Less lethal technology: medical issues
1. Gary M. Vilke, Theodore C. Chan. Policing. Bradford: 2007. Vol. 30, Iss. 3; pg. 341

Abstract (Summary)
Purpose - Less lethal weapons have become a critical tool for law enforcement when confronting
dangerous, combative individuals in the field. The purpose of this paper is to review the medical
aspects and implications of three different types of less lethal weapons.
Design/methodology/approach - The paper conducted a comprehensive medical literature review
on blunt projectiles, irritant sprays including oleoresin capsicum (OC), and conducted energy
devices such as the Taser(TM). It reviews the history, mechanisms of action, intended and other
physiologic effects, and medical safety risks and precautions of these devices. In particular, the
paper focuses on the issue of sudden in-custody death and less lethal weapons, reviewing case
reports, animal research and human investigative studies on this topic. Findings - In general,
these three different types of less lethal weapons have been effective for their intended use. Each
type of less lethal weapon has a number of physiologic effects and specific medical issues that
must be considered when the weapon is used. There is no clear evidence that these devices are
inherently lethal, nor is there good evidence to suggest a causal link between sudden in-custody
death and the use of irritant sprays or conducted energy devices. Originality/value - While
further research on the physiologic effects of these devices is needed, this paper provides law
enforcement with a medical review of less lethal weapons including blunt projectiles, irritant
sprays such as OC, and conducted energy devices such as the Taser.
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Introduction
Less lethal weapons have been a critical tool for law enforcement use when confronting
dangerous, combative individuals in the field. Over the years, there have been many different
less lethal devices used by law enforcement officers. These weapons include impact projectile
weapons, irritant sprays and conductive energy devices (CEDs), which occupy an intermediate
level in the use of force continuum. Use of these technologies is thought to increase the safety of
both the intended target individual by avoiding the use of lethal force, as well as the officer by
facilitating the control of dangerous individuals. However, injuries and deaths have occurred
following the use of such weapons which were previously known as "less-than-lethal." At times
the injuries or deaths are directly linked to use of the devices, while in many cases, a causal link
remains controversial.

Impact or blunt projectiles include bean bags and rubber bullets. These weapons are less lethal
than firearms and allow a safe distance between the officer and subject. Irritant sprays and riot
control agents, such as tear gas, mace (CN) and oleoresin capsicum (OC), have been used by law
enforcement to facilitate compliance and temporarily incapacitate violent individuals or crowds.
CEDs such as the Taser have become increasingly popular in law enforcement as a less lethal
technology to temporarily subdue individuals. In this chapter, we review the different types of
less lethal weapons, including their history, mechanisms of action, intended and other
physiologic effects, and medical safety risks and precautions.
In addition, we review the research regarding the potential association of these devices with
sudden in-custody deaths. This report includes a review of case reports, animal research and
human research investigating this issue. In general, case reports of sudden deaths associated with
these weapons cannot determine specific causality. Findings from animal research are limited in
their applicability to humans. Even human studies investigating the physiologic effects of these
devices may be limited depending on the specific conditions of the study subjects and how
closely field conditions are replicated.
Impact projectiles
Impact projectiles are used as an alternative to standard firearm rounds when trying to disperse a
crowd from a distance or subdue a combative, dangerous individual without the use of lethal
force. Modern day impact projectile weapons were first used during the Hong Kong Riots of the
1950s and 1960s, utilizing projectiles made of wood. Similar weapons were used during conflicts
in the Northern Ireland, Israel and Palestine in the 1970s and 1980s. Early devices included hard
rubber missile-shaped projectiles that were difficult to direct, resulting in injuries to the head,
face and chest. These projectiles have evolved into PVC-type bullets, modern-day blunt rubber
bullets, and bean bag type rounds, which are currently in use by law enforcement agencies.
The action of the blunt impact projectile is to induce pain, irritation and minimal injury to the
subject without causing any life-threatening injuries. In general, all involve a blunt type impact
that can impart energies on the order of 100-200 Joules depending on the type of round and the
distance from firing. The physiologic effects of blunt impact projectiles are directly related to
anatomic location where the blunt impact projectile strikes the subject and induces blunt force
trauma to the individual.
Case reports, reviews and research studies
The majority of the medical literature on this topic is based on case reports and case series. Both
injuries and deaths have been reported with blunt impact projectiles which have caused injury by
direct penetration into the body. [72] Wawro and Hardy (2002) and Hardy report of a 56-yearold man who survived after his chest wall was penetrated by bean bag rounds fired from a 12
gauge shell at an unknown distance. Similar cases of intrathoracic bean bag penetration have
also been reported by others, including penetration with intact bean bags as well as bean bag
pellets when the bag fails ([10] Charles et al. , 2002; [22] Grange et al. , 2002). Suyama
described 25 patients evaluated for injuries related to less lethal weapons implemented during a
period of civil unrest in Cincinnati, Ohio. There were no deaths, but three patients required
admission, including one with a pulmonary contusion, one with a liver laceration and one with

