A comment received today from "Gilbert"

I can’t believe the number of Canadian cops and even some coroners and judges who are still accepting Excited Delirium as a ‘cause-of-death’. Neither the CMA or AMA recognize it. Then the Braidwood Inquiry looking into the death of Robert Dziekanski blew the ED idea out of the water, as a concocted concept to help police explain away ‘unintended consequences’ during and after Taser incidents. Have you ever heard of ED mentioned in anything other than Taser-related fatalities?

Mother Jones published an eye-opening piece in 2009, right around the time when Taser International quietly announced in a training bulletin that officers should avoid chest shots because of proximity to the heart. That flies in the face of the claims made by the company a decade earlier, when its executives crowed about Tasers being safe to use on any assailant. Mother Jones reported the manufacturer’s questionable methods of promoting ED to anyone who would listen—mainly police and lawyers- through a second-party organization based in Las Vegas, Nevada! The article is a bit dated now, in that Taser has lost at least one other major product liability case- that being the late 17-year old Daryl Turner, who was stunned twice in the chest by a cop in North Carolina. The Turner family won a $10-million dollar jury judgement, although it was halfed on appeal. Taser was rapped for 'failure to warn' about cardiac risks; these are risks TI executives were told about in 2006 by one of their own scientists after one of their own healthy volunteers suffered a heart attack during a controlled experiment. Luckily a defib was nearby and the volunteer survived. They company kept selling product, only issuing the chest-avoidance warning in late 2009. That case set the legal precedent that Tasers can kill. Commissioner Braidwood concluded that too. And now, if you read the fine print you'll see TI itself is admitting its products can cause cardiac and metabolic changes that can lead to death.

It’s tough to be a pit bull

Thanks to KV, who provided the following information:

Oct 18, 2010, Deuce the Neopolitan mastiff, Corvallis, Wa. Bit officer, tased, died of suffocation (in his regular muzzle) while being transported to Humane Society. A previous injury caused swelling in his throat. First report said he was a pit bull.

July 12, 2010, Apollo the pit bull, Altoona Pa. Also was pepper sprayed. “After attempts to find the dog's owner failed, Cpl Boyles said Sgt. William Gibbons struck one of the dogs with a Taser. Boyles said he assumed that is what killed the animal."

Jan 3, 2010, Hershey the pit bull, Salem, Or. Fighting another pit bull, still fighting after 4 shocks, collapsed after 5th one.

Aug 27, 2009, Peatross’s pit bull, Danville, Va. Fighting pitbulls were tased, one lived, one died immediately. Also pepper sprayed. Catch pole choking was blamed.

June 5, 2007, Muscub the boxer, Fredericton, New Brunswick. Tasered, died en route to SPCA Police thought he was a pit bull.

June 5, 2005, Palfoss's pit bull, Portland, Or. 3 or more shocks. The Oregon State University's veterinary lab performed a necropsy on the dog. A preliminarly report concludes the pit bull died from circulatory collapse but reaches no judgement on whether repeated taser shocks killed it. Police insist that tasers didn't kill the dog; rather, they say it died from "over-excitement" after multiple 50,000-volt zaps. Earlier that week (June 1) Portland had issued tasers to all street police.

Oct 3, 2003, unidentified pit bull, Albany, NY. 30 sec+ in 5 second bursts, dead when tasing ended. Could not be revived with heart compressions.

In a September 2008 letter, entitled "Taser safety", published in the Canadian Medical Association Journal, Mark Kroll explains to Canadian doctors why dogs are better models for the human heart than pigs are: “The second erroneous implication is that small swine provide a reasonable model with which to measure the risk of electrical induction of ventricular fibrillation in humans. Swine, especially small ones, are extremely sensitive to the electrical induction of ventricular fibrillation. In pigs, the Purkinje fibers cross the entire ventricular wall whereas in dogs and humans they are confined to a very thin endocardial layer. Activation in swine proceeds from the epicardium to the endocardium, whereas it occurs in the reverse direction in dogs and humans. Thus, swine are much more sensitive to external electrical currents. In humans, even if the barbs of an electronic control device are placed directly on the cardiac axis, no effect is captured with echocardiographic monitoring.”

STU professor backs outright ban on tasers

March 20, 2009
MICHAEL STAPLES, Daily Gleaner

A report released this week says directed energy devices can cause seizures in people if the electric barbs pierce the scalp and shock the brain has renewed calls for police departments to stop using the stun guns.

Michael Boudreau, a criminology professor at St. Thomas University, said an outright ban on tasers is needed.

"When they were first introduced, there were good intentions behind their use - in terms of trying to (respond to a situation) without resorting to a firearm. (But) the taser, it seems, has now become the first go-to weapon, as opposed to other sorts of tactics," he said.

Tasers emit 50,000 volts of electricity.

An article published in the Canadian Medical Association Journal this week on the accidental jolting in the back of the head of an Ontario police officer described how the individual collapsed and went into a seizure for about a minute.

Boudreau said the report highlights how dangerous the weapons can be.

"It's fine for the manufacture to say 'don't point it at someone's head,' but, obviously, accidents can happen and this is a clear case of one ... No matter how well they are used, mistakes can be made."

An American organization said it's watching taser-related developments in Canada with great interest.

"Our coalition is not supporting a ban, but working for strict regulations, oversight and good training ... that people do not consistently get here," Mary Hussmann of the Coalition to Control Tasers, based in Columbia, Mo., said in an interview.

The Coalition to Control Tasers is composed of the American Civil Liberties Union, GRO-Grass Roots Organizing, Mid-Missouri Women's International League for Peace and Freedom, and the National Association for the Advancement of Colored People.

"We are very impressed that the people (in Canada) are standing up," Hussmann said.

"(Tasers) should be very rarely used. I think a lot of people in Canada are on the right track. People understand what guns are used for but they don't quite get where these tasers fit in."

Boudreau said he agrees extra training is a good idea, but instruction has to be ongoing.

"I might be prepared to say, 'yeah that's a good thing,' if there was a guarantee this training was going to be extensive and almost something like semi-annual. Without that extensive training, I still remain highly skeptical," he said.

Boudreau said taser usage is more tightly regulated in Canada than in the U.S., but that hasn't prevented incidents from occurring here.

"More public education is needed for the police to tell why they really need these things," he said.

Boudreau said Americans can learn from Canadian mistakes that, despite what the police say, tasers remain contentious weapons and that the time has come for a moratorium.

"Hopefully, they can learn they are not working here either and here we have a much more highly regulated police force," he said.

Generalized tonic-clonic seizure after a taser shot to the head

March 17, 2009
Canadian Medical Association Journal

Esther T. Bui, MD, Myra Sourkes, MD and Richard Wennberg, MD
From the Division of Neurology, Krembil Neuroscience Centre, University Health Network, Toronto Western Hospital, University of Toronto, Toronto, Ont.

Correspondence to: Dr. Richard Wennberg, Toronto Western Hospital, Ste. 5W444, 399 Bathurst St., Toronto ON M5T 2S8; fax 416 603-5768; r.wennberg@utoronto.ca

Abstract

During a police chase on foot, a previously well police officer was hit mistakenly by a taser shot meant for the suspect. The taser gun had been fired once, sending 2 barbed darts into his upper back and occiput. Within seconds, the officer collapsed and experienced a generalized tonic-clonic seizure with loss of consciousness and postictal confusion. Subsequent magnetic resonance imaging scans of the head and electroencephalograms were normal. The patient has experienced no recurrence of seizure over more than a year of follow-up. This report shows that a taser shot to the head may result in a brain-specific complication such as generalized tonic-clonic seizure. It also suggests that seizure should be considered an adverse event related to taser use.

The taser stun gun, manufactured by Taser International in Scottsdale, Arizona, is a weapon used increasingly among law enforcement personnel to temporarily incapacitate detainees. Questions have arisen in both the scientific literature and the lay press about the device's safety.1–3 In this article, we report the occurrence of a generalized tonic-clonic seizure in a person who received a taser shot to the head.

Case report

The patient was a previously well police officer in his 30s who took part in a police chase involving a suspected robber. He and a colleague cornered the suspect, who initially appeared to surrender but then attempted an escape. The officer had begun to chase the suspect on foot when he experienced a sudden, severe pain in the back of his head. He later described the moment as feeling like he had been "hit by a bat." He recalled letting out a brief gasp before losing consciousness. He had no recollection of falling to the ground on top of the suspect. Police records indicate that the officer's colleague had fired a taser shot meant for the suspect but that the 2 copper darts had instead struck the officer in the occiput and upper back. The officer had been wearing an armoured vest. Immediately after being shot, he was found by his colleague to be unresponsive and foaming at the mouth. His eyes were rolled upward and he had generalized tonic-clonic movements with apnea lasting for about 1 minute. He did not have urinary incontinence. Postictally, he was initially confused and combative. Emergency medical services personnel were able to restrain him. They recorded a Glasgow Coma Score of 9 within 5 minutes after arrival; 5 minutes later, his score was 13.

The patient's next memory was of being in the emergency department. During this period, he felt as if he were in "a bad dream." As he gradually regained orientation over the next few hours, he became aware of thoracic tightness that was aggravated by deep breaths, and a severe headache. He was monitored overnight, then discharged in stable condition.

The patient had no history of febrile or unprovoked seizures, head injuries, headaches, meningitis or encephalitis. He had no family history of seizures or of other neurologic or psychiatric conditions. His developmental history was normal. He was not taking any medications.

The results of a general physical and neurologic examination were normal. Results of routine blood tests were unremarkable except for an elevated leukocyte count of 12.9 (normal 3.6–11.0) x 109/L 30 minutes after the event (decreasing to 11.2 x 109/L 5 hours later) and an elevated serum creatine kinase level of 580 (normal < 232) U/L.

The patient returned to full-time work 5 days after the incident. He experienced persistent headaches, dizziness, back pain and chest tightness. Magnetic resonance imaging scans of the head (1.5 and 3 Tesla) as well as routine and 24-hour ambulatory electroencephalography were performed 1, 2 and 12 months after the seizure. All findings were normal.

