A quantum of force: The consequences of measuring routine conducted energy device punctures as...

A Quantum of Force: The Consequences ofCounting Routine Conducted EnergyWeapon Punctures as Injuries

Robert J. Kaminski, Robin S. Engel, Jeff Rojek,Michael R. Smith and Geoffrey Alpert

In a recent paper, researchers reported increases in the risk of citizen injuryassociated with police use of conducted energy devices (CEWs), a finding thatis contrary to that reported in most previous studies. These authors speculatethat the differences in findings when compared to other similar studies maybe due, in part, to the exclusion of routine CEW dart punctures as injuries by

Robert J. Kaminski is associate professor in the department of criminology and criminal justice,University of South Carolina. His research focuses on violence against the police, police use offorce, less-lethal technologies, and the causes and prevention of officer and suspect line-of-dutyinjuries. His has published in a variety of journals, including Criminology, the American Journal ofPublic Health, Criminal Justice and Behavior, Crime and Delinquency, Homicide Studies, andViolence Against Women. Robin S. Engel, PhD is associate professor of criminal justice at theUniversity of Cincinnati. Her research includes empirical assessments of police behavior, police/minority relations, police supervision and management, criminal justice policies, criminal gangs,and violence reduction strategies. Previous research has appeared in Criminology, JusticeQuarterly, Journal of Research in Crime and Delinquency, Journal of Criminal Justice, Crime andDelinquency, and Criminology and Public Policy. Jeff Rojek is assistant professor in the depart-ment of criminology and criminal justice at the University of South Carolina. His primary researchinterests are in the area of police officer and organizational behavior. His most recent publicationshave appeared in Criminology, Journal of Research in Crime and Delinquency, Crime and Delin-quency, and Police Quarterly. Dr Michael R. Smith is professor of criminal justice and vice provostat the University of Texas at El Paso. Prior to assuming his current position, he served as dean ofthe College of Liberal Arts and Social Sciences at Georgia Southern University and chair of theDepartment of Criminology and Criminal Justice at the University of South Carolina. Dr Smith is aformer police officer and holds a JD from the University of South Carolina School of Law and a PhDin Justice Studies from Arizona State University. He has served as a principal or co-principal inves-tigator on many research and evaluation grants and contracts over his career. He has writtenextensively on racial profiling, use of force, and other critical issues at the intersection of law,public policy, and policing. His most recent publications have appeared in Criminology & PublicPolicy, the American Journal of Public Health, and Review of Policy Research. Geoffrey P. Alpertis a professor in the department of criminology and criminal justice at the University of South Car-olina. Dr Alpert has been conducting research on high-risk police activities for more than 30 years.He is currently working with Cal POST on their Vehicle Operations Training Advisory Council, andthe Queensland Police Service and Griffith University in Brisbane, Australia. He is a member of theInternational Association of Chiefs of Police Research Advisory Committee. Correspondence toRobert J. Kaminski, Department of Criminology & Criminal Justice, University of South Carolina,Columbia, SC 29208, USA. E-mail: [email protected].

JUSTICE QUARTERLY, 2013http://dx.doi.org/10.1080/07418825.2013.788729

� 2013 Academy of Criminal Justice Sciences

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other researchers, and they called on the research community to collectivelyagree on how CEW injuries should be operationalized. In this paper, we empir-ically demonstrate the differences in findings when routine CEW puncturewounds are included as citizen injuries and when they are not. Ultimately, wereject the authors’ measurement approach as inconsistent with how injuriesassociated with other types of force are routinely coded and measured.

Keywords police use of force; conducted energy weapons; citizen injuries

Introduction

One of the most consistently documented and researched behavior in policingis the use of force. Despite the litany of studies that have been conducted over

the years to measure the types, frequency, and correlates of police coercion,there has been little consensus derived across academics and practitionersregarding many of the most fundamental issues surrounding the use of force by

police. In contrast to this larger body of literature, however, recent findingsregarding the use of one type of weapon—conducted energy weapons

(CEWs)1—have generated relatively consistent findings. Most recent studies ofthe use of CEWs by police have shown that they substantially reduce the num-

ber and severity of injuries to citizens compared to other types of force andhave similar effects on injuries to officers or are benign (Lin & Jones, 2010;

MacDonald, Kaminski, & Smith, 2009; Smith, Kaminski, Rojek, Alpert, & Mathis,2007; Taylor & Woods, 2010). Notably, the only two studies to date employing

quasi-experimental designs bolster confidence in these results (MacDonaldet al., 2009; Taylor & Woods, 2010).

These findings, however, have recently been called into question based on

new findings reported by Terrill and Paoline (2011) in Justice Quarterly.Employing a nonexperimental design, these authors examined CEW usage in

seven mid-to large-size US police agencies. Using different methods and mea-sures, they reported significant increases in citizen injuries involving the use of

CEWs compared to other types of force across a majority of their statisticalmodels. Terrill and Paoline highlighted the importance of their findings by not-

ing that their study “is the first to report a fairly consistent increased riskbetween the use of CEWs and citizen injury,” leading them to suggest that“recent policy recommendations made by a number of researchers (MacDonald

et al., 2009; PERF, 2005; Smith et al., 2007; Taylor & Woods, 2010) as to howor when to use CEWs, are premature” (Terrill & Paoline, 2011, p. 24). Yet,

contrary to most prior studies, Terrill and Paoline’s measure of citizen injuryincluded routine minor CEW punctures. They speculated that the differences in

their findings when compared to other studies of similar size, scope, and

1. Conducted energy weapons are also known as electro-muscular disruption devices, electroniccontrol devices, neuro-muscular incapacitation devices, and conducted electrical devices.

