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Investigative Lessons Learned from Temporal Deaths Associated with 4th Amendment Seizures. Michael Brave, Esq., M.S., B.S. National/International Litigation Counsel, TASER International, Inc. Member/Manager, LAAW International, LLC Email – firstname.lastname@example.org Telephone – (651) 248-2809
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Michael Brave, Esq., M.S., B.S.
National/International Litigation Counsel, TASER International, Inc.
Member/Manager, LAAW International, LLC
Email – email@example.com
Telephone – (651) 248-2809
E-fax – (480) 275-3291
ECD Legal Resources Website – www.ecdlaw.info
ICD Resources – www.incustodydeath.com
as Dr. Mash said – there will be more CEW electrical effect on heart deaths – due to the literature – why?????
(Zipes 2012) “It is clear from the information cited above that an ECD shock to the chest can produce cardiac electrical capture at rapid rates in animals and humans.” (emphasis added)
(Zipes, 2012) "Although it is possible that body size might influence cardiac capture and development of VF, clearly big people can still develop VF from an ECD shock (see the Table).“ (largest 220 pounds)
What does this mean?
"The concept of cardiac capture by transthoracic electrical impulses in humans was pioneered by Zoll,8 replicated by many others subsequently,9 and is now a standard part of resuscitative equipment. The threshold for transthoracic cardiac electrical capture is 100 microcoulombs,10 which is the output of the TASER model X26.1
"Both clinical concepts and experimental data support this and are well summarized in Zipes’ discussion.2 The most salient points are that the energy delivered by the device is sufficient to achieve transthoracic capture when delivered to the anterior chest, analogous to clinical transthoracic pacing,7 in combination with a rate of stimulation that is sufficient to induce ventricular fibrillation."
EN 8 - Falk RH, Zoll PM, Zoll RH. Safety and efficacy of noninvasive cardiac pacing: a preliminary report. N Engl J Med. 1983;309:1166 –1168.
2. replicated by many others subsequently,9
EN 9 - Klein LS, Miles WM, Heger JJ, Zipes DP. Transcutaneous pacing: patient tolerance, strength-interval relations, and feasibility for programmed electrical stimulation. Am J Cardiol. 1988;62:1126 –1129.
EN 9 – Klein LS … Zipes DP 1988
Also, the 1988 Klein paper (their Fig. 2) showed that it took another 20 mA (milliamperes) (= 800 µC) to get more rapid pacing similar to that attainable with an internal pacemaker. And, this was at a pacing rate still far slower than the rate required or necessary to induce ventricular fibrillation (VF).
3. is now a standard part of resuscitative equipment.
4. The threshold for transthoracic cardiac electrical capture is 100 microcoulombs,10
EN 10 - Grimnes S, Martinsen OG. Clinical applications of bioelectricity. In: Biomedical Engineering Desk Reference. 1st ed. New York, NY: Elsevier; 2009:241–382.
EN 10 – Grimnes
In the 1964 Zoll paper, cited in the Grimnes treatise, statement that the researchers used “long subcutaneous precordial needles” (emphasis added)
references endnote 4 (of the 1964 Zoll paper). Endnote 4 is: Zoll, P. M., H.A, Frankl,. R.N. Zarskya, J. Linenthal & A.H. Belgard. 1961. Long-term electric stimulation of the heart for Stokes-Adam disease. Ann. Surg. 154: 330.
5. which is the output of the TASER X26.1
EN 1 - Test results for the Model X26 conducted energy weapon (CEW) in accordance with TASER International device specifications. April 22, 2009. Report A85R9006/9031/9059B1.
The mot salient points are that the energy delivered by the device is sufficient to achieve transthoracic capture when delivered to the anterior chest, analogous to clinical transthoracic pacing,7
EN 7 - Falk RH, Zoll PM, Zoll RH. Safety and efficacy of noninvasive cardiac pacing. A preliminary report. N Engl J Med Sci. 1983;309:1166 –1168.
EN 8 - Falk (1983)
EN 9 – Klein, Zipes (1988)
- for higher capture rate
EN 10 – Grimnes (Zoll)
EN 1 – TASER X26
EN 8 – Falk (1983)
MINIMUM Pacing Tresholds
+ 800 µC
“long precordial needles”
Falk (1983), Klein/Zipes (1988), Grimnes/Zoll:
- MINIMUM “HARMLESS” capture thresholds
- NO dangerous capture rates
- NO VF or cardiac arrest (NO one died)
Pediatric transthoracic capture threshold:
- 1,160–3,920 µC - 53 of 56 patients (ages 0.9–17.9 years) resulted in successful capture
Transcutaneous Cardiac Capture to VF Safety Margins:
- 12.6 ± 2.9 times or 1,260 %
In no death incident did the medical examiner (ME) determine that the cause of death was direct CEW electrical stimulation of the heart.