an Achilles tendon rupture ([66] Suyama et al. , 2003). [14] de Brito et al. (2001) retrospectively
reviewed five years of bean bag injuries in Los Angeles County Hospital and reported on 40
patients with one death from a massive hemothorax caused by chest penetration of the projectile.
In addition to penetrating trauma, blunt impact projectiles can also cause significant injury from
blunt trauma. Chute and Smialak reported a case of a 61-year-old woman shot in the chest with a
plastic bullet (AR-1 baton round) who subsequently collapsed, suffered cardiac arrest and died.
Autopsy showed she had sustained multiple rib fractures to the left chest, an underlying lung
laceration, and heart lacerations that led to significant bleeding into the chest cavity. The cause
of death was reported as blunt force injuries of chest due to plastic bullet wound ([11] Chute and
Smialek, 1998).
Several studies have looked at the injury patterns from the use of plastic and rubber bullets.
Their conclusions all tend to show that while generally regarded as less lethal weapons,
significant injuries including death can occur when the weapons strike the chest, abdomen, or
head. Millar et al. reviewed 90 patients who had sustained injuries to various parts of their
bodies, concluding that the eyes, face, skull, bones, and brain are at greatest risk of injury from
rubber bullets. The distance at which the rubber bullets resulted in serious injury ranged from 17
to 25 meters ([45] Millar et al. , 2005). Hughes reviewed 29 cases of injuries from a new plastic
baton round in Northern Ireland. There were no fatalities, but seven patients required admission
([31] Hughes et al. , 2005). Steele retrospectively reviewed patients presenting to six hospitals
during a one-week period of civil unrest in Northern Ireland who were injured by plastic bullets.
He reported a total of 155 patients with 172 injuries, no fatalities, but 42 admissions, with three
to intensive care. Of those in intensive care, one had globe rupture and multiple facial fractures,
one had a laparotomy for three perforations of the small bowel and the third required
splenectomy for a splenic laceration ([62] Steele et al. , 1999). Ritchie and Gibbons reported on
80 subjects injured by rubber bullets, with four who died, three from ventricular dysrhythmias
secondary to cardiac contusion and one from a hemopneumothorax. An additional 19 patients
required hospitalization for significant chest wounds ([56] Ritchie and Gibbons, 1990).
Commotion cordis is a rare occurrence when a direct blow to the chest causes a sudden fatal
disturbance of cardiac rhythm in the absence of demonstrable signs of significant mechanical
injury to the heart. Although, no in-custody death cases associated with impact projectiles have
been specifically attributed to commotion cordis, blunt impact weapons generate energies that
are on the order of those that have induced commotion cordis in other situations (such as an
individual struck to the chest with a baseball). Therefore, one could speculate that these devices
would have the same risk of causing ventricular fibrillation (VF) and sudden death.
Overall, impact projectiles have been used widely and effectively as less lethal weapons. From
the medical perspective, injuries and rare deaths have been directly related to the blunt traumatic
force delivered by the projectile onto the individual. While efforts continue to focus on reducing
this risk, it is unlikely that such injuries can be completely eliminated given that these devices
are designed to deliver pain and irritation through blunt force.
Irritant sprays
Irritant sprays include agents like CN, CS, and OS (pepper spray), which can be used to disperse
large gatherings or to temporarily incapacitate individuals. These agents are commonly dispersed

as gases, smoke or aerosols, and therefore, may affect users as well as subjects.
CN was first synthesized in 1871. It was used in World War I as well as served as the primary
tear gas used by law enforcement and the military up through the 1950s. It is a colorless
crystalline substance that can be disseminated in a smoke form from an explosive device, such as
a grenade, or propelled as a liquid or powder. It acts as an irritant smoke when in contact with
skin or mucous membrane tissues such as the eyes, nasal passages, oral cavity and airway.
Symptoms of exposure include sneezing, rhinorrhea, coughing and increased airway secretions,
as well as burning sensations of the nasal passages and airways. Oral cavity and gastrointestinal
exposure can result in the sensation of burning in the mouth, increased salivation, gagging,
nausea, and vomiting. Ocular exposure to CN causes a burning sensation in the eye, injection of
the conjunctiva, eye irritation, photophobia, and tearing. Similarly, skin contact can result in
burning, irrigation, and erythema.
CS is an irritant agent first synthesized in 1928, and replaced CN as the standard riot control
irritant agent in the US Army in 1959. Because of its perceived improved effectiveness, it had
replaced CN in most law enforcement agencies in the USA by the lat 1950s as well. CS is
typically disseminated by dispersion of the powder or solution by explosion, spray or smoke.
Because of its insoluble nature, decontamination of buildings or other items after exposure can
be challenging. CS also has a high-flammability rating and has been noted to have caused some
structure fires ([13] Danto, 1987).
The clinical effects that may be seen with the use of CS are similar to those of CN, resulting in
irritation and inflammation of the skin, airways, and mucous membrane tissues on exposure. The
effects typically start within minutes of exposure and continue as long as the person is exposed
to the material. After minutes of exposure, a sensation of skin burning will typically occur,
particularly over moistened or freshly shaven areas. The degree of symptoms tends to worsen
based on concentration and duration of exposure. Increased exposure can have symptoms
progress to gagging and vomiting, more skin and mucus membrane burning and subjective
tightness in the chest. These symptoms improve after removal of the exposure and gradually
resolve over 30-60 minutes, but skin erythema may last up to several hours. However, if the
exposure is with a high concentration of CS, under high temperature or humid conditions, severe
erythema along with edema and skin vesication can occur, typically occurring within the first
hour. Tolerance to CS has been demonstrated from prolonged or repeated exposures ([52] Punte
et al. , 1963; [2] Bestwick et al. , 1972).
During the riots in Washington DC in 1968, firefighters were often exposed to CS when they
entered buildings in which the agent had been previously used. Movement around the building
and use of water hoses re-aerosolized the material, causing erythema and edema on the skin of a
number of firefighters ([54] Rengstorff and Mershon, 1969a). In workers with repeated exposure
and sensitization to CS, acquired contact dermatitis has occurred, confirmed by skin testing.
Symptoms ranged from simple erythema to large vesicles and bullae. No pulmonary symptoms
were reported ([60] Shmunes and Taylor, 1973).
OC or pepper sprays are derived from the natural oily extract of pepper plants in the genus
capsicum. The use of OC spray by law enforcement agencies increased in the 1980s as the use of
CS was on the decline, and by the 1990s, the majority of states had legalized OC spray use by

