The Journo.l of Emergency Medicine. Vol••• No••• pp. 1-7. 2011
Copyright is) 2011 American Academy of Emergency Medicine
•
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ELSEVIER

doi:10.l016/j.jemermed.2010.1~.019

~~~ Clinical

~

Reviews

EMERGENCY DEPARTMENT EVALUATION AFTER CONDUCTED ENERGY
WEAPON USE: REVIEW OF THE LITERATURE FOR THE CLINICIAN
Gary M. Vilke,

MD,*

William P.Bozeman,

MD,t

and Theodore C. Chan,

MO*

'D.epartment of Emergency Medicine, University of Cal~omla at San Diego Medical Center, San Diego. Califomia, and
.
tWake Forest University, Winston Salem. North Carolina
Reprint Address: Gary M. Vilke, MD, Department of Emergency MecflCine. UC San Diego Medical Center, 200 West Arbor Drive,
Mailcode #8676, San Diego,. CA 92103

o Abstract-Background: Conductive energy weapons
(CEWs) al'e used daily by law enfol'eement, and patients
are oCten brought to an emergency department (ED) for
medical clearance. Study Objectives: To review Ihe medical
literature on the topic of CEWs and to offer evidence-based
recommendations to Emergency Physicians for evaluation
and treatment of patients who have received a CEW exposure. Methods: A MEDLINE literature search froln 1988
to 2010 was performed and limited to human studies p»;blished from January 1988 to January 20, 2010 for English
language articles with the following keywords: TASER, conductive energy device(s), electronic weapon(s), conductive
energy weapon(s), non-lethal weapon(s), conducted energy
device(s), conducted. energy weapon(s), conductive electronic device(s), and electronic control devlce(s). Studies
identified then underwent a structured review from which
results could be evaluated. Results: There were 140 articles
on CEWs screened, and 20 appropriate articies were rigorously reviewed and recommendations given. These studies
did not report any evidence of dangerous laboratory abnormalities, physiologic changes, or.immediate or delayed cardiac ischemia or dysrhythmias after exposure to CEW
electrical discharges of up to 15 s. Conclusions: The current
medical literature does not support routine performance of
laboratory studies, electrocardiograms, or prolonged ED
observation or hospitalization for ongoing cardiac monitoring after CEW exposure in an otherwise asymptomatic
Position Paper Approved by the American Academy of Emergency Medicine Clinical Guidelines Committee

awake and alert patient.
Emergency Medicine

© 2011 American Academy of

o

Keywords-conductive energy weapons; TASER; emergency deparbncnt; treatment

INTRODUCTION
Use of conducted energy weapons (CEWs) such as the
TASER (TASER International Inc., Scottsdale, AZ) in,
cludes delivery of a series of brief electrical pulses, which
result in pain and muscular contractions. The pulses may
be delivered via a pair of sharp metal probes fired from
the device, commonly referred to as "probe mode," or
by direct contact with the front of the dcvice, commonly
referred to as "drive stun" or "touch stun" mode.
Current practice in managing patients who present to
the Emergency Department (ED) 'after being exposed to
a CEW varies from place to place and by' individual practitioners. Some hospitals have the practice of admitting
all patients who were exposed to a TASER to the hospital
for overnight telemetry monitorlhg, whereas other systems allow Emcrgcncy Medical Scrvices providers to remove the darts in the field and the police take the patient
directly to jail without ever going to an ED.
This article seeks to review the medicallilerature on
the topic of CEWs and to offer evidence-based recommendations to Emergency Physicians for evaluation and

RECEIVED: 16. August 2010; FINAL SUBMISSION RECEIVED: 9 October 2010;
ACCEPTED: 31 October 2010

EXHIBIT
48

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G. M. Vilka at al.
treatment of patients who have received a CEWexposure.
The clinical question being asked was: Do patients who
present to an ED after a CEW exposure need any specific
radiographic or laboratory evaluation or any specific
monitoring based solely because a CEW was used?
This work was done at the request of and published as
a position statement by the American Academy ofEmergency Medicine Clinical Guidelines Committee.