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design may be due to the inclusion of minor dart punctures as “injuries,” andfurther articulated several reasons why they departed from previous

approaches regarding the measurement of citizen injury associated with CEWs.They concluded by recommending that the research community collectively

decide how to better operationalize CEW-related injuries.Given the importance of police use of force, and that Terrill and Paoline’s

findings are contrary to those reported in previous research studies, their

approach merits additional consideration and attention from researchers. Wetherefore consider the consequences of including routine CEW-related

punctures as measures of citizen injuries. First, we review the prior literaturesurrounding use of force and specifically CEW usage, including Terrill and

Paoline’s most recent contribution. Using data from a large West-coast lawenforcement agency, we next empirically demonstrate the differences in

findings when routine puncture wounds are included as citizen injuriescompared to when they are not. In direct contrast to Terrill and Paoline, we

argue that our findings regarding CEW-related citizen injury (when properlymeasured) are consistent with the majority of previous empirical research find-ings. We conclude with a discussion of the practical and policy implications of

including routine CEW punctures in measures of citizen injuries. We also revisitprior measurement decisions in the use of force literature and note how Terrill

and Paoline have previously departed from conventional measures of policeuse of force and now citizen injury. Ultimately, we reject these authors’

measurement approach as inconsistent with how injuries associated with othertypes of force are routinely coded and measured, and we discuss the negative

consequences that such an overly expansive view of injuries may have on thedevelopment of future technologies designed to reduce injuries and save lives.

Police Use of Force and Conducted Energy Devices

The use of physical force by police has been a matter of great debate and

controversy for decades. From Westley’s (1953) initial characterization ofpolice use of force as violence to Bittner’s (1985) observation that the core of

the police role in society is the nonnegotiable use of coercive force, theconceptualization and study of police use of force is often a central compo-

nent of criminal justice research. Over the years, successful attempts atreducing police use of force and the resulting harms associated with it haveincluded changes in laws, legislation, policies, training, and practice (Fyfe,

1988). And most recently, law enforcement officials have turned to the use ofless-lethal technologies (e.g. CEWs and pepper spray) as weapons of choice to

reduce citizen and officer injuries when force must be used to control resistantcriminal suspects (MacDonald et al., 2009; Taylor, Alpert, Kubu, Woods, & Dun-

ham, 2011).CEWs have been used by law enforcement since at least the 1980s. They are

handheld devices that use compressed nitrogen to launch two or four

THE CONSEQUENCES OF COUNTING ENERGY WEAPON PUNCTURES AS INJURIES 3

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(depending on the manufacturer and device) tiny barbed darts tethered to apower source by insulated wires that project outward to maximum distances

of 15-35 feet. CEWs also have a “touch-stun” mode used for pain compliance.When the darts attach to clothing or penetrate the skin, they deliver short

electric pulses with very low average current that interrupts the electrical sig-nals from the central nervous system to the peripheral body, typically leadingto neuro-muscular incapacitation (Kroll & Ho, 2009). Although some law

enforcement agencies purchased Stinger Systems’� CEWs, Taser International�

has been the market leader supplier (US Department of Justice, 2009).

The introduction of CEWs as a use-of-force alternative significantly shiftedthe use-of-force landscape. Although early models of the TASER� were not

widely adopted during the 1980s, in part because they were less effective thannewer models (Meyer, 2009), the number of law enforcement agencies employ-

ing 100 or more sworn officers adopting CEWs grew substantially following themarketing of the TASER� model M-26TM in 1999. According to the Bureau of

Statistics, only 14.5% of agencies deployed CEWs in 2000. This percentagetripled by 2003 (43.9%) and as of 2007, 74.9% of agencies deployed CEWs (LawEnforcement Management and Administrative Statistics, 2006, 2003, 2011).

CEW Effectiveness

An initial consideration regarding CEWs is their ability to successfully incapaci-tate resistant and combative subjects so that they can be brought under

control by arresting officers. The early seven-watt versions of CEWs were lesseffective than current models and were often ineffective against suspectsunder the influence of Phencyclidine (PCP) or in a state of excited delirium

(Meyer, 2009). Other assessments found CEWs to be effective between 50 and85% of the time (Donnelly, 2001), while more recent evaluations by Taser

International� and individual law enforcement agencies reported CEWs wereeffective between 80 and 94% of the time (White & Ready, 2007, 2010). Inde-

pendent research on CEW effectiveness has also reported high levels of suc-cessful incapacitation of resistant suspects, albeit the reported percentages

are lower than those reported by CEW manufacturers. For example, researchconducted by Mesloh, Henych, Hougland, and Thompson (2005) demonstrated

that the use of CEWs was immediately effective (with no further suspect resis-tance) in 67.7% of the 400 random sampled use-of-force reports from theOrange County Sheriff’s Office in 2001-2003. Delayed effectiveness was

reported in 9.6% of the reports and ineffectiveness on first application in 22.7%of the reports. The main reasons for failure were missed shots, suspects wear-

ing baggy clothes, or loosened probes. Subsequent analyses of use-of-forcereports from the Orange County Sheriff’s Office and the Orlando Police

Department in 2001-2005 reported 59.8% effectiveness without further suspectresistance (Mesloh, Henych, & Wolf, 2009). Importantly, both studies reported

that CEWs were more effective than all other types of force at ending suspect

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resistance on first application; these findings are similar to those reported byMeyer (2009).

