Thumpversion for the Tasered*

Bernard Lown, MD

For several years I have been in a quandary about writing this article. Silence when innocent people are being killed is a moral dereliction. But intervention is also an ethical failure if it may encourage an offensive practice that leads to occasional deaths. This unspoken philosophic soliloquy has ping ponged in my mind, heading nowhere. It was like harboring a small festering wound that would not heal. Finally the impulse to speak out prevailed. Bear with me, because this story, with its incomprehensible title, is both instructive and important.

A strong thump on the lower sternum during the first moments after a cardiac arrest may restore a normal heartbeat and save a life. I discovered this technique in the late 1960s and labeled it “Thumpversion.”(1,2) Like much in clinical medicine, the discovery of chest thumping resulted from an unplanned and serendipitous observation.

Some fifty years ago, in my laboratory at the Harvard School of Public Health, we were exploring factors that predisposed a normal dog’s heart to ventricular fibrillation — the chaotic disorganized heart rhythm that characterizes sudden cardiac death. We were also studying the type of electrical discharge that could effectively and safely restore a normal rhythm.

Specifically, we were mapping the vulnerable period of the cardiac cycle. This interval, lasting a mere 0.035 of a second in duration, occurs with each heartbeat. It is the only moment in the cardiac cycle when the heart is susceptible to ventricular fibrillation. Once the chaotic rhythm of ventricular fibrillation ensues, the heart stops pumping blood. Spontaneous recovery is impossible. Within a few minutes life is extinguished. Electrical current, irrespective of intensity, will not disrupt the heart’s rhythm if delivered outside the vulnerable period.

We conducted these studies on anesthetized, tracheal intubated, and heavily instrumented animals. These experiments were difficult to set up and tedious to conduct as well as time consuming, frequently requiring an entire day to complete. I was dismayed to learn that the doctors and technicians conducting these studies would at times leave the laboratory during the lunch hour. If the anesthetic drug dissipated, the unattended animals would wake and experience severe discomfort. I had sent out several memoranda warning against such impermissible behavior.

During one lunch hour I decided to conduct an inspection. Indeed an animal was left unattended and was waking from anesthesia. After administering an anesthetic agent, I waited for the investigator in charge to return.

Being impatient, I decided to continue the familiar experimental protocol. Sequential electrical stimuli were to be delivered through an electrode catheter attached to the heart muscle. The very first stimulus I discharged provoked ventricular fibrillation. With this improper action, I believed that I had ruined the experiment. No defibrillator was in sight. Panicked, I thumped the lower sternum with a hefty blow. A normal heart rhythm immediately ensued. Dismay at the outcome of my unwarranted intervention turned to elation at the unexpected result. When we applied this procedure to patients with life-threatening heart rhythm disorders, the thump worked as well as it did in dogs.(3)

Why I thumped the chest wall was not at all clear. The maneuver had not been previously employed for terminating ventricular fibrillation. Nor had I ever contemplated such a recourse. Yet the intellectual climate was right. We had earlier discovered that direct-current electrical discharges could terminate a host of rhythm disorders of the human heartbeat.(4) However, randomly delivered electrical shocks could discharge during the vulnerable cardiac period and induce a fatal arrhythmia. To prevent this, we synchronized the discharge to fire only outside the vulnerable period. I labeled this electrical method “Cardioversion,” which soon became the standard treatment for a host of heart rhythm abnormalities.(5) It was therefore consistent to designate the new maneuver “Thumpversion.” I was pleased that we did not always need complex technologies to resolve a threat to survival. In fact, we possess in our fists the equivalent of an electrical discharge sufficient in magnitude to terminate a life-threatening heart rhythm disorder.

The key determinant of the outcome for a cardiac arrest relates to the duration of ventricular fibrillation. Thumpversion is effective when administered within the first two minutes after the onset of a cardiac arrest. Its immediate availability makes it invaluable. A strong blow to the lower breastbone is an appropriate first measure. If ineffective, nothing is lost; if effective, a life is gained.

Little did I imagine that Thumpversion would find a new application from an unexpected quarter. The police, whose job it is to help protect our safety and survival, are now inadvertently inducing cardiac arrests. These result from the use of Taser stun guns, which can shoot an electrical discharge as large as 50,000 volts to disrupt the neuromuscular system and momentarily paralyze a human being.

Since its introduction in 1999, the popularity of these stun guns has soared. According to Arizona-based Taser International, the leading supplier in the past decade, 80 percent, or 14,201, of the nation’s law enforcement agencies (mainly police departments but also prisons and jails) have adopted the use of Taser stun guns.(6)

Small and portable, Tasers resemble revolvers. When triggered, they shoot out two nitrogen-fueled probes, delivering an electric charge that incapacitates a victim.(7) They inflict pain and paralyze without leaving evidence of having been fired. The mantra endlessly repeated by Taser International is that the disabling electric shock has no lasting adverse consequences.