MATERIALS AND METHODS

Independent review of the articles as well as discus. sion and joint review by the au~ors was undertaken to answer the clinical question.. Thc references were sorted
intQ 3 categories: supportive. neutral. and opposed. A table was constructed to assign the supportive references to
the appropriate location using both the Grade'of Evidence
and' the Quality of Evidence.
Finally, recommendations were made· based on the reo'
view of the literature and assig!1ed a level of recommendation. which are defined in Table 3.

This was a structured review of the literature on the topic
of CEWs. A literature search of the National Library of
Medicine's MEDLINE database's PubMed system was
performed and limited to studies published from Janu~y
1988 to January 20, 2010 written in the English language.
Keywords used in the search were: TASER, conductive
energy device(s), electronic weapon(s), conductive energy weapon(s), non-lethal weapon(s), conducted energy
device(s), conducted energy weapon(s), conductive electronic device(s), and electronic control device(s). After
searching the articles found from these key word parameters! the Reference sections were also reviewed for
additional articles.
Studies included for the final review were limited to
randomized controlled trials, clinical trials, prospective
and retrospective cohort studies, and meta-analyses in human subjects. Case reports, case series, and general· review
articles were not included for the selection criteria for formal rigorous review. The final list of all of the articles was
assessed independently by two emergency medicine physicians to determine the c)assification of the article and
deem whether appropriate'for formal review.
. Each of the articles selected underwent a Grade of Evidence Review. Each of the selected articles was subjeCted to detailed rcview 6y all three authors. The level
of the evidence was assigned a grade using the definitions
as noted in Table 1 and were based on reference focus,
specific research design, and methodology.
Each of the selected articles was also subjected to detailed review and assigned a Quality Ranking based on
a critical assessment with regards to quality of the design
and methodology. Thi~ included Design Consideration
(e.g., focus, model structurc, prescnce of controls) and
Methodology Consideration (actual methodology utilized). The definitions of the Quality Ranking scores
are included in Table 2.

RESULTS
The findings of the original key word search in MEDLINE are noted in Table 4 under the column u# ALL references." Combining these references resulted in 140
unique articles on CEWs. From these original 140 articles, the Reference sections were also reviewed, and ,no
further novel articles were identified. It was noted that
not all articles that were captured with these key words
involved CEWs. which is why there were 145 articles
found using the key words "conductive electronic devices" but only 140 unique articles identified on. the topic.
Studies included for the final review were limited to
randomized controlled trials, 'clinical trials, prospective
and retrospective cohort studies, and meta-analyses.
The numbers of references yielded by the various search
parameters are included in the column labeled "final review" in Table 1. There were a total of20 articles deemed
appropriate for intensive critical review based on their
suspected relevance to the clinical question (1-20).
These 20 articles include: randomized controlled trials
(n:; 2). prospectivc controlled trials (n = 2), prospective
cohort studies (n 13), and retrospective cohort studies
(n == 3) (Table 5).
Table 6 includes the Grade of Evidence and the Quality of Evidence for each of the articles reviewed. The references were sorted into three categories: supportive,
neutral, and opposed. All were supportive; none were
classified as neutral or opposed.
'

=

Recommendation 1: Cardiac Monitoring and
Electrocardiogram Screening after CEW Use
Levelo/recommendation: Class A. The current human literature has not found evidence of immediate or delayed
cardiac ischemia or dysrhythmia.~ after CEW exposures.

Table 1. The Definitions of the Grades of Evidence of 1he Articles
Grade A
GradeB
GradeC
GradeD

Randomized clinical trials or meta-analyses (multiple clinical trials) or randomized clinical trials (smaller trials), directly
addressing the review issue
.
., •
Randomized clinical trials·or meta-analyses (multiple clinical trials) or randomized clinical trlal.s (smaller tnaIS).lndlrectly
addressing the review Issue
Prospective. controlled, non-randomized, cohort studies
.
Retrospective, non-randomized, cohort or case-control stUdies

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Ev~ation after CEW Use

3

Table 2. The Definitions of the Quality Ranking Scores of the Articles
Ranking
Outstanding
Good
Adequate
Poor
Unsatisfactory

Design Consideration
Present
Appropria~e

Appropriate
Adequate with possible bias
Limited or biased
Questionable/none

of up to 15 s. Therefore, the medical literature does not
support routine performance of electrocardiograms
(ECGs), prolonged ED observation, or hospitalization
for ongoing cardiac monitoring after CEW exposure in
an otherwise asymptomatic awake and alert patient
with a short duration « 15 s) o/CEWexposure.
