
(Resolution 401, A-08)

Presented by:

Carolyn B. Robinowitz, MD, Chair

Referred to:

Reference Committee D
(James L. Milam, MD, Chair)

Resolution 401, “Tasers,” introduced by the American Academy of Child and Adolescent
Psychiatry, American Psychiatric Association, American Academy of Psychiatry and the Law, and
the
American Academy of Pediatrics and referred at the 2008 Annual Meeting, asks:
That our American Medical Association (AMA) Council on Science and Public Health
prepare a report summarizing the scientific data on morbidity and mortality associated with
the use of Tasers;
That our AMA advocate for the development of appropriate guidelines to ensure that
Tasers are only used in a manner which minimizes the risk of injury or death; and
That our AMA encourage The Joint Commission and other appropriate accreditation and
regulatory agencies to develop standards and guidelines regarding the use of Tasers in
hospitals and other health care facilities.
Conducted electrical devices (CEDs) were designed as non-lethal weapons to assist law
enforcement personnel in subduing subjects who actively resist arrest, or who present a serious
threat to themselves or others. As these new tools have become more prominent in the law
enforcement arsenal, their deployment has been temporally associated with more than 330 arrestrelated or in-custody deaths since 2001.1 The association of CEDs such as Tasers® a with fatalities,
dramatized by video evidence, has led to further scrutiny of their use by human rights advocacy
groups, government oversight bodies, law enforcement organizations themselves, and the media.
This report reviews the technology of CEDs, evidence of their direct physiological effects, and data
on the morbidity and mortality associated with their use by law enforcement. The vast majority of
published data concern the use of Tasers®. General guidelines on use-of-force policies and the
role played by CEDs are noted, and their relevance to public health and the health care system is
discussed.
METHODS
English-language reports on studies using human or animal subjects were selected from a PubMed
search of the literature from 1985 to March 2009 using the text terms “taser,” or “conducted
electrical device” or the MeSH terms “law enforcement/methods” or “weapons,” in combination
a

TASER is an acronym for Thomas A. Swift Electronic Rifle

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with “electric injuries,” and “diagnosis,” “etiology,” “physiopathology,” “prevention and control,”
“mortality,” or “forensic medicine.” Additional articles were identified by manual review of the
references cited in these publications. Web sites of Taser International, the U.S. Department of
Justice, the Canadian House of Commons, Amnesty International, and the International
Association of Police Chiefs also were searched for relevant resources.
BACKGROUND
Conducted Electrical Weapons
The design of CEDs, especially Tasers®, has evolved over the last 20 years. Early versions of
CEDs (e.g., stun guns) did not incapacitate subjects, and primarily attempted to achieve compliance
through the infliction of pain. Current Taser® models are more efficient in incapacitating criminal
suspects, and are the primary CEDs used by law enforcement. According to the manufacturer,
Tasers® are currently used in more than12,750 law enforcement, military, and correctional
agencies around the world, including more than two-thirds of law enforcement agencies in the
United States.2 Taser International produces various models for law enforcement personnel (M-26
and X-26), as well as civilian models (C2 and X-26C), which are less powerful.
The most recent evolution of the Taser® for law enforcement is the X-26 model. The X-26 is
battery operated with a removable cartridge containing coiled electrical wires at the front, coupled
with a data port that records the time and date of activation, and also incorporates an audio and
video recording camera. Propelled by compressed nitrogen, the X-26 cartridge can launch the two
tethered insulated wires with barbed probes up to 35 feet. When the trigger is depressed, a pulse
wave with a high voltage leading edge (up to 50,000 V in open circuit) is delivered followed by a
pulsed low amperage current delivered over 5 seconds. Both probes must attach to the skin or
clothing. The initial short duration, high voltage signal allows a current path to be established
through clothing via an “arc” of ionized air. The standard discharge cycle can be terminated early
by the officer or can be extended, as long as the barbs remain in sufficient contact with the
individual, by holding or repeatedly depressing the trigger. With the cartridge removed, the Taser®
also can be used in push stun mode by directly applying a pair of electrical contact points
(approximately 1.5 inches apart at the tip) to the subject. In comparison, the most recent civilian
model (C2) can launch the probes up to 15 feet and can deliver a 30-second energy burst, thus
enabling the subject to escape during that time period. The C2 also can be used in stun mode.
When used in the probe mode (i.e., barbed wires propelled by compressed nitrogen), the pulsed,
low-amperage current activates α-motor neurons causing strong, repetitive contractions of skeletal
muscles and temporary immobilization. The affected muscle mass area is determined by the
probe’s position and separation. In addition to temporary incapacitation, sensory nerves are
stimulated causing substantial discomfort and pain.
Another company, Stinger Systems, also markets a projectile CED in the United States (the S200).3 The open circuit maximum voltage, pulse waveform, cycle duration, current characteristics,
and peak amperage of the S-200 differ somewhat from the Taser X-26.
Federal, State, and Local Laws
Because they use compressed nitrogen rather than gunpowder to propel the probes, the federal
Bureau of Alcohol, Tobacco, Firearms, and Explosives (ATF) does not classify the Taser® as a
firearm; therefore, their sale to civilians is not subject to federal restrictions. The Transportation

