Advertisement

Forensic Science, Medicine and Pathology

, Volume 14, Issue 3, pp 358–366 | Cite as

Cardiac and skeletal muscle effects of electrical weapons

A review of human and animal studies
  • Sebastian N. Kunz
  • Hugh Calkins
  • Jiri Adamec
  • Mark W. Kroll
Review

Abstract

Conducted Electrical Weapons (CEWs) are being used as the preferred non-lethal force option for police and special forces worldwide. This new technology challenges an exposed opponent similarly to the way they would be challenged by physical exercise combined with emotional stress. While adrenergic and metabolic effects have been meta-analyzed and reviewed, there has been no systematic review of the effects of CEWs on skeletal and cardiac muscle. A systematic and careful search of the MedLine database was performed to find publications describing pathophysiological cardiac and skeletal muscle effects of CEWs. For skeletal muscle effects, we analyzed all publications providing changes in creatine kinase, myoglobin and potassium. For cardiac effects, we analyzed reported troponin changes and arrhythmias related to short dart-to-heart-distances. Conducted electrical weapons satisfy all relevant electrical safety standards and there are, to date, no proven electrocution incidents caused by CEWs. A potential cardiovascular risk has been recognized by some of the experimental animal data. The effects on the heart appear to be limited to instances when there is a short dart-to-heart-distance. The effect on the skeletal muscle system appears to be negligible. A responsible use of a CEW on a healthy adult, within the guidelines proposed by the manufacturer, does not imply a significant health risk for that healthy adult.

Keywords

Forensic medicine Conducted electrical weapon TASER Ventricular fibrillation Electrocution 

Notes

Compliance with ethical standards

Conflict of interest

This paper is a result of literature research, which was not funded. SNK, HC, and MWK are members of the scientific medical advisory board of Axon Int. (fka TASER). MWK also is on Axon corporate board. HC & MWK have been expert witnesses in law-enforcement litigation and HC has been an expert witness in cases of arrest related deaths involving CEWs.