White and Ready (2007) examined 243 CEW uses by NYPD emergency serviceunit personnel on persons who were in an agitated state (e.g. under the influ-

ence of drugs and mentally ill) that presented a danger to themselves or othersfor the years 2002-2004. They found that suspects were reported as being inca-pacitated 84.7% of the time, but that of those initially incapacitated, 21.3%

continued to resist (calculated from Table 2, p. 182). If one considers contin-ued resistance as less than “effective,” the effectiveness rate would be 63.4%,

which is similar to other studies. In a follow up study, White and Ready (2010)used multiple regression analyses to examine CEW effectiveness of 375 CEW

deployments by the NYPD during 2002-2005. Of suspects initially incapacitated,33.0% continued to resist and of suspects not incapacitated (e.g. due to CEW

failure), 10.9% continued to resist. The authors found that suspect body weightgreater than 200 lb, a distance of three feet or less, alcohol or drug

intoxication, violence directed towards officers, CEW misses, and use of otherless-lethal devices were all significant predictors of continued suspectresistance. Interestingly, other variables, such as suspect race, gender, and

mental status were unrelated to reported CEW effectiveness.

CEWs, Deaths, and Deadly Force

One of the major concerns of police use of CEWs is sudden in-custody death

following exposure. According to Amnesty International, 500 subjects diedfollowing exposure to CEWs in the USA since 2001 (Trimel, 2012). Suddenin-custody death during police confrontations is not a new phenomenon and

these outcomes have been variously attributed to positional asphyxia,exposure to pepper spray (oleoresin capsicum, OC), prolonged violent

struggle, excited delirium syndrome, drug intoxication, cardiovascular dis-ease, or other factors (Chan, Vilke, Neuman & Clausen, 1997; DiMaio &

DiMaio, 2006; Petty, 2004; Reay, Fligner, Stilwell, & Arnold, 1992; Roeggla,Roeggla, Moser, & Roeggla, 1999). The difficulty, of course, is determining

whether less-lethal weapons such as OC and CEWs cause or contribute tosudden in-custody deaths, or whether these deaths would have occurred

even in the absence of exposure to these weapons.Several medical-based studies have attempted to determine the contribu-

tion of CEWs to injury and in-custody deaths following exposure. Two studies

involved medical screenings and record reviews of 1,627 exposed subjects(Bozeman et al., 2009; Eastman et al., 2007). Eastman et al. (2007) examined

426 exposed subjects and found all nonfatal injuries were minor, though therewas one death. This subject had a core body temperature of 107.4 and was

intoxicated on cocaine, and likely would have died even without the shockfrom a CEW (White & Ready, 2009). Bozeman and colleagues (2009) examined

1,201 exposed subjects, and reported that the vast majority (99.75%) suffered


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no injuries or only superficial injuries. Although there were two fatalities, uponautopsy it was concluded the deaths were unrelated to CEW exposure.

Several retrospective mortality reviews were conducted by medicalresearchers who examined hundreds of autopsy and toxicology reports of

persons who died proximate to CEW exposure. Many subjects were found tobe intoxicated on drugs, suffered from cardiovascular disease, and/or werein a highly-agitated state at the time of exposure (excited delirium). The

general conclusion from this body of research was that CEWs are not acommon cause or contributor to sudden in-custody death (Kornblum &

Reddy, 1991; Strote & Hutson, 2006; Swerdlow, Fishbein, Chaman, Lakkired-dy, & Tchou, 2009; US Department of Justice, 2011). An exception is a

study by Zipes (2012), who reviewed eight cases of CEW-proximate deathsand concluded that CEWs can cause cardiac dysrhythmias and sudden death,

though this study has been challenged on a number of grounds (see, e.g.Vilke, Chan, & Karch, 2013). Furthermore, although the vast majority of

CEW-proximate deaths have been attributed to causes other than CEWs,Amnesty International reported that CEWs contributed to or caused morethan 60 deaths as determined by medical examiners (Trimel, 2012). Further,

some subjects without any apparent risk factors have also died followingCEW exposure (US Department of Justice, 2011). Clearly, the deployment of

a CEW by law enforcement personnel should not be taken lightly.While the focus of research on CEWs has been on their contribution or

potential contribution to in-custody deaths (Kaminski, 2009), relatively littleempirical research has examined the potential of CEWs to reduce citizen

fatalities and the use of lethal force by police. Given the deterrent and inca-pacitation effects of CEWs and other less-lethal weapons such as OC, however,it is likely that their use early on during resistive and violent encounters

prevents further escalation and the need for the use of deadly force by policein some cases (Mesloh, Henych, Hougland, & Thompson, 2005; Thomas et al.,

2010; White & Ready, 2007, 2010). For example, Taser International� reportsthat as of October 2012, police use of CEWs saved over 97,000 people from

potential death or serious bodily injury (http://www.taser.com/taser-prod-ucts-save-lives). Likewise, several law enforcement agencies reported large

reductions in the use of lethal force by its officers following the introductionof CEWs (see, e.g. Smith et al., 2009), though there have been some excep-

tions (Amnesty International, 2004; Thomas et al., 2011). However, these sim-ple pre-post CEWs research designs suffer from a number of threats to internalvalidity and are often not the product of independent research (Adams & Jenn-

ison, 2007; Alpert & Dunham, 2010; Campbell & Stanley, 1966; Kaminski et al.,1998; Smith et al., 2009; Taylor & Woods, 2010).