the public ([61] Smith and Greaves, 2002). Concentrations of OC may range from 1 to 15
percent, with the commercially available OC typically being about 1 percent in concentration.
Delivery modes include liquid stream spray, aerosol spray, and powder delivered as a projectile.
OC spray can cause direct irritation to the eyes, skin and mucous membranes. The onset of
symptoms is almost instantaneous, causing burning and tearing of the eyes, as well as eye spasm,
ranging from involuntary blinking to sustained closure of the eyelids. Cutaneous symptoms may
include flushing, tingling and intense burning sensation of the skin, particularly over recently
shaved areas. Mucous membrane exposure, especially of the nasal passages, will cause irritation,
rhinorrhea and congestion, with some subjects reporting nausea. Exposure of the airway and
respiratory tract to aerosolized OC causes tingling, coughing, gagging and shortness of breath, as
well as a transient laryngeal paralysis and a temporary inability to speak ([63] Steffee et al. ,
1995).
Case reports and reviews
CN and CS: A few cases of severe allergic reactions have been reported with CN, particularly
following a previous exposure. One case was reported in a military recruit who had been
previously exposed to CN 17 years earlier which manifested as minimal itching at that time.
Following a repeated exposure, he developed generalized itching, which progressed over the
next several hours to generalized erythema all parts of his body except the face portion which
had been covered by a mask. He developed a fever to 103 and by 48 hours had diffuse vesication
and edema, followed ultimately by sloughing of much of his skin, but recovered ([53] Queen and
Standler, 1941). Other cutaneous reactions have been reported as well ([40] Madden, 1951).
Thorburn reported on the medical complications associated with prolonged exposure to CN in a
prison where there were recurrent and prolonged exposures in closed spaces with limited
ventilation. Cutaneous complications included first and second degree burns. Treatment with
steroids and bronchodilators for laryngotracheo-bronchitis, inflammation of the airway, was
needed in several patients, but none reported any permanent damage. All eye complaints were
transient and required no specialized treatment, resulting in no corneal injuries or permanent
damage ([69] Thorburn, 1982).
Chapman and White reported on a prisoner who was found dead under his bunk 46 hours after a
reported prolonged CN gassing of inmates in cells with no ventilation. The deceased inmate was
found in rigor mortis and on autopsy was noted to have evidence of inflammation and damage to
his airway and lungs ([9] Chapman and White, 1978). Another reported death occurred after
closed room exposure with an estimated ten times the lethal concentration. On autopsy, there
were similar findings as with the previous case ([52] Punte et al. , 1963).
Park and Giammona report a case in which CS tear gas canisters were fired into a house
resulting in a four-month-old infant being exposed for two-to-three hours. The infant required
hospital admission for frequent suctioning of upper airway secretions and was treated with
steroids and antibiotics as well as positive pressure ventilation for respiratory distress and
wheezing. He was ultimately discharged home fully recovered after 28 days ([50] Park and
Giammona, 1972). Thomas et al. reported on nine marines involved with strenuous exercise and
exposure to CS in field training who developed a transient pulmonary syndrome. They presented
with cough, shortness of breath, hemoptysis and hypoxia, with some requiring close monitoring