A diagnosis of mild traumatic brain injury (concussion), in addition to provoked seizure, was considered after a neurologic consultation during assessment of the patient at a rehabilitation centre 6 months after injury. A psychiatric consultation 7 months after injury suggested an Axis I diagnosis of adjustment disorder with depressed and anxious mood. Formal neuropsychological testing performed 9 months after injury showed no definite evidence of cognitive impairment in any domain.

The patient has not had further seizures since the injury more than 1 year ago. His symptoms of anxiety, difficulties concentrating, irritability, nonspecific dizziness and persistent headaches have not completely resolved. Treatment trials have included amitriptyline 50 mg nightly, topiramate 25 mg nightly, escitalopram 10 mg nightly, almotriptan 12.5 mg as needed and ibuprofen 200–400 mg as needed.


Comments

A taser stun gun is a device designed to temporarily immobilize a human target by delivering a direct-current type of shock through 2 barbed copper darts. The shock causes involuntary muscle contraction. Neuromuscular transmission is thought to be affected primarily at the level of the peripheral motor nerve, although studies have shown that stimulation of the spinal cord may occur with dart penetration as far away as the anterior torso.4,5 The muscle contraction induced by tasers is typically tonic, with retained consciousness, no clonic movements and no postictal confusion.4 The manufacturer's website estimates that a single shot lasts about 5 seconds, delivers 19 pulses per second with a typical charge of 100 microcoulombs per pulse, generates an average net current of 2 milliamperes and has an estimated peak voltage of 1300 volts.6

The data are sparse on how this device may affect the central nervous system. A case has been reported involving intracranial penetration by a taser dart with loss of consciousness for 5 minutes.7 The person who had been struck recovered shortly afterward with a mild headache. No details were reported on whether a seizure occurred, although only 1 of the 2 darts struck the patient.7 Another case report describes cranial penetration by a taser dart (with the second dart found in a hair braid) with transient decreased consciousness; no further details were given.5 Other reports of secondary loss of consciousness related to taser shots have involved only cases of severe traumatic head injuries that resulted from falls during neuromuscular incapacitation.5

The description by witnesses of the event involving our patient is most compatible with a generalized tonic-clonic seizure. The loss of consciousness, clonic movements, foaming at the mouth and postictal confusion experienced by our patient differentiate the episode from the usual transient incapacitation induced by tasers. The taser current that passed to his brain from the dart in the occiput probably provoked the seizure directly, with a mechanism akin to that of seizures induced by electroconvulsive therapy. In electroconvulsive therapy, an initial charge of 38–60 millicoulombs is used, according to therapeutic protocol in the United States.8 It is plausible that a copper dart penetrating the scalp and discharging 95 pulses of 100 microcoulombs each could trigger a generalized convulsion.

Given previous case reports of taser-induced cardiac arrhythmias, one could speculate that an initial induced cardiac arrhythmia and a secondary hypoxic seizure, or convulsive syncope, occurred in our case. Convulsive syncope is believed to result from reticular disinhibition in the brainstem resulting from hypoxia-induced cortical dysfunction.9 However, this mechanism seems unlikely in this case, especially given that the points of impact of the taser darts were over the head and upper back and not the heart.

Even less likely is the possibility that the convulsion was induced by a concussion resulting from the direct physical impact of the darts or impact of the patient's head on the ground. Our patient's prolonged period of unresponsiveness and subsequent postictal confusion is not typical of a concussive convulsion, which is usually characterized by immediate onset and a rapid recovery that takes place over a few minutes.10 On the other hand, we believe that his persistent symptoms after injury may be attributable in part to postconcussion syndrome, presumably secondary to mild traumatic brain injury caused by either the impact of the taser dart or the subsequent fall to the ground during the provoked seizure.

Until now, most reports of taser-related adverse events have understandably concentrated on cardiac complications associated with shots to the chest.2 Our report shows that a taser shot to the head may result in brain-specific complications. It also suggests that seizure should be added to the list of taser-related adverse events.

Footnotes

Une version française de ce résumé est disponible à l'adresse www.cmaj.ca/cgi/content/full/180/6/625/DC1

This article has been peer reviewed.

Contributors: All of the authors were involved in the preparation of this manuscript and approved the final version submitted for publication.

Competing interests: None declared.

REFERENCES

Stanbrook MB, Hébert PC, Kale R, et al. Tasers in medicine: an irreverent call for proposals [editorial]. CMAJ 2008;178:1401-2.[Free Full Text]

Nanthakumar K, Massé S, Umapathy K, et al. Cardiac stimulation with high voltage discharge from stun guns. CMAJ 2008;178:1451-7.[Abstract/Free Full Text]

Hume M, Dhillon S. Questions hang over taser death. Globe and Mail [Toronto] 2007 Oct. 26; Available: www.theglobeandmail.com/servlet/story/RTGAM.20071025.wtaser1026/BNStory/National/home (accessed 2009 Jan. 7).

Sun H, Webster JG. Estimating neuromuscular stimulation within the human torso with Taser stimulus. Phys Med Biol 2007;52:6401-11.[CrossRef][Medline]

Mangus BE, Shen LY, Helmer SD, et al. Taser and taser associated injuries: a case series. Am Surg 2008;74:862-5.[Medline]

Kroll MW. Cardiac safety. Scottsdale (AZ): Taser International; 2007. Available: www.taser.com/research/Science/Pages/CardiacSafety.aspx (accessed 2009 Jan. 9)

Rehman TU, Yonas H, Marinaro J. Intracranial penetration of a TASER dart. Am J Emerg Med 2007;733:e3-4.

Lisanby SH. Electroconvulsive therapy for depression. N Engl J Med 2007;357:1939-45.[Free Full Text]

Stephenson JBP. Fits and faints. Oxford (UK): MacKeith Press, Blackwell; 1990. p. 41.

McCrory PR, Bladin PF, Berkovic SF. Retrospective study of concussive convulsions in elite Australian rules and rugby league footballers: phenomenology, aetiology, and outcome. BMJ 1997;314:171-4.[Abstract/Free Full Text]

Tasers can cause seizures: report

March 16, 2009
Sue Bailey, THE CANADIAN PRESS

OTTAWA – Stun guns can cause seizures if their tiny electric barbs pierce the scalp and shock the brain, says a new article on the accidental jolting of a police officer.

The unnamed Ontario cop, in his 30s, was chasing a suspected robber when he was hit in the back of the head with a Taser fired by his partner.

Within seconds, the officer collapsed and went into a full-blown seizure – foaming at the mouth – for about a minute, says the article co-written by Toronto neurologist Dr. Richard Wennberg.

What is billed as the first report of its kind on such a phenomenon is published in the Canadian Medical Association Journal released Monday.

The officer had no history of seizures, head injuries, neurological or psychiatric conditions, it says. His developmental history was normal and he was not on medication of any kind.

"Until now, most reports of Taser-related adverse events have understandably concentrated on cardiac complications associated with shots to the chest," the article concludes.

"Our report shows that a Taser shot to the head may result in brain-specific complications. It also suggests that seizure should be added to the list of Taser-related adverse events."

What appears to be a rare if not isolated case should serve as a cautionary tale, Wennberg said in an interview, especially as Taser use grows.

"In that it hadn't ever been reported before, we felt sort of obligated to report on it in the medical literature so that people would know that for sure this can happen.

"To discharge that amount of electrical current in a region overlying the brain, it didn't seem impossible to me that this could happen in a mechanism similar to giving electroconvulsive therapy or something like that."

Wennberg says stun guns pack about the same jolt used to induce seizures in electroshock therapy. It's a procedure that has had some success in treating severe depression by hitting a kind of reset button in the brain.

"No one has any real idea" why it works, Wennberg said. "It does seem to be kind of like rebooting the system."

The police officer came out of his seizure bewildered and with a severe headache. He was later diagnosed with a concussion, likely from the impact of the dart or from hitting his head after collapsing. He still suffers headaches and has difficulty concentrating 18 months later, Wennberg said.

He has not had any seizures since.

Wennberg said he and two other co-authors of the report searched ``anything that's ever been published in medical literature" and did not find a similar case.

"The data are sparse on how this device may affect the central nervous system," says the article.

Taser International Inc., the Arizona-based maker of the device, specifically warns that stun guns should not target the head.

"We do, both in training and warnings, make mention that the head should not be targeted," spokesperson Peter Holran said in a statement following inquiries by The Canadian Press.

"Taser International is aware of a few incidents during training in which an officer experienced a seizure following a hit by a Taser device."

Those incidents were not written up in medical reports. But the company's document 'Product Warnings: Law Enforcement' clearly warns against targeting sensitive areas such as the head and further states that the risk of a seizure "may be heightened if electrical stimuli or current passes through the head region."

The company said it did not receive an advance copy of the case report from the Canadian Medical Association Journal.

"Taser International will review the case report of this single incident once available," it said.

Wennberg says the officer's ordeal was indeed a mishap.

"They certainly don't mean for these things to ever be aimed at the head – nor was it meant to be in this case even. But it wouldn't always have to be an accident. I'd be surprised if (a seizure) didn't happen most of the time to people if they actually did get Tasered in the head."

Taser International has steadfastly defended the relative safety of its devices although it stresses that no use-of-force tool is risk-free.

More than 20 Canadians have died after being Tasered. Polish immigrant Robert Dziekanski, who died Oct. 14, 2007 after RCMP officers repeatedly zapped and then pinned him to the floor, is the subject of an inquiry in B.C.

"Specifically in Canada, while previous incidents were widely reported in the media as 'Taser deaths,' the role of the Taser device has been cleared in every case to date," says Taser International.

U.S. study raises more questions about stun gun safety

January 25, 2009
CBC News

The Taser stun gun has been advertised and sold as a police tool that can decrease the number of suspect shooting deaths and officer injuries, but a new study suggests its use does not reduce the number of people who die in custody.