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Safety Administration prohibits airline passengers from possessing Tasers®, but can authorize their
use by trained flight crew members.
Outside of the realm of law enforcement, at least 43 states allow civilians to purchase Tasers®,
based on variable state statutes or local ordinances.4 Some jurisdictions regulate CEDs as firearms
or restrict where such devices can be carried. The issue of CED availability and potential use by
civilians is not further examined in this report.
POLICIES AND PROCEDURES RELATED TO USE OF FORCE, INCLUDING TASERS®
Police officers are legally and morally required to use the lowest level of force necessary to control
a situation and to deescalate at the earliest opportunity. Use-of-force policies are based on a
continuum that provides various recommended options when encountering a subject based on the
subject’s actions and the officer’s perception of the situation. Subject actions are classified as: (1)
compliant; (2) passive resistance; (3) active resistance; (4) assault causing physical injury; or (5)
assault that could cause serious physical injury or death. A model (continuum) for use-of-force
options has been developed by the Federal Law Enforcement Training Center (FLETC),
Department of Homeland Security.5,6 When confronted with the potential for serious physical
injury or death, police officers can respond with lethal force (i.e., firearms). The use of firearms
under such circumstances is associated with a subject mortality of approximately 50%. Thus,
alternatives to lethal force and better methods to subdue individuals that limit injuries and death are
important tools.
Some semantic confusion exists regarding the classification of CEDs. The Department of Justice’s
National Institute of Justice (NIJ) classifies CEDs as a “less-lethal” technology. The NIJ defines a
less-lethal weapon as “any apprehension or restraint device that, when used as designed and
intended, has less potential for causing death or serious injury than conventional police weapons.”7
Such weapons (i.e., CEDS, chemical sprays, blunt force projectiles, directed energy devices) are
designed to temporarily incapacitate or restrain an individual when lethal force is not appropriate.
The ideal less-lethal weapon incapacitates a potentially dangerous person to facilitate his or her
safe arrest, with only minimal risk of injury or death to the subject, law enforcement personnel, or
bystanders. Others classify CEDs as a “less-than-lethal” weapon, which implies that use ordinarily
will not result in lethality, but that a greater likelihood of serious bodily injury or death exists
compared with “non-lethal” interventions.8,9
Although many law enforcement agencies rely on the FLETC continuum for training and decisionmaking in the field, a report issued by the General Accounting Office in 2005 found that the
threshold at which Taser® use is deemed appropriate varied among police departments.5 Some
departments restricted its use to situations involving harmful assault or serious threats to oneself or
others, while others permitted Taser® deployment at much lower thresholds; for example, on
subjects who were “passively resisting” by not responding to lawful verbal commands of the
officer. Training and recertification requirements for Taser® use also varied among police
departments.
Guidelines for CED Use
Law enforcement agencies attempt to ensure proper deployment of CEDs by establishing and
employing use-of-force policies, training requirements, operational protocols, and safety
procedures. Because questions have been raised about the patterns of CED use and whether their
use poses significant health risks, many related issues have emerged among law enforcement
agencies. These include appropriate placement of CEDs on the use-of-force continuum; activation