and treatment for hypoxia, but all nine recovered and demonstrated normal lung function within
a week after the exposure ([68] Thomas et al. , 2002). Hu reported a case of exposure in an
asthmatic who developed semi-chronic symptoms of cough and shortness of breath for up to two
years after the exposure. Her FEV1 (Forced Expiratory Volume in 1 second) at four weeks post
exposure was 62 percent of predicted and her forced vital capacity was 78 percent. At one and a
half years after exposure, her FEV1 was 128 percent of predicted, with a 16 percent drop with
brisk exercise in cool air ([30] Hu and Christiani, 1992). Based on the report, it is difficult to
determine if her subjective symptoms of dyspnea were related to her underlying chronic asthma
rather than the CS exposure.
The use of CS has resulted in reports of eye injuries, particularly when a tear gas cartridge is
discharged at close range. In some cases, particles of agglomerated CS were driven into the eye
tissue by the force of the dispersion device, typically a blast. In these cases, chemical reaction
damage of the cornea was noted over the course of months to year, which are characteristically
different than blast injuries from particles other than CS ([36] Levine and Stahl, 1968).
OC: Since, OC spray is commonly used by many law enforcement agencies, there are many case
reports and case series of deaths and injuries following OC use ([63] Steffee et al. , 1995; [21]
Granfield et al. , 1994; [51] Pollanen et al. , 1998; [47] O'Halloran and Frank, 2000). Amnesty
International claims that over 90 persons have died after exposure to pepper spray in the USA
since the early 1990s ([1] Amnesty International, 2005). [21] Granfield et al. (1994) reported 30
cases of in-custody death following OC exposure, in which drugs and underlying natural
diseases were a significant factor in a majority of these cases. [47] O'Halloran and Frank (2000)
reported of 21 cases of restraint in-custody death, of which ten of the restraint episodes were
preceded by use of OC spray, and [51] Pollanen et al. (1998) reported 21 in-custody restraint
deaths of which four had been sprayed with OC.
However, a causal connection between OC exposure and death remains controversial. There is
no definitive evidence that OC is inherently lethal. In almost all of these cases of reported deaths
associated with OC, the OC spray was determined not to have been the cause of death, with the
exception of only one case. In that patient, Steffee et al. reported that a person who had a history
of asthma and was sprayed with OC spray 10-15 times suffered a sudden cardio-respiratory
arrest. Autopsy revealed severe epithelial lung damage with the cause of death attributed to
severe bronchospasm probably precipitated by the use of pepper spray ([63] Steffee et al. ,
1995).
Billmire described a four-week old healthy infant who was sprayed in the face with a 5 percent
OC spray when a key chain self-defense canister accidentally discharged. The child had sudden
onset of gasping respirations, epistaxis, apnea, and cyanosis. The child required mechanical
ventilation and extraocorporeal membrane oxygen support. The child was discharged home after
a 13-day hospitalization ([3] Billmire et al. , 1996). An 11-year-old boy required intubation and
ventilation four hours after exposure for severe croup (upper airway inflammation) that resulted
from intentional inhalation of OC spray. He was extubated two days later and recovered
uneventfully ([73] Winograd, 1997).
Since, OC is typically directed towards the face, symptoms often involve the eyes. Corneal
abrasions have been reported in up to 7 percent by [71] Watson et al. (1996) and 8.6 percent of

cases by [7] Brown et al. (2000). These findings have been noted as transient and do not require
any additional treatment beyond decontamination with water irrigation. These temporary ocular
injuries were also reported by [70] Vesaluoma et al. (2000).
Research studies
CN and CS: There is limited human research on the risks of CN in terms of inducing disability or
death. Although permanent eye damage has been reported associate with the use of CN at close
range, it is challenging to separate out whether the damage is from the CN or the actual weapon.
However, at harassing or standard field concentrations, there is no evidence that CN causes
permanent eye injury. Holland performed human studies in which 0.5 milligram of CN placed on
subjects' skin for 60 minutes caused irritation and erythema, as compared with CS which had no
effects when used in amounts of less than 20 milligram. Skin vesication was seen with the same
dose of CN when the skin was moist, whereas no vesication occurred with CS at levels of 30
milligram or less ([29] Holland and White, 1972).
There is little evidence that CS results in any permanent lung damage even after several
exposures to field concentrations ([4] Blain, 2003). In 36 subjects exposed to CS, [2] Bestwick et
al. (1972) found no change in tidal volume, peak flow or vital capacity when comparing preexposure values to those measured immediately afterward and at 24 hours post-exposure. In
another study on human subjects, [52] Punte et al. (1963) reported that individuals subjected to
daily exposures to CS showed no changes in airway resistance immediately following, as four or
ten days after CS exposure.
In terms of other types if injuries, human studies have been performed to assess the effects of CS
on skin using different concentrations and assessing the effects of various ambient temperatures
and humidity levels. Subjects developed first and second degree burns at different levels and the
authors concluded that many variables affect the likelihood of blistering, making risk assessment
difficult to predict ([26], [27] Hellreich et al. , 1967, 1969). Human ocular exposures of 0.1 or
0.25 percent CS carried in different solutions caused the inability to open the eyes for 10-135
seconds. Evaluation after the exposure via slit lamp examination noted a transient conjunctivitis,
but no corneal damage ([54], [55] Rengstorff and Mershon, 1969a, b).
OC: Because of its ability to block pain sensation and itching, capsaicin has been studied in
many different clinical conditions including treatment of psoriasis, osteoarthritis, post-herpetic
neuralgia, and diabetic neuropathy. These capsaicin-related pharmacotherapies have typically
been associated with topical application of the agent. Given its ability to induce cough, capsaicin
has also been utilized to study the cough reflex and the pulmonary system, as well as to assess
the efficacy of various cough suppressants ([18] Foster et al. , 1991).
Some animal and in-vitro human tissue studies have suggested that capsaicin increases airway
resistance and bronchoconstriction ([38] Lundberg et al. , 1983; [24] Hansson et al. , 1992).
However, clinical studies in humans with nebulized capsaicin are less definitive. Fuller reported
that inhaled nebulized capsaicin resulted in a temporary increase in airway resistance that was
dose-dependent, maximal at 20 seconds, and lasting less than 60 seconds ([19] Fuller et al. ,
1985). [5] Blanc et al. (1991) and [12] Collier and Fuller (1984) both reported no significant
decrease in FEV1 in subjects who inhaled nebulized capsaicin at concentrations sufficient to
induce cough. However, direct bronchoconstriction caused by capsaicin may be masked by