The study was conducted by researchers at the University of California San Francisco. They surveyed U.S. city police departments for cases of in-custody sudden deaths in the absence of lethal force in the five years before they started using Taser stun guns and the same period after deployment began. Fifty of the 84 departments approached were able to provide data.

The research group found a sharp increase in the rate of in-custody sudden death in the first full year of Taser deployment compared with the average rate in the five years before the stun guns were used.

"A little bit to our surprise we found a statistically significant six-fold increase in the in-custody sudden death rate in the first full year of Taser deployment, and that rate then declined down near baseline in years two to five," said one of the researchers, cardiologist Zian Tseng.

Tseng testified last May at the Braidwood inquiry, which is looking into the death of a Polish immigrant Robert Dziekanski at Vancouver International Airport in October 2007.

Over the entire reporting period, researchers found the average rate of 1.57 sudden deaths per 100,000 arrests in the 50 cities. In the first full year after stun guns were deployed, the rate was 5.96 per 100,000 arrests, a 6.4-fold increase over the predeployment period.

The study showed that in the first complete year after deployment, the rate of deaths caused by officers using firearms remained high at 15.1 per 100,000 arrests, a 2.3-fold increase over the predeployment period. In years two to five after deployment, the rate of lethal force deaths decreased to 9.1 per 100,000 arrests.

Officers adjusted use, researcher believes

Tseng said his team concluded that police likely changed the way they used the Taser after the first year and that accounted for the drop in sudden in-custody deaths. He thinks the findings point to the importance of stringent policies for Taser use.

Tseng told Vancouver's Braidwood inquiry that a normal healthy person could die after a jolt from the stun gun if the shock went into the chest during a vulnerable point in the heart beat.

The U.S. researchers acknowledge their study is "purely observational" and has limitations because they did not ask police for details about the reported in-custody deaths and did not ask whether the Taser had actually been applied in those incidents, meaning the weapon was used only in a subset of these deaths.

However, they said, other investigators have suggested that stun guns may cause sudden death by increasing the risk of excited delirium, a much-debated condition in which sudden death occurs after a violent struggle.

Canadian physicians concerned

The Canadian Medical Association has raised concerns in the past about police departments relying on the manufacturer's claims of safety, and has called on police departments to open their databases to researchers.

Dr. Matthew Stanbrook, deputy editor for science at the CMA's Journal, thinks the U.S. study is a good first step toward building a body of work about real-life stun gun use.

"Greater societal pressure needs to be put on agencies on this to release that information for the public good because people are asking serious questions about this," he said.

Taser International, which is based on Scottsdale, Ariz., has been selling the most popular brand of stun gun to police departments in North America since 2001. The company has data on its website that it says shows the number of injuries to police officers has dropped dramatically since the introduction of the stun gun.

The San Francisco study found no change in the injury rate to officers. However, researchers noted in their report that the 10 largest U.S cities where stun guns are used most frequently refused to release their Taser data for the study.

EDITORIAL: Time to stun taser use

November 4, 2008
Calgary Herald

An immediate moratorium on the use of Taser stun guns would be an appropriate response to the latest death -- this time in Calgary. The incident also highlights the need for national standards to be developed, based on independent research -- not that funded by Taser International, the company that makes the weapons.

Calgary police used a Taser on an agitated man during his arrest in an apparent break and enter on the weekend. He died Monday in hospital.

Many questions remain, including whether or not the Taser deployed even worked. Still, in the face of increasing fatalities, any insistence from police and authorities that no evidence exists proving the weapons are a danger, loses credibility.

People are dead who might otherwise be alive had their condition been recognized as one requiring medical attention, not an electric shock. The condition is commonly referred to by police and other experts as "excited delirium." There's no consensus among experts on what effect a jolt of up to 50,000 volts has on suspects in this agitated state.

Tasers may not be directly linked to deaths, but they are certainly indirectly associated with at least 22 fatalities in Canada, alone. In North America, that number jumps to 300.

The most controversial death was caught on video last year, when 40-year-old Robert Dziekanski died at the Vancouver International Airport after being Tasered twice by RCMP.

The latest two fatalities occurred within a week of each other, both in Alberta. Last week, Edmonton police used a stun gun to subdue a man on a rampage in a pawn shop. He died a day later.

The use of Tasers by North American police forces is a relatively new phenomenon, and one that still has many unknowns in practice, if not in theory. Victoria was the first Canadian jurisdiction to adopt the weapons in 1999, but their use has exploded in the past four years, with some 2,000 to 3,000 weapons now available to officers in Canada.

Tasers are supposed to be an effective, last-resort alternative to lethal force. They are supposed to save lives, not end them. Yet, a media review of 563 Taser incidents reported by the RCMP between 2002 and 2005 revealed a disturbing pattern of use by the Mounties. The high-powered weapons were used as a quick means to subdue low-risk suspects or prisoners.

The Canadian Medical Association Journal believes more independent study of potential health risks is needed. A recent editorial noted most of the research is funded by the weapon's maker, Taser International.

Tasers may well be a better alternative to firearms, but they are only as good as the training and protocols governing how police officers use them.

The answer lies in part with the politicians, who should be pushing for a coherent national policy, instead of blindly defending their use until evidence proves otherwise.

An unbiased, national review of police-confrontation deaths before and after Tasers were introduced needs to be conducted. And until it's proven beyond doubt that Tasers had nothing to do with the 22 deaths, the use of such force should be suspended.

Officials defend Tasering

October 31, 2008
By JIM MACDONALD The Canadian Press

EDMONTON — Alberta’s premier and solicitor general are downplaying the role a stun gun may have played in the death of an Edmonton man who was zapped twice by police.

Trevor Grimolfson died after he was confronted by police armed with Tasers as he ran amok in an Edmonton pawn shop Wednesday.

His death is being investigated by the Alberta Serious Incident Response Team, an independent organization that reviews fatalities involving police forces in Alberta. But Grimolfson’s family is already questioning the use of a stun gun on him.

Solicitor General Fred Lindsay said Thursday there’s no proof Tasers have caused any deaths. He said there’s plenty of evidence, however, to suggest that they have prevented people from being killed.

"What I will say is the Taser is an effective tool and it’s an alternate tool to lethal force," said Lindsay. "In over 2,000 cases where it’s been used in this country, it’s actually saved people’s lives."

More than 20 people have died in Canada after being stunned by Tasers.

The U.S. company that makes the devices points out they have never been directly blamed for a death. Steve Tuttle, the vice-president of communications for Taser International, said the family’s assertion that the device may have played apart in Grimolfson’s death isn’t based on the facts. "Until all the facts surrounding this tragic incident are known, it’s extremely inappropriate to jump to conclusions on the cause of death," he said from the company’s offices in Scottsdale, Ariz.

There is already a long list of independent research that has verified the safety of the devices, Tuttle said. More than 130 studies have been done on Taser technology and 80 per cent of them have been independent, Tuttle said. "We have yet to see a human study come back and give us an indication that these devices are unsafe," Tuttle said.

Lindsay said a condition known as excited delirium may be responsible for the deaths rather than the Taser itself. "How many of those deaths have been confirmed to be because of the use of the Taser? I haven’t seen a lot of evidence come forward yet that confirms at the end of the investigation that it was caused by the voltage that was put into the person’s body by the Taser."

Premier Ed Stelmach noted that Lindsay himself was jolted with a Taser during a demonstration earlier this year. "This minister is standing. He got Tasered and he’s alive."

Dr. Matthew Stanbrook, a deputy editor of the Canadian Medical Association Journal who has been critical of the lack of studies on conducted energy weapons, said there’s a great need to know more about the potential health effects of the devices.

Stanbrook, who is an associate professor at the University of Toronto, said it’s in the public’s interest to know whether they are potentially harmful.

"We need independent, public analysis of a robust, broad data set of all the times this has been used, by experts who are capable of doing it, so we can get an answer as to whether this device causes harm," he said.

He said such research may answer whether the devices may be contributing to in-custody deaths, especially for people who are highly agitated — either due to mental-health issues or drugs and alcohol.

"The truth is right now, we simply don’t know. We’ve got a lot of concerns, but no answers," Stanbrook said.

Stanbrook dismissed excited delirium as an explanation for such deaths, saying there’s no agreement in the medical community about whether it’s a real syndrome.

EDITORIAL: Concerns rise on taser use

May 18, 2008
Chronicle Herald (Halifax)

THE grieving mother of Robert Dziekanski, the Polish immigrant who died after being Tasered by Mounties at Vancouver’s international airport last fall, last week told a B.C. public inquiry into Taser use that the incident has "shattered" her faith in the RCMP.

Police forces across Canada which use Tasers should be paying close attention to Zofia Cisowski’s words.

Despite a string of unexplained incidents – in Canada and elsewhere – in which people have died after being Tasered, police spokesmen have continued, for the most part, to defend Tasers as safe, useful tools for law enforcement. Tasers are proven to have saved thousands of lives, they say, echoing claims – and sometimes the precise numbers used – by the device’s manufacturer, Taser International. Tasers are a superior alternative, backers claim, when otherwise deadly force might need to be used.

The trouble is, the real life evidence backing these claims is sometimes sparse.

If thousands of lives have been saved because of Taser use, surely police forces can produce hundreds of examples showing where that was the case. As for the claim of Tasers being a better option than firearms, surely police are not saying they would otherwise have had to use their guns in incidents such as when an 82-year-old man was Tasered in his hospital bed in B.C. recently because he was brandishing a penknife, or when a Dartmouth teenager was Tasered in her own bedroom in February 2007, after being unco-operative with police called to the house by a parent.

The public’s faith in the judgment of law enforcement officials – including the transit police in Vancouver, who have been Tasering some people who have attempted to flee rather than pay their fares – has been continually eroded by reports of incidents in which police officers use Tasers both too quickly and against inappropriate targets. It’s as if police, rather than trying to talk down situations, reach for the "Easy" button and draw and fire their Tasers.

