Guía para Elaborar un Manual de Comunicación Interna

The arguments against the use of Tasers have been made in many reports and media articles. Key issues or concerns about their use by police are:

• the risk of death after Taser use

• the risk of injury after Taser use

• mission creep and the use of Tasers as a compliance device

• the misuse of Tasers.

2.2.1 Risk of death or serious injury after Taser use

Amnesty International has claimed that since June 2001 more than 330 people are reported to have died in the US after being subjected to Taser use, and 25 similar deaths have been reported in Canada. In at least 50 cases, coroners are reported to have listed the Taser as a cause or contributory factor in the death.46

Amnesty International reviewed at least 90 autopsy reports and other sources – including media reports, lawsuits and reports of official investigations involving the use of M26 and X26 Tasers. While noting that their review was not a scientific study and they were not in a position to reach conclusions about the role of the Taser in each case, they made a number of observations. These included that:

• most of those who died were agitated, disturbed and/or under the influence of stimulant drugs, and a significant proportion had heart disease

• many were subjected to multiple or prolonged shocks, often far more than the standard five second cycle

• in most cases, the deceased are reported to have gone into cardio-respiratory arrest at the scene shortly after being shocked

• in some cases, the deceased had no drugs in their system or underlying health problems and collapsed shortly after being shocked

• in a significant proportion of cases (43% of the autopsy reports reviewed), the deceased was subjected to a Taser in the chest

• in many cases, additional forms of restraint were applied – including methods known to impair breathing or restrict the flow of blood to the brain.

Amnesty International also observed that although some individuals were highly disturbed and combative, the vast majority (around 90%) of those who died were unarmed, and many of them did not appear to present a serious threat when they were subjected to a Taser application and other force.

In relation to medical risks, the Braidwood Inquiry concluded that:

Even in the case of people with healthy hearts:

• An external electrical current can overtake the human body’s internal electrical system, resulting in ventricular capture, which may lead to ventricular tachycardia and, in some cases, ventricular fibrillation.

• There is evidence that the electrical current from a conducted energy weapon is capable of triggering ventricular capture.

• Based on animal studies, I am satisfied that the greatest risk of ventricular fibrillation arises when the probes are vectored across the heart, and that the risk of ventricular fibrillation increases as the tips of the probes get closer to the wall of the heart.

• There is a short ‘window’ during the heart’s normal beat cycle (the T-wave), when the heart is most vulnerable to an external electric shock. However, this narrow window does not apply to rapid ventricular capture causing ventricular tachycardia, which may degenerate into ventricular fibrillation. • Although there is often a lack of physical evidence on autopsy to determine whether arrhythmia was the cause of death, if a person dies suddenly and from no obvious cause after being subjected to a conducted energy weapon, death is almost certainly due to an arrhythmia.

The risk of ventricular fibrillation increases significantly in several circumstance – if the subject has cardiovascular disease or in thin subjects who have a smaller skin-to-heart distance. The intense pain, coupled with anxiety and stress, can cause an outpouring of adrenalin that can stimulate the heart and lead to dangerous arrhythmias. Skeletal muscle contractions can lead to acidosis, which affects the electrolyte balance, making the heart more susceptible to ventricular fibrillation. Also, an electrical current coinciding with a T-Wave peak may induce fibrillation with

a threshold 25 or more times lower than at other times in the heartbeat cycle. Finally, there are several risks associated with deployment against a subject who is wearing an implanted pacemaker or defibrillator.

Several researchers have raised concerns that the electrical current from a conducted energy weapon may induce spasm in the muscles of respiration (diaphragm and intercostal muscles), interfering with the subject’s ability to breathe. This could, in the case of prolonged deployment, lead to acute respiratory failure or acidosis. The body’s natural response to acidosis is to hyperventilate, which can be frustrated if the subject is lying face down, if pressure is applied to the chest or neck area, or if the officer’s attempt to restrain the subject results in the subject struggling. The weapon’s electrical current might also cause muscle damage (rhabdomyolysis), which can lead to cardiac arrest or acute renal (kidney) failure.47

In 2011, the US National Institute of Justice completed a study of deaths following electro muscular disruption. This study was directed by a steering group that included the National Institute of Justice, the College of American Pathologists, the Centres for Disease Control and Prevention, and the National Association of Medical Examiners. To support the study, a medical panel consisting of forensic pathologist/medical examiners and specialists in cardiology, emergency medicine, epidemiology and toxicology was established. The panel did not include people who had worked as litigation consultants for or against Conducted Energy Device (CED) manufacturers.