cough and deep inhalation as both have bronchodilatory effects. In fact, doses of inhaled
capsaicin low enough to not induce coughing have been shown to cause changes in airway
resistance and pulmonary function ([20] Fuller, 1991; [41] Maxwell et al. , 1987; [25] Hathaway
et al. , 1993).
Unlike capsaicin, data on the human effects of OC spray are limited, particularly any
interventional data ([58] Ross and Siddle, 1996). A number of observational reports have been
published assessing safety of OC spray use, including a two-year joint study by the FBI and US
Army that reported that OC spray was not associated with any long-term health risks ([48]
Onnen, 1993).
Chan et al. conducted a randomized, cross-over controlled trial in 35 volunteer human subjects
who were exposed to either OC spray or placebo propellant without OC, followed by a ten
minute period of being placed in either the sitting or prone maximal restraint position.
Pulmonary function testing was performed and arterial blood gases sampled during this time. OC
exposure did not result in abnormal pulmonary dysfunction, hypoxemia or hypoventilation when
compared to placebo in either the sitting or restraint positions. However, there was an increase in
mean heart rate and blood pressure in subjects exposed to OC that did not occur in the placebo
group. The investigators concluded that OC spray did not result in any evidence of respiratory
compromise with and without restraint that would make place subjects at risk for asphyxiation
from OC exposure. The changes in cardiovascular parameters, however, indicated the need for
additional study ([8] Chan et al. , 2002).
Beyond clinical research in the laboratory setting, OC spray use has been widespread and a
number of epidemiologic studies have reported on its use and safety. The California State
Attorney General reported that no fatal consequences occurred in over 23,000 exposures to OC
spray. Watson et al. reviewed 908 exposures to OC spray that had occurred locally and found
that fewer than 10 percent of subjects required any medical attention, and more specifically less
than 1 percent had respiratory complaints requiring medical treatment. None of these patients
were determined to have any significant injuries. Additionally, no fatalities were reported in
either of these studies ([71] Watson et al. , 1996; [39] Lundgren, 1996).
Overall, OC spray has been used hundreds of thousands of times with no long-term health effects
reported. Although there are case reports of death following use, in the large majority of cases
other causes such as drug intoxication, excited delirium or underlying medical condition, have
been implicated as the primary cause of death in the large majority of these cases. Moreover,
clinical and epidemiologic studies on OC have yet to report any compelling evidence that OC is
inherently dangerous or lethal.
Conductive energy devices
CEDs were introduced into the law enforcement force continuum in the late 1970s. CED is a
generic term referring to any device to subdue and control an individual by delivering electrical
energy to the subject. The most well-known CED is the Taser ® (Thomas A. Swift Electric Rifle)
energy device, but others on the market include the Stinger stun gun and the remote activated
custody control (RACC) belt ® . There are other electronic belts, shields, and a host of hand-held
contact stun guns available to law enforcement. Many of these products are also available to the
general public.

In the past decade, the Taser has become the most popular incapacitating neuromuscular device
on the market with an estimated 10 percent of all police officers in this country currently
carrying the device ([23] Hamilton, 2005). According to Taser International ® , Tasers have been
purchased by over 9,000 police departments in the USA and abroad. The manufacturer asserts
that the device helps officers avoid the use of deadly force while lowering the risk of injury to
users. It has been reported that the device has been used on over 150,000 volunteers during
training sessions and on over 100,000 subjects by law enforcement officers in actual field
confrontations, though the true total number of uses is unknown ([67] Taser International, 2006).
The Taser X26 is a handheld device resembling a handgun intended to be used on subjects up to
21 feet away. The energy output of the device is 26 watts total, 1.76 joules per pulse, at 1.62
milliamps, and 50,000 volts. It utilizes an automatic timing mechanism to apply the electric
charge for 5 seconds. The device initially propels two probes at a velocity of 180 feet per second.
The electrical energy is discharged through a sequence of dampened sine-wave current pulses
each lasting about 11 microseconds. This energy is neither pure AC nor pure DC, but probably
akin to rapid fire, low amplitude DC shocks.
CEDs work by incapacitating volitional control of the body. These weapons create intense
involuntary contractions of skeletal muscle, causing subjects to lose the ability to directly control
the actions of their voluntary muscles. CEDs directly stimulate motor nerve and muscle tissue,
overriding central nervous system control and causing incapacitation regardless of the subject's
mental focus, training, size, or drug intoxication state. Subjects report painful shock-like
sensations and the feeling that all of their muscles are contracting at once. During the CED
discharge, subjects are unable to voluntarily perform motor tasks, however they remain
conscious with full memory recall.
This effect terminates as soon as the electrical discharge is halted. Immediately after the taser
shock, subjects are usually able to perform at their physical baseline. There is no known
permanent lasting effect on the muscular system aside from any injuries that may result from an
associated fall. There is a large experience of police trainees who have been tasered as part of
their training. Most reported that the experience was unpleasant and declined to be re-tasered. A
few subjects described a tingling sensation in the area under the probe sites lasting a few minutes
after being tasered ([34] Koscove, 1985). There is some residual muscle soreness reported by
some who have been tasered.
CED effects vary depending on the particular device used, body location of and distance
between the probes, and the condition of subject. For example, probes spread apart over a larger
distance on the subject's body will have a greater effect because it allows for the electrical
discharge to affect a larger portion of the body ([16] Fish and Geddes, 2001). The effects of these
devices have been reported to increase with the duration of application such that prolonged
exposures may result in some sensation of fatigue and weakness even after the discharge is
halted ([57] Robinson et al. , 1990). On the other hand, CEDs may fail to have their intended
effect if the probes do not make adequate contact with the body, the probe spread is not wide
enough thereby only affecting local muscle groups, or if the device fails to discharge.
Case reports and reviews

