Police officers in at least five US states have filed lawsuits against Taser International claiming they suffered serious injuries after being shocked with the device during training classes.[26]

However, in the United States, a water or oil based pepper spray is more common than CS. This allows for the possibility of a Taser being used after an individual has been subjected to pepper spray without the concern for a fire.[24]

To assess more carefully the internal validity of individual studies within research designs, the Task Force has developed design-specific criteria for assessing the internal validity of individual studies. The EPC may supplement these with the use of newer methods of assessing quality of individual studies as appropriate.

TASER 10 civilian

Supporters claim that electroshock guns are a safer alternative to devices such as firearms. Taser International now uses the term, "less lethal" instead of "non-lethal," which does not mean the weapon cannot cause death, but that it is not intended to be fatal, and in most cases is not.[61] Non-lethal weapons are defined as "weapons that are explicitly designed and primarily employed so as to incapacitate personnel or material, while minimizing fatalities, permanent injury to personnel, and undesired damage to property and the environment."[citation needed]

A study by the Potomac Institute concluded: "Based on the available evidence, and on accepted criteria for defining product risk vs. efficacy, we believe that when stun technology is appropriately applied, it is relatively safe and clearly effective. The only known field data that are available suggest that the odds are, at worst, one in one thousand that a stun device would contribute to (and this does not imply "cause") death. This figure is likely not different than the odds of death when stun devices are not used, but when other multiple force measures are. A more defensible figure is one in one hundred thousand."[135]

According to Taser International, Tasers are intended "to incapacitate dangerous, combative, or high-risk subjects who pose a risk to law enforcement/correctional officers, innocent citizens, or themselves".[153]

The Task Force rarely accepts ecological evidence alone as sufficient to recommend a preventive service. The Task Force is careful in its use of this type of evidence because substantial biases may be present. Ecological evidence is data that are not at the individual level but rather relate to the average exposure and average outcome within a population. Ecological studies usually make comparisons of outcomes in exposed and unexposed populations in one of two ways: 1) between different populations, some exposed and some not, at one point in time (i.e., cross-sectional ecological study); or 2) within a single population with changing exposure status over time (i.e., time-series ecological study). In either case, the potential for ecological fallacy is a major concern. Ecological fallacy is the bias or inference error that may occur because an association observed between variables at an aggregate level does not necessarily represent an association at an individual level. In addition, ecological data sets often do not include potential confounding factors; thus, one cannot directly assess the ability of these potential confounders to explain apparent associations. Finally, some ecological studies use data collected in ways that are not accurate or reliable.

An evaluative study carried out in 2001 by the British Home Office investigated the potential for Tasers to ignite CS spray. Seven trials were conducted, in which CS gas containing methyl isobutyl ketone (a solvent in CS sprays used by all of the police forces in the United Kingdom) was sprayed over mannequins wearing street clothing. The Tasers were then fired at the mannequins. In two of the seven trials, "the flames produced were severe and engulfed the top half of the mannequin, including the head". This poses a particular problem for law enforcement, as some police departments approve the use of CS before the use of a Taser.[23]

Stun gun vs Taser

A later study[140] done by Pierre Savard, Ing., PhD., Ecole Polythechnique de Montreal, et al., for the Canadian Broadcasting Corporation (CBC), reproduced the results of the Ruggieri study and indicated that the threshold of energy needed to induce deadly ventricular fibrillation decreased dramatically with each successive burst of pulses. The threshold for women may be less.[141]

On 5 July 2005 Michael Todd, then Chief Constable of Greater Manchester Police, England, let himself be shot in the back with a Taser, to demonstrate his confidence that Tasers can be used safely. This was captured on video, and the video was released to the BBC on 17 May 2007. He was wearing a shirt and no jacket. When tased, he fell forward onto his chest on the ground, and (he said afterwards) "I couldn't move, it hurt like hell," he said after recovering. "I wouldn't want to do that again."[48][49][50]

Medical literature reports that one police officer suffered spine fractures after being shocked by a Taser during a demonstration.[56]

A 2012 study published in the American Heart Association's journal Circulation found that Tasers can cause "ventricular arrhythmias, sudden cardiac arrest and even death." At least 49 people died in 2018 in the US after being shocked by police with a Taser.[3][4][5]

While they are not technically considered lethal, some authorities and non-governmental organizations question both the degree of safety presented by the weapon and the ethical implications of using a weapon that some, such as sections of Amnesty International, allege is inhumane. As a consequence, Amnesty International Canada and other civil liberties organizations have argued that a moratorium should be placed on Taser use until research can determine a way for them to be safely used.[11] In 2012 Amnesty International documented over 500 deaths that occurred after the use of Tasers.[12]

Participants in a study may differ from persons receiving primary care in many ways. Such differences may include sex, ethnicity, age, comorbid conditions, and other personal characteristics. Some of these differences have a small potential to affect the study's results and/or the outcomes of an intervention. Other differences have the potential to cause large divergences between the study's results and what would be reasonably anticipated to occur in asymptomatic persons or those who are the target of the preventive intervention.