Studies have looked for dysrhythmias during and immediately after CEW use (1,11-14,19,20). There have
been no reports of ectopy, dysrhythmia, QT
prolongation, interval changes, or other ECG changes
immediately afler CEW use. Additionally, studies have
looked at delayed monitoring findings and there have
been no changes in ECGs 60 min or longer post CEW
use (13,17,20).
Studies have also looked at serial troponin levels as
a marker of cardiac injury or ischemia. A number of stud~
ies have looked at troponin levels at 6 h post CEWactivation, and all levels except one have been normal
(12,13,15,20). The one study that showed elevated
troponin was on a healthy young male subject who
received a 5-s TASER activation (13). The troponin I
values all were < 0.3 nglmL, except a single value of 0.6
nglmL at the 24-h draw, which had been normal at the
16-h draw, and returned to normal within 8 h of the reported elevation. The subject was evaluated at the hospital

Methodology
Consideration Present

Both Com;iderations
Present

Appropriate
Appropriate
Adequate
LImited
Questionable/none

Yas, both present
No, either'present
No, either present
No, either present
No, either present·

by a cardiologist and showed no evidence of myocardfal
infarction or cardiac disability. His inpatient evaluation
included a treadmill stress test (Treadmill Myoview test
utilizing standard Bruce protocol with a double product
of 24,335 achieved) and a rest/adenosine-augmented
stress-gated tomographic myocardial perfusion study utilizing Tc99 m radiopharmaceutical injection. The results
of both tests were interpreted as normal.
Echocardiograms during CEW use have also shown no
abnormalities during activation to suggest electrical capture or'structural cardiae damage (3,11):

Recommendation 2: Laboratory Testing after CEW Use
Levelo/recommendation: Class A. The current human literature has not found evidence of dangerous laboratory
abnormalities or physiologic changes after CEW exposures of up to 15 s. Therefore, the medical literature
does not support routine performance oflaboratory studies, prolonged ED observation, or hospitalizalion for ongoing labaratory monitoring after a short duration 0/
CEWexposure « 15 s) in an otherwise asymptomatic
awake and alert patient.
Studies have not shown any clinically significant
changes in electrolyte levels or renal function in subjects
with up to 15-8 CEWactivations (9,13, l8,20):There have

Table 3. Definitions for Recommendations
Criteria for Level of
Recommendation

Level of Recommendation
Class A
Recommended with outstanding evidence

Class 6 1

•
•
•
•
•
•
•
,.
•

Class 62

• Optional or alternativc approach

ClassB
Acceptable and appropriate
with gOOd evidence

ClassC
Not acceptable or not appropriate
Class Indetenninate
Unknown

•
•
•
•

Acceptable
Safe
Useful
Established/definitive
'Accepiable
Safe
Useful
Not yet definitive
Standard approach

Unacceptable
Unsafe
Not useful
Minimal to no evidence

Mandatory Evidence
o
D

•
•
•
•
•
•
•
•
•
•
•
•

Level ME grade
Outstanding quality
Robust
All positive
Level ME grade lacking
Adequate to Good quality
Most evidence positive
No evidence of harm
Higher grades of evidence
Consistently positive
Lower grades of evidence
Generally, but not consistently, positive
No positive evidence
Evidence of hann

• Minimal to no evidence

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G. M. Vilke et al.

4
Table 4. All English-language Articles Found with the
Following Search Parameters

Search Parameter
Conductive electronic devices
TASER

Conductive energy devices
Conductive electronic device
Conductive energy device
Electronic weapon
Electronic weapons
Conducted energy weapons
Non-lethal weapons
Non-lethal weapon
Electronic control devices
Electronic control·device
Conducted energy weapon
Conductive energy weapon
Conductive energy weapons
Conducted energy device
Conducted energy devices

#I All References II Anal Review

145
137
113
112

87

o
15
4

o

4
8

70
54

8

32

6

30
22
12

11
4
3
3

o
o

o
o
o
o
1
3

DISCUSSION

3

o
o

been mild but clinically insignificant elevations in lactate
levels with CEW activations. However, these have been
demonstrated to be of a smaller magnitude relative to
other forms of physical exertion with a similar duration
(8,10,12,13,18,20).