There has been a great deal of publicity in the lay press recently regarding in-custody deaths in
subjects following use of the Taser ([23] Hamilton, 2005). Amnesty International claims that
more than 70 persons have died after Taser deployment by law enforcement. Some have
postulated that the electrical discharge of CEDs on the body can induce life-threatening heart
conduction abnormalities or cardiac dysrhythmias, disrupt normal respiration or cause metabolic
derangements that could lead to death. However, there is limited research on the direct
physiologic effects of CEDs and a direct causal connection between CEDs and the reported
fatalities remains controversial.
Kornblum and Reddy examined 16 deaths that were associated with Taser use over a five-year
period. All of these cases involved young men with a history of drug abuse who were behaving
in a bizarre or unusual fashion drawing police attention. The ultimate cause of death was
determined to be drug overdose in the majority of cases. The authors suggest that most of the
subjects died after being in a manic, agitated, combative state, known as agitated delirium. Drug
intoxication itself caused or predisposed the subjects to have increased risk for sudden death, and
that the taser was not likely the causative factor. There was one case, however, in which Taser
was felt to be contributory. In this case, the subject had a history of cardiac disease, for which he
had been told to get a pacemaker, but had not done so. On autopsy he had a diseased heart and
lethal levels of PCP in his system, but the cause of death was listed as cardiac arrhythmia due to
sick sinus syndrome, mitral valve prolapse, and electrical (Taser) stimulation while under the
influence of PCP ([33] Kornblum and Reddy, 1991). Overall, the authors of the report concluded
that the Taser in and of itself did not cause death, but may have contributed in this one case.
In a prospective case review conducted by Ordog in Los Angeles in the mid-1980s, 218 patients
who presented to the emergency department after being shot with a taser were evaluated. These
patients were then compared with 22 similar patients who were shot by police with 0.38 caliber
handguns during the same time period. In 76 percent of the cases in which the Taser was
utilized, subjects displaying bizarre and uncontrollable behavior. Ninety-five percent were men
and 86 percent had a history of recent phencyclidine (PCP) use. The mortality rate in the taser
group in this study was 1.4 percent (3 of 218 patients) and the morbidity rate was 0 percent. All
three patients who died arrived to the emergency department in asystole, had high levels of PCP
in their system and went into cardiac arrest shortly after being tasered, ranging anywhere from 5
to 25 minutes after taser deployment. The medical examiner's reports on all three cases listed
PCP toxicity as the cause of death, with no signs of myocardial damage, airway obstruction, or
other fatal pathologic findings. Of the 22 patients shot with the 0.38 special, 50 percent of died
and 50 percent had varying degrees of serious morbidity ([49] Ordog et al. , 1987).
Strote et al. evaluated deaths associated with Taser use found via a search of Lexus-Nexus and
Google. They identified 71 deaths associated with Taser use, with 28 (39 percent) having
autopsy reports available. The average age was 34.8 years, all were male, and 39 percent were
White, 46 percent were Black and 14 percent were Hispanic. No deaths were found to occur
directly because of Taser use, but 21 percent reported a possible contributory component. Causes
of death was felt to be directly drug related in 57 percent of cases, with 68 percent of the cases
having cocaine or methamphetamine use. Excited delirium was either directly or indirectly
responsible in 57 percent of cases and 46 percent of cases had significant pre-existing cardiac
disease reported ([65] Strote et al. , 2005).