Taser "recommended officers avoid tasing suspects in the chest area, citing the potential for cardiac arrests, lawsuits and effectiveness of the device". Central Texas Constable Richard McCain, whose deputy used a Taser weapon against an unarmed 72-year-old woman (resulting in a $40,000 lawsuit settlement), describes Taser's directive as "not really practical".[37]

The United Nations Committee against Torture reports that the use of Tasers can be a form of torture, due to the acute pain they cause, and warns against the possibility of death in some cases.[57] The use of stun belts has been condemned by Amnesty International as torture, not only for the physical pain the devices cause, but also for their heightened abuse potential. Amnesty International has reported several alleged cases of excessive electroshock gun use that possibly amount to torture.[58] They have also raised extensive concerns about the use of other electro-shock devices by American police and in American prisons, as they can be (and according to Amnesty International, sometimes are) used to inflict cruel pain on individuals.[59]

Supporters claim that electroshock weapons such as Tasers are more effective than other means including pepper-spray (an eye/breathing inflammatory agent), batons or other conventional ways of inflicting pain, even handguns, at bringing a subject down to the ground with minimum physical exertion.[25]

When the evidence for a key question includes more than a few trials and there appears to be homogeneity in interventions and outcomes, meta-analysis is considered by the topic team. (Please see Section 4.6 about how the EPC may incorporate published meta-analysis and systematic reviews into the Task Force review.) Meta-analysis provides the advantage of giving summary effect size estimates generated through a transparent process. The decision to pool evidence is based on the judgment that the included studies are clinically and methodologically similar, or that important heterogeneity among included trials can be addressed in the meta-analysis in some way, such as subgroup or sensitivity analyses. The EPC review team considers whether a pooled effect would be clinically meaningful and representative of the given set of studies. A pooled effect may be misleading if the trials clinically or methodologically differ to such a degree that the average does not represent any of the trials. Interpretations of pooled effect sizes should consider all sources of clinical and methodological heterogeneity. Similarly, the interpretation of pooled results takes into account the width of the confidence interval and the consequences of making an erroneous assessment, not simply statistical significance. Results of meta-analyses are usually presented in forest plot diagrams.

A February 2005 memorandum from the Aberdeen Proving Ground, a United States Army weapons test site, discouraged shocking soldiers with Tasers in training, contrary to Taser International's recommendations. The Army's occupational health sciences director warned that "Seizures and ventricular fibrillation can be induced by the electric current." and that "the practice of using these weapons on U.S. Army military and civilian forces in training is not recommended, given the potential risks."[citation needed]

As indicated above, studies that provide data on all-cause and cause-specific mortality may have low statistical power to detect even large or moderate effects of the preventive intervention on all-cause mortality. This is especially true when the disease targeted by the screening test is not common.

Adherence is likely to be greater in research studies than in usual primary care practice because of the presence of certain research design elements. This may lead to overestimation of the benefit of the intervention when delivered to persons who are less selected (i.e., who more closely resemble the general population) and who are not subject to the special study procedures.

When available and relevant, the Task Force considers data on both all-cause and cause-specific mortality in making its recommendations, taking into account the real and methodological contributions to any discrepancies between apparent and true effect. When a condition is a common cause of mortality, all-cause mortality is the desirable health outcome measure. However, few preventive interventions have a measurable effect on all-cause mortality. When there is a discrepancy between the effect of the preventive intervention on all-cause and disease-specific mortality, this is important to recognize and explore.

TASER X26P

The Task Force recognizes that research design is an important component of the validity of the information in a study for the purpose of answering a key question. Although RCTs cannot answer all key questions, they are ideal for questions regarding benefits or harms of various interventions. Thus, for the key questions of benefits and harms, the Task Force currently uses the following hierarchy of research design:

Tasers are illegal or subject to legal restrictions on their availability and use in many jurisdictions.[citation needed] According to Taser International, the taser is legal for civilian use without restriction in 34 states in the United States, and legal with some form of restriction in the remaining states in the United States, with the exception of the state of Hawaii, where the Taser is illegal for civilian use.[154]

All literature searches are conducted using MEDLINE and the Cochrane Central Registry of Controlled Trials, using appropriate search terms to retrieve studies for all key questions that meet the inclusion/exclusion criteria for the topic. Other databases are included when indicated by the topic (e.g., PsycINFO for mental health topics). Searches are limited to articles published in the English language. For reviews to update recommendations, searches are conducted for literature published approximately 12 months prior to the last search of the previous review to the present. For new topics, the date range for the search is determined by the nature of the screening and treatment interventions for the topic, with longer time frames for well-established interventions that have not been the focus of recent research activity or topics with limited existing research and shorter time frames for topics with more recently developed interventions. The EPC review team supplements these searches with suggestions from experts and a review of reference lists from other relevant publications.