The claimed benignity of these weapons contradicts the common injunction to avoid contacting bare electric outlets or electrical wiring and to stay indoors during lightning storms. Indeed, it has long been established that electricity can electrocute. This is no secret in the United States, with its rampant electric chairs and a tragic history of the death of thousands of workers during the country’s electrification in the late nineteenth century. In fact, electrocution continues as the fifth leading cause of fatal occupational injuries in the United States.

So what do we know of the adverse effects of Tasers? Surprisingly little other  than stray anecdotes that filter haphazardly into the media. State and federal agencies do not track how often Tasers are used, how and why they are used, against whom they are used, or how many people are injured or killed as a result.(8)

For whatever reasons Tasers are fired , they are clearly not used to execute a miscreant. They are intended to stun a person momentarily as a substitute for resorting to lethal weapons. So how much experimental research has been conducted on their safety, and where has the data been published?

I did not find published information in the medical literature on the effects of Taser electrical discharges on the heart. Patrick Smith, Taser’s chief executive, commented, ”We tell people that this has never caused a death, and in my heart and soul I believe that’s true.”(8) The deaths that did result are blamed on drug overdose. No explanation has been offered for the coincidence of the so-called drug-induced deaths with the firing of a Taser stun gun. Alex Berenson, in an extensive article in the New York Times, noted that the company’s primary safety studies involved a single pig and five dogs. The limited experiments were conducted by a company-paid researcher and were not published in a peer-reviewed journal.(8)

I have had much experience with the uses of electrical current. To develop the DC defibrillator, now in standard use, we tested various forms of electrical current in more than five hundred dogs.(4 ) The studies extended to other animals — including cats, pigs, rabbits, and monkeys — to ascertain that the results relating to effectiveness and safety were not species specific.

We found, as did others, that electricity consistently induced cardiac arrest in all hearts by provoking ventricular fibrillation. We affirmed that electrical current disabled the heart only when the discharge was delivered during the brief vulnerable period. An observation relevant to the use of Tasers was that the heart is far more susceptible to ventricular fibrillation during stimulation of the sympathetic nervous system, namely, when the animal is either physically or psychologically stressed. (9,10) This of course would be the case in people subjected to Taser discharges. Panic, fear, excitement, drugs, drunkenness, or running from the police will activate the sympathetic nervous system, which readies an animal for fight or flight, and which is manifested by a racing heartbeat, elevated blood pressure, and an increased metabolic rate.

As expected, there have been numerous casualties. Over several years Amnesty International has been examining the consequences of the use of Taser guns and declared, “Industry claims that Taser stun guns are safe and non-lethal simply do not stand up to scrutiny.”(11) The conclusion was based on a compilation of 334 deaths in the United States following shootings with stun guns during the period June 2001 to August 2008. As there has been no careful oversight or recordkeeping, and coroners invariably ascribe death to preexisting conditions or drugs, there exists no exact data of the actual number of killings inflicted by Tasers.

Which brings me to the intent of this communication. An electrically induced cardiac arrest can be readily reversed. It is due to a disorganized heart rhythm that can be terminated by a hefty thump with a fist. If the subject is unconscious and pulseless, the victim needs to be rolled on to his or her back and thumped with a vigorous blow to the lower breastbone. The more quickly this is accomplished, the greater the likelihood of the victim surviving.

I have hesitated offering this recommendation, fearing that it may lend support to the use of Tasers. Once there is a relatively effective remedy for its most unwanted consequence, inhibition for its employment will be further diminished. Offering this counsel reflects my conviction that physicians must not be diverted by philosophical quandaries from attending to the victim at hand. When a subject is in distress, a doctor’s exclusive priority is to alleviate the suffering. Withholding an opinion over the past few years since I became informed of the use of Tasers has been a mistaken moral judgment.

This advice for the use of Thumpversion does not diminish my intense opposition to the employment of Tasers. I object using a device that may inflict death when the justification for its use is its non-lethality.

It should be understood that Thumpversion can not be 100 percent effective in reversing ventricular fibrillation. A host of unknown and uncontrollable factors may interdict its effectiveness. These include delay in its use; the presence, type, and severity of heart disease; the degree of the victim’s agitation; the presence of mental illness or epilepsy; the use of prescription and over-the-counter drugs; and the consumption of narcotics or alcohol. These and a host of other factors determine whether thumping or any other measure will restore a normal heartbeat. Inflicting the ultimate punishment of death cannot be left as an arbitrary impulsive action of a police officer whose judgment may be clouded by the stressful encounter.