A more rigorous prospective study of CEW use on mentally-ill subjects byHo, Dawwes, Johnson, Lundin, and Miner (2007) that used data self-reported

by law enforcement agencies submitted to Taser International� estimatedthat CEWs were deployed in nearly 50% of encounters in which deadly force

would have been justified. While they cannot prove a counterfactual, they

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http://www.taser.com/taser-products-save-lives

http://www.taser.com/taser-products-save-lives

estimated that 1,100 lives were potentially saved over a six-year periodbecause of the availability of CEWs. A prospective study of 426 CEW field

uses in a large US city concluded that the availability of CEWs clearlyprevented police use of lethal force in 5.4% or 23 encounters (Eastman

et al., 2008). However, in another pre-post test study, Lee et al. (2009)examined CEW use in 50 of 123 police agencies surveyed in California (40%response rate) and found that CEWs were not associated with a decrease in

firearm-related deaths. Given the variability in findings, additional researchis needed to better assess the relationship between CEW use and police use

of deadly force and civilian fatalities, preferably through studies employingquasi-experimental designs.

CEWs and Nonfatal Officer and Suspect Injuries

Among the reasons law enforcement agencies adopt less-lethal weapons suchas CEWs is to gain compliance from resistive and combative suspects whilereducing the likelihood of injury and the severity of injury to officers and

suspects (Thomas et al., 2011). A central question, therefore, is whether ornot CEWs are effective in gaining compliance and reducing injuries and the

severity of injuries.With the widespread adoption of CEWs during the 2000s, many law enforce-

ment agencies have since reported substantial reductions in officer and suspectinjuries, but these studies were not independent and relied on overly simplistic

pre-post test comparisons. Using more sophisticated research designs andstatistical methods, several independent studies have since been conducted,with the majority reporting that the use of CEWs significantly reduced injuries

to suspects and/or officers as well as the severity of injuries to suspects (Lin &Jones, 2010; MacDonald et al., 2009; Paoline, Terrill, & Ingram, 2012; Smith

et al., 2007; Taylor & Woods, 2010). Further these studies reported that therisk of moderate to severe harm from the use of CEWs was quite low. Several

studies, however, were correlational, cross-sectional, or relied on statisticalcontrols for potential rival explanations and therefore could not support causal

inferences (Kaminski, 2009; Terrill & Paoline, 2011).2

Two studies, however, are noteworthy because they employed quasi-experi-

mental designs that reduce many of the threats to internal validity (Campbell& Stanley, 1966). Studies conducted by MacDonald et al. (2009) and Taylor andWoods (2010) reported substantial and statistically significant reductions in

injuries to both officers and suspects in several law enforcement agencies.Specifically, MacDonald et al. (2009) examined 108months of pre-post

CEW-adoption data (1998-2006) and 60months of pre-post CEW-adoption data(2002-2006) in the Orlando (FL) and Austin (TX) police departments, respec-

2. Although a detailed discussion is beyond the scope of this paper, a recent study questioned theobjectivity of industry-funded studies on the safety of CEWs (Azadani et al., 2011).


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tively. Using count regression models to estimate injury incident rates,MacDonald et al. found in Orlando that the average monthly incidence of

suspect injuries decreased by 53% after adopting CEWs while the rate of officerinjuries declined by 62%. The adoption of CEWs by the Austin Police Depart-

ment was associated with 30 and 25% reductions in the average monthly ratesof suspect and officer injuries, respectively.

Likewise, Taylor and Woods (2010) compared four years of pre-post CEW

adoption data from seven law enforcement agencies with six matched agenciesthat did not adopt CEWs. Examining a variety of injury outcomes, they found

that CEW adoption was associated with lower rates of officer injuries, theseverity of suspect injuries, and injuries to suspects and officers requiring

medical attention. In summary, the bulk of the available evidence stronglyindicates that CEWs are associated with reductions in the frequency and sever-

ity of injury to officers and civilians.

The Terrill and Paoline (2011) Study

Despite the research findings reported above, Terrill and Paoline (2011)recently summarized this body of research as indicating that “the relation-

ship between CEWs and citizen injuries is unclear” (2011, p. 6). Theseresearchers further critiqued this body of research by noting that previous

studies: (1) did not adequately control for other types of force; (2) didnot control for additional factors that might account for injuries; and (3)

did not adequately test the impact of CEWs “beyond one simple referencecategory” (2011, pp. 6-7). To address these concerns, Terrill and Paolineanalyzed 13,913 use-of-force cases across seven police departments. Of

these use-of-force incidents, 2,607 (18.7%) involved the use of CEWs.Further, the authors reported that of the 13,913 use-of-force incidents,

4,447 (31.9%) involved an injury to the citizen. More specifically, citizenswere injured in 41.2% of CEW-only incidents and 47% of CEW plus other

types of force incidents, compared to only 28.9% of nonCEW incidents. Aseries of logistic regression models comparing CEW usage to other types of

force demonstrated that even after controlling for some officer and citizendemographics, along with some forms of citizen behavior, the bivariate

findings (that CEWs resulted in a greater likelihood of citizen injurycompared to other types of force) held in seven of the eight estimatedmodels. Supplemental analyses also demonstrated that CEW usage was

significantly associated with a greater likelihood of citizen injury, evenwhen injury was measured as a scaled variable (i.e. no injury, bruises/

abrasions, lacerations, and broken bones) and as a hospitalization dichoto-mous variable.