The head of the U.S. southern regional office of Amnesty International, Jared Feuer, said that 277 people in the United States have died after being shocked by a Taser between June 2001 and October 2007, which has already been documented. He also said that about 80% of those on whom a Taser was used by U.S. police were unarmed. "Tasers interfere with a basic equation, which is that force must always be proportional to the threat", Feuer said. "They are being used in a situation where a firearm or even a baton would never be justified."[44] A spokesperson for Taser International said that if a person dies from a "tasering" it is instantaneous and not days later.[45] Taser International announced that it is "transmitting over 60 legal demand letters requiring correction of... false and misleading headlines."[46]

Taser darts penetrate the skin, and therefore may pose a hazard for transmitting diseases via blood. U.S. Occupational Safety and Health Administration (OSHA) requirements and the bloodborne pathogen protocols should be followed when removing a Taser probe.[20] The removal process may also be addressed in an exposure control plan (ECP) in order to increase Taser probe removal safety.[20]

Taser International previously described its devices as "non lethal," but changed and now uses the term "less lethal," which is a term for "intermediate weapons" in the lexicon of law enforcement.[9][10]

TASER 7

The action of using a taser of a person or object; Taze (rapper), British rapper. See also.

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Fire - An officer pulls the trigger firing two probes which are attached by copper wire to the device. ... Officer aiming taser at a target in the distance. Share ...

By means of its analytic framework and key questions, the Task Force indicates what evidence is needed to make its recommendation. By setting explicit inclusion/exclusion criteria for the searches for each key question, the Task Force indicates what evidence it will consider admissible and applicable. The critical aspect used to determine whether an individual study is admissible is its internal and external validity with respect to the key question posed. This initial examination of the internal and external validity of individual studies is conducted by the EPC review team using the USPSTF criteria as a baseline and newer methods of quality assessment as appropriate (go to Appendix VI and Appendix VII for more detail on USPSTF criteria). Likewise, studies of interventions that require training or equipment not feasible in most primary care settings would be judged to have poor external validity and would not be admissible evidence.

Data is abstracted in abstraction forms or directly into evidence tables specific to each key question. Although the Task Force has no standard or generic abstraction form, the following broad categories are always abstracted from included articles:

After literature searches are conducted, the EPC review team uses a two-stage process to determine whether identified literature is relevant to the key and contextual questions. This two-stage process is designed to minimize errors and to be efficient, transparent, and reproducible. First, titles and abstracts are reviewed independently by two reviewers by broadly applying a priori inclusion/exclusion criteria developed during the work plan stage of the review. When in doubt as to whether an article might meet the inclusion criteria, reviewers err on the side of inclusion so that an article is retrieved and can be reviewed in detail at the article stage. All citations are coded with an excluded or included code, which is managed in a database and used to guide the further literature review steps. Two reviewers then independently evaluate the full-text articles for all citations included at the title/abstract stage. Included articles receive codes to indicate the key question(s) for which they meet criteria and excluded articles are coded with the primary reason for exclusion, though additional reasons for exclusion may also apply.

Tasers, like other electric devices, have been found to ignite flammable materials. For this reason Tasers come with express instructions not to use them where flammable liquids or fumes may be present, such as filling stations and methamphetamine labs.

Third, when the preventive intervention is applied in a population with strong competing causes of mortality, the effect of the preventive intervention on all-cause mortality may be very small or absent, even though the intervention reduces cause-specific mortality. For example, preventing death due to hip fracture by implementing an intervention to decrease falls in 85-year-old women may not decrease all-cause mortality over reasonable time frames for a study because the force of mortality is so large at this age.

A study published by the American Journal of Cardiology found that California police departments that introduced Tasers experienced significant increases in the numbers of in-custody sudden deaths and firearm deaths in the first full year following deployment. The rates declined to predeployment levels in subsequent years. No significant change in the number of officer injuries was found.[134]

For each systematic review, the EPC review team establishes a database of all articles located through searches and from other sources. The database is the source of the final literature flow diagram documenting the review process. Information captured in the database includes the source of the citation (e.g., search or outside source), whether the abstract was included or excluded, the key question(s) associated with each included abstract, whether the article was excluded (with primary reason for exclusion) or included in the review, and other coding approaches developed to support the specific review. For example, a hierarchical approach to answering a question may be proposed at the work plan stage, specifying that reviewers will consider a type of study design or a clinical setting only if research data are too sparse for the preferred type of study. While reviewing abstracts and articles, these can be coded to allow easy retrieval during the conduct of the review, if warranted.