Even more disturbing is recent evidence that Tasers may, in certain circumstances, affect the heart’s internal rhythms. Dr. Zia Tseng, a San Francisco cardiologist and electrophysiologist, earlier told the B.C. inquiry that Tasers pose potentially fatal health risks which are not taken into account by studies "proving" the devices’ safety. Taser research, he said, is done under optimal conditions, not the kind of operational realities police officers often face. Fatal arrhythmias induced by Tasers wouldn’t show up in autopsies, Dr. Tseng also testified.

Earlier in May, the Canadian Medical Association Journal released a new study showing Tasers could, depending on how close to the heart a shock was administered and whether the subject being Tasered had excess levels of adrenaline or other drugs in their system, adversely affect heart rhythms. In light of those findings, the Journal’s reporting that RCMP operating manuals actually suggest Tasers might be the "most effective" way to deal with agitated, delirious people surely indicates those manuals need revision.

With serious questions about safety, and inconsistencies in police training and policies, we urge the Taser be holstered.

See other recent editorials.

Taser boss invokes Star Trek

May 15, 2008
By Carlito Pablo, straight.com

Strip away Tom Smith’s corporate persona as chair of Taser International Inc., and you’ll find an unabashed Star Trek fan.

When Smith fielded questions from the media after defending the 50,000-volt stun gun before a provincial inquiry on May 12, the Arizona-based executive couldn’t help but make a reference to the TV science-fiction series that he and his brother and company cofounder, Rick, grew up watching.

“We believe today we are the wired version of the Star Trek phaser, trying to get to that point where we’re using the minimum amount of force necessary to end the confrontation as safely as possible,” Smith told reporters at SFU’s Morris J. Wosk Centre for Dialogue in downtown Vancouver.

In the Star Trek universe, phasers are energy-beam weapons that can be set to stun, kill, or even vaporize an enemy. Smith claimed that in the real world and in the hands of law enforcers, Tasers are nonlethal devices that are designed only to incapacitate a person at the receiving end of two metal probes attached to wires.

Earlier in the day, Smith told the inquiry, being conducted by former B.C. Court of Appeal justice Thomas Braidwood, that Tasers aren’t entirely risk-free because they cause people to fall down. However, he stressed that the use of the stun gun actually prevents other injuries and even deaths caused by other weapons, primarily firearms.

But according to Vancouver lawyer and police watchdog Cameron Ward, Tasers have been involved in far too many deaths across North America since they were introduced.

“Many of those deaths, if not most of them, remained unexplained,” Ward told the Georgia Straight at the sidelines of the inquiry, which was ordered following the death of Polish immigrant Robert Dziekanski after he was tasered at the airport.

Ward represents the family of Robert Bagnell, who died in June 2004 after he was shot with a Taser by the Vancouver police.

According to a blog maintained by Bagnell’s sister, Patti Gillman, 344 North Americans, including 20 Canadians, have died since 1999 after they were shocked with the device. “Twenty-seven people have died in the U.S. since the beginning of this year,” the TNT—Truth…Not Tasers blog states. “Seventy-seven North Americans (that we know of) died in 2007, five of them Canadian.”

Amid often-conflicting claims about the safety of Tasers, the Canadian Medical Association Journal published an editorial on May 1 panning Taser International–funded studies indicating that the weapon is safe.

“They even set up demonstration booths where, like some bizarre extreme sport, people line up voluntarily to experience a taser shock for themselves,” the editorial stated. “Notably, volunteers are almost always shocked in the back and not in the chest, where the electrodes might cross the heart, nor do the volunteers experience the repeated and sustained shocks often used in the field, a feature that has led the United Nations to classify the Taser as a form of torture.”

The CMAJ also stated that new and independent research is needed to settle the issue of whether or not Tasers kill.

On May 12, Liberal MP Ujjal Dosanjh also appeared before the Braidwood. As B.C.’s attorney general, Dosanjh approved the introduction of the stun gun in the province in 1999. Dosanjh told the inquiry that he is “absolutely disappointed” that back then he was briefed that Tasers were safe and that their use had been thoroughly researched. “Now we know that is not true,” he said.

Dosanjh told reporters after his testimony that “all public officials are at the mercy of those who advise them.”

Although noting that there is “absolutely no conclusive evidence that Tasers don’t kill”, Dosanjh also said that he doesn’t want to “take away Tasers from the police forces”.

“I want them properly restrained in terms of the use,” he said. “I want the police officers really properly trained, and I want better research, and more and better reporting. If they don’t do any of those things, I believe that there ought to be a moratorium placed on the use of Tasers.”

Outside the Thomas Braidwood inquiry, three key players offered their views about the use of Tasers

Ujjal Dosanjh
Vancouver South MP, Liberal public-safety critic, and former B.C. premier and attorney general
“I think that ultimately the Taser is a device that [police] may be required to use under appropriate circumstances. The fact is that the RCMP and other police forces need to have stronger national standards for using these kinds of devices. We need to do more research. You want to know under what conditions they ought to use it and what the guidelines ought to be.”

Tom Smith
Chairman of the board and cofounder, Taser International Inc.
“We’ve done as long as 45 seconds in human exposures. We’re not seeing increased risks. I was the first person ever hit by our technology, in 1993. I’ve been tasered numerous times. We’ve had a number of studies that have been ongoing. I encourage studies. It just again goes back to this being the most studied nonlethal technology available today in the world.”

Cameron Ward
Vancouver lawyer and police watchdog who represents Robert Bagnell’s family
“The device is being used far too frequently, and not as an alternative to lethal force but as a tool for compliance. Before 2000, police were able to deal with nonviolent people in distress by talking to them and, if necessary, by using soft physical force. What we’re finding is that they’re using it as a weapon of first resort. They’re using it before making any attempt to talk people down or subdue them in conventional ways.”

More on: U.S. judge orders references to tasers removed from autopsies

This despicable and scandalous development in an Ohio court last week has barely registered on the radar screen south of the border (notwithstanding Robert Anglen's excellent report on the weekend). My hat is off to the CANADIAN MEDIA who see this for the travesty of justice that it is.


May 7, 2008
THE CANADIAN PRESS

Ohio judge orders stun gun references removed from autopsies

AKRON, Ohio — An Ohio medical examiner must change her autopsy findings to delete any reference that stun guns contributed to the deaths of three people involved in confrontations with law enforcement officers, a judge has ruled.

The decision was a victory for Taser International Inc., which had challenged rulings by Summit County Medical Examiner Lisa Kohler, including a case in which five sheriff's deputies are charged in the death of a jail inmate who was restrained by the wrists and ankles and hit with pepper spray and a stun gun.

Kohler ruled that the 2006 death of Mark McCullaugh Jr., 28, was a homicide and that he died from asphyxiation due to the "combined effects of chemical, mechanical and electrical restraint."

Visiting Judge Ted Schneiderman said in his ruling last week that there was no expert evidence to indicate that Taser devices impaired McCullaugh's respiration. "More likely, the death was due to a fatal cardiac arrhythmia brought on by severe heart disease," the judge wrote.

Schneiderman ordered Kohler to rule McCullaugh's death undetermined and to delete any references to homicide.

The judge also said references to stun guns contributing to the deaths of two other men must be deleted from autopsy findings. Dennis Hyde, 30, died in 2005 after a confrontation with Akron police, and Richard Holcomb, 18, died the same year after being hit with a stun by a police officer in suburban Springfield Township.

It was unclear what affect Schneiderman's ruling may have on the upcoming criminal trial of the five sheriff's deputies. One of them, Deputy Stephen Krendick, is charged with murder. Other deputies face charges of reckless homicide or felonious assault. All have pleaded not guilty.

Krendick's trial is scheduled to begin June 16. A spokesman for the Cuyahoga County prosecutor's office, which is handling the case, said its lawyers are prepared to go forward.

Steve Tuttle, vice-president of communications for Arizona-based Taser International, said the company was pleased with the Schneiderman's ruling, which came down Friday.

"Taser International believed from the beginning that these determinations of cause of death must be supported by facts, medical research and scientific evidence," Tuttle said.

John Manley, a Summit County prosecutor who represented Kohler, said the judge's order went too far. The county is considering an appeal, he said after the decision came down.

"Taser is quite a force to be reckoned with and does everything to protect their golden egg, which is the Model X26," Manley said.


May 7, 2008
CBC News

U.S. court ruling on Tasers worries Canadian doctors

A court ruling in the United States about Tasers is causing concern in Canada's medical community. The U.S.-based manufacturer of the controversial stun guns, Taser International, has won a court order in Ohio that forces a medical examiner to change autopsy reports.

Dr. Lisa Kohler had found that electrical shocks from Tasers were partially to blame for the deaths of three men in separate confrontations with police.

Taser International launched and won a civil suit, forcing Kohler to delete any reference to the deaths being related to electric shocks, and to term them "accidental deaths."

Dr. Matthew Stanbrook of the Canadian Medical Association (CMA) says the decision doesn't take into account the difficult of determining an exact cause of death in almost every case.

"If we were required to have at the level of scientific and medical certainty that something was the cause of death, before we were permitted to declare it, most of the people who died in North America would have died of unknown causes," Stanbrook said.

"It is a physician making their best judgment given all the facts available."

Stanbrook is deputy editor of the CMA Journal, which last week carried an editorial that expressed discontent with the current research into the effects of Taser use on suspects. The editorial said most of that work was done at the behest of Taser International and needed to be verified by independent researchers.

"New and independent research, both epidemiologic and biological, into whether Tasers can kill is essential to settle this issue," the editorial said.

Doctors and medical examiners in the United States have also expressed unease over the Ohio court decision.

Dr. Jeff Jentzen of the National Association of Medical Examiners said the case could affect other autopsy results.

"The physician shouldn't be threatened by individual companies attempting to preserve the reputation of their project," Jentzen said.

Taser International CEO Rick Smith told CBC News in January that medical examiners had to be sure of their facts because if they made what he called a careless opinion, they will be held accountable in court.

In submissions to the court in Ohio, Taser International said 68 wrongful-death or injury lawsuits involving Taser use have been dismissed or found in favour of the company.