J. Adamec has no conflict to declare.

References

  1. 1.
    Koscove EM. The Taser weapon: a new emergency medicine problem. Ann Emerg Med. 1985;14:1205–8.CrossRefPubMedGoogle Scholar
  2. 2.
    Stopyra JP, Winslow JE, Fitzgerald DM, Bozeman WP. Intracardiac electrocardiographic assessment of precordial TASER shocks in human subjects: a pilot study. J Forensic Legal Med. 2017;52:70–4.CrossRefGoogle Scholar
  3. 3.
    Underwriters Laboratories. UL standard for electric fence controllers. In: Laboratories U, UL69, vol UL 69, 10th ed. Northbrook: Underwriters Laboratories; 2009.Google Scholar
  4. 4.
    Nimunkar AJ, Webster JG. Safety of pulsed electric devices. Physiol Meas. 2009;30:101–14.CrossRefPubMedGoogle Scholar
  5. 5.
    International Electrotechnical Commission. Household and similar electrical appliances – Safety – IEC 60335-2-76: Particular requirements for electric fence energizers. 2.1 ed: IEC, Geneva, Switzerland; 2006.Google Scholar
  6. 6.
    Nanthakumar K, Billingsley IM, Masse S, Dorian P, Cmeron D, Chauhan VS, et al. Cardiac electrophysiological consequences of neuromuscular incapacitating device discharges. J Am Coll Cardiol. 2006;48:798–804.CrossRefPubMedGoogle Scholar
  7. 7.
    Walcott GP, Kroll MW, Ideker RE. Ventricular fibrillation threshold of rapid short pulses. Conf Proc IEEE EMBC. 2011;33:255–8.Google Scholar
  8. 8.
    Rahko PS. Evaluation of the skin-to-heart distance in the standing adult by two-dimensional echocardiography. J Am Soc Echocardiogr. 2008;21:761–4.CrossRefPubMedGoogle Scholar
  9. 9.
    Horowitz LN, Spear JF, Moore EN. Relation of the endocardial and epicardial ventricular fibrillation thresholds of the right and left ventricle. Am J Cardiol. 1981;48:698–701.CrossRefPubMedGoogle Scholar
  10. 10.
    Horowitz LN, Spear JF, Moore EN. Relationship of the endocardial and epicardial ventricular fibrillation thresholds of the right and left ventricle. Am J Cardiol. 1981;48:698–701.CrossRefPubMedGoogle Scholar
  11. 11.
    Horowitz LN, Spear JF, Josephson ME, Kastor JA, Moore EN. The effects of coronary artery disease on the ventricular fibrillation threshold in man. Circulation. 1979;60:792–7.CrossRefPubMedGoogle Scholar
  12. 12.
    Allison JS, Qin H, Dosdall DJ, Huang J, Newton JC, Smith WM, et al. The transmural activation sequence in porcine and canine left ventricle is markedly different during long-duration ventricular fibrillation. J Cardiovasc Electrophysiol. 2007;18:1306–12.CrossRefPubMedGoogle Scholar
  13. 13.
    Brave MA, Lakkireddy DR, Kroll MW. Validity of the small swine model for human electrical safety risks. Conf Proc IEEE EMBC. 2016;38:2343–8.Google Scholar
  14. 14.
    Hamlin RL, Burton RR, Leverett SD, Burns JW. Ventricular activation process in minipigs. J Electrocardiol. 1975;8:113–6.CrossRefPubMedGoogle Scholar
  15. 15.
    Kano M, Toyoshi T, Iwasaki S, Kato M, Shimizu M, Ota T. QT PRODACT: usability of miniature pigs in safety pharmacology studies: assessment for drug-induced QT interval prolongation. J Pharmacol Sci. 2005;99:501–11.CrossRefPubMedGoogle Scholar
  16. 16.
    Walcott GP, Kroll MW, Ideker RE. Ventricular fibrillation: are swine a sensitive species? J Interv Card Electrophysiol. 2015;42:83–9.CrossRefPubMedGoogle Scholar
  17. 17.
    Valentino DJ, Walter RJ, Dennis AJ, Margeta B, Starr F, Nagy KK, et al. Taser X26 discharges in swine: ventricular rhythm capture is dependent on discharge vector. J Trauma. 2008;65:1478–85. discussion 1485-77CrossRefPubMedGoogle Scholar
  18. 18.
    Geddes LA, Cabler P, Moore AG, Rosborough J, Tacker WA. Threshold 60-Hz current required for ventricular fibrillation in subjects of various body weights. IEEE Trans Biomed Eng. 1973;20:465–8.CrossRefPubMedGoogle Scholar
  19. 19.
    Han J, Garciadejalon P, Moe GK. Adrenergic effects on ventricular vulnerability. Circ Res. 1964;14:516–24.CrossRefPubMedGoogle Scholar
  20. 20.
    Papp JG, Szekeres L. Analysis of the mechanism of adrenergic actions on ventricular vulnerability. Eur J Pharmacol. 1968;3:15–26.CrossRefPubMedGoogle Scholar
  21. 21.
    Wu JY, Sun H, O'Rourke AP, Huebner SM, Rahko PS, Will JA, et al. Taser blunt probe dart-to-heart distance causing ventricular fibrillation in pigs. IEEE Trans Biomed Eng. 2008;55:2768–7.CrossRefPubMedGoogle Scholar