In October and November 2007, four individuals died after being tasered in Canada, leading to calls for review of its use. The highest-profile of these cases was that of Robert Dziekański, a non-English speaking man from Poland who died in less than two minutes after being tasered by Royal Canadian Mounted Police (RCMP) at the Vancouver International Airport, October 14, 2007.[71][72] The tasering was captured on home video and was broadcast nationally.[73] This was followed by three further death-after-tasering incidents in Montreal, Halifax, Nova Scotia, and Chilliwack, British Columbia, leading Amnesty International to demand Taser use end in Canada, as it had records of 16 other such deaths in the country.[74]

The choice of the study population may affect the magnitude of the benefit observed in the study through inclusion/exclusion criteria that limit the study to persons most likely to benefit; other study features may affect the risk level of the subjects recruited to the study. The absolute benefit from a service is often greater for persons at increased risk than for those at lower risk.

The Guardian newspaper was running a database, The Counted, in 2015, tracking US killings by police and other law enforcement agencies that year. As of 6 November 2015[update], 47 deaths of the 965 killed were classified as taser events.[47]

The Commissioner for Public Complaints made several recommendations regarding the use of Tasers by the Royal Canadian Mounted Police (RCMP) including:[157][158][159]

Summit County, Ohio Medical Examiner Lisa J. Kohler cited Taser use as a cause of death in three cases, Mark D. McCullaugh, Dennis S. Hyde, and Richard Holcomb. Taser International sued, and on May 2, 2008, visiting judge Ted Schneiderman ordered the Medical Examiner to remove all references to "Taser" in the reports and change the cause of death in McCullaugh's case from "Homicide" to "Undetermined."[155]

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According to the Star Tribune, by April 2021 there had been 16 known cases, including the killing of Daunte Wright in Brooklyn Center, Minnesota, when a police officer in the United States fired a pistol at someone but claimed to have intended to use a Taser instead.[146] Other notable incidents included a 2002 shooting in Rochester, Minnesota,[147] the fatal 2009 shooting of Oscar Grant by a Bay Area Rapid Transit officer in Oakland, California, and the deadly 2015 shooting of Eric Harris by a volunteer reserve deputy in Tulsa, Oklahoma.[148] In 2018, an officer coming to assist a policeman being assaulted during a traffic stop shot and wounded the arrestee in Lawrence, Kansas.[149] After discharging her gun, startled, she yelled, "Oh, shit, I shot him."[150] Though that officer was charged, a judge dismissed the charges.[150] In 2019, a scuffle in a jail cell led to another accidental shooting by a backup officer in New Hope, Pennsylvania.[148] The Bucks County, Pennsylvania District Attorney declined to press charges against the officer, saying state law excused the officer's conduct from criminal prosecution because of his "honest but mistaken" belief he was firing his Taser when he shot the wounded prisoner.[151] In both the Kansas and Pennsylvania cases, the officers shouted "Taser" before firing their gun.[151][150][152]

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Within key questions, it may be most informative to stratify the evidence by subpopulation or by type of intervention/comparison or outcome, depending on how the Task Force has conceptualized the questions for the particular topic. The EPC review team does not publish an actual grade for the strength of the evidence but rather synthesizes the issues in the bulleted list above for each key question to inform the Task Force's assessments of the adequacy of the evidence (Section 6).

Existing systematic reviews or meta-analyses that meet quality and relevance criteria can be incorporated into reviews done for the Task Force. Existing reviews can be used in a Task Force review in several ways: 1) to answer one or more key questions, wholly or in part; 2) to substitute for conducting a systematic search for a specific time period for a specific key question; or 3) as a source document for cross-checking the results of systematic searches. Quality assessment of existing systematic reviews is a critical step and should address both the methods used to minimize bias as well as the transparency and completeness of reporting of review methods, individual study details, and results. The Task Force has specific criteria for critically appraising systematic reviews (Appendix VI). The EPC may supplement these criteria with newer methods of evaluating systematic reviews and meta-analyses. Relevance is considered at two levels: "Is the review or meta-analysis relevant to one or more of the Task Force key questions for this review?" and "Did the review include the desired study designs and relevant population(s), settings, exposure/intervention(s), comparator(s), and outcome(s)?" Recency of the review is also a consideration and can determine whether a review that meets quality and relevance criteria is recent enough or requires a bridge search.

Three situations can result in a discrepancy between the effect on disease-specific and all-cause mortality. First, when a preventive intervention increases deaths from causes other than the one targeted by the intervention, all-cause mortality may not decline, even when cause-specific mortality is reduced. This indicates a potential harm of the intervention for conditions other than the one targeted.