May 6, 2008
Adrian Humphreys, NATIONAL POST

Taser win in court puts chill on doctors

“It is dangerously close to intimidation,” says group representing medical examiners

Taser won a court case in Ohio which forces medical examiners in that state to expunge any mention of the device as contributing to deaths of people in police custody.

A lawsuit by the makers of Taser stun guns has prompted an Ohio court to order a chief medical examiner to delete any reference to the use of a stun gun as a contributing factor in the deaths of three men, a move rebuked as "dangerously close to intimidation" by the National Association of Medical Examiners.

The outcome of the U.S. civil trial comes as the device is under scrutiny in Canada at an inquiry in British Columbia following the death of Polish immigrant Robert Dziekanski at Vancouver's airport in October after he was stunned by a Taser.

Taser, which has a reputation for vigorous legal defence of its popular law-enforcement products, filed a lawsuit against Dr. Lisa Kohler, chief medical examiner in Summit County, Ohio, after she named the use of a stun gun as a contributing factor in three deaths in her jurisdiction.

The case went to trial last month and on Friday, Judge Ted Schneiderman ruled in Taser's favour. Judge Schneiderman was explicit: "There is simply no medical, scientific, or electrical evidence to support the conclusion that the Taser X26 had anything to do with the death of Dennis S. Hyde, Richard Holcomb, or Mark D. McCullaugh."

"The multiple number of experts offered by [Taser International] in the area of sudden and unexpected death while law enforcement attempted to obtain custody, provided overwhelming credible medical and scientific evidence to support their positions."

Judge Schneiderman then ordered Dr. Kohler to change her official autopsy reports and death certificates for each of the three men.

John Manley, chief counsel of civil litigation in the Summit County Prosecutor's Office, said he is disappointed with the judgment. He is considering filing an appeal. He said defending against Taser was a daunting task.

"They are very vigilant, as you would expect a corporation to be who is making a product that makes so much money for you. "They have a record of 68 and 0 -- they've never lost and are quite a force to be reckoned with," he said.

Jeffrey Jentzen, president of the National Association of Medical Examiners, an organization that represents the majority of medical examiners in the United States, said the court's ruling and Taser's legal propensity is sending an unwelcome message to medical examiners. "Our membership is very concerned about these cases and the reaction of Taser to these cases," he said last night.

"Our membership is looking into the area and although Taser has developed its own opinion, there are certainly opposing opinions as to their involvement in causing sudden death in individuals.

"Our organization feels that it violates the physician's ability to make a medical decision. Ordering a professional physician to change or alter their records is in violation of their right to practise medicine.

"Taser has sued a number of medical examiners for making informed medical opinions in an attempt, I think, to both protect their product and send a threatening message to medical examiners.

"It is dangerously close to intimidation," he said. "They are attempting to send a message to medical examiners that if they elect to make that determination they may face a civil suit."

Steve Tuttle, Taser's vice-president of communications, said he was surprised by Dr. Jentzen's comments, disagrees with them and defended the company's decision to seek redress appropriately through the courts.

"I would disagree with that premise completely. At the end of the day, the judge's ruling is very, very crystal clear," Mr. Tuttle said.

In a previous statement, Mr. Tuttle said: "Taser International remains adamant in our position of not settling suspect injury or death lawsuits.

"Taser International's products have been demonstrated by numerous medical studies to be safe and effective. Taser International therefore aggressively defends our products in all litigation brought against the company with the best legal, scientific and medical expertise available."

Taser has faced more than 100 product liability suits, according to the company's filings to the Securities and Exchange Commission, the U.S. stock market regulator. The company's report lists wrongful deaths, training-related injuries to officers and injuries during arrests as being among the claims alleged.

There have been at least 10 training-injury lawsuits filed against Taser since 2003, according to the company. They include one by an RCMP officer who suffered a back injury after a voluntary Taser strike, he claims. Officers are encouraged to experience a Taser shot as part of their training, the lawsuit says.

A majority of lawsuits against it have been dismissed and several have brought judgments in Taser's favour.

Jonathan Kay on the best corporate media department in the world (even if they did get my name wrong)

May 7, 2008
Jonathan Kay, National Post

The people who man the media shop at Taser International Inc. are the aces of the corporate flak world. You write anything — anything — even vaguely skeptical (let alone downright negative, in which case they rattle their legal sabers) about stun guns, and they, er, zap you with an inbox full of electro-spin.

Case in point: my Tuesday column about this week's Canadian Medical Association Journal study on the health risks of being stun gunned, which earned me (or, should I say, "Jay") the note below. True, the guy not only got my name wrong, but also the name of my article (which he seems to have confused with Marni's blog post on the same subject). Still, it's the thought that counts.

Jay,

I read with interest your column entitled “Watch where you put that Taser” which appeared last Friday. As such, I wanted to make certain you had a copy of the official statement issued by TASER International related to the discussion article published in the Canadian Medical Association Journal. The statement is attached below.

Related to the CMAJ article and editorial, TASER International will point out that Dr. Stanbrook’s editorial is based primarily on a 2005 article from the Arizona Republic as his ONLY source that TASER International has “’sponsored research to prove the Taser's safety,’ he continues. ‘Just about all the research, as it turns out.’” Over the three years since that article was written, much of the research by the Governments of the United States, Canada, the United Kingdom, and leading academic and medical institutions has been funded independent of TASER International. To date, there are more than 120 major studies or analysis of TASER devices and TASER technology with more than 80 percent of them funded independent of TASER International. In fact, the US Department of Justice has been a prolific funder of TASER research recently and one of the first to fund human studies.

Finally, I have provided you with a press release issued this morning by TASER International regarding a Summit County, Ohio law suit involving erroneous medical examiner reports in three cases involving TARSER devices. I thought that you find this of interest and relevant.

<<080505 Summit Co OH Lawsuit.doc>>

My best,

Peter

________________________________________________

The following is the official statement of TASER International regarding the Canadian Medical Association Journal article “Cardiac stimulation with high voltage discharge from stun guns”:

The manuscript released today by researchers at the University of Toronto appears to be a discussion paper that offers no new research. Rather it appears to be simply a discussing of prior papers and findings. TASER International is dismayed by attempts to present this information as something it is not.

Most important to note is that the authors of this manuscript themselves, in their conclusion, clearly state that there are “many studies suggesting that stun guns do not affect the heart” and that, “the evidence and studies presented in this review suggest that, in some circumstances, stun guns may stimulate the heart while discharges are being applied. However, there is no conclusive evidence to show whether stun gun stimulation (under certain electrophysiological conditions) can result in cardiac arrhythmias late after stun gun discharge.”

The authors, also in their conclusion, acknowledge that final conclusions should not be drawn solely from the referenced pig studies and call for human studies to be done: “In our view, it is inappropriate to conclude that stun gun discharges cannot lead to adverse cardiac consequences in all real world settings. We believe that the findings that stun gun discharges are able, under specific circumstances, to stimulate the heart should be taken into account in future studies involving people. Whether stun guns can stimulate the heart can only be established if one can record electrical activity in the heart during a discharge, especially when the vector of discharge is directed across the heart. Additional research studies involving people will help to resolve the conflicting theoretical and experimental findings, and they could lead to the design of devices with electrical pulses that cannot stimulate the heart.”

To this point exactly, three human studies on the effects of TASER® electronic control devices will be presented at the Heart Rhythm Society’s Heart Rhythm 2008 , May 14-17, 2008, in San Francisco, CA USA. The studies include:

(Thursday May 15, 2008) Presenting Rhythm in Sudden Custodial Deaths After Use of TASER® Electronic Control Device, Charles Swerdlow, MD, FHRS, Mark W. Kroll, PhD, FHRS, Howard Williams, Mazda Biria, MD, Dhanunjaya Lakkireddy, MD and Patrick J. Tchou, MD. Cedars-Sinai Medical Center, Los Angeles, CA, University of Minnesota, Minneapolis, MN, San Marcos Police Department, San Marcos, TX, University of Kansas Medical Center, Kansas City, KS, Cleveland Clinic, Cleveland, OH.

(Friday May 16, 2008) Can Electrical-Conductive Weapons (TASER®) alter the functional integrity of pacemakers and defibrillators and cause rapid myocardial capture? Dhanunjaya R. Lakkireddy, MD, Mazda Biria, MD, Esam Baryun, MD, Loren Berenbom, MD, Rhea Pimentel, MD, Martin P. Emert, MD, Kevin Kreighbaum, RN, Mark W. Kroll, PhD and Atul Verma, MD. Mid America Cardiology @ University of Kansas Hospital, Kansas City, KS, University of Minnesota, Minneapolis, MN, Southlake Regional Health Center, Toronto, ON, Canada.

(Friday May 16, 2008) Echocardiographic Evaluation of Human Transcutaneous TASER® Application Along the Cardiac Axis, Jeffrey D. Ho, MD, Donald M. Dawes, MD, Robert F. Reardon, MD, Anne L. Lapine, MD, Jeremy D. Olsen, MD, Benjamin J. Dolan, BA and James R. Miner, MD. Hennepin County Medical Center, Minneapolis, MN, Lompoc District Hospital, Lompoc, CA.

The Heart Rhythm Society is the international leader in science, education and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education and optimal health care policies and standards.

U.S. court ruling on Tasers worries Canadian doctors

May 7, 2008
CBC News

A court ruling in the United States about Tasers is causing concern in Canada's medical community. The U.S.-based manufacturer of the controversial stun guns, Taser International, has won a court order in Ohio that forces a medical examiner to change autopsy reports.

Dr. Lisa Kohler had found that electrical shocks from Tasers were partially to blame for the deaths of three men in separate confrontations with police.

Taser International launched and won a civil suit, forcing Kohler to delete any reference to the deaths being related to electric shocks, and to term them "accidental deaths."

Dr. Matthew Stanbrook of the Canadian Medical Association (CMA) says the decision doesn't take into account the difficult of determining an exact cause of death in almost every case. "If we were required to have at the level of scientific and medical certainty that something was the cause of death, before we were permitted to declare it, most of the people who died in North America would have died of unknown causes," Stanbrook said. "It is a physician making their best judgment given all the facts available."