“Case series generally provide weak evidence of causality because they are particularly prone to bias and confounding.”
In the hierarchy of scientific evidence, a case series has very important weaknesses, including: "[l]ack of comparison group markedly limits conclusions about causality" and "[r]isk, incidence, prevalence cannot be ascertained"
May 24, 2012 Zipes’ deposition (pgs 159-160)
24 Q … can you state to a reasonable degree of
May 24, 2012 Zipes deposition (pgs 164-165)
21 Q When we left, we were talking about cardiac capture.
22 Just to be clear, the first element or factor
23 necessary in order to have cardiac effect on a human
24 being from the stimulation by a TASER electronic
25 control device is cardiac capture, correct?
1 A Yes.
"In 1 example, intravenous epinephrine in an anesthetized pig, infused at a concentration that increased the spontaneous sinus rate 50% to replicate the clinical “fight or flight” situation, improved the TASER model X26 electrical capture ratio from 3:1 to 2:1 and resulted in VF induction.12“
[Zipes, D.P. 1975. Electrophysiological Mechanisms Involved in Ventricular Fibrillation. Supplement III to Circulation, Vols. 51 and 52, December, 1975, pages III-120 - III-300.]
- (Epinephrine initially decreased VFT, then increased VFT. )
What probability of risk is acceptable?
What is the definition of “zero?”
How much effort, time, resources, money will be put into the death investigation?
 Snyder, H.N., Arrest in the United States, 1990-2010. Bureau of Justice Statistics, Office of Justice Programs, U.S. Department of Justice. October 2012, NCJ 239423.
 Hall, C. 2013. RESTRAINT . Canadian Police Research Centre, Canadian Safety and Security Program, Government of Canada. October 2013.
 Hall, C.A., McHale, A., Kader, A.S., Stewart, L.C., MacCarthy, C.S., Fick, G.H. 2012. Incidence and outcome of prone positioning following police use of force in a prospective, consecutive cohort of subjects. Journal of Forensic and Legal Medicine xxx (2012) 1–7.
 Strote J, Walsh M, Angelidis M, Basta A, Hutson HR., Conducted electrical weapon use by law enforcement: an evaluation of safety and injury, J Trauma. May 2010; 68(5):1239–1246.
 Bozeman, W.P., Hauda, W.E., Heck, J.J., Graham, D.D., Martin B.P., Winslow, J.E. 2009. Safety and Injury Profile of Conducted Electrical Weapons Used by Law Enforcement Officers Against Criminal Suspects. Annals of Emergency Medicine. Volume 53, Issue 4, Pages 480-489, April 2009.
 Eastman, A.L., et al., Conductive electrical deces: a prospective, population-based study of the medical safety of law enforcement use, J Trauma, 2008, 64(6): p. 1567–72.
 Steven A. Koehler, MPH, PhD, et. al., Deaths Among Criminal Suspects, Law Enforcement Officers, Civilians, and Prison Inmates: A Coroner-Based Study, The American Journal of Forensic Medicine and Pathology, pages 334–338, Volume 24, Number 4, December 2003.
Importance of putting issues and outcomes into perspective
Who law enforcement encounters (population %):
abuse in past year based on DSM-IV criteria
Law enforcement numbers (percentages):
2009 - US Population Death/Mortality Numbers:
2009 - Of those 2,436,682 deaths:
Complete unambiguous documentation of events/evidence?
(a) Dispatch supervisor
(d) On-Scene Supervisors
(2) Post-Incident Medical Care:
(a) Fire/EMS Personnel (including dispatcher)
(b) Ambulance Personnel
(d) Hospital Personnel (ER, Nurses, Doctors)
(3) Law Enforcement Supervisors/Trainers/Execs:
(a) Field Supervisors
(c) Middle-Level Supervisors
(d) Decision Makers
(4) Elected/Government Interference
(5) Special Oversight Person, Groups
(6) Incident Investigators:
(7) Medical Examiner, Coroner, Forensic Pathologist
(8) Specialty Pathologist, Toxicologist, Researcher
(10) Family Members and Friends
(11) Special Interest Groups/Critics
Capture all relevant evidence, including:
(Involving Law Enforcement Officers (LEOs)):
~ 1 death per 15,385 arrests
~ 1 death per 700 people going to jail
~ 1 death per 600 uses of pepper spray
~ 1 death per 323 arrests using weapons