  22. 22.
    Lakkireddy D, Wallick D, Verma A, Ryschon K, Kowalewski W, Wazni O, et al. Cardiac effects of electrical stun guns: does position of barbs contact make a difference? Pacing Clin Electrophysiol. 2008;31:398–408.CrossRefPubMedGoogle Scholar
  23. 23.
    Lakkireddy D, Wallick D, Ryschon K, Chung MK, Butany J, Martin D, et al. Effects of cocaine intoxication on the threshold for stun gun induction of ventricular fibrillation. J Am Coll Cardiol. 2006;48:805–11.CrossRefPubMedGoogle Scholar
  24. 24.
    Kroll MW, Lakkireddy D, Rahko PS, Panescu D. Ventricular fibrillation risk estimation for conducted electrical weapons: critical convolutions. Conf Proc IEEE Eng Med Biol Soc. 2011;33:271–7.Google Scholar
  25. 25.
    Walcott GP, Kroll M, Ideker RE. Relationship of the swine to the human ventricular fibrillation threshold. J Interv Card Electrophysiol. 2015;42:83–9.CrossRefPubMedGoogle Scholar
  26. 26.
    Panescu D, Kroll M, Brave M. Cardiac fibrillation risks with TASER conducted electrical weapons. Conf Proc IEEE EMBC. 2015;37:323–9.Google Scholar
  27. 27.
    Kunz SN, Aronshtam J, Trankler HR, Kraus S, Graw M, Peschel O. Cardiac changes due to electronic control devices? A computer-based analysis of electrical effects at the human heart caused by an ECD pulse applied to the body's exterior. J Forensic Sci. 2014;59:659–64.CrossRefPubMedGoogle Scholar
  28. 28.
    Sun H, Haemmerich D, Rahko PS, Webster JG. Estimating the probability that the Taser directly causes human ventricular fibrillation. J Med Eng Technol. 2010;34:178–91.CrossRefPubMedGoogle Scholar
  29. 29.
    Panescu D, Kroll MW, Efimov IR, Sweeney JD. Finite element modeling of electric field effects of TASER devices on nerve and muscle. Conf Proc IEEE EMBC. 2006;28:1277–9.Google Scholar
  30. 30.
    Stratbucker RA, Kroll MW, McDaniel W, Panescu D. Cardiac current density distribution by electrical pulses from TASER devices. Conf Proc IEEE EMBC. 2006;28:6305–7.Google Scholar
  31. 31.
    Panescu D, Kroll MW, Stratbucker RA. Theoretical possibility of ventricular fibrillation during use of TASER neuromuscular incapacitation devices. Conf Proc IEEE EMBC. 2008;30:5671–4.Google Scholar
  32. 32.
    Leitgeb N, Niedermayr F, Neubauer R, Loos G. Numerically simulated cardiac exposure to electric current densities induced by TASER X-26 pulses in adult men. Phys Med Biol. 2010;55:6187–95.CrossRefPubMedGoogle Scholar
  33. 33.
    Dawes DM, Ho JD, Reardon RF, Miner JR. The cardiovascular, respiratory, and metabolic effects of a long duration electronic control device exposure in human volunteers. Forensic Sci Med Pathol. 2010;6:268–74.CrossRefPubMedGoogle Scholar
  34. 34.
    Ho JD, Dawes DM, Reardon RF, Strote SR, Kunz SN, Nelson RS, et al. Human cardiovascular effects of a new generation conducted electrical weapon. Forensic Sci Int. 2011;204:50–7.CrossRefPubMedGoogle Scholar
  35. 35.
    Ideker RE, Dosdall DJ. Can the direct cardiac effects of the electric pulses generated by the TASER X26 cause immediate or delayed sudden cardiac arrest in normal adults? Am J Forensic Med Pathol. 2007;28:195–201.CrossRefPubMedGoogle Scholar
  36. 36.
    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 enforcement officers against criminal suspects. Ann Emerg Med. 2009;53:480–9.CrossRefPubMedGoogle Scholar
  37. 37.
    Kim PJ, Franklin WH. Ventricular fibrillation after stun-gun discharge. N Engl J Med. 2005;353:958–9.CrossRefPubMedGoogle Scholar
  38. 38.
    Schwarz ES, Barra M, Liao MM. Successful resuscitation of a patient in asystole after a TASER injury using a hypothermia protocol. Am J Emerg Med. 2009;27(515):e511–2.Google Scholar
  39. 39.
    Zipes DP. Sudden cardiac arrest and death following application of shocks from a TASER electronic control device. Circulation. 2012;125:2417–22.CrossRefPubMedGoogle Scholar
  40. 40.
    Zipes D. Are you tasing me? TASERS can cause fatal [ventricular tachy] arrhythmias: HRS debate. 2010. http://www.heartrhythmondemand.org/.2009. Accessed 15 Jan 2010.
  41. 41.
    Naunheim RS, Treaster M, Aubin C. Ventricular fibrillation in a man shot with a Taser. Emerg Med. 2010;27:645–6.Google Scholar
  42. 42.