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parameters involving at-risk populations (see below); training questions, including mandatory
exposure of officers to these devices; risks for injury and death in exposed subjects; and policies
and procedures that are necessary to better ensure safe encounters between police officers and
criminal suspects. Accordingly, detailed national guidelines, containing more than 50 provisions
for CED use, have been developed by the U.S. Department of Justice and Police Executive
Research Forum to inform officers on their appropriate deployment within the use-of-force
continuum.10
The discussion below focuses on research that has been conducted on the physiologic effects of
CEDs in animals and humans, their effects on subjects who have been targeted, and information
relevant to their impact (after deployment) on police injuries and the use of lethal force.
PHYSIOLOGIC EFFECTS: ANIMAL MODELS AND HUMAN SUBJECTS
The occurrence of sudden deaths in close proximity to CED use immediately raised speculation
about their potential direct effects on cardiac and respiratory function.
Cardiac Effects
Several studies on the cardiac effects of Tasers® have been conducted in anesthetized, ventilated
swine models, both by industry-sponsored and independent investigators. Standard Taser®
discharges are largely ineffective in generating ventricular fibrillation in the swine model,11 and
other studies support the view that a large safety factor, proportional to body mass, exists for
inducing ventricular fibrillation.12,13 Other studies have demonstrated the ability of Tasers® (or
devices modified to generate Taser-like waveforms) to provoke ventricular tachycardia, and rarely,
ventricular fibrillation. Ventricular arrhythmias typically are provoked only with prolonged
discharges and electrode placements that bracket the heart, ensuring a transcardiac path.14-17
Standard Taser® discharge can induce capture of implantable pacemakers and provoke discharge
of implantable defibrillators in swine models, but sustained arrhythmias generally do not occur
under such conditions.18,19 These results have led some to hypothesize that thin stature and chest
impalement may lower the safety margin for Taser® discharges in human subjects.7
Because they have a heart-body weight ratio and general cardiac anatomy similar to that of
humans, swine have been used in the testing and development of pacemakers and implantable
cardiac defibrillators. However, swine have a relatively low threshold for ventricular fibrillation,
in part, because their Purkinje fibers cross the entire ventricular wall, in contrast to human hearts in
which these fibers are largely confined to a thin layer in the endocardium. Additionally, the
cardiac impulse proceeds from the epicardium to the endocardium in swine, potentially increasing
their sensitivity to externally applied electrical currents compared with humans. These differences
diminish the relevance of this model for evaluating the safety of CED exposure in humans.20
Theoretical modeling suggests that Tasers® are extremely unlikely to directly trigger cardiac
arrhythmias in humans.21 Experimental human studies have examined the cardiac and metabolic
safety of Tasers®, largely using limited duration discharges applied to the dorsum of healthy,
resting volunteers. In such subjects, a 2- to 10-second Taser® discharge provokes a modest
increase in heart rate (generally already high due to anticipatory anxiety) and changes in the PR
and QT interval that are not clinically significant.22-26 Additionally, short-lived increases in minute
ventilation and tidal volume occur, accompanied by small changes in serum lactate, bicarbonate
and creatine kinase (at varying time points), but no clinically significant changes in systemic pH or
electrolyte balance. Similarly, a 15-second discharge from a Taser X-26 does not increase the core
body temperature of resting, non-environmentally stressed adult subjects.27 Furthermore, no