Mehl reported a case of a miscarriage in a 32-year-old pregnant woman at approximately 8-10
weeks gestation one week after she had received a Taser activation. One probe lodged above the
uterus in the abdomen, and the other in the left thigh. Reports of the duration of shock varied
from 3 to 10 seconds. She fell to the ground and was reportedly unable to move for 5 minutes
afterwards. One day later she began having vaginal spotting that continued for 7 days and was
subsequently diagnosed with an incomplete miscarriage. Pathology analysis of the tissue from a
uterine curettage revealed products of conception with extensive hemorrhage, necrosis, and
inflammation. Though a temporal relationship is suggested between the Taser activation and
miscarriage, no clear cause and effect relationship can be established ([44] Mehl, 1992).
Research
Human research on the effects and safety of CEDs is limited, with most physiologic
investigations having been conducted in animal models. One of the reasons for the limited
human studies is the requirement that such studies be approved by local human research
protections committees, which are often wary of these devices because of preconceived notions
based on media and press reports. In fact, the approval of the original devices were not based on
actual human or animal studies, but rather theoretical calculations of the physical effects of
dampened sinusoidal pulses, for which the US Consumer Product Safety Commission concluded
that the taser should not be lethal to a normal healthy person ([46] Obrien, 1991).
One of the more common concerns regarding CEDs is whether these devices can cause cardiac
dysrhythmias or cardiac standstill. The development of dysrhythmias or standstill would then
cause the heart to not pump blood to the rest of the body, resulting in sudden death. The two
main cardiac rhythm disturbances that are of greatest concern are VF, which is the lack of
organized electrical activity and contraction of heart muscle cells, and asystole, which is the
absence of any electrical activity.
For externally applied current, the fibrillatory current (the current that produces VF 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 and the timing in the cardiac cycle during which the current is
applied ([34] Koscove, 1985; [15] Ferris et al. , 1936; [35] Kouwenhoven et al. , 1959). The
threshold for VF in men for externally applied, 60 Hertz current has been proposed to be 500
milliamps for shocks of less than 200 microseconds duration, and 50 milliamps for shocks of
more than two seconds ([34] Koscove, 1985). The longer a current flows, the greater the chance
a shock will occur during the vulnerable part of the cardiac cycle (early ventricular
repolarization which is approximately 10-20 percent of the cardiac cycle) ([17] Forrest et al. ,
1992). The Taser X26 carries a current of 2.1 milliamps for a duration of 0.0004 seconds ([67]
Taser International, 2006).
Additionally, resistance is also going to play a role into how much current actually flows for a
given voltage (voltage = current × resistance). The lower the resistance, the larger the current
that will flow. The total resistance of the body is the sum of internal resistance plus twice the
skin resistance as current enters and exits the body ([17] Forrest et al. , 1992). A skin effect is
known to exist when high-frequency electricity is used as these currents tend to stay near the
surface of a conductor. Since, the Taser devices use very high-frequency electricity, the output of
the Taser is believed to stay near the skin and muscle surface of the body and not penetrate

deeply to the internal organs, such as the heart ([6] Bleetman et al. , 2004).
A porcine study published by Roy in 1989 used an older model stun gun that produced high
voltages (>100,000 volts) and short duration pulses (<20 microseconds). The investigators
compared five different models of stun gun with varying energies. The average value of the
current applied during each shock was calculated to be 3.8 milliamps. When towels were placed
between the skin and the electrodes to simulate clothing, the maximum current spike was 190
milliamps with a pulse length of 20 microseconds. Using two anesthetized normal healthy pigs,
the investigators were able to induce VF when the leads of the stun gun were applied directly to
the heart or to the chest of one of the animals in which a cardiac pacemaker had been implanted.
Important to note was that these adverse effects were immediate, not delayed. The authors
surmised that the mechanism of action inciting VF was not pacemaker inhibition, but rather
fibrillatory current directly accessing the heart via the pacemaker leads. This device's shock also
produced cardiac standstill when applied through layers of simulated clothing over a prolonged
period. However, these findings only occurred with the two stun gun models delivering the
highest energy. There were no cardiac effects seen with the lower energy units. This study
demonstrated that VF was indeed possible, but only at very high-energy outputs and when the
electrical discharge occurred directly over or with direct access to the heart ([59] Roy and
Podgorski, 1989).
More recently, McDaniels and Stratbucker studied the Air Taser and Advanced Taser M26 in
five anesthetized dogs with an average weight of 54 pounds. Over 200 electrical discharges of
the devices placed directly over the chest failed to induce VF in any of the animals. The authors
did note that when both probes were placed directly over the heart they were able to pace the
heart similar to a pacemaker, but still did not induce VF ([43] McDaniel et al. , 2000).
Stracbucker et al. studied 13 adult domestic pigs by applying Taser-like electrical discharge to
the thorax similar to human use of the device, and then gradually increased the energy output
above that level until VF was achieved. The investigators did not induce VF in the pigs until
levels of energy 20 times that of the standard Taser level. When using energy levels below that
threshold, 43/43 discharges did not induce VF ([64] Stracbucker et al. , 2003).
In another animal study, McDaniel et al. evaluated the cardiac effects on nine pigs shocked using
a device that delivered an electrical discharge identical in waveform and charge to the Taser X26
device. The electrodes were placed across the thorax of the animals using the barbs that matched
the probes used by the standard device. The animals were shocked for 5 seconds, simulating field
use of the device. The study used gradually increasing amounts of charge delivered to identify
two levels. The first being the lowest amount of charge required to induce VF at least once,
called the VF threshold. The second defined as the highest discharge that could be applied five
times without inducing VF called the maximum safe level. The authors then compared this value
to the standard device discharge and the ratio of the two values to determine the safety index.
The study found that the electrical discharge required to induce VF was 15 to 42 times the
energy output of a standard Taser discharge. This safety factor increased with the size and
weight of the subject. The conclusion of the authors was that discharge levels output by fielded
Taser devices have an extremely low probability of inducing VF ([42] McDaniel et al. , 2005).
In one of very few studies in human subjects, Levine et al. conducted a study monitoring 67