Yet, as with all studies, Terrill and Paoline’s measurement of key variableslikely influenced their findings. In particular, their measurement of citizen

injury departs from most previous research and common practice regarding

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CEW usage and reporting. Specifically, Terrill and Paoline’s measure of citizeninjury was based on officers’ perception and reporting of injuries on official

reports (and these reports varied across sites). As they noted:

There was little to no direction in the policy guidelines to designate thecriteria individual officers were to apply to determine whether a citizen wasinjured other than the officer’s perception of injury or complaint of injuryby the citizen. According to queries with officials across the sites, each offi-cer using force was provided the discretionary power to determine injury,based on his/her assessment, as to whether the force he/she used causedsuch. Thus, the injuries analyzed as part of this inquiry are considered inju-ries by police personnel, as opposed to a determination made by theauthors. (2001, p.10)

Thus, there was likely little consistency in the reporting of injuries, with someofficers in some departments documenting dart punctures and minor burns

from CEWs as lacerations or abrasions (and therefore included in Terrill andPaoline’s dichotomous injury measure), while other officers did not report

these minor wounds as injuries. It appears that in their scaled injury variable,Terrill and Paoline categorized these minor wounds as either minor injuries(abrasions) or moderate injuries (lacerations). Unfortunately, we could not dis-

cern if their findings would change if they had used the more common measureof citizen injury that did not include these types of minor wounds. Also note

that these types of minor wounds were not included for uses of force otherthan CEWs. For example, Terrill and Paoline indicated in a footnote that simi-

lar minor “injuries” resulting from the use of chemical sprays were likely notcaptured in their study, because officers may not perceive skin inflammation

or eye irritation and the resulting blurring and burning sensation as injuries(2011, p. 15). Based on findings generated using this more expanded measureof citizen injury, Terrill and Paoline called on the “research community” to

“collectively decide how to operationalize police-inflicted injuries as a resultof CEW usage, especially in light of the practical implications of our research”

(2011, p. 28).In summary, based on previous studies, we know the following about police

use of CEWs. First, current versions of CEWs are highly effective at incapaci-tating subjects when appropriately deployed, but estimates of the rates of

effectiveness vary based on how effectiveness is defined. While CEWs are notrisk-free, the risk of death or serious injury from CEW exposure appears to be

very low. Further, there is some evidence that CEWs have reduced police useof deadly force and civilian fatalities, though to date the findings are mixed.The vast majority of studies show that CEWs are associated with reductions in

police and/or suspect injuries as well as the severity of injuries amongsuspects. This research has been recently called into question by Terrill and

Paoline (2011), with claims that the associated reductions reported in policeand suspect injuries during use of force incidents involving CEWs are likely due

to improper measurement and operationalization of key constructs (in this


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case, injuries). This core fundamental question regarding the appropriatemeasurement of CEW-induced injuries is the subject of our inquiry below.

Data and Methods

Data for our analyses are from one of the 12 police agencies that previously

provided data for a study conducted by Smith et al. (2009) (see also MacDonaldet al., 2009).3 This agency is selected because it provides a data-set containing

a large number of use-of-force incidents and the detail necessary to assess theconsequences of counting and not counting CEW punctures on suspect injury

rates and predictors of injury in regression models. We include only CEW punc-tures because touch-stun mode is infrequently applied and there are only three

reported CEW-related burns. The data-set contains information on the types offorce used by each officer in a given incident. The data also include an indica-

tor of whether or not a suspect sustained an injury and if so the type (e.g. abra-sion, laceration, puncture wound, and broken bone) and severity of the injurysustained, as well as several control variables. Information on 2,477 use-of-

force incidents that occurred 1 January 2005-31 December 2005 is included.

Measures and Descriptive Statistics

Four dependent variables, displayed in Table 1, examine the effects of exclud-

ing and including CEW dart punctures as injuries sustained during use-of-forceincidents—two dichotomous outcomes measuring injury/no injury and twotrichotomous outcomes measuring injury severity.4 The first dichotomous

measure (labeled BiInjury-1) excludes CEW punctures to approved targets(i.e. not counted as an injury), and is coded 1 if one or more suspects were

injured in an incident and 0 otherwise. As shown, 31.7% of the force incidentsinvolve an injury to a suspect when dart punctures are excluded as a measure

of injury. Punctures to unapproved targets, such as the head, face, or groin,however, are included as injuries. The second dichotomous variable (labeled

BiInjury-2) includes CEW punctures to approved targets as injuries, increasingthe injury rate from 31.7 to 35.7% or an increase of 98 injury events (examin-

ing CEW incidents only, the injury rate increases from 32.3 to 81.1%).Regarding the trichotomous outcomes, counting CEW punctures does notchange the rate of major injuries, but does increase the minor injury rate from

3. Due to the original data sharing agreement, we are obligated to keep the identity of the agencyconfidential. The agency selected, however, is a large law enforcement agency in the UnitedStates.4. Bruises, sprains, scrapes and soft tissue damage are classified as minor injuries, except whenincluding CEW punctures to approved targets; in which case these are included as an injury for thedichotomous measure and a minor injury for the trichotomous measure. Fractures, lacerations, dogbites, concussions, gunshot wounds, and puncture wounds to the head, face or groin (unapprovedtargets) are classified as major injuries for both measures.

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28.7 to 32.6%, and decreases the no injury category from 68.3 to 64.3% (exam-

ining CEW incidents only, the minor injury rate increases from 27.9 to 76.6%).We also include three measures of CEWs to assess their effects on injuries.

CEW is coded 1 if a CEW was deployed, regardless of whether or not anothertype of force was also used (8.1%) and 0 otherwise. CEW Only is coded 1 if the

only force used was a CEW (2.7%) and 0 otherwise, and CEW+ is coded 1 if aCEW was used and one or more other types of force also was used (5.5%) and 0

otherwise. NonCEW is coded 1 if force other than a CEW was used (94.5%) and0 otherwise.