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evidence of dysrhythmia or myocardial ischemia is apparent, even when the barbs are positioned
on the thorax and cardiac apex.23 Case reports indicate that standard Taser® discharges induce
ventricular capture in patients with pacemakers, and also can capture, but do not trigger the
discharge of implantable cardiac defibrillators.28,29 Whether the pacemaker is signaling that
Tasers® induce ventricular capture, or whether the pacemaker is simply capturing the electrical
train of the Taser® pulse is not established.
Although CED activation in normal volunteers appears to be very safe, these studies do not
sufficiently reproduce the risks of Taser® exposure among criminal suspects, in whom coexisting
medical and psychiatric conditions, alcohol and drug use, and other factors are often present.
Human volunteers report that CED exposure is an extremely unpleasant experience, inducing both
physiologic and psychological stress. Some experimental studies have begun to address these
confounding factors. For example, preliminary reports of CED exposure in healthy volunteers
designed to simulate (to a degree) the physiologic effects of fleeing from or struggling with police
officers suggest that changes in systemic pH, lactate, and other markers are comparable to those
associated with exercise of the same duration.30-33 Such studies cannot fully evaluate the responses
of individuals who are confrontational, have taken drugs, or are desperate for escape, highly
agitated, and combative.
MORBIDITY AND MORTALITY
The emerging relevance of Taser® use for emergency room care was noted almost 25 years ago.34
Despite the designation of the Taser® as a less lethal, or less-than-lethal weapon, Amnesty
International has catalogued a temporal association between the use of CEDs and more than 330 incustody sudden deaths in North America between June 2001 and August 2008, all involving M-26
or X-26 Tasers®.1 Therefore, some debate still centers on whether to describe CEDs as non-lethal,
less-than-lethal, or less lethal, and as impact or non-impact weapons. Because CEDs have been
deployed at lower thresholds on the use-of-force continuum, deaths occurring in association with
their use make the safety and deployment of CEDs a significant public health issue.
Most but not all studies undertaken by law enforcement agencies (and others) indicate that
deploying CEDs relative to other use-of-force options such as pepper spray, physical force, police
dogs, and batons reduces injuries to officers and suspects and reduces the use of lethal force.8,35-40
CED activation also has recognized risks. For example, a potential exists for the probes to
penetrate vulnerable parts of the body such as the eyes, mouth, head, or genitals, or large vessels in
the neck and groin region. The strong muscle contractions induced by CEDs cause falls and
impact-related injuries (e.g., fractures and head injuries), particularly in elderly individuals or
pregnant women. Because experimental studies are inherently limited, epidemiologic and
prospective investigations during actual weapon use are vitally important in conducting a realistic
risk assessment of these weapons.
Mortality
Arrest-related deaths are not new and predate the deployment of CEDs. Initial studies on early
CED weapons concluded that their association with in-custody deaths shared characteristics (to a
large degree) with other in-custody deaths. Deceased subjects had a high prevalence of alcohol or
other drug use, especially stimulants or phencyclidine (PCP), were agitated or exhibited otherwise
bizarre behavior, engaged in intense physical struggle, and were subjected to various types of
physical restraint.41-43