An investigation by the Canadian Press and Canadian Broadcasting Corporation found that one-third of those shot by a Taser by the Royal Canadian Mounted Police received injuries that required medical attention as a result. The news agencies used Freedom of Information requests to obtain the Taser-use forms filled out by RCMP officers from 2002 to 2007.[78]

Taser safety issues relate to the lethality of the Taser. The TASER device is a less-lethal, not non-lethal, weapon, since the possibility of serious injury or death exists whenever the weapon is deployed.[1] It is a brand of conducted electroshock weapon sold by Axon, formerly TASER International. Axon has identified increased risk in repeated, extended, or continuous exposure to the weapon; the Police Executive Research Forum says that total exposure should not exceed 15 seconds.[2]

After hearing many witnesses and briefs the report[136] by the Canadian House of Commons, Standing Committee on Public Safety and National Security makes 17 recommendations as a result the death due to the repetitive tasering of a Polish immigrant at the Vancouver International airport.

Compliance Strategy Group (John Kiedrowski, Principal Consultant, Michael Petrunik and Ronald-Frans Melchers, Associate Consultants) conducted An Independent Review of the Adoption and Use of Conducted Energy Weapons by the Royal Canadian Mounted Police[160] that was completed in June 2008, but only released under access to information and privacy around September 12, 2008. The report is available from the RCMP under access to information, but is censored (e.g., no recommendations). The report as released by the RCMP may be found on the Canadian Broadcasting Corporation website www.cbc.ca. The Report reviews how the RCMP made the decisions to introduce the conducted energy weapons, training, policies and procedures, and accountability. The report is approximately 150 pages and provides an excellent analysis on how a police force adopted the Taser. The authors of the report argued that the police did not do their due diligences, is concerned about training and the issues of accountability. The report also pointed out that the police in Canada have misclassified the Taser as a prohibited weapon whereas under the criminal code it is referred to as a prohibited firearm, and refers to excited delirium as "folk knowledge".

TASER 10

These opportunities include corrections, law enforcement, the court system, probation and parole. Common Job Titles for Criminal Justice Graduates.

The evidence review development begins with finalization of topic scope, review approach, and research plan, as described above, and continues in the next stage with literature searches. The stages in the evidence review development are displayed in Figure 5.

Tasers may also not leave the telltale markings that a conventional beating might. The American Civil Liberties Union has also raised concerns about their use, as has the British human rights organization Resist Cardiac Arrest.

I. Properly powered and conducted RCT; well-conducted systematic review or meta-analysis of homogeneous RCTs II-1. Well-designed controlled trial without randomization II-2. Well-designed cohort or case-control analysis study II-3. Multiple time-series, with or without the intervention; results from uncontrolled studies that yield results of large magnitude III. Opinions of respected authorities, based on clinical experience; descriptive studies or case reports; reports of expert committees

Between June 2001 and June 2007, there were at least 245 cases of deaths of subjects after having been shocked using Tasers.[130] Of these cases:

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One issue often raised with the use of the Taser are the effects of metabolic acidosis. This is a temporary condition where the body produces lactic acid within the muscles in the same way as it does during strenuous physical exercise.[21][22]

A 2012 study published in the American Heart Association's journal Circulation found that Tasers can cause "ventricular arrhythmias, sudden cardiac arrest and even death."[3][13] In 2014, NAACP State Conference President Scot X. Esdaile and the Connecticut NAACP argued that Tasers cause lethal results.[14] Reuters reported that more than 1,000 people shocked with a Taser by police died through the end of 2018 with 153 of those deaths being attributed to or related to the use of Tasers.[15] Approximately 49 people died in 2018 in the US after being shocked by police with a Taser.[4][5] Fulton County, Georgia District Attorney Paul Howard Jr. said in 2020 that “under Georgia law, a taser is considered as a deadly weapon.”[16][17][18]

Search terms used for each key question, along with the yield associated with each term, are documented in an appendix of the final evidence review. A followup or "bridge" search to capture newly published data is conducted close to the time of completion of the draft evidence review, with the exact timing determined by the topic team.

Taser for women

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In 2008 San Francisco cardiologist and electrophysiologist Zian Tseng told the Braidwood Inquiry that a healthy individual could die from a Taser discharge, depending on electrode placement on the chest and pulse timing. He said that the risk of serious injury or death is increased by the number of activations, adrenaline or drugs in the bloodstream, and a susceptible medical history. Tseng said that when he began researching Tasers and spoke of his concerns three years previously Taser International contacted him, asking him to reconsider his media statements and offering funding, which Tseng refused saying he wanted to remain independent.[19]

These criteria (Appendix VI) provide general guidelines for categorizing studies into one of three internal validity categories: "good," "fair," and "poor." These specifications are not inflexible rules; individual exceptions, when explicitly explained and justified, can be made. In general, a "good" study is one that meets all design-specific criteria. A "fair" study is one that does not meet at least one specified criterion, but has no known important limitation that could invalidate its results. "Poor" studies have at least one "fatal flaw" or multiple important limitations. A fatal flaw is due to a deficit in design or implementation of the study that calls into serious question the validity of its results for the key question being addressed.