Acid base status has been evaluated and has not shown
any significant pH shifts for a 5-1> CEW activation
(13,18,20). Similar findings with mild transient pH
shifts were noted in CEW use for longer durations of
application up to IS s (9).

Recommendation 3; Evaluation after Use
Drive Stun or Touch Stun Mode

nerves, and bones. Musclc contractions due to the CEW
may produce spinal compression fractures and other
soft tissue injuries. Falls may occur from loss of muscular
control and protective reflexes, resulting in blunt trauma.
Literature review indicates that significant injuries due to
this mechanism are rare, occurring in<O.S% of realworld deployment in subjects (2,16).
As above, routine BCG, cardiac monitoring, laboratory testing, or other forms of evaluation specific to the
electrical component of short-duration CEW use are
generally unnecessary.

0/ CEW in

Level 0/ recommendation: Class B. For patients who have
undergone drive stun or touch sllln CEW exposure, mcdical scrccning should focus on local sldn effects at the
exposure site, ~hich may include local skin irritation or
minor contact bums. This recommendation is based on
a literature review in which thousands of volunteers and
individuals in police custody have had drive stun CEWs
used with no untoward effects beyond local sldn effects.
As above, routine ECG, cardiac monitoring, laboratory testing, or other forms of evaluation specific to the
electrical component of short-duration CEW usc are
generally unnecessary.
Recommendation 4; Evaluation after Use oj CEW in
Probe Mode .
Level o/recommendation.. Class B. For patients who have
u.ndergone probe mode CEW exposure, medical screening should focus on probe penetration sites, potential
injuries due to muscle contractions, and potential trauma
due to falls. CEW probes may strike the eyes, or penetrate
skin and nearby superficial structures such as vessels,

CEWs are commonly used by police as an intermediate
force option. Civilian models of CEWs are also available
to the public. Patients may be brought to EDs for medical
evaluation after CEWexposure. The primary goal in conducting this literature search was to identify whether routine monitoring, ECG, with or without laboratory tests are
necessary for a patient who presents after receiving an
electrical discharge from a CEW.··
Our evaluation considered both techniques in which
a CEW can be used. They are the drive or touch stun
mode, and the probe mode. In the drive stun mode, the
tip of the device is placed in contact with the subject
and locally conducts energy across the two probes that
are present on the tip of the device. This mode typically
causes local painful stimuli. The other technique is the
"probe mode," which uses two shaw metal darts that
are shot from a distance into the subject or the subject's
clothing, causing cncrgy to arc a greater distance across
thc two probes. If there is enough of a probe spread, generalized muscle contraction, sometimes termed "neurom\!scular incapacitation," is produced. This may result
in the subject falling.if he or she is in a standing position.
There are case reports of injuries sustained directly from
the darts, such as ocular, skull, or genital penetration
(21,22). Other case reports of spinal compression
fractures, presumably from intcnse muscle contractions
of thc back musculature in subjects withosteopenia,
have been documented (23,24). There are no studies
demonstrating the effects on pregnant women, so
physicians will need to make clinical decisions on the
need for fetal assessment and monitoring based on the
type of CEW use, location, and patient prescntation.