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In 43% of autopsy reports reviewed by Amnesty International, the deceased had been shocked in
the chest.1 In more than half of the autopsy reports, the subjects (average age 36 years) had evident
cardiovascular disease, an incidence that is significantly higher than that occurring in the general
population of 36-year-old adult males. Some of those who died had no underlying disease or drugs
in their system, but collapsed after being subjected to repeated or prolonged shocks and/or shocks
to the chest, heightening concern that these factors may increase the risk of death or injury, even in
relatively healthy individuals. These findings led Amnesty International to call for a suspension in
the use of CEDs pending further (objective) study, or, at a minimum to “limit their use to situations
where they are immediately necessary to avoid or reduce the likelihood of recourse to firearms.”1
One case series based on a convenience sample of in-custody deaths between January 2001 and
January 2005 identified 75 deaths that were associated with Tasers®.44 Thirty-seven autopsy
reports were made available for review. This study also revealed cardiovascular disease in more
than half of the deceased subjects. Additionally, 78% had used substances, mostly stimulants, and
76% exhibited features typical of “excited delirium” (see below). Taser® use was considered a
potential or contributory cause of death in 27% of these subjects. The generalizability of this study
is limited because it was based on easily identifiable cases, was restricted to available autopsy
reports, relied on (historical) information from police reports, and lacked access to official medical
records. However, the overall findings are consistent with prior studies of restraint-related
fatalities, with the authors noting:
As has been stated elsewhere, it is likely that such pre-existing disease, when combined
with stimulant use, struggle against law enforcement, and definitive restraint maneuvers
(Taser® or otherwise), creates a high-risk situation for restraint-related fatalities.7
Similarly, the Police Executive Research Forum referred to a study it had commissioned of 118
deaths following Taser® activations, noting that “the results indicated that multiple and continuous
activations of CEDs may increase the risk of death or serious injury, and that there may be a higher
risk of death in people under the influence of drugs.”10
Excited Delirium
Although not a validated diagnostic entity in either the International Classification of Diseases or
the Diagnostic and Statistical Manual of Mental Disorders, “excited delirium” is a widely accepted
entity in forensic pathology and is cited by medical examiners to explain the sudden in-custody
deaths of individuals who are combative and in a highly agitated state.45 Excited delirium is
broadly defined as a state of agitation, excitability, paranoia, aggression, and apparent immunity to
pain, often associated with stimulant use and certain psychiatric disorders. The signs and
symptoms typically ascribed to “excited delirium” include bizarre or violent behavior,
hyperactivity, hyperthermia, confusion, great strength, sweating and removal of clothing, and
imperviousness to pain. Speculation about triggering factors include sudden and intense activation
of the sympathetic nervous system, with hyperthermia, and/or acidosis, which could trigger lifethreatening arrhythmias in susceptible individuals. Biochemical studies have shown alterations in
the function of dopamine neurons and specific gene activation products in the central nervous
system of such individuals.45 The intense pain associated with Taser® exposure, the psychological
distress of incapacitation, and hazards associated with various restraint methods also could
contribute.
Of note, one study of emergency department cases over a six-year period evaluated 216 subjects
who had been restrained in the “hobble” position; 20 of these subjects died suddenly and
unexpectedly.46 Almost all of these subjects had cardiovascular disease or were under the influence

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of a stimulant. Four had been exposed to pepper spray, three to CEDs, and two had both
exposures. The authors concluded that “such individuals are at a higher risk for sudden death,
particularly those who are obese, under the influence of stimulant drugs, or have underlying
(cardiovascular) disease.” Ongoing debate exists on whether certain forms of physical restraint
such as the “hobble” position and “hogtying” place some individuals at risk for positional asphyxia,
even in the absence of the use of pepper spray or CEDs.
Governmental Review
Widespread media attention to some Taser®-associated deaths has triggered governmental review
of their use in both Canada and the United States.5,7,47 In June 2008, the National Institute of
Justice published an interim report of its ongoing inquiry into deaths following police use of
CEDs.7 Although this interim report acknowledged the need for more research into the effects of
CEDs, it concluded that medical evidence is lacking to support the view that CEDs pose a
“significant risk” for inducing cardiac dysrhythmia when “deployed reasonably” and that law
enforcement officials “need not refrain from deploying CEDs provided the devices are used in
accordance with accepted national guidelines.”10,36 The report also urged “caution” in the use of
“multiple activations.” In its guidelines for CED use, the Police Executive Research Forum also
recommends that, following the application of a CED, officers should “use a restraint technique
that does not impair respiration.”10,36
In response to the highly publicized death of a subject in the Vancouver airport, the Canadian
House of Commons Standing Committee on Public Safety and National Security evaluated CED
use and recommended that the Royal Canadian Mounted Police restrict the use of the Taser® by
classifying it (effective no later than December 15, 2008) as an “impact weapon” rather than an
intermediate weapon, so that its “use can be authorized only in situations where the subject is
displaying assaultive behaviour or posing a threat of death or grievous bodily harm to the police,
himself or the public.”47 The Committee further advised that this restriction should not be lifted
“before independent research has indicated that use of the Taser® poses no unreasonable risk for
the subject.”
To more clearly establish the potential role of Tasers® in arrest-related deaths, the following
information would be useful: (1) total in-custody deaths (or deaths proximate to restraint); (2)
total Taser® deployments (or field applications); and (3) total in-custody deaths not involving
Taser® use. Since 2003, all U.S. law enforcement agencies are required to not only report, but also
categorize all in-custody deaths.48 During the period from 2003 to 2005, 47 states and the District
of Columbia reported 2,002 arrest-related deaths proximal to law enforcement’s use of force,
including 1,095 homicides by law enforcement personnel, 96% of which involved the use of a
firearm by the arresting officer.49 Approximately 4% of persons who died had been placed under
physical restraints. CEDs were involved in 36 arrest-related deaths during this period. In 17 of
these, the CED was causally linked to the death. This report acknowledges that the ability of CEDs
to cause death is a subject of debate, and that due to reporting gaps, these 36 cases do not represent
a complete count of all deaths in which the use of a CED was involved.
Prospective Field Evaluations
Two recent studies are instructive.50,51 One prospective, multicenter, observational study tracked a
consecutive case series of all CED weapon uses against criminal suspects at six U.S. law
enforcement agencies for three years (2005-2008).50 Physician site investigators reviewed police
and medical records to identify and classify injuries sustained by subjects after CED use. To
quality for consideration, law enforcement agencies had to use conducted electrical weapons, have