In 2015, the Washington Post reported that in the 11-month period from January to November 2015, 48 people died in the United States in incidents in which police used Tasers, according to police, court, and autopsy records.[133]

The Task Force is interested in targeting its recommendations to those populations or situations in which there would be maximal net benefit. Thus, it often takes into consideration subgroup analyses of large studies or studies evaluating particular subgroups of interest. The Task Force examines the credibility of those analyses, however, depending on such factors as: the size of the subgroup; whether randomization occurred within subgroups; whether a statistical test for interaction was done; whether the results of multiple subgroup analyses were consistent within themselves; whether the subgroup analyses were prespecified; and whether the results are biologically plausible.

The EPC review team provides an overall summary of the evidence by key question in table format (Appendix XII). The table includes the following domains:

A 2007 study published in The American Journal of Forensic Medicine and Pathology questioned the apparent contradiction created by the claim that the Taser X26 does not stimulate the heart muscle, while clearly causing skeletal muscle contraction and stimulation. They estimated the average current pulse of the X26 at 1 ampere. They concluded that it is primarily proximity (or lack thereof) of the heart to the electrodes that prevents stimulation of the heart, along with the short duration of the pulse, which allows the heart to return to near its baseline state prior to the next pulse, due to the larger time constant for the heart muscle vs skeletal muscles. They estimated a 0.4% chance of heart muscle stimulation among the general population with optimum (or worst case) electrode placement, which would normally resolve itself with the resumption of a normal heart beat.[142]

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Medical conditions or use of illegal drugs can significantly heighten such risk for subjects in an at-risk category.[6] In some cases however, death occurred after Taser use coupled with the use of force alone, such as positional asphyxiation, with no evidence of underlying medical condition and no use of drugs.[7][8]

Factors related to the experience of providers in the study should be considered in comparison with the experience of providers likely to be encountered in U.S. primary care. Studies may recruit providers selected for their experience or high skill level. Providers involved in studies may undergo special training that affects their performance of the intervention. For these and other reasons, the effect of the intervention may be overestimated or the harms underestimated compared with the likely experience of unselected providers in the primary care setting.

Although tests on police and military volunteers have shown Tasers to function appropriately on a healthy, calm individual in a relaxed and controlled environment,[11] the real-life target of a Taser is, if not mentally or physically unsound, in a state of high stress and in the midst of a confrontation. According to the UK's Defence Scientific Advisory Council's subcommittee on the Medical Implications of Less-lethal Weapons (DoMILL), "The possibility that other factors such as illicit drug intoxication, alcohol abuse, pre-existing heart disease, and cardioactive therapeutic drugs may modify the threshold for generation of cardiac arrhythmias cannot be excluded." In addition, Taser experiments "do not take into account real life use of Tasers by law enforcement agencies, such as repeated or prolonged shocks and the use of restraints".[51][52][53][54][55]

While their intended purpose is to avoid the use of lethal force (firearms), 180 deaths were reported to have been associated with Tasers in the US by 2006. By 2019 that figure had increased to over 1,000[38][39] It is unclear in each case whether the Taser was the cause of death, but several legislators in the U.S. have filed bills clamping down on them and requesting more studies on their effects.[40] A study led by William Bozeman of Wake Forest Baptist Medical Center of nearly 1,000 persons subjected to Taser use concluded that 99.7% of the subjects had suffered no injuries, or minor ones such as scrapes and bruises, while three persons suffered injuries severe enough to need hospital admission, and two died. Bozeman's study found that "...paired anterior probe impacts potentially capable of producing a transcardiac discharge vector." occurred in 21.9% of all deployments.[41] Multiple studies have since concluded that CEW use directly impacts cardiac and brain function, and can lead to cardiac arrest as well as dangerously elevated heart rate.[42][43]

On December 12, 2007, in response to the death of Robert Dziekański, Canadian Public Safety Minister Stockwell Day requested that the federal Commission for Public Complaints Against the RCMP (CPC) prepare recommendations for immediate implementation. The CPC report recommended to "immediately restrict the use of the conducted energy weapon (CEW)" by reclassifying it as an "impact weapon."[76] The commission released its report on 18 June 2008; recommendations include restricting use to experienced officers (5 years or more), providing medical attention to those who have been shocked, and improving previous documentation of specific deployment of the weapon, among other things.[77][78][79]

The EPC review team abstracts only those articles that meet inclusion criteria. Abstractions are conducted by trained team members, and a second reviewer checks the abstracted data for accuracy, including data included in a summary table, a meta-analysis, or in calculations supporting a balance sheet/outcomes table. Initial reliability checks are done for quality control.