The study included extensive consultation with stakeholders and considered nearly 300 CED related deaths, all the available peer-reviewed literature, and extensive information about the use of CEDs in the field. According to the final report:

There is no conclusive medical evidence within the state of current research that indicates a high risk of serious injury or death from the direct or indirect cardiovascular or metabolic effects of short-term CED exposure in healthy, normal, nonstressed, nonintoxicated persons. Current medical research in humans and animals suggests that a single exposure of less than 15 seconds from a TASER® _{X-26™ or similar model CED is not a stress of a magnitude that}

separates it from the other stress-inducing components of restraint or subdual. Based on cases reviewed by this panel, most adverse reactions and deaths associated with CED deployment appear to be associated with multiple or prolonged discharges of the weapons. There is limited research with regard to exposures of greater than 15 seconds. Further, extended CED exposure may not be effective in the subdual of some individuals with high levels of drug intoxication or mental illness. Therefore, if the CED is ineffective in subduing an individual after a prolonged exposure, law enforcement officers should consider other options.48

The report also stated that:

• The potential for moderate or severe injury related to CED exposure is low. However darts may cause puncture wounds or burns, puncture wounds to an eye could lead to loss of vision, falls due to muscle contraction or incapacitation can lead to potentially fatal head injuries or skeletal fractures, and CED strikes to the head have resulted in dart penetration of the skull, unconsciousness and seizures.

• There is currently no medical evidence that CEDs pose a significant risk for induced cardiac dysrhythmia in humans when deployed reasonably. In addition, current research does not support a substantially increased risk of cardiac dysrhythmia when the darts penetrate a person’s chest in front of the heart. However, it is recognised that CED use involving this area of the chest is not totally risk-free. CED use on people with pacemakers and defibrillators can also be potentially hazardous.

• Very little research has been conducted about whether the positioning of the CED darts has an effect on respiration (breathing).

• Further study is needed to determine the amount of stress caused by prolonged or repetitive CED exposure in normal subjects. While it would be useful for similar studies to be conducted in relation to people with significant disease or drug intoxication, ethical constraints would prevent this.

• Exposing small children, those with diseased hearts, the elderly, pregnant women and other potentially at-risk individuals to CED deployments should be minimised or avoided (when recognised), as the effects of CED exposure in these populations is not clearly understood and more data is needed.

• Some form of medical screening is recommended after all CED exposures.

Earlier this year, a study published in Circulation – the American Heart Association’s peer-reviewed journal – found that the electrical shocks from Electronic Control Devices (ECDs) can result in cardiac arrest due to ventricular tachycardia or fibrillation and death. The study examined eight cases that were part of Taser-related litigation. They involved immediate loss of consciousness and sudden cardiac arrest and/or death during or after receiving shocks from Taser X26, with one or both probes in the chest near or over the heart. In seven of the eight cases, the person died.49

2.2.2 Excited delirium and its association with death resulting from Taser use

There continues to be controversy surrounding the existence and role of ‘excited delirium’ in causing or contributing to deaths that have occurred after a person has been the subject of a Taser use. Excited delirium is:

… one of several terms that describe a syndrome that is broadly characterized by agitation, excitability, paranoia, aggression, great strength and unresponsiveness to pain, and that may be caused by several underlying conditions, frequently associated with combativeness and elevated body temperature.50

The notion of excited delirium is controversial because it is not a recognised medical condition, and is most commonly used in the context of explaining why people resisting police have died. As noted in our 2008 report:

Despite the controversy about whether a condition called excited delirium actually exists, there is no doubt that deaths have occurred where people who are highly excited, agitated, aggressive and incoherent, by reason of intoxication, mental illness or a combination of factors, have been restrained by police using Tasers and/or other tactics. In light of the fact that many people displaying these characteristics come into contact with police and may need to be restrained by them, and it is not currently known what exactly causes and contributes to some of these deaths, the development of … policies by police [to manage people displaying the signs and symptoms associated with excited delirium] appears to be a sensible approach.51

The Braidwood Inquiry acknowledged that police officers are increasingly being called on to deal with emotionally disturbed people who exhibit extreme behaviours, including violence, imperviousness to pain, superhuman strength and endurance, hyperthermia, sweating and perceptual disturbances. However, this cluster of behaviours is not a medical condition or a diagnosis, but symptoms of various underlying medical conditions. The Braidwood Inquiry concluded that it is not helpful to blame resulting deaths on ‘excited delirium’ as this avoids having to examine the underlying medical condition or conditions that actually caused death, and whether use of a Conducted Energy Weapon (CEW) and/or other methods to restrain the subject contributed to the death. Instead of escalating the situation by using a CEW or force to physically restrain the subject:

The unanimous view of mental health presenters was that the best practice is to de-escalate the agitation, which can best be achieved through the application of recognized crisis intervention techniques.52

The Braidwood Inquiry further stated that in extreme circumstances where crisis intervention techniques fail to de- escalate the situation, it may be necessary to physically restrain the subject, which may require the use of a CEW. In such cases, best practices are to ensure that a CEW is used for the shortest period of time possible, that officers immediately restrain the subject and that medical personnel provide treatment once the subject is restrained.53

The National Institute of Justice’s 2011 final report on the study of deaths following electro muscular disruption noted that the term ‘excited delirium’ has been criticised. However, it went on to state that whether or not the term is used, the behaviour and medical conditions associated with excited delirium are well recognised and at least some of the people experiencing it are at risk of death in the short term. Police should become familiar with the behaviour and indications associated with excited delirium, and generally limit Taser discharges to the minimal amount needed to achieve restraint.54

In the study published in Circulation discussed in the preceding section, of the eight cases examined, only one person survived. For the eight cases in the study:

• The drug screen results showed that two people did not have drugs or alcohol in their systems, two people had drugs only in their system, two people had alcohol only in their system, and two people had both drugs and alcohol in their system.