Police have argued that stun guns serve as a substitute for lethal force as well as protecting the safety of officers. Indeed police need optimum protection when they conduct their multiple duties, foremost shielding the public from all types of harm and maintaining law and order. But this does not grant them the authority to take a human life. Available evidence indicates that those who were killed did not threaten the life of any police officer. Ninety-five percent had no weapons. None had dangerous weapons or guns. It is clear that unarmed subjects have been electrically shocked for arguing, talking back, being discourteous, refusing to obey an order, resisting arrest, or fleeing a minor crime scene. Amnesty International concluded that Taser stun guns are employed as tools of routine force — rather than as alternatives to firearms. (11)

These weapons have even been used against schoolchildren. For example, in March 2008, an 11-year-old girl with a learning disability was shocked with a Taser after she hit a police officer. A 9-year-old girl was recently shot with a Taser gun in Arizona. (8) Tasers were used against peaceful protesters during a sit-in in Pittsburgh. They have been used against pregnant women, the elderly, the disabled, and those with dementia. In at least six cases, Tasers were used on individuals suffering from medical conditions such as seizures — one was a doctor who had crashed his car during an epileptic convulsion. He died after being repeatedly shocked at the side of the highway while dazed and confused when failing to comply with an officer’s commands. (11)

Police have other options to subdue noncompliant, disturbed, or violent individuals. There is little evidence that Tasers reduce police shootings or that they work better than other alternatives to guns, like pepper spray. A 2002 study in Greene County, Missouri, found that Tasers were only marginally more effective than pepper spray at restraining suspects. Pepper spray worked in 91 percent of cases, while the Taser had a 94 percent success rate. (8)

Not discussed in the available literature is the extreme discomfort and pain experienced by victims who have been shocked with Tasers. I have had much experience in employing an electrical discharge while cardioverting patients with diverse cardiac rhythm disorders. These patients are fully anesthetized. In some rare cases, patients who had been given inadequate anesthetic drugs felt the shock. They have complained bitterly of having been kicked by a mule. Subjects shocked with Tasers have experienced full body seizure, a loss of control, a feeling of total paralysis, and a sense of impending death.

While cardioversion involves a single brief electrical discharge lasting merely a fraction of a second, Taser shocks are delivered with a much larger charge and for a much longer duration. Many of the people who died were subjected to repeated or prolonged shocks — far more than the five-second “standard” cycle — or shot by more than one officer at a time. Among the 94 who were killed and autopsied, these ranged from three to twenty-one shocks. One man died after being shocked for fifty-seven continuous seconds.(11) According to Amnesty International, some “ police officers are running amok with their weapons.”(11)

Thumpversion is no justification for legitimizing the use of stun guns. As John Stuart Mill counseled, “Against a great evil, a small remedy does not produce a small result; it produces no result at all.” It is disconcerting that a device that can kill is presented as a humane alternative to lethal force. Even more dismaying is that doctors who have been using electrical current in pacemakers, cardioverters, and defibrillators and who are well aware of the hazards of provoking ventricular fibrillation have remained mum. There have been no words of disapprobation from medical ethicists, the legal profession, or the clergy. The victims are primarily the poor, the disabled, the mentally ill, outcasts, and people of color. Silence in the face of injustice is complicity. Martin Luther King reminds us, “Our lives begin to end the day we become silent about things that matter.”

Bibliography

1. Pennington J, Taylor J, Lown B. Chest thump for reverting ventricular tachycardia . New Eng J Med 1970; 283: 1192-95.
2. Lown B, Taylor J. Thumpversion. Editorial. New Eng J Med 1970; 283: 1223-24.
3. Lown B. The antiarrhythmic blow to the sternum: Thumpversion. Heart Rhythm 2009; 6:1512-13.
4. Lown B, Neuman J, Amarasingham R, Berkovits BV.  Comparison of alternating current with direct current electroshock across the closed chest. Am J Cardiol 10: 223‑233, 1962.
5. Lown B, Amarasingham R, Neuman J. New method for terminating cardiac arrhythmias. JAMA 182: 548‑555, 1962.
6. Hirschkorn P. Family seeks justice in taser death. CBC News. June 28, 2009. http://www.cbsnews.com/stories/2009/06/27/eveningnews/main5119168.shtml
7. Talvi SJA. Stunning revelations. In These Times; November 2006, 20-25.
8. Berenson, A. As police use of tasers soars, questions over safety emerge. New York Times. July 18, 2004.
9. Lown B, Verrier R, Corbalan R. Psychological stress and threshold for repetitive ventricular response. Science 1973: 182;834-36.
10. Verrier RL, Lown B. Behavioral stress and cardiac arrhythmias. Ann Rev Physiol 1984,46:155-76.
11. Amnesty International. Tasers — potentially lethal and easy to abuse. Press release, December 16, 2008. http://www.amnesty.org/en/news-and-updates/report/tasers-potentially-lethal-and-easy-abuse-20081216

* Research on Tasers incorporated in this article was conducted by Shelley White.