As noted above, the litcraturc review for this clinical
guideline focused on studies that involved rigorous methodologies to cvaluate the physiologic effects of CEWs in
humans. We did not include specific case reports or case
serie.~ which in and of themselves cannot support any
causal connection between CEWs and physiologic
changes. We also did not include animal studies, which

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g
~
~

~

Table 5. Details of the 20 Reviewed Articles
List

#
1
2
3

4

5
6
7

8
9
10
11
12
13
14
15
16

Article Information

Grade

Quality

Bozeman WP et al. Immediate cardiovascular effects of the Taser X26 conducted electrical weapon. Ernerg Med J 2009
C Good
Bozeman WP et a!. Safety and injury profile of conducted electrical weapons used by law enforcement officers against orimlnal
0 Good
suspects. Ann Emerg Med 2009
Dawes OM et at Echocardiographlc evaluation ofTASER)(26 probe deployment into the chests of human volunteers. Am J Emerg C Good
Mad 2010
Dawes DM et al. ElectriCal characteristics of an electronic control device under a physiologic load: Ii brief report Pacing Clin
C Good
Electrophysiol 2009
'
Dawes DM et al. 15-5econd conducted electrical weapon exposure does not cause core temperature elevation in nonC Good
environmentally stressed resting adults. Forensic Sci Int 2008
Dawes D et aI. The neuroendocrine effects of the TASER X26: a brief report. Forensic Sci Int 2009
B Good
Eastman AL et at Conductive electrical devices: a prospective, population-based study of the medical safety of law enforcement
use. J Trauma 2008
'
Ho JD et aI. Prolonged TASER use on exhausted humans does not worsen markers of acidosis. Am J Ernerg Med 2009
Ho JD et al. Lactate and pH evaluation In exhausted humans with prolonged TASER)(26 exposure or continued exertion. Forensio
Scllnt2009
Ho JD et al. Absence of electrocardiographio change after prolonged appllcatJon of a conducted electrical weapon in physically
exhausted adults. J Emerg Med 2009
Ho JD et al. Echocardiographic evaluation of a TASER-X26 application in the ideal human cardiac axis. Acad Emerg M~d 2008
Ho JD e~ al. Respiratory effect at-prolonged electrical weapon application on human volunteers. ~d Emerg Med 2007
Ho JD et el. Cardiovascular and physiologic effects of conducted electrical weapon discharge in resting adults. Acad Emerg Med
2006
' .
Levine SO et at Cardiac monitoring of human subjects exposed to the taser. J Emerg Med 2007
Sloane CM et aI. Serum troponln I measurement of subjects exposed to the Taser X-26. J Emerg Med 2008
Strote J et al. Conducted electrical weapon use by law enforcement: an evaluation of safety and injury. J Trauma 2009

Filed 02/25/11 Page 5 of 7

17 VanMeenen KM et al. Cardiovascular evaluation of electronic control device exposure in law enforcement trainees: a multisite
study. J Occup Environ Med 2010
18 Vilke GM et al. Physiologic effects of the TASER after exercise. Acad Emerg Med 2009

o

Adequate

C Good
B Good

0 Good

~

Design, Size

(!)

Prospective cohort (n = 2~)
Retrospective cohort (field
use)(n = 1201)
Prospective cohort (n = 10)
Prospective cohort (n = 9)
Prospective controlled trial
'(n=32)
Prospective randomized
controlled
trial (n = 52)
Retrospective cohort (field
use) (n = 426)
Prospective cohort (n = 38)
Prospective randomized
controlled trial (n = 40)
Prospective coho,rt (n,= 25)

C Good
Prospective cohort (n = 34)
C OutstandingProspective cohort (n = 52)
C OutstandingProspective cohort (n = 66)
C Good
C Good
D Adequate
C Good

Prospective cohort (n '" 105)
Prospective cohort (n 66)
Retrospective cohort (Field
use){n = 1101)
Prospeqtive cohort (n = 118)

=

C OutstandlngProspective controlled trial
(n=25)
19 Vilke GM et aI. Twelve-lead electrocardiogram monitoring of subjects before and after voluntary expoSure to the Taser X26. Am J C Good
Prospective cohort, (n 32)
Emerg Med 2008
20 Vilke GM et al. Physiological effects of a conducted electrical weapon on human subjects. Ann Emarg Med 2007
C Outstanding Prospective cohort (ri 32)

=
=

-i
I

-i
C
;0

Z

m

;0
0'1
0
0

...lo.

I\.)

en

G. M. Vilke et al.

6
Table 6. Supportive .Evidence (Article # Referenced)
Quality/Grade
Outstanding
Good
Adequate

A

o

B

c

6,9

12,13,18,20·
1,3,4,5,8.10,11,14,15,17.19

E

F

2
7,16

Poor
Unsatisfactory

There were no neutral or opposed references.

are often more limited in .scope and have questionable
applicability to clinical human findings.