Stanbrook is deputy editor of the CMA Journal, which last week carried an editorial that expressed discontent with the current research into the effects of Taser use on suspects. The editorial said most of that work was done at the behest of Taser International and needed to be verified by independent researchers.

"New and independent research, both epidemiologic and biological, into whether Tasers can kill is essential to settle this issue," the editorial said.

Doctors and medical examiners in the United States have also expressed unease over the Ohio court decision. Dr. Jeff Jentzen of the National Association of Medical Examiners said the case could affect other autopsy results. "The physician shouldn't be threatened by individual companies attempting to preserve the reputation of their project," Jentzen said.

Taser International CEO Rick Smith told CBC News in January that medical examiners had to be sure of their facts because if they made what he called a careless opinion, they will be held accountable in court.

In submissions to the court in Ohio, Taser International said 68 wrongful-death or injury lawsuits involving Taser use have been dismissed or found in favour of the company.

Taser proponents dominate inquiry

VANCOUVER -- The first of two provincial inquiries examining the use of Tasers by police began yesterday, and while it's far too early to predict what conclusions will be made at the end of Round One, one can see where things are headed.

"Stun weapons" are not the malevolent instruments some have learned to hate, suggested J. Patrick Reilly, a U.S. electrical engineer and Taser expert, and the first witness to appear before inquiry boss Thomas Braidwood.

Rather, they are tools that police can use to deal efficiently with "dangerous" or "belligerent" people. The use of electronic control weapons such as Tasers rarely results in death, Mr. Reilly noted. "The probability of that is very small."

It will be a refrain heard often from the inquiry floor in the next three weeks. Many of the 40 witnesses scheduled to speak are from the law enforcement business. Tasers are popular with police departments. Even some transit cops brandish them. In Vancouver, this is another source of controversy. Transit police have fired on 10 people, including "non-compliant" customers, since January, 2007, the Vancouver Sun recently reported.

None of the transit riders has filed an official complaint, but the B.C. Civil Liberties Association, which will make a presentation here, has asked that people come forward and appear before Mr. Braidwood.

The inquiry is to have "no preconceived agenda…no preconceived notions" about the use of Tasers by police, commission counsel Art Vertlieb said yesterday. But in one of several interviews he gave before the inquiry launched yesterday, Mr. Braidwood said it "appears" that Vancouver transit police "didn't follow their own policy in the use of [Tasers]. I'm not involved in making any blame or anything but that would certainly red-flag it."

In another interview, Mr. Braidwood seemed mildly skeptical about how the RCMP was investigating the apprehension and accidental death of Robert Dziekanski. The Polish immigrant died last year during an incident involving the RCMP at Vancouver International Airport. Bewildered and frustrated after a long flight from Poland, Mr. Dziekanski acted aggressively at the airport. The Mounties were called. He was twice hit with Taser shots and was manhandled while writhing on the ground.

The event was captured by a passerby on video and eventually was broadcast around the world. Public reaction, Mr. Braidwood said in his opening remarks, "was immediate and intense."

Indeed, the tragedy moved B.C.'s provincial government to call the two inquiries. Mr. Braidwood was appointed to head them both. But the Dziekanski case, while the catalyst, will not be discussed in any detail at the present inquiry; that is for "later this year," Mr. Braidwood said. Witnesses at the second inquiry, an evidentiary proceeding, will be required to take an oath and avail themselves to cross-examination by lawyers.

It may not happen at all. A date for the second inquiry can't be set until the RCMP completes its own investigation of the Dziekanski death. If charges are recommended to the Crown, and the officers are sent to trial, then Mr. Braidwood's second inquiry could be delayed for years.

And while the RCMP has promised to participate in the inquiry now underway, only its complaints commission chairman, Paul Kennedy, has confirmed he will testify. But he's not free until June, which is after the public forums are to have ended. Mr. Braidwood has asked that the length of the first inquiry be extended. He's still waiting to hear back from the B.C. government, he said yesterday. For now, he'll have to be content hearing from technical experts and municipal police officers, as well as health officials.

Mr. Reilly, the first witness, described how research he con-ducted on the environmental impact of electrical production evolved to the study of electric shocks on people. The research was aimed at determining how much electrical shock a person could tolerate.

He eventually conducted research for the U.S. Army, examining the safety and efficacy of electronic weapons similar to Tasers. A report he wrote in 2004 was funded by the U.S. Department of Defence; he also wrote a book on the subject.

Mr. Reilly described how the devices work. When triggered, a compressed nitrogen charge inside a gun propels two barbed projectiles; these are attached to copper wires. The projectiles lodge into the target's skin. The operator of the weapon then releases "pulsed electric shocks" that are set five seconds apart. These travel the length of the wires and enter the target's body, causing him to lose musculature control. "Usually" the target will "cry out" in pain and "fall down," Mr. Reilly said.

The devices are not "benign," he conceded, but neither do they pose a serious risk of death if used properly. New research conducted since making his studies has simply "reinforced the opinion I had then," he said yesterday. He may have missed a study published by the Canadian Medical Association Journal just last week, which concluded that "in some circumstances, stun guns may stimulate the heart while discharges are being applied … In our view, it is inappropriate to conclude that stun gun discharges cannot lead to adverse cardiac consequences in all real world settings."

The CMAJ authors are not among the 40 witnesses scheduled to speak at the inquiry.

Proceedings continue today with statements from the Victoria Police Department's controlled electronic weapons program co-ordinator, an emergency room physician and a prison warden. Tom Smith, founder and chairman of TASER International, Inc., is to appear next week.

EDITORIAL: Tasers do affect the heart

May 3, 2008
The Globe and Mail

The case for a moratorium on police use of tasers in Canada has been immeasurably strengthened by a group of cardiologists and research scientists from the University of Toronto. They have exploded police and manufacturer claims that the taser does not affect the heart and therefore does not cause fatal heart problems. With taser use growing rapidly - the Mounties alone use them more than 20 times a week - a study by the University of Toronto researchers published in the latest issue of the Canadian Medical Association Journal should be bedside reading for legislators across Canada.

The issue of taser safety has been dominated by questionable science, a point made inadvertently by RCMP Commissioner William Elliott and Alberta Solicitor-General Fred Lindsay when they were voluntarily tasered on Thursday. The idea was to demonstrate that the electric stun gun's effects wear off almost as soon as the five-second zap ends. Step right up, ladies and gents. This is the science of the snake-oil salesman.

It would take more than one William Elliott for an effective experiment, and some of them would have to be on psychotropic drugs, or have a weak heart, or be in the anxious, sweating, breathless state police call "excited delirium."

Especially key, the gun's electrical charge would have to fall across the heart - what the University of Toronto professors call "the worst-case scenario" - and not just across the abdomen. And perhaps Mr. Elliott would afterward volunteer to have a 100-kilogram officer press a knee on his exhausted windpipe. (Respiratory exhaustion, not just heart problems, may be behind some of the taser-related deaths.) Then it would simulate the real world - the world in which Robert Dziekanski was fatally tasered by the Mounties at the Vancouver airport in October.

This is not to deny that the taser has benefits. In Brampton, Ont., this week, police saved a man's life by zapping him after he took a knife to his own neck. But police are permitted to use tasers where serious physical harm is not at issue, in part because they assume it is risk-free.

As the CMAJ study shows, this assumption is wrong. "New and independent research, both epidemiologic and biological, into whether tasers can kill is essential to settle this issue," the journal says in an accompanying editorial. The safety of tasers is a live issue.

Police don't believe it. To them, "tasers do not kill" has become a mantra; no matter how many people die (20 in Canada in the past five years), the mantra does not change. Not even Mr. Dziekanski's death prompted Mr. Elliott and his outfit to question the official line. On what does that line rest? Largely on a few studies of tasers' effects on pigs, and on coroners' inquests that have not directly blamed the taser for deaths.

But the CMAJ study from the University of Toronto researchers found major weaknesses in the pig studies, and clear evidence, both in a study they did on pigs and in pig studies they reviewed, that the heart could be affected when the gun's two barbs struck in such a way that the electricity passed through the heart (without the barbs actually penetrating the heart). In one study, researchers opened a pig's chest when it was zapped and observed that the heart was affected. The stun gun could cause the pigs to abruptly lose their blood pressure. Two pigs died immediately after the stun-gun discharge in the study. As for the inquests, the CMAJ makes no reference to them, but in an interview, co-author Paul Dorian said that "as a scientist, I'm sympathetic to the difficulty of ascribing cause with very limited information." His study concludes: "It is inappropriate to conclude that stun gun discharges cannot lead to adverse cardiac consequences in all real world settings." But that is exactly the police conclusion.

Whom is the public to believe, Mr. Elliott and Mr. Lindsay, who faced the taser's barbs, or medical scientists who specialize in the heart? The answer seems obvious.

Police guidelines for taser use are based on faulty assumptions. A temporary suspension of taser use would allow for those guidelines to be rewritten to reflect the weapon's real world risks.

EDITORIAL: Stunning concerns

May 3, 2008
The Kingston Whig Standard

Are electric stun guns potentially lethal? Are they more dangerous than their manufacturer and police forces let on? Definitive answers to these questions have been hard to find. So much so that it was becoming clear that medical intervention would be necessary - that doctors and researchers would have to enter into the debate.

Now they have. This week, an editorial in the Canadian Medical Association Journal called for more independent studies into the devices. It points out that enough people have died soon after being shocked that further investigation is warranted.

More than 300 North Americans, including 20 in Canada, have died after being shot with stun guns. Sadly, it took the videotaped death of Polish immigrant Robert Dziekanski in Vancouver International Airport last October to arouse wider public concern.

Determining whether or not the stun guns are as safe as the manufacturer says they are will influence how and when they are used. Initially, they were promoted as a less lethal alternative to guns. But a Canadian Press analysis of RCMP stun-gun use between 2002 and 2005 revealed that in 563 incidents, 79 per cent of the suspects were unarmed and didn't necessarily pose a high risk to officers.