Second, when the condition targeted by the preventive intervention is rare and/or the effect of the intervention on cause-specific mortality is small, the effect on all-cause mortality may be immeasurably small, even with very large sample sizes.

Stun gun

The criteria used to rate the external validity of individual studies according to the population, setting, and providers are described in detail in Appendix VII. As with internal validity, this assessment is usually conducted initially by the EPC review team, with input from Task Force members for critically important or borderline studies. This assessment is then used to answer the question, "If the study had been done with the usual U.S. primary care population, setting, and providers, what is the likelihood that the results would be different in a clinically important way?"

Information relevant to applicability is consistently abstracted (e.g., participant recruitment setting and approach, inclusion/exclusion criteria for the study). The EPC review team uses these general categories, and other categories if indicated, to develop an abstraction form or evidence table specific to the topic. For example, source of funding may be an important variable to abstract for some topics, and performance characteristics are abstracted for diagnostic accuracy studies.

On Sunday 18 November 2007 in Jacksonville, Florida, Christian Allen, 21, was pulled over by police because his car radio was too loud. After a struggle he and a passenger escaped on foot, an officer gave chase, caught Allen and tasered him at least three times. Allen died later in custody.[75]

The removal process may also be addressed in an Exposure Control Plan in order to increase Taser probe removal safety.[34]

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Observational studies are often used to assess harms of preventive services. The Task Force also uses observational evidence to assess benefits. Multiple large, well-conducted observational studies with consistent results showing a large effect size that does not change markedly with adjustment for potential known confounders may be judged sufficient to determine the magnitude of benefit and harm of a preventive service. Also, large well-conducted observational studies often provide additional evidence even in situations when there are adequate RCTs. Ideally, RCTs provide evidence that an intervention can work (efficacy), and observational studies provide better understanding if these benefits exist across broader populations and settings.

Critics claim that risk-averse police officers resort to using Taser in situations in which they otherwise would have used more conventional, less violent alternatives, such as trying to reason with a cornered suspect.[60]

A study conducted by electrical engineer James Ruggieri and published December 2005 in the Journal of the National Academy of Forensic Engineers measured a Taser's output as 39 times more powerful than specified. The study concluded that the discharge is sufficient to trigger ventricular fibrillation, a 50 percent risk according to the IEC 479-1 series of electric safety standards. Ruggieri said that high rise-time pulses breaks down skin tissue, decreasing its resistance and increasing current through the body.[139] Ruggieri showed that when the skin resistance drops lower than the device's region of linear operation, the current dramatically increases.

A Chicago study suggests that use of the Taser can interfere with heart function. A team of scientists and doctors at the Cook County hospitaltrauma center stunned 6 pigs with two 40-second Taser discharges across the chest. Every animal was left with heart rhythm problems and two of the subjects died of cardiac arrest. One of the subjects died three minutes after being shot indicating, according to researcher Bob Walker, that "after the Taser shock ends, there can still be effects that can be evoked and you can still see cardiac effects."[144][145]

The EPC, at its discretion, may include some poor-quality studies in its review. When studies of poor quality are included in the results of the systematic review, the EPC explains the reasons for inclusion, clearly identifies which studies are of poor quality, and states how poor-quality studies are analyzed with regard to good- and fair- quality studies. When poor-quality studies are excluded, the EPC identifies the reasons for exclusion in an appendix table.

Although the Taser[137] is a programmable device, the controlling software does not limit: a) the number of the bursts of pulses and the time between bursts while the trigger is held down continuously, or b) the number of times the shock cycles can be repeated. Thus the design does not adequately reduce the likelihood that the victim's heart enters into a deadly ventricular fibrillation.

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On September 30, 2009, the manufacturer Taser International issued a warning and new targeting guidelines to law enforcement agencies to aim shots below the chest center of mass as "avoiding chest shots with ECDs avoids the controversy about whether ECDs do or do not affect the human heart"[35] Calgary Police Service indicated in a news interview that the rationale for the warning was "new medical research that is coming out is showing that the closer probe to heart distances have a likelihood, or a possibility, that they may affect the rhythm of the heart".[36]

If there are too few studies or data are too clinically or statistically heterogeneous for quantitative synthesis, the EPC review team qualitatively synthesizes the evidence in a narrative format, using summary tables to display differences between important study characteristics and outcomes across included studies for each key question.