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a physician already affiliated with the agency’s tactical team with access to agency records, provide
routine pre-incarceration medical screening to all arrestees (jail intake, paramedic evaluation at the
scene, physician evaluation in hospital emergency departments), and perform mandatory use-offorce reviews after each CED use. CEDs were used against 1,201 subjects during a 36-month
period; probe mode was used in 65% of subjects, stun mode in 27%, and both modes in the
remainder. The mean number of discharges was 1.8 (median = 1).
Significant injuries (i.e., those requiring hospital admission, producing long-term disability, or that
were life threatening) occurred in three subjects (0.25%), including two intracranial injuries from
falls and one case of rhabdomyolysis. The remainder were classified as suffering minor or no
injuries. The majority of mild injuries were superficial puncture wounds from the darts, and some
blunt trauma or bruising attributable to falls. Two subjects died in police custody, but medical
examiners eliminated CED use as a causal or contributory factor in both cases. Both subjects had
struggled violently with police, and required additional restraint measures. One suffered from
cardiomyopathy and had cocaine in his system; the other was being treated for mental illness
(unspecified), and was subdued only after pepper spray application, two CED discharges, and
restraint in the prone position. The subject collapsed 5 minutes after CED discharge, and was
subsequently found to have an extremely high serum concentration of olanzapine. This outcome
was judged to be “typical of other in-custody deaths.”
The most carefully controlled prospective study involved an analysis of 426 consecutive CED
activations in the Dallas police department from November 2004 through January 2006.51 The
study established on ongoing registry of CED application (Taser® X-26) after introduction of the
device into the force continuum. All suspects who were subdued following CED activation were
evaluated by paramedics, the jail intake nurse, or a police department tactical physician. In
addition, the on-call tactical physician, if not already on the scene, was notified of the activation.
Medical review of the registry entrants ultimately was conducted by the physician-led medical
team.
One subject collapsed during transfer from the ground to the ambulance (after two standard
discharges) and subsequently died. This individual had high serum concentrations of cocaine and
metabolites and a core body temperature of > 107° F on arrival at the emergency room. No other
suspect had an injury requiring treatment other than simple first aid. In 5.4% of the deployments
the Taser® was deemed to have clearly prevented the use of lethal force. This study helps to
corroborate the safety profile for CED use when a prescribed policy is followed. The use of a
comprehensive training program likely contributed to the strong safety record in this study, as well
as the fact that police personnel knew all Taser® applications would be strictly evaluated for
compliance with established departmental use-of-force policies.
USE OF CONDUCTED ELECTRICAL DEVICES IN HEALTH CARE FACILITIES
In many hospitals security is provided by contract agencies or off-duty law enforcement personnel.
The Joint Commission standard EC.2.10 addresses security, noting: “The hospital identifies and
manages its security risks.” The Element of Performance for EC.2.10.1 states: “The hospital
develops and maintains a written management plan describing the process it implements to
effectively manage the security of patients, staff, and other people coming to the hospital’s
facilities.” Furthermore, the Joint Commission surveys hospitals to ensure that the hospital
complies with the policies that it has established based on the risk assessment for that facility.
Available personnel and security assessments vary greatly among hospitals, so a uniform Joint
Commission-based guideline on the use of CEDs in hospitals is probably not warranted.