Recommendations in this review are limited to CEW
exposure durations of 15 s or less. This reflects the exposure durations commonly used in the exiSting human
literature and will apply to the large majority (> 90%)
of subject~ against whom CEWs are used by police officers. Although several reports have included exposure
durations of 20-45 s and have not demonstrated concerning cardiac or physiologic effects, collectively this small
body of literature is inadequate to support guidelines on
medical screening after longer duration exposures.
Therefore, until confirmatory studies of adequate power
are available, clinicians should use their own judgment
regarding the need for screening tests in this popUlation.
It is important to point out that these recommendations
focus solely on the issue ofCEWs and their physiologic
effects on humans. Clinical evaluation and testing ~ay
very well be warranted when evaluating patients after
CEW application, not due to the CEW exposure, but as
a result of the patient's underlying condition such as alcohol or drug intoxication, altered mental status, physical exhaustion: excited delirium, or psychiatric conditions that
precipitated the application of the CEW in the first place.

conditions like intoxication, prolonged struggling, altered
mental status, or symptoms of excited delirium syndrome
may also be present in patients exposed to CEWs, although the CEW does not seem to be the precipitating
factor. Presence of these findings should prompt additional evaluation or treatment of the.underlying condition
as clinically warranted.
For CEW activations in' the probe mode, patients
-should be screened for injuries related to the dart penetration or surface bums due to CEW ilse, as well as injuries
associated with falls and muscle contractions. Among patients who had a CEW activation in drive stun or touch
stun mode, evaluation should focus on skin manifestations, which are typically limited to surface bums, also
called signature marks.

REFERENCES
1. Bozeman WP. Barnes DG Jr, Winslow JE 3rd, Johnson IC 3rd.
2.

3.

CONCLUSIONS
The current human literature has not found evidence of
dangerous laboratory abnormalities, physiologic
changes, or immediate Of delayed cardiac ischemia or
dysrhythmias after exposure to CEW electrical discharges of up to 15 s. Therefore, the current medical literature does not support routine perfomlance of
laboratory studies, ECGs, or prolonged ED observation
or hospitalization for ongoing cardiac monitoring after
CEW exposure in an otherwise asymptomatic awake
and a lert patient.
Testin'g for cardiac conduction abnormalities or injury,
or other physiologic effects of CEWs may be appropriate
in individual cases based on medical history such as history of cardiac disease or symptoms like chest discomfort, shortness of breath, or palpitations suggestive of
cardiac issues, pain suggesting muscle contraction injuries, or prolonged CEW exposure> 15 s. Coexisting

4.
5.

6.
7.

8.
9.

10.

Phillips CR. Alson R. Immediate cardiovascular effects or the Taser
X26 conducted electrical weapon. Emerg.MOO J 2009;26:567-70.
Bozeman WP, Hauda WE 2nd. Heck JJ. Graham DD Jr, Martin BP.
Winslow JE. Safety and injury' profile of conducted electrical
weapons used by law enforcel11ent ofticers against criminal
suspects. Ann Emerg Med 2009;53:480-9.
.
Dawes DM. Ho m. Reardon RF, Miner JR. Echocardiograpnic evaluation ofTASER X26 probe deployment into the-chests of human
volunteers. Am 1 Emerg Med 2010;28;49-55.
Dawes DM. Ho lD. Kroll MW, Miner JR. Electrical characteristics
of an electronic control device under a physiologic load: a brief
report. Pacing Clin Electrophysiol 2010;33:330-6.
Dawes DM, Ho.JD, Johnson MA, Lundin E, Janchar TA. Miner JR.
IS-Second conducted electrical weapon exposure does not cause
core temperature elevation in non·environmentally stressed resting
adults. Forensic Sci InI2008;176:253-7,
Dawes D. Ho J, MinerI. The ncuroendocrine effecls of the TASER
X26: a briefrcport. Forensic Sci InI2009;lS3:14-9.
Eastman AL. Melzger JC, Pepe PE, et al. Conductive electrical
devices: a prospective, population-based study of the medical safety
oflaw enforcement use. J Trauma 2008;64:1567-12.
Ho m, Dawes DM. Bullman LL. Moscati RM. Janchar TA.
Miner JR. Prolonged TASER use on cxhau..ted humans does nol
worsen markers ofncidosis. Am J Emerg Med 2009;27:413-S.
