1. Medical Safety Update Less Lethal Weapons / Conducted Energy Devices (CED) William P. Bozeman, MD, FACEP, FAAEM Tactical Physician Assoc Director of Research Department of Emergency Medicine Wake Forest University NCSTL, November 2006

2. WPB Background Emergency Physician Trauma / Critical Care subspecialty Tactical Physician, >6 yrs Academic / Researcher –animal & human studies –PI, national LLW Study

3. LLW – general profile Law enforcement experience: –Operationally effective tools –Decrease use of lethal force –Decrease injuries in suspects and officers Medical experience: –LLW do cause injuries –Most are minor –Rare major injuries & deaths

4. Medical Effects of Less Lethal Weapons

5. Less Lethal Weapons

7. Medical effects…

9. Conducted Energy Devices Fire 2 probes Series of electrical pulses –pain –involuntary muscle contractions 5 second duration –may terminate early –may repeat

10. CED Concerns Secondary injuries –Falls  blunt trauma Probe striking eyes or vessels –~¼ inch max. penetration Cardiac Affects (??)...

11. Cardiac Safety VFib Threshold: 10-50 joules Medical Therapy: 150-360 joules Taser output: 1.76 joules (M26) 0.36 joules (X26)

12. Recent Advances in CED Medical Research (Highlights)

13. Relative Risk of Force Options UK Data Includes all police UOF incidents –Taser M26 –CS spray –Canine –Baton (Excellent review of prev. literature too) Jenkinson, J Forensic Science, 2006

14. Cardiac Monitoring During Taser Use in Humans 2 studies – CA, NC –104 patients (officers) –151 shocks No rhythm problems Increases heart rate, BP Bozeman, Annals Emerg Med, Oct 2006 Levine, Acad Emerg Med, May 2006

15. VFib threshold (pig studies) In General: –Need 15 - 40 times Taser output to induce VFib Cocaine increases this threshold –50% – 100% above baseline resistance Lakkireddy, J Am Coll Cardiol, Aug 2006 McDaniel, PACE, Jan 2005

16. Electrical Capture During Shock (pig studies) Standard Taser discharge may cause abnormal heart beats –Not detected by normal EKG due to noise –Applicable to humans? –Significance? Nanthakumar, J Am Coll Cardiol, Aug 2006

17. Ongoing Research – the NIJ LLW Study “Injuries Produced by Law Enforcement Use of Less Lethal Weapons: A Prospective Multicenter Trial”

18. LLW Study Prospective, multicenter, “real world" trial 12 LE agencies nationwide –Vary in size, location, population, policies (i.e. representative sample with good external validity) Tracks 100% of LLW uses via UOF reporting –Kinetic impact projectiles –CED / Taser

19. After LLW use: UOF investigation documents events & injuries –includes retrieval of medical records by LE agency –HIPAA has specific provision for this Tactical physician reviews all LLW UOF reports & materials –determines injury type & severity (a priori definitions) –None / Mild / Moderate / Severe

20. Current Status Approx 500 real-world LLW cases to date –Almost all are Taser uses First Interim analysis (@ 300 pts)  –Minority of cases have some injury – all mild –No significant injuries Study completion this summer, report in fall

21. Summary – Medical Safety Any force option, including CED, can cause injuries –Most are mild, but can be severe –Specific risk still not determined Current data support safety of CED –At least as safe as CS spray, canine, or baton More questions under investigation…

22. Questions?