Table 1 Descriptive statistics for variables used in the analysis

Variable Description Code N %

BiInjury-1 One or more suspects injured—CEW punctures not counted 0—no 1,687 68.31—yes 783 31.7

BiInjury-2 One or more suspects injured—CEW punctures counted 0—no 1,589 64.31—yes 881 35.7

TriInjury-1 Severity of suspect injury—CEW punctures not counted 0—none 1,687 68.31—minor 708 28.72—major 75 3.0

TriInjury-2 Severity of suspect injury—CEW punctures counted 0—none 1,589 64.31—minor 806 32.62—major 75 3.0

CEW Conducted energy device—with or without other type of force 0—no 2,271 2011—yes 91.9 8.1

CEW-only Conducted energy device without other force 0—no 2,406 661—yes 97.3 2.7

CEW+ Conducted energy device with other force 0—no 2,337 1351—yes 94.5 5.5

Non-CEW Non-CEW force—with or without use of CEW 0—no 136 2,3361—yes 5.5 94.5

OC Pepper spray 0—no 1,414 1,0581—yes 57.2 42.8

Soft-Hands Physical control holds without weapons 0—no 1,174 1,2981—yes 47.5 52.2

Hard-Hands Strikes of any kind without weapons 0—no 1,823 6491—ye 73.7 26.3

Takedowns Throws, sweeps, tackles, etc. 0—no 1,448 1,0241—yes 58.6 41.4

Hobble Suspect handcuffed and ankles held together by restraint device 0—no 2,245 2271—yes 90.8 9.2

Other force Canine, teargas, impact munitions, baton controls, etc. 0—no 2,243 2291—yes 90.7 9.3

Assault One or more suspects assaulted/battered one or more officers 0—no 1,417 1,0731—yes 56.9 43.1

>1 officer Two or more officers involved in incident 0—no 949 1,5231—yes 38.4 61.6

>1 suspect Two or more suspects involved in incident 0—no 2,296 1761—yes 92.9 7.1

Female Female suspect involved in incident 0—no 2,162 3031—yes 87.7 12.3

Mixed race Two or more suspects of different race/ethnicity 0—no 2,445 201—yes 99.2 0.8

Impaired One or more suspects impaired by drugs and/or alcohol 0—no 1,811 6541—yes 73.5 26.5

Note. Number of observations = 2,477.


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Other officer use-of-force related control variables are coded similarly.These include measures of: OC (used in 42.8% of force incidents); Soft-Hands

(i.e. any physical control holds without the use of a weapon, such as grabbing,holding, and joint locks, used in 52.2% of force incidents); Hard-Hands (i.e.

any strikes without a weapon, such as punching, kicking, kneeing, and elbow-ing, used in 26.3% of force incidents); Takedowns (e.g. throws, tackles, sweepsand swarms, used in 41.4% of force incidents); Hobble (i.e. restraint device in

which a suspect’s hands are handcuffed and ankles are held together, used in9.2% of force incidents); and Other Force (collapsed category including less

frequent types of force, such as canines, teargas, impact munitions, batonstrikes, and soft baton controls, used in 9.3% of force incidents). Note that

CEWs are the least used tactic by this police agency (8.1% of force incidents),likely due in part because not all officers within this agency were issued CEWs

during the time of the study.Several additional dichotomous controls included account for the level of

violence directed at police, the number of officers and suspects involved inthe encounters, and the gender and racial/ethnic composition of the partici-pants. Specifically, as reported in Table 1 43.1% of incidents involved one or

more suspects assaulting or battering one or more officers; 61.6% of incidentsinvolved two or more officers; 7.1% of incidents involved two or more suspects;

12.3% of incidents involved one or more female suspects; .8% of incidentsinvolved suspects of different race/ethnicity; and 26.5% of incidents involved

one or more suspects who were perceived to be impaired by drugs and/or alco-hol (26.5%).5

Analysis

Following Terrill and Paoline (2011), we assess the effect of CEWs on citizen

injuries, noting our differences in how injury is measured (including andexcluding CEW punctures). We first estimate four models in a series of eight

binary logistic regressions (Table 2) using the various CEW measures describedabove, along with the control variables. Each model is estimated twice; once

excluding routine CEW punctures as injuries and a second time including punc-tures as injuries. For example, Model 1.1 in Table 2 excludes routine CEW

punctures as injuries, while Model 1.2 includes them.The first two sets of models (Models 1.1-2.2) use the dummy variables CEW

(CEWs used whether or not other types of force also used) and nonCEW (the

use of any force other than a CEW whether or not a CEW also used). In addi-tion, to test whether the effect of CEWs on injury is dependent on whether or

not force other than a CEW is also used in a given incident, an interaction termbetween CEW and nonCEW is added to the second set of models (Models 2.1

and 2.2). Our expectation for the set of models without the interaction term

5. Due to the data sharing agreement with the law enforcement agencies, officer demographiccharacteristics are not available (Smith et al., 2009).

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(Models 1.1 and 1.2) is that CEW will be inversely associated with the odds ofsuspect injury when routine punctures are excluded as injuries, but will be

positively associated when punctures are included as injuries. Regarding thesets of models including the interaction term (Models 2.1 and 2.2), we hypoth-

esize that the injury-reducing effects of CEWs generally observed in the litera-ture will depend on whether or not other types of force are used. Here, weexpect the interaction term to be positive and significant regardless of

whether or not punctures are counted as injuries.In the second and third sets of models (Models 3.1-4.2), the summary mea-

sure of nonCEW force is replaced with the specific types of nonCEW force usedby officers (e.g. OC, Hard Hands, etc.). The first set of models (Models 3.1 and

3.2) test the effect of CEW when excluding and including routine dart punc-tures as injuries, respectively. We expect CEWs to be inversely related to the

odds of injury when punctures are excluded (Model 3.1) and positively relatedwhen they are included in the measure (Model 3.2).