Ho m, Dawes DM. Cole JB, HOllinger IC, Overton KG. Miner JR.
Lactate and pH evaluation in exhausted humans with prolonged
TASER X26 exposure or continued exenion. Forensic Sci Int
2009;190;80-6. .
Ho 10, Dawes DM, Heegaard WG. Calkins HG, Moscali· RM.
Miner JR. Absence of electrocardiographic change after prolonged
application of" a conducted eJeclrical weapon in physically exhausted adults. J Emerg Med 2009 May 12: IEpub ahead of printJ.

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7

11. Ho ro. DaweS DM. Reardon RF. et aI. Ecl1ocardiographic evalualion of a TASER-X26 application in the ideal buman cardiac axis.
Acad Emerg Med 2008;15:838-44.
12. Ho JD. Dawes DM. Bultman LL, et aI. Respiratory effect of prolonged electrical weapon application on human volunteers. Acad
Emerg Med 2007;14:197-201.
13. Ho ID. Miner JR. Lakireddy DR, Bultman LL, Heegaard WO. Cardiovascular and physiologic effects of conducted electrical'weapon
discharge in resting adults. Acad Emerg Med 2006;13:S89-9S.
14. Levine SD, Sloane eM, Chan TC, Dunford N, Vilke GM. Cardiac
moniloring of human subjects exposed 10 the taser. J Emerg Med
2007;33:113-7.
15. Sloane CM, Chan Te, Levine SD, Dunford IV, Neuman T.
Vilke GM. Serum tropanin'l measuremenl of subjects exposed to
the Taser X-26.1 Emert Med 2008;35:29-32.
16. StrOle I, Walsh M, Angelidis M. Basla A, Hutson HR. Conducted
electrical weapon use by law enforcement: an evaluation of safety
and injury. J Trauma 2010;68:1239-46.
17. VanMeenen KM, Cberniack NS, Bergen MT, el al. Cardiovascular
evaluation of electronic control device expOsure in law enforce·

18.
19.

20.
21.
22.
23.
24.

ment trainees: a multisite study. J Occup Environ Med 2010;52:
197-201.
Vilke OM. Sloane eM. Suffecool A, et al. Physiologic effects of the
TASER after exercise. Aead Emerg Med 2009;16:71J4....]0.
Vilkc OM, Sloane C, Levine S, Neuman T, Castillo E. Chan TC.
1Welve-lead electrocardiogram monitoring of subjects before and
after voluntary exposure to the Taser X26. Am J Emerg Med
2008;26: 1-4.
Vilke GM, Sloane CM, Bouton KD, et a!. Physiological effects of
a conducted electrical weapon on human sUhjccts. Ann Emerg
Mod 2007;50:569-75.
Rehman TV, Yonas H. Case report: intracranial penetration of
a TASER dart. Am J Emerg Mcd 2007;25:733.
Ng W. Cbehade M. Taser penetrating ocular injury. Am] OphlhalmoI200S;139:113-S.
Sloane CM. Chan Te, Vilke GM. Thoracic spine compression
fracture after TASER activation. ] Emers Med·2008;34:283-5.
Winslow JE. Bozeman WP, Fortner Me, Alson RL. Thoracic compression fractures as a result of shock from a conduc.ted energy
weapon: a case. report. Ann Emerg Mcd 2007;50:584-6.

ARTICLE SUMMARY
1. Why is this topic important?
Conductive Energy Weapons (CEWs) are used daily by
law enforcement and patients are often brought to Emergency Departments (ED) for medical clearance.
2. What does this review attempt to show?
The clinical question being asked was: Do patients who
present to an Emergency Department after a. CEW exposure need any specific radiographic or laboratory evaluation or any specific monitoring based solely because
a CEW was used?
3. What arc the key findings?
These' studies did not report any evidence of dangerous
laboratory abnormalities, physiologic changes, or
immediate or delayed cardiac ischemia or dysrhythmias
after exposure to CEW electrical discharges of up to 15
seconds.
4. How is patient care impacted?
There might be more efficient use of the emergency
department and ICU beds.

TI-TURNER50014
Case 3:10-cv-00125-RJC-DCK Document 46-13

Filed 02/25/11 Page 7 of 7