Review of: Strote J, Range Hutson H: "Taser use in restraint-related deaths." Prehospital Emergency Care. 10(4):447 450, 2006.
This review of TASER related deaths was conducted by performing an Internet search of all such fatalities during a four year period beginning January 2001. The authors identified 75 cases of which 37 (49.3%) had autopsy reports available. The reports were then analyzed for patient demographics; preexisting cardiac disease; toxicology; evidence of excited delirium; restraint techniques used; and listed causes of death.
The found all 37 cases involved men ages ranging from 18 to 50. Cardiovascular disease was found in 54.1%. Illegal substance use was found in 78.4% of which the vast majority (86.2%) were found to have used stimulants. A diagnosis of excited delirium was given in 75.7% of the cases and the TASER was considered a potential or contributory cause of death in 27%.
I must congratulate the authors on a valiant attempt to help us gain greater insight into the subject of excited delirium. Unfortunately, their methodology is lacking. First, the identification of potential cases for review by performing a Google Search is far from scientific and substantial selection bias must be assumed. A more straightforward but almost impossible tack would have been to request similar lists from state medical examiner databases.
With that said, let s further examine the cases they identified. One demographic that is not included in the abstract is that the average Body Mass Index for these cases was 30.8. These were obese men, with the largest topping the scale with a BMI of 48.4!
The authors agree that all the cases exhibited signs consistent with excited delirium, despite the fact that only 78% had illegal substances found on toxicology. While I don t disagree with them that excited delirium played a major - if not the primary - role in the deaths, further information is needed to make that claim.
I agree with the authors that excited delirium is a major issue facing both law enforcement and EMS. The combination of significant underlying cardiac disease, illegal substance abuse and excited delirium can result in hyperthermia, acidosis and a highly agitated state that requires substantial physical restraint to control.
What I don t agree with is the attempt to link TASER use with any of these deaths. The authors made no attempt to determine the number of TASER deployments per subject or the degree of physical restraint necessary to contain the subjects. There was also no indication of the presence or involvement by EMS in any of these cases.
It is premature to draw any linkage between TASER use and death-in-custody. Additional studies are needed. One interesting study would be to look at the number of deaths in custody using a given type of physical restraint with and without TASER use. I believe we will find that it is the presence of excited delirium and physical restraint that lends itself to lethal outcomes and not the deployment of the TASER.