    Swerdlow CD, Fishbein MC, Chaman L, Lakkireddy DR, Tchou P. Presenting rhythm in sudden deaths temporally proximate to discharge of TASER conducted electrical weapons. Acad Emerg Med. 2009;16:726–39.CrossRefPubMedGoogle Scholar
  43. 43.
    Kroll MW, Fish RM, Calkins H, Halperin H, Lakkireddy D, Panescu D. Defibrillation success rates for electrically-induced fibrillation: hair of the dog. Conf Proc IEEE EMBC. 2012;34:689–93.Google Scholar
  44. 44.
    Haouzi P, Ahmadpour N, Bell HJ, Artman S, Banchs J, Samii S, et al. Breathing patterns during cardiac arrest. J Appl Physiol. 2010;109:405–11.CrossRefPubMedGoogle Scholar
  45. 45.
    Zuercher M, Ewy GA, Otto CW, HJilwig RW, Bobrow BJ, Clark L, et al. Gasping in response to basic resuscitation efforts: observation in a swine model of cardiac arrest. Crit Care Res Prac. 2010;10:1–7.Google Scholar
  46. 46.
    Goudge S. The health effects of conducted energy weapons: The Expert Panel on the Medical and Physiological Impacts of Conducted Energy Weapons. Council of Canadian Academies. 2013. http://www.scienceadvice.ca/en/assessments/completed/cew.aspx. Accessed 2 May 2017.
  47. 47.
    Kroll MW, Lakkireddy DR, Stone JR. Luceri RM. TASER electronic control devices and cardiac arrests: coincidental or causal? Circulation. 2014;129:93–100.CrossRefPubMedGoogle Scholar
  48. 48.
    Vilke GM, Sloane CM, Bouton KD, Kolkhorst FW, Levine SD, NeumanTS, et al. Physiological effects of a conducted electrical weapon on human subjects. Ann Emerg Med. 2007;50:569–75.CrossRefPubMedGoogle Scholar
  49. 49.
    Sloane CM, Chan TC, Levine SD, Dunford JV, Neuman T, Vilke GM. Serum troponin I measurement of subjects exposed to the Taser X-26. J Emerg Med. 2008;35:29–32.CrossRefPubMedGoogle Scholar
  50. 50.
    Dawes D, Ho J, Miner J. The neuroendocrine effects of the TASERX26®: a brief report. Forensic Sci Int. 2009;183:14–9.CrossRefPubMedGoogle Scholar
  51. 51.
    Ho JD, Dawes DM, Heegaard WG, Calkins HG, Moscati RM, Miner JR. Absence of electrocardiographic change after prolonged application of a conducted electrical weapon in physically exhausted adults. J Emerg Med. 2011;41:466–72.CrossRefPubMedGoogle Scholar
  52. 52.
    Moscati R, Ho JD, Dawes DM, Miner JR. Physiologic effects of prolonged conducted electrical weapon discharge in ethanol-intoxicated adults. Am J Emerg Med. 2010;28:582–7.CrossRefPubMedGoogle Scholar
  53. 53.
    Ho J, Dawes D, Nelson RS, Lundin EJ, Ryan FJ. Acidosis and catecholamine evaluation following simulated enforcement `use of force´ encounters. Acad Emerg Med. 2010;17:60–8.CrossRefGoogle Scholar
  54. 54.
    VanMeenen KM, Cherniack NS, Bergen MT, Gleason LA, Teichman R, Servatius RJ. Cardiovascular evaluation of electronic control device exposure in law enforcement trainees: a multisite study. J Occup Environ Med. 2010;52:197–201.CrossRefPubMedGoogle Scholar
  55. 55.
    Ho JD, Miner JR, Lakireddy DR, Bultman LL, Heegard WG. Cardiovascular and physiologic effects of conducted electrical weapon discharge in resting adults. Acad Emerg Med. 2006;13:589–95.CrossRefPubMedGoogle Scholar
  56. 56.
    FDA Modernization Act of 1997: modifications to the list of recognized standards; availability; withdrawal of draft guidance "Use of IEC 60601 standards; medical electrical equipment"--FDA. Notice. Federal register. 1998;63:55617–55630.Google Scholar
  57. 57.
    Bills E. Risk management for IEC 60601-1 third edition. Biomed Instrum Technol. 2006;40:390–2.CrossRefPubMedGoogle Scholar
  58. 58.
    Lakkireddy D, Khasnis A, Antenacci J, Ryshcon K, Chung MK, Wallick D, et al. Do electrical stun guns (TASER X26) affect the functional integrity of implanted pacemakers and defibrillators? Europace. 2007;9:551–6.CrossRefPubMedGoogle Scholar
  59. 59.
    Vanga S, Vacek J, Berenbom L, Lakkireddy D. Conducted electrical weapons and implantable cardiac devices. In: Kroll M, Ho J, editors. TASER conducted electrical weapons: physiology, pathology, and law. New York City: Springer-Kluwer; 2009. p. 223–34.CrossRefGoogle Scholar
  60. 60.
    Lakkireddy D, Biria M, Baryun E, Berenbom L, Pimentel R, Emert M, et al. Can electrical-conductive weapons (TASER®) alter the functional integrity of pacemakers and defibrillators and cause rapid myocardial capture? Heart Rhythm. 2008;5:S97.Google Scholar
  61. 61.