Police officers in at least five US states have filed lawsuits against Taser International claiming they suffered serious injuries after being shocked with the device during training classes.[26]

When assessing the external validity of a study, factors related to the study setting should be considered in comparison with U.S. primary care settings. The choice of study setting may lead to an over- or under-estimate of the benefits and harms of the intervention as they would be expected to occur in U.S. primary care settings. For example, results of a study in which items essential for the service to have benefit are provided at no cost to study patients may not be attainable when the item must be purchased. Results obtained in a trial situation that ensures immediate access to care if a problem or complication occurs may not be replicated in a non-research setting, where the same safeguards cannot be ensured, and where, as a result, the risks of the intervention are greater. When considering the applicability of studies from international settings, the EPC often uses the United Nations Human Development Index to determine which settings might be most like the United States.

The Task Force does not usually accept ecological evidence alone as adequate to establish the causal association of a preventive service and a health outcome because it is not possible to completely avoid the potential for making the ecological fallacy in these studies,. In some very unusual situations, ecological evidence may play the primary role in the Task Force's evidence review and subsequent recommendation (e.g. screening for cervical cancer) , but this is rare. The Task Force may use ecological evidence for background or to develop an understanding of the context for which the preventive service is being considered. In addition, a review of ecological evidence may be warranted when well-known ecological data are used as evidence by others to justify a recommendation for Task Force consideration. The Task Force only rarely considers ecological studies as part of its evidentiary assessment. These circumstances could include when evidence from other study designs is considered inadequate but high-quality ecological evidence, especially studies demonstrating a very large magnitude of benefit or harm, could add important information. When the Task Force critically appraises ecological studies for use to develop a recommendation, the following criteria are used to assess the quality of the studies: 1) the exposures, outcomes, and potential confounders are measured accurately and reliably; 2) known potential explanations and potential confounders are considered and adjusted for; 3) the populations are comparable; 4) the populations and interventions are relevant to a primary care population; and 5) multiple ecological studies are present that are consistent/coherent.

Although research design is an important determinant of the quality of information provided by an individual study, the Task Force also recognizes that not all studies with the same research design have equal internal validity (quality).

Judgments about the external validity (applicability) of a study pertinent to a preventive intervention address three main questions:

Reaffirmed topics are topics kept current by the Task Force because the topic is within the Task Force's scope and priority and because there is a compelling reason for the Task Force to make a recommendation. Topics that belong in this category are well-established, evidence-based standards of practice in current primary care practice (e.g., screening for hypertension). While the Task Force would like these recommendations to remain active and current in its library of preventive services, it has determined that only a very high level of evidence would justify a change in the grade of the recommendation. Only recommendations with a current grade of A or D are considered for reaffirmation. The goal of this process is to reaffirm the previous recommendation. Therefore, the goal of the search for evidence in a reaffirmation evidence update is to find new and substantial evidence sufficient enough to change the recommendation.

According to a study presented at the Heart Rhythm Society's 2007 Scientific Sessions, Tasers may present risks to subjects with implanted pacemakers.[138] However, a study conducted by the Cleveland Clinic in 2007 on a single animal determined that a standard five-second Taser X26 application "does not affect the short-term functional integrity of implantable pacemakers and defibrillators.... The long-term effects were not assessed."[29]

The Task Force strongly prefers multiple large, well-conducted RCTs to adequately determine the benefits and harms of preventive services. In many situations, however, such studies have not been or are not likely to be done. When other evidence is insufficient to determine benefits and/or harms, the Task Force encourages the research community to conduct large, well-designed and well-conducted RCTs.

Methodological issues can arise because of difficulties in the assignment of cause of death based on records. In the absence of detail about the circumstances of death, it may be attributed to a chronic condition known to exist at the time of death but which is not, in fact, the direct cause. Coding conventions for death certificates also result in deaths from some causes being attributed to chronic conditions routinely present at death. For example, it is conventional to assign cancer as the primary cause of death to persons with a mention of cancer on the death certificate. The result of these methodological issues is a biased estimate of cause-specific mortality when the data are obtained from death certificates, which may not reflect the true effect an intervention has on death from the targeted condition. Similar methodological issues may occur as a result of adjudication committees.

Taser International has stated in a training bulletin that repeated blasts of a taser can "impair breathing and respiration". Also, on Taser's website[25] it is stated that, for a subject in a state described as "excited delirium", repeated or prolonged stuns with the Taser can contribute to "significant and potentially fatal health risks".[26] (The term "excited delirium" is not recognized by the American Medical Association or American Psychological Association.[27] but was recently recognized by the American College of Emergency Physicians). In such a state, physical restraint by the police coupled with the exertion by the subject are considered likely to result in death or more injuries. Critics alleged that electroshock devices can damage delicate electrical equipment such as pacemakers, but tests conducted by the Cleveland Clinic found that Tasers did not interfere with pacemakers and implantable defibrillators.[28][29]