• Four people had a normal heart, one person had a confirmed heart problem, and three people were alleged by one party to have a structural heart disease.

• In six cases, the person received multiple and/or continuous Taser applications, and in two cases the person received a single five second Taser electrical cycle. The total durations of shocks ranged between five and 62 seconds, with the longest continuous shock being 49 seconds.55

The study found that the sudden deaths were unlikely to be due to excited delirium because there was an immediate loss of consciousness or death during or after the Taser deployments:

Alternative explanations such as excited delirium would be more relevant when there was a significant time delay between ECD deployment and loss of consciousness/responsiveness or death. However, when loss of consciousness/responsiveness occurs during/immediately after an ECD chest shot, as it did in each of the cases above, and the subsequent rhythm is VT/VF or asystole (if a long time has elapsed without resuscitation) with no other cause apparent, it

becomes difficult to exonerate the effects of the shock. It is also possible that combinations exist. For example, prolonged QT interval in takotsubo cardiomyopathy or metabolic changes from prolonged or repeated shocks might predispose to pacing-induced VT/VF.56

The study also rejected the idea that the alleged structural heart diseases or high blood alcohol concentrations were the reasons for the sudden deaths:

Several victims were alleged to have structural heart disease (cases 2, 4, 7, and 8) and/or had elevated blood alcohol concentrations (cases 1, 3, 4, and 8). Although sudden death caused by underlying heart disease or alcohol is possible, one would have to postulate that the heart disease or alcohol coincidentally induced sudden loss of consciousness precisely at the time of ECD application. Far more likely is that stimulation from the ECD in the presence of structural heart disease and/or alcohol intoxication induced VT/VF.57

2.2.3 Recent deaths associated with incidents involving Taser use by police in

Australia

In recent years, there have been several deaths after the use of a Taser by police officers in Australia. In NSW, a man who was armed with two knives died soon after being subjected to Taser use by police in early October 2010.58

In March 2012, a man died after being pursued by several officers and being subjected to multiple Taser use. The pursuit occurred following an alleged incident at a Sydney city convenience store. This matter is currently the subject of a coronial inquest. These cases are further discussed in Chapter 9.

In June 2009, in Brandon in North Qld, a man died soon after police used a Taser on him. In that incident, the Taser was reportedly fired up to 28 times before the man’s death.59 _{This incident is the subject of a coronial inquest held on}

11 and 12 July 2011, which has been adjourned for findings.60

In April 2009, a 39 year old Aboriginal man died in the Northern Territory after he was subjected to two Taser applications as well as multiple bursts of OC spray by police.61 _{The man had been behaving strangely and causing}

concerns to his family. When police arrived, they considered that the man was exhibiting irrational and extreme behaviour, and decided to take him into their custody or control so that he could receive a mental health assessment at the hospital. The man did not wish to go to the hospital, resulting in a confrontation with police. After being subjected to two Taser applications and a considerable amount of OC spray, he experienced breathing difficulties and later died in the hospital. The cause of death was found to be coronary atherosclerosis.

The Coroner heard that:

• The man might have been suffering mental health issues, or had suffered them in the past.

• The man had heart disease and might have already been suffering a heart attack when the police arrived at the scene, which could explain his strange behaviour.

• The man’s heart condition presented a very significant risk of sudden and unexpected damage to the heart, which frequently results in death.

• A combination of stresses the man was under around the time of the incident could have led to his heart attack – including his arguments with family and police, his scuffle with the police, being placed on the ground, being subjected to multiple Taser and OC spray uses, and running around and falling down.

• There was no evidence to support a finding of positional asphyxia.

The Coroner determined that although the Taser was discharged eight times over two minutes and 14 seconds, the probes were not connected at the time and only two of the Taser applications seemed to have been successful. He expressed the view that due to the other great stresses the man was under at the time, the actions of the police might or might not have contributed to the man’s death. However he did find that the use of the Taser in this case was premature and inappropriate, stating that:

In hindsight, and in circumstances where the deceased was not armed nor making any threats to kill or cause serious harm, in my view the use of the Taser was premature and inappropriate. However, given the speed and confusion of the event, and agitation and noncompliance of the deceased, I do not wish to criticize the inexperienced and junior police officer himself. … In my view, better training of officers such as … in just when to use the Taser is necessary.62

The Coroner heard evidence that the use of the Taser fell within the previous guidelines – under which the Taser should only be used where there is a real and imminent risk of violence – but that there is a proposal to increase the