    Vanga SR, Bommana S, Kroll MW, Swerdlow C, Lakkireddy D. TASER conducted electrical weapons and implanted pacemakers and defibrillators. Conf Proc IEEE Eng Med Biol Soc. 2009;31:3199–204.Google Scholar
  62. 62.
    Cao M, Shinbane JS, Gillberg JM, Saxon LA, Swerdlow CD. Taser-induced rapid ventricular myocardial capture demonstrated by pacemaker intracardiac electrograms. J Cardiovasc Electrophysiol. 2007;18:876–9.CrossRefPubMedGoogle Scholar
  63. 63.
    Haegeli LM, Sterns LD, Adam DC, Leather RA. Effect of a Taser shot to the chest of a patient with an implantable defibrillator. Heart Rhythm. 2006;3:339–41.CrossRefPubMedGoogle Scholar
  64. 64.
    Paninski RJ, Marshall ME. Link MS. ICD oversensing caused by TASER. J Cardiovasc Electrophysiol. 2013;24:101.CrossRefPubMedGoogle Scholar
  65. 65.
    Khaja A, Govindarajan G, McDaniel W, Flaker G. Cardiac safety of conducted electrical devices in pigs and their effect on pacemaker function. Am J Emerg Med. 2011;29:1089–96.CrossRefPubMedGoogle Scholar
  66. 66.
    Calton R, Cameron D, Masse S, Nanthakumar K. Images in cardiovascular medicine. Duration of discharge of neuromuscular incapacitating device and inappropriate implantable cardioverter-defibrillator detections. Circulation. 2007;115:e472–4.CrossRefPubMedGoogle Scholar
  67. 67.
    Adedipe A, Maher P, Strote J. Injuries associated with law enforcement use of force. Trauma. 2012;15:99–106.CrossRefGoogle Scholar
  68. 68.
    Strote J, Walsh M, Angelidids M, Basta A, Hutson HR. Conducted electrical weapon use by law enforcement: an evaluation of safety and injury. J Trauma. 2010;68:1239–46.CrossRefPubMedGoogle Scholar
  69. 69.
    Jauchem JR, Cook MC, Beason CW. Blood factors of Susscrofa following a series of three TASER electronic control device exposures. Forensic Sci Int. 2008;175:166–70.CrossRefPubMedGoogle Scholar
  70. 70.
    Jauchem JR, Sherry CJ, Fines DA, Cook MC. Acidosis, lactate, electrolytes, muscle enzymes, and other factors in the blood of Susscrofa following repeated TASER exposures. Forensic Sci Int. 2006;161:20–30.CrossRefPubMedGoogle Scholar
  71. 71.
    Jauchem JR, Beason CW, Cook MC. Acute effects of an alternative electronic-control-device waveform in swine. Forensic Sci Med Pathol. 2009;5:2–10.CrossRefPubMedGoogle Scholar
  72. 72.
    Dennis AJ, Valentino DJ, Walter RJ, Nagy KK, Winners J, Bokhari F, et al. Acute effects of TASER X26 discharges in swine model. J Trauma. 2007;63:581–90.CrossRefPubMedGoogle Scholar
  73. 73.
    Dawes DM, Ho JD, Sweeney JD, Lundin EJ, Kunz SN, Miner JR. The effect of an electronic control device on muscle injury as determined by creatine kinase enzyme. Forensic Sci Med Pathol. 2011;7:3–8.CrossRefPubMedGoogle Scholar
  74. 74.
    Ho JD, Dawes DM, Chang RJ, Nelson RS, Miner JR. Physiologic effects of a new generation conducted electrical weapon on human volunteers. J Emerg Med. 2014;46:428–35.CrossRefPubMedGoogle Scholar
  75. 75.
    Sanford JM, Jacobs GJ, Roe EJ, Terndrup TE. Two patients subdued with a TASER device: cases and review of complications. J Emerg Med. 2011;40:28–32.CrossRefPubMedGoogle Scholar
  76. 76.
    Ho JD. Dawes DM. TASER device-induced rhabdomyolysis is unlikely. J Emerg Med. 2011;40:68–9.CrossRefPubMedGoogle Scholar
  77. 77.
    Dawes D, Ho J, Readon F, Strote S, Nelson R, Lundin E, et al. The respiratory, metabolic, and neuroendocrine effects of a new generation electronic control device. Forensic Sci Int. 2010;207:55–60.CrossRefPubMedGoogle Scholar
  78. 78.
    Ho J, Dawes D, Bultman L, Moscati R, Janchar T, Miner J. Prolonged TASER use on exhausted humans does not worsen markers of acidosis. Am J Emerg Med. 2009;27:413–8.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Sebastian N. Kunz
    • 1
    • 2
  • Hugh Calkins
    • 3
  • Jiri Adamec
    • 4
  • Mark W. Kroll
    • 5
    • 6
  1. 1.Department of Forensic PathologyLandspítali University HospitalReykjavikIceland
  2. 2.University of IcelandReykjavikIceland
  3. 3.Johns Hopkins Medical InstitutionsBaltimoreUSA
  4. 4.Institute of Forensic MedicineLudwig-Maximilians University MunichMunichGermany
  5. 5.Department of Biomedical EngineeringUniversity of MinnesotaMinneapolisUSA
  6. 6.California Polytechnical InstituteSan Luis ObispoUSA

Personalised recommendations