The models in the final set (Models 4.1 and 4.2) are similar except thatwe substitute CEW Only (incidents in which the only reported force was aCEW) and CEW+ (incidents in which a CEW and one or more other types of

force were used). In Model 4.1 (excluding punctures), we expect CEW Onlyto be inversely associated with the odds of injury and CEW+ to be positively

associated. In Model 4.2 (punctures included as injuries), we expect bothCEW Only and CEW+ to be positively associated with the odds of suspect

injury.A second series of eight models is estimated to assess the effect of CEWs on

the severity of injury when punctures are excluded and included as forms ofinjury. These results are presented in Tables 3 and 4. Following the same basicframework, the sets of models in Table 3 use the summary measure of nonCEW

force, while the sets of models in Table 4 use the specific types of nonCEWforce in place of the summary measure. Expectations regarding the effects of

CEWs are the same as with the binary logistic regression results, except thatwe are modeling the odds of the severity of injury rather than the odds of

injury.We initially used ordered logistic regression to estimate the severity of injury

models; however, tests of the proportional odds assumption indicated that atleast one variable in every model failed to meet the assumption (Long, 1997).6

To avoid incorrect inferences, we instead use the generalized ordered logisticregression model, which relaxes the proportional odds assumption and allowsthe effects of the relevant independent variables to vary over the cut points or

thresholds of the dependent variable (Williams, 2006).

6. The ordered logistic regression model produces a single coefficient for each independentvariable, with the important assumption that the effects are the same across all of the categoriesof the dependent variable, i.e., that the slopes are parallel to one another or equivalently thatthe odds are proportional. When violated, alternative models must be considered See Long (1997,pp. 140–145) for a more thorough explication.


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Results

Binary Logistic Regression Results

We begin with a discussion of the binary logistic regression output, displayedin Table 2. As expected, use of a CEW when punctures are excluded as injuries

(Model 1.1) significantly decreased the odds of suspect injury (OR = .57,p6 .01), while Model 1.2 shows that use of a CEW when punctures are included

as injuries significantly increased the odds of suspect injury (OR = 5.18,p6 .001). In short, the specific measurement of injuries matters in these mod-els. As shown in Models 2.1 and 2.2, the effect of CEWs on injury depends on

whether or not other types of nonCEW force are used, regardless of whetheror not punctures are included. In other words, the odds of injury are greatest

in incidents where officers deployed a CEW and used some other type(s) offorce. This suggests that these incidents are somehow unique in their injury

potential (e.g. incidents in which nonCEW types of force failed to allowofficers to gain control of suspects or that the CEW failed and thus other types

of force were needed). Note, however, the effect is substantially larger whenpunctures are excluded (OR = 23.42, p6 .001), compared to when they areincluded (OR = 4.92, p6 .001).

Table 2 Binary logistic regression models of suspect injury

Variable Model 1.1 Model 1. 2 Model 2.1 Model 2.2 Model 3.1 Model 3.2 Model 4.1 Model 4.2

CEW 0.57⁄⁄ 5.18⁄⁄⁄ 0.04⁄⁄⁄ 1.48 1.05 14.39⁄⁄⁄ – –Non-CEW 0.25⁄⁄⁄ 0.14⁄⁄⁄ 0.09⁄⁄⁄ 0.09⁄⁄⁄ – – – –CEW� non-CEW – – 23.42⁄⁄⁄ 4.92⁄⁄⁄ – – – –CEW only – – – – – – 0.64 18.41⁄⁄⁄

CEW+ – – – – – – 1.24 12.20⁄⁄⁄

OC – – – – 0.39⁄⁄⁄ 0.39⁄⁄⁄ 0.39⁄⁄⁄ 0.39⁄⁄⁄

Soft hands – – – – 1.17 1.15 1.14 1.16Hard hands – – – – 2.84⁄⁄⁄ 2.81⁄⁄⁄ 2.81⁄⁄⁄ 2.81⁄⁄⁄

Takedowns – – – – 2.47⁄⁄⁄ 2.40⁄⁄⁄ 2.44⁄⁄⁄ 2.40⁄⁄⁄

Hobble – – – – 0.69⁄ 0.73 0.67⁄ 0.75Other force – – – – 4.78⁄⁄⁄ 4.79⁄⁄⁄ 4.64⁄⁄⁄ 4.84⁄⁄⁄

Assault 2.28⁄⁄⁄ 2.23⁄⁄⁄ 2.32⁄⁄⁄ 2.25⁄⁄⁄ 1.46⁄⁄ 1.41⁄⁄ 1.47⁄⁄⁄ 1.41⁄⁄

>1 officer 2.61⁄⁄⁄ 2.54⁄⁄⁄ 2.50⁄⁄⁄ 2.49⁄⁄⁄ 1.35⁄ 1.29⁄ 1.33⁄ 1.31⁄

>1 suspect 1.07 1.01 1.06 1.01 1.43 1.37 1.43 1.37Female 0.40⁄⁄⁄ 0.42⁄⁄⁄ 0.41⁄⁄⁄ 0.42 0.46⁄⁄⁄ 0.47⁄⁄⁄ 0.46⁄⁄⁄ 0.47⁄⁄⁄