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Concern has been expressed, as noted above, about the use of CEDs in individuals who are not
compliant with law enforcement because of existing mental health problems. Although a few
media reports of CED use in violent patients confined to mental health facilities have appeared, no
systematic review or study of CED use for controlling violent patients or their use as negative
reinforcement in uncooperative patients is available. Psychiatric facilities that accept Medicaid or
Medicare payments are not permitted to use CEDs. Regardless, CEDs should not be used for the
purpose of negative reinforcement in such patients.
SUMMARY AND CONCLUSION
Concerns about the use of CEDs fall into three general areas: (1) they are used too frequently and
at lower levels on the use-of-force continuum than indicated; (2) appropriate training and
supervision of CED use is lacking in some jurisdictions; and (3) CEDs may contribute to the death
of suspects, either directly or indirectly.
CEDs have a role to play in law enforcement and prudent use can save lives during interventions
that would otherwise involve the use of deadly force. If deployed according to an appropriate useof-force policy, and used in conjunction with a medically driven quality assurance process, Taser®
use by law enforcement officers appears to be a safe and effective tool to place uncooperative or
combative subjects into custody. Treating CEDs as “only a substitute for deadly force, would
endanger officers and negate the benefit that has been demonstrated.”8 Training protocols should
emphasize that multiple activations and continuous cycling of CEDs appear to increase the risk of
death or serious injury.10
The growing use of CEDs makes it virtually inevitable that more cases of in-custody death are
occurring in proximity to CED activation. As noted by Link and Estes, important variables
confounding Taser®-related deaths “cannot be fully investigated in retrospective reviews,
registries, or reproduced in clinical investigations.”52 The “influence of confounding clinical
factors such as excited delirium, physical restraint techniques, underlying cardiovascular disease,
hyperadrenergic states, metabolic derangements, or the influence of alcohol, stimulants, or other
drugs remains unknown in epidemiologic investigations, and uncontrollable in clinical
investigations.”
Ongoing issues include: (1) the need for clear usage guidelines, including restrictions on the
application of multiple discharges; (2) an appreciation of the potential risks of injury and death
associated with CED use and the gaps in knowledge about potential factors that affect the relative
safety of deployment, and the risks of sudden death after exposure and physical restraint; (3) the
need for independent peer-reviewed research into the safety (and usefulness) of CEDs in field
applications; and (4) the need to establish a more comprehensive national database of in-custody
deaths.
RECOMMENDATIONS
The Council on Science and Public Health recommends that the following statements be adopted in
lieu of Resolution 401(A-08) and the remainder of the report be filed:
1. That our American Medical Association establish policy that law enforcement departments and
agencies should have in place specific guidelines, rigorous training, and an accountability
system for the use of conducted electrical devices (CEDs) that is modeled after available
national guidelines. (New HOD Policy)

CSAPH Rep. 6-A-09 -- page 10
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2. That our AMA encourage additional independent research involving actual field deployment of
CEDs to better understand the risks and benefits under conditions of actual use. Federal, state,
and local agencies should accurately report and analyze the parameters of CED use in field
applications. (Directive to Take Action)
3. That our AMA establish policy that law enforcement departments and agencies have a
standardized approach to the medical evaluation, management and post-exposure monitoring of
subjects exposed to CEDs. (New HOD Policy)
Fiscal Note: Less than $500

CSAPH Rep. 6-A-09 -- page 11

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