subjects electrocardiographically immediately before and after Taser shock during police
training sessions. The investigators reported no changes in cardiac rhythm, ECG morphology, or
presence aberrantly conducted beats following the taser discharge. Mean heart rate increased by
just over 19.4 beats/minute following the taser shock, but no abnormal cardiac dysrhythmias
were identified ([37] Levine et al. , 2005).
Recently, Ho et al. evaluated 66 volunteer subjects who received a standard five second Taser
activation at a training course. The authors obtained venous blood samples before, immediately
after, and 16 hours and 24 hours after activation. The blood samples were analyzed for troponin,
myoglobin, lactate, potassium, glucose, blood urea nitrogen, creatinine, and creatine kinase
levels. There were no significant changes from baseline values of the electrolyte or blood
urea/creatinine ratio. There was an increase in the serum bicarbonate and creatinine kinase levels
at 16 and 24 hours. Serum myoglobin levels were elevated at all three time intervals post-Taser
activation, but the troponin levels all remained < 0.3 nanograms per millilitre except for a single
24 hour post exposure level. That subject was evaluated at a hospital by a cardiologist, with no
evidence of myocardial infarction or cardiac disability found. The troponin level returned to
normal eight hours later ([28] Ho et al. , 2006).
The potential for life-threatening cardiac dysrhythmias or cardiac muscle damage to occur as a
result of the electrical discharge from current Taser devices appears to be low based on the
available studies. However, there may be theoretical risks to patients with pacemakers or
underlying cardiac disease, and the effect of recurrent or prolonged taser discharges remains
unclear.
To date, little research has been conducted on the non-cardiac effects of the Taser. An air force
study published by Jauchem et al. investigated the metabolic effects of repeated taser activations
on sedated swine that received five-second Taser activations alternating with five seconds of rest
for three continuous minutes. The animals demonstrated transient, clinically insignificant
increases in potassium and sodium, a significant decrease in blood pH (increase in acid level)
that returned toward normal after 1 hour, a significant rise in blood lactate that returned to
baseline after 2 hours, and a significant rise in whole blood pCO2 that returned to baseline after
1 hour. The correlation of these results to use in humans, where far fewer applications are
utilized, is unknown ([32] Jauchem et al. , 2005).
More recently, the respiratory effects of the Taser were studied in 32 human subjects who
underwent a 5 second Taser discharge. In this study, pulmonary function, ventilation,
oxygenation and carbon dioxide elimination were monitored in human volunteers up to 1 hour
after the Taser shock. Overall, ventilation and respiratory rate actually increased during the first
10 minutes, then returned to baseline levels. The subjects did continue to breathe during the 5
second shock. There was no evidence of abnormally low oxygen or elevated carbon dioxide
levels in the blood following the shock, suggesting the Taser had no detrimental impact on
respiratory function (Chan, SAEM 2007). The effect of Taser discharges on neurologic function
remain to be studied.
Conclusion
Impact projectiles, irritant spray agents, and CEDs are important in the use of force
armamentarium for law enforcement when dealing with violent, combative individuals who

place themselves and the general public at risk. While associated with rare cases of sudden incustody deaths, it is unclear what causal connection may exist between these less lethal
technologies and reported fatalities. In many instances, individuals were in conditions which
placed them at high risk for sudden death regardless of what force was utilized. In addition, a
combination of force methods may have been utilized in these cases. Further, research is needed
to study the impact of these weapons on human physiology, as well as the underlying condition
of those individuals who come in contact with law enforcement and are at greatest risk.
American Journal of Forensic Medicine and Pahtology
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[Appendix]
About the authors
Gary M. Vilke is a Professor of Clinical Medicine and Director of Clinical Research in the
Department of Emergency Medicine at the University of California, San Diego. He is the former
Medical Director for Emergency Medical Services at the County of San Diego. He has authored
numerous publications and original research studies on less lethal weapons including Oleoresin
capsicum spray and conducted energy devices. Gary M. Vilke is the corresponding author and
can be contacted at: gmvilke@ucsd.edu
Theodore C. Chan is a Professor of Clinical Medicine and the Medical Director for the
Department of Emergency Medicine at the University of California, San Diego. He has authored
numerous publications and original research studies on less lethal weapons, and is co-editor of
the text, Sudden Deaths in Custody .

[Author Affiliation]
Gary M. Vilke, Department of Emergency Medicine, San Diego Medical Center, University of
California, San Diego, California, USA
Theodore C. Chan, Department of Emergency Medicine, San Diego Medical Center, University
of California, San Diego, California, USA