Amnesty International has called for a moratorium on the use of stun guns until further studies are done. Indeed, overuse of the weapons is becoming a concern. Last month it was revealed that Vancouver transit police were zapping people who refused to pay their fares.

Public health and safety may be compromised by stun-gun use. We welcome the doctors' input.

CANADIAN MEDICAL ASSOCIATION JOURNAL - Tasers in medicine: an irreverent call for proposals

EDITORIAL
Canadian Medical Association Journal
Early release, published at www.cmaj.ca on May 1, 2008 – subject to revisions

In this issue, we call your attention to an emerging and increasingly popular medical device: the taser. It may strike you as odd to hear tasers described as medical devices. Tasers are probably more familiar to you, depending on your point of view, as a valuable tool for subduing criminals and safeguarding the lives of law enforcement personnel(1) or, alternatively, as a potentially lethal weapon being deployed with wanton disregard for public safety.(2) The latter perspective has possibly been inflicted on society by the media, which has an annoying habit of publicizing when someone dies after being exposed to a taser discharge. In fact, media reports to date have documented over 300 such deaths, 20 in Canada.(3,4) Critics charge that tasers are too dangerous, that independent studies evaluating their safety are urgently needed and that a moratorium should be placed on their use.(2-4)

Fortunately, comforting words can be found if you're looking for reassurance that tasers really are the greatest invention since pepper spray - another weapon that medicine has appropriated, now that capsaicin cream is used as a topical analgesic. You see, despite what scientific demonstration of potentially lethal effects in animals and humans (as reviewed by Nanthakumar and colleagues in this issue(5)), overwhelming circumstantial evidence and a certain notorious airport video might lead you to believe, tasers are perfectly safe and have never, ever killed anyone. We know this because TASER International, manufacturer of the market¬leading device, says so, claiming "the TASER ECD cannot stop the heart".(6) And TASER International is an honourable, and for most of its existence very profitable, company.

So honourable, in fact, that they have sponsored research to prove the taser's safety. Just about all the research, as it turns out.(7) Moreover, they pay for experts to travel across North America and spread the good news about how safe tasers are and correct any misconceptions that might arise from events like deaths of suspects in police custody or immigrants in Vancouver's airport.(8) They even set up demonstration booths where, like some bizarre extreme sport, people line up voluntarily to experience a taser shock for themselves.(9) Notably, volunteers are almost always shocked in the back and not in the chest, where the electrodes might cross the heart, nor do volunteers experience the repeated and sustained shocks that are often used in the field, a feature that has led the United Nations to classify the taser as a form of torture.(10)

TASER International appears to attract loyalty. The scientific literature bears witness to a small group of dedicated researchers who diligently write letters to journals pointing out flaws in studies reporting harm from tasers. Unfortunately, some of these researchers occasionally neglect to mention their participation on TASER International's medical advisory board or board of directors.(11,12) TASER International itself sometimes goes further, to the extent of suing a researcher for publishing scientific results critical oftasers in a peer-reviewed journal and a medical examiner for the "error" of listing taser exposure on a death certificate as the cause of death.(13) Obviously, no one is better suited to instruct a qualified physician, coroner or specialist in forensic pathology on how to determine the cause of death than advisors to a corporation with a vested interest in the device being critiqued. This bold step ushers in a new medico-legal era: physicians can now be sued not only for delivering bad care but also for holding bad opinions.

Owing to these diligent efforts, the taser's good reputation has been maintained. Law enforcement agencies worldwide are increasingly adopting its use. In the United States, the general public can also exercise their second-amendment right to bear tasers, with the latest consumer models sporting stylish leopard print or camouflage motifs.

And now, apparently, it is medicine's turn. You see, the company and its hired experts have managed to explain why so many people seem to die after being zapped by a taser without this being in any way the fault of the device. They have taught us about an emerging disorder called "excited delirium." As reported recently in CMAJ,(14) this disorder, which does not officially exist as a recognized clinical condition in the DSM-N classification, enjoys lively discussion whenever tasers are involved. The message to remember is that tasers do not kill people: excited delirium does. Only cynics would observe that tasers nevertheless appear to be the leading risk factor associated with sudden death due to excited delirium, suggesting a potential cure for this increasingly prevalent and fatal condition if society could accept the drastic measure of withdrawing tasers from use.

Despite this, some law enforcement training materials actually discuss excited delirium as an indication for taser use(15) which is a position endorsed by the manufacturer. As it seems from this that tasers are being recommended as a treatment for a medical condition, we infer that they are in effect being construed as a medical device. Now, we have some bad news for the manufacturer. To be approved for use, medical devices must satisfy rigourous scientific standards and be subjected to clinical trials. This is to protect the public from unsafe medical devices. Fortunately for TASER International, there are no similarly rigourous scientific standards mandated to protect the public from potentially unsafe law enforcement devices. Tasers can thus be used freely on any member of the population, albeit safeguarded by the sound judgment of law enforcement personnel and, in the United States, by the sound judgment of most any adult who has money to purchase one.

To keep health care professionals from being excluded from this exciting treatment option, perhaps the Canadian Institutes of Health Research should issue a call for proposals for taser research. A randomized trial of tasers for excited delirium would seem a logical place to start, but given the lack of an accepted case definition for this condition, a study in ordinary delirium might have to do. For those who might have ethical concerns with such a trial, we point out that a management strategy currently popular in this context, the off-label use of antipsychotics, is already known to increase the risk of death,(16) thus one could argue that clinical equipoise exists as to whether tasers would be a safer and more effective intervention. The emergency department may be a safer environment to study taser use because, curiously, patients rarely seem to die of excited delirium in an emergency department and physicians' hearts are comforted by the presence of a defibrillator.

On the other hand, perhaps the CIHR should issue a different kind of call. The CIHR could start by recognizing that deaths occurring in association with taser use make the safety of these devices a public health issue. New and independent research, both epidemiologic and biological, into whether tasers can kill is essential to settle this issue. Also, law enforcement agencies could be made to open up their databases on taser use for independent analysis, on the principle that the assertion that tasers have saved lives of police and suspects alike, while plausible, should be proven, not merely asserted as fact. We imagine that, to TASER lnternational, this type of research may seem unnecessary and pedantic. We're sorry, but in the end, we are used to thinking like physicians and scientists concerned about health, preferring to gather and analyze the facts rather than succumbing to the bald assertions of a large corporate entity that has demonstrated a willingness to squelch any messages that could hurt its bottom line.

Matthew B. Stanbrook MD PhD Deputy Editor, Scientific, CMAJ
With the Editorial-Writing Team (Paul C. Hebert MD MHSc,
Rajendra Kale MD, Barbara Sibbald BJ, Ken Flegel MDCM MSc and Noni MacDonald MD MSc)

REFERENCES

1. Klint DE. TASER device liability and litigation risk. Scottsdale (AZ): TASER International, 2007. Available here. (accessed 2008, Apr 15).

2. Amnesty International's concerns about Tasers. Ottawa: Amnesty International Canada, 2007. Available here. (accessed 2008 Apr 15).

3. Amnesty International reiterates call to suspend police use of tasers following airport death [news release]. Ottawa (ON): Amnesty International Canada, 2007. Available here. (accessed 2008 Apr 15).

4. TNT - TRUTH...not TASERS [blog]. Available: http://truthnottasers.blogspot.com/ (accessed 2008 Apr 15).

5. Nanthakumar K, Masse S, Umapathy K, et al, Cardiac stimulation with high voltage discharge from stun guns CMAJ 2008;1781:1451-7.

6. Kroll MW. Cardiac safety. Scottsdale (AZ): TASER International: 2007 Mar 25. Available here. (accessed 2008 Apr 15).

7. Anglen R. Taser tied to "independenr' study that backs stun gun. Arizona Republic 2005 May 21. Available here. (accessed 2008 Apr 14).

8. S. Alphonso C, Leeder J, EI Akkad O. Taser firms picked up coroner's tab to give lectures. The Globe and Mail 2007 Nov 30. Available here. (accessed 2008 Apr 15).

9. Basler R. Oh, we're playing LASER tag? Not TASER tag? My bad... London (UK): Reuters: 2007. Available here. (accessed 2008 Apr 15).

10. United Nations Office at Geneva. Committee against torture concludes thirty-ninth session. Geneva: United Nations, 2007. Available here.(accessed 2008 Apr 15).

11. Kroll M, Luceri RM, Calkins H. A very interesting case study involving a TASER conducted electrical weapon (CEW) used on a patient with a pacemaker. J Cardiovasc Electrophysiol 2007;18:E29-30.

12. Kroll MW, Calkins H, Luceri RM. Electronic control devices and the clinical milieu. J Am CoIl Cardiol 2007;49:732-3.

13. Randerson J. Stun gun makers sue experts over safety criticisms. Guardian (UK) 2006 Mar 9. Available here. (accessed 2008 Apr 15).

14. Truscott A A knee in the neck of excited delirium. CMAJ 2008;178:669-70.

15. Royal Canadian Mounted Police. Operational manual. Chapter 17.7: Conducted energy weapon. Ottawa: the Police, 2007. Available here. (accessed 2008 Apr 15).

16. Singh S, Wooltorton E. Increased mortality among elderly patients with dementia using atypical antipsychotics. CMAJ 2005;173:252.

Medical journal calls for independent studies on Taser safety

May 1, 2008
The Canadian Press

OTTAWA — Potential health risks of Taser stun guns must be independently studied, says the latest Canadian Medical Association Journal in a sardonic editorial that blasts the manufacturer for intimidation tactics.

Taser International funds much of the research it cites to support Taser safety while challenging and sometimes suing those who raise concerns, it says.

"Tasers are perfectly safe and have never, ever killed anyone," writes Dr. Matthew Stanbrook, an assistant professor, researcher and specialist in respirology at the Toronto Western Hospital.