Mixed race 3.40⁄⁄ 2.86⁄ 2.77⁄ 2.89⁄ 3.19⁄ 3.29⁄ 3.19⁄ 3.29⁄

Impaired 0.92 0.93 0.92 0.93 0.96 0.96 0.95 0.96Constant 0.73 1.31 2.04⁄⁄ 2.04⁄ 0.19⁄⁄⁄ 0.20⁄⁄⁄ 0.19⁄⁄⁄ 0.19⁄⁄⁄

Pseudo R2 0.08 0.14 0.09 0.14 0.19 0.23 0.19 0.23

Notes. ⁄p < .05, ⁄⁄p < .01, ⁄⁄⁄p6 .001; coefficients are odds ratios; pseudo-R2 =McFadden’s.Model 1.1 = punctures not counted, non-CEW force types collapsed.Model 1.2 = punctures counted,non-CEW force types collapsed.Model 2.1 = punctures not counted with interaction term, non-CEW force types collapsed.Model 2.2 = punctures counted with interaction term, non-CEW force types collapsed.Model 3.1 = punctures not counted, specific force types.Model 3.2 = punctures counted, specific force types.Model 4.1 = punctures not counted, CEW only, specific force types.Model 4.2 = punctures counted, CEW only, specific force types.

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Models 3.1-4.2 in Table 2 substitute the specific types of nonCEW force usedby officers for the summary measure. In Model 3.1, CEW is not significantly,

inversely associated with the odds of injury when punctures are excluded, butgiven the statistically insignificant effect (p = .779) and a coefficient near 1.0

(OR = 1.05), we conclude that the effects of CEWs are benign and neitherdecrease nor increase the odds of injury. When punctures are included as inju-ries in Model 3.2, however, we observe large and statistically significant

increases in the odds of suspect injury (OR = 14.39, p6 .001).Consistent with our expectations, Model 4.1 shows that the effect of CEWs

without other types of force and the use of a CEW in conjunction with othertypes of force reduces injuries; although the effects fail to attain statistical

significance (OR = .64, p = .254 and OR = 1.24, p = .308, respectively). Whenpunctures are included as injuries (Model 4.2), however, the use of a CEW

alone and the use of a CEW in conjunction with other types of force signifi-cantly increase the odds of suspect injury (OR = 18.41, p6 .001 and OR = 12.20,

p6 .001, respectively).

Generalized Ordered Logistic Regression Results

Models 1.1-2.2 in Table 3 repeat the analysis for the corresponding models inTable 2, except we model the severity of injury using generalized ordered logis-

tic regression. Note that for ease of display, redundant coefficients equal acrossthe cut points of the dependent variable are not repeated. As expected, when

punctures are excluded from the injury measure (Model 1.1), CEWs reduce theodds of both minor and major injury (versus no injury) and the odds of majorinjury (vs. no or minor injury) (OR = .57, p6 .01). However, when punctures are

included (Model 1.2), CEWs increase the odds of minor/major injury (OR = 5.35,p6 .001), but dramatically decrease the odds of major injury (OR = .14,

p6 .001). This indicates that the effect of counting routine punctures on therelationship between CEW use and the magnitude of suspect injury is an increase

in the odds of minor injuries rather than more serious injuries.Models 2.1 and 2.2 include the interaction between CEW and nonCEW usage.

Similar to the binary logistic model results, regardless of whether or not punc-tures are included, the effect of CEWs on injury depended on whether or not

other types of force are also used. Model 2.1 shows that the odds of minor/major injury increased substantially, as did the odds of major injury whenother types of force are used in conjunction with CEWs (OR = 26.06, p6 .001).

Similar results are obtained in Model 2.2, except the effects of the interactionterm differed across the cut points. Specifically, the use of other types of

force in conjunction with a CEW increase the odds of minor/major injury(OR = 4.70, p6 .001), but the effect on major injury is much higher in

magnitude (OR = 71.07, p6 .001).Models 1.1-2.2 in Table 4 substitute the specific types of nonCEW force for

the summary measure of nonCEW force used in Table 3. When punctures are


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Table 4 Generalized ordered logit models of severity of suspect injury using specificforce types

Model 1.1 Model 1.2 Model 2.1 Model 2.2

Variable InjuryP 2 InjuryP 3 InjuryP 2 InjuryP 3 InjuryP 2 InjuryP 3 InjuryP 2 InjuryP 3

CEW 1.09 – 14.49⁄⁄⁄ 0.92 – – – –CEW only – – – – 0.67 – 18.77⁄⁄⁄ 1.65CEW+ – – – – 1.34 0.40 12.33⁄⁄⁄ 0.65OC 0.40⁄⁄⁄ – 0.39⁄⁄⁄ – 0.39⁄⁄⁄ – 0.40⁄⁄⁄ –Soft hands 1.17 0.24⁄⁄⁄ 1.17 0.17⁄⁄⁄ 1.16 0.17⁄⁄⁄ 1.18 0.17⁄⁄⁄

Hard hands 2.86⁄⁄⁄ 0.64 2.85⁄⁄⁄ 0.67 2.85⁄⁄⁄ 0.67 2.85⁄⁄⁄ 0.69Takedowns 2.48⁄⁄⁄ 1.00 2.43⁄⁄⁄ 0.77 2.48⁄⁄⁄ 0.77 2.43⁄⁄⁄ 0.83Hobble 0.69⁄ – 0.74 – 0.68⁄ – 0.76 –Other force 4.41⁄⁄⁄ 11.75⁄⁄⁄ 4.12⁄⁄⁄ 14.66⁄⁄⁄ 