"We know this because Taser International . . . says so, claiming 'the Taser . . . cannot stop the heart.' And Taser International is an honourable and, for most of its existence, very profitable company.

"So honourable, in fact, that they have sponsored research to prove the Taser's safety," he continues. "Just about all the research, as it turns out. Moreover, they pay for experts to travel across North America and spread the good news about how safe Tasers are and correct any misconceptions that might arise from events like deaths of suspects in police custody or immigrants in Vancouver's airport."

Stun guns are now the subject of several continuing or pending inquiries across Canada. The weapons came under intense scrutiny last fall when amateur video of the death of Polish immigrant Robert Dziekanski at Vancouver International Airport was released, to public outrage.

No comment from Taser International was immediately available. It has vigorously defended its devices in several lawsuits and stresses that the weapon has never been directly blamed for a death. It has, however, been cited repeatedly as a contributing factor.

Especially at issue is the unknown effect of zapping severely agitated suspects with up to 50,000 volts. The sudden deaths of several people who were in a heart-pounding state before being Tasered have been explained using the contentious, non-medically recognized term "excited delirium."

"It's troubling that it's trotted out so often as an explanation for these events given the uncertainty around it," Stanbrook said in an interview. Taser advocates, along with an RCMP training manual, go so far as to suggest it might be best to zap people in that condition so they may be quickly subdued and medically treated, he added.

"It seems that these deaths due to excited delirium only occur in the context of being confronted with a law-enforcement officer with or without a Taser. Delirium in general is a very common condition - we see it all the time in hospitals.

"It is rare if ever that people who are delirious in hospitals have sudden death. So this has really come out of nowhere as something that suddenly kills people and requires rapid intervention."

To recommend the Taser as a go-to management tool in such situations "seems to us bordering on the absurd," Stanbrook said."Another perspective . . . is this is exactly the situation in which someone is at risk of dying from the Taser."

He says federally funded, independent research is badly needed to get to the bottom of such questions. At the very least, there should be an unbiased review of police-confrontation deaths before and after Tasers were introduced to assess net harm or benefit.

More than 300 people in North America, including 20 in Canada, have died soon after being Tasered. The electronic guns are overwhelmingly popular with police, who say they avoid injuries to suspects and officers and are certainly a better option than firearms.

Amnesty International and other critics have called for a moratorium pending an independent and comprehensive safety review. They say "Taser creep" has led to the jolting of unarmed suspects as a matter of handy compliance rather than to defuse major threats.

A Canadian Press analysis of 563 Taser incidents reported by the RCMP between 2002 and 2005 revealed that more than 79 per cent of suspects were unarmed.

The reports also suggested a pattern of use by the Mounties as a quick means to keep relatively low-risk prisoners, drunks and unruly suspects in line. More recent reports released by the RCMP have been heavily censored to remove key details such as exact dates and injuries linked to the stun guns.

Canadian medical journal calls for independent studies on taser safety

May 1, 2008
The Canadian Press

OTTAWA — A scathing editorial in the latest Canadian Medical Association Journal says the safety of Taser stun guns must be studied independently. The journal blasts Taser International, which makes the powerful weapons, for funding much of the research used to support the safety of Tasers. It reviews existing scientific studies and says there's an urgent need for new and unbiased research.

More than 300 people in North America, including 20 in Canada, have died soon after being Tasered. The electronic guns are overwhelmingly popular with police, who say they avoid injuries to suspects and officers. The medical association says Taser International has aggressively challenged researchers and coroners who've raise safety concerns.

A knee in the neck of excited delirium

March 11, 2008
Amanda Truscott
Canadian Medical Association Journal

Some call it an entirely manufactured psychological condition. The police believe it is not only legitimate, but potentially fatal.

The latter, though, may have a vested interest in perpetuating the notion that "excited delirium" is a valid medical condition, given the heat they've taken following last year's death of Polish citizen Robert Dziekanski at Vancouver International Airport after being shot by a taser, a hand-held weapon that uses compressed air to direct a jolt of electricity up to 10.6 metres away.

Did Dziekanski die from "excited delirium" or multiple taser shocks? And what about the officer's knee pressed into his neck?

Dziekanski touched down in Vancouver on Oct. 14, 2007, following a 13-hour flight from Poland and for 8 hours roamed the immigration lounge, steadfastly insisting that his mother would soon meet him. She, meanwhile, awaited his arrival in the baggage claims area, while airport officials did nothing to ensure the pair could connect. Lost, confused and unable to speak English, Dziekanski used office chairs to build a makeshift barricade between a pair of glass doors as if to ensure that no one could remove him from his meeting place with his mother. Obviously frustrated, he began to throw computer equipment onto the floor and against a glass wall. The police were summoned and in stunning sequence of events captured on video by an eyewitness's cell phone, Dziekanski was pinned the floor, shot by a taser and eventually died.

Public outrage prompted the federal government to call an investigation into officers' use of tasers. The Commission for Public Complaints Against the RCMP [Royal Canadian Mounted Police] released an interim report on Dec. 12, 2007, recommending restrictions on the weapon's use. A coroner's inquest will commence in May.

The RCMP claim excited delirium was the cause of death. Media and civil liberties groups are skeptical about both the cause, and the condition.

A controversial condition, "excited delirium" has been defined as being characterized by agitation, incoherence, bizarre behaviour, high temperature, superhuman strength, a high tolerance for pain — and sometimes, the compulsion to break or bang on glass. Those who study it say it can be brought on by drug use, alcohol withdrawal, low blood sugar, mental illness or extreme fatigue. It does not, however, appear in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM).

But "delirium" — minus the "excited"— does.

Dr. Ian Dawe, director of Psychiatric Emergency Services at St. Michael's Hospital in Toronto, explains delirium as "a fluctuating level of consciousness," a set of symptoms that stereotypically appear together as a result of intoxication or an underlying medical condition.

The DSM says most sufferers of delirium fully recover but some don't as "delirium may progress to stupor, coma, seizures, or death, particularly if the underlying cause is untreated."

Dawe says there are 2 kinds of delirium: active and hypoactive. People suffering from the former might behave more or less as Dziekanski did: they can be agitated, irrational, and hard to communicate with. The hypoactive form, meanwhile, makes people quiet and withdrawn.

Active delirium can increase risks associated with physical restraints, Dawe says. But when someone suffering from delirium dies, determining the cause is problematic. Was it delirium? The taser? Restraint? A complex interplay of all the above?

Dawe says "excited delirium" is a pop culture phenomenon and doesn't have much currency among psychiatrists, although police, coroners and forensic pathologists use it.

University of Miami Professor of Neurology Dr. Deborah Mash, who has studied the condition for 20 years, says "sudden death in the context of emotional stress is well-known. Just because there isn't something called 'agitated delirium' or 'excited delirium' — that vernacular is not in the DSM-IV — doesn't mean that the symptom set is not in the DSM, because it is. We have evidence to suggest it's a brain disease."

Mash argues the condition is the result of an interaction between genes and environment: the gene remains silent until triggered by something like alcohol, drugs, stress or sleep deprivation — anything that affects dopamine. "It's always the same. The presentation is the same, the behavioural syndrome is the same, the hyperthermia is there, and the phenomenon of sudden death is there. And it doesn't matter whether they were restrained, or hogtied, or pepper sprayed or tasered — it's the same."

"This is a condition where law enforcement doesn't have a lot of options ... now, if you just left someone with excited delirium in the woods, I mean, what would happen to them? We don't know the answer. We've had purported excited delirium deaths where there were no police involved."

Yet, here's the rub. Those who die of "excited delirium" usually do so while in police custody, often after having been tasered.

To be sure, it's not a disease invented by the RCMP. In fact, they are late to the adoption of "excited delirium" as a condition. As early as 1849, Dr. Luther Bell described the inexplicable sudden death of psychotic patients as "acute exhaustive mania," while Dr. Charles Wetli coined the term "excited delirium" in 1985 to explain sudden death in recreational cocaine users.

Yet, so convinced are police that "excited delirium" is a legitimate condition that PoliceOne.com, an international information website for police officers, includes a direct link to an excited delirium training video created by the Las Vegas Police Department. In the video, Sherriff Bill Young even asserts that excited delirium leads people to blame police for deaths they didn't cause.

The video explicitly recommends using tasers to override the central nervous system, incapacitating the suspect just long enough for officers to properly restrain him. In a dramatization, a handcuffed suspect lies on the ground, surrounded by 7 officers. They place no weight on him and eventually turn him on his back and sit him upright. Nothing is done that might constrain the suspect's breathing, a point PoliceOne.com is careful to caution against.

The latter is by no means moot — the link between restraint, excited delirium and oxygen supply has long been the subject of debate and concern.

A 1998 review of 21 cases of unexpected deaths in people in a state of excited delirum — 18 of which were people in police custody — found that all "suddenly lapsed into tranquility shortly after being restrained (CMAJ 1998:158[12]: 1603-07). In all 21 cases, the victims had been restrained either face-down or through pressure applied to their necks. In 12 cases, excited delirium was brought on by a psychiatric disorder. In 8 cases, cocaine was the culprit. In 8 cases, the victims suffered chest compression from the weight of 1–5 people.

The study concluded that "the possibility that positional asphyxia contributes to unexpected death in people in states of excited delirium cannot be ignored." Those suffering from excited delirium were in need of more than the usual amount of oxygen, yet the techniques used to restrain them could restrict their ability to breathe.

Dawe is sympathetic to people faced with the task of controlling situations like Dziekanski's. "I wouldn't want to lay blame on anyone." He'd like to enhance cooperation between police, paramedics and mental-health professionals, so that police could have "a broader range of options" when dealing with such cases. St. Michael's has partnered up with 2 downtown Toronto police divisions to create a "mobile crisis intervention team" — a constable and a mental-health nurse who deal with 911 dispatches involving emotionally disturbed people. The idea is to decriminalize mental health issues and reduce visits to the prison and the hospital.

"If something good can come out of tragedy, it's that perhaps we can develop a different approach to these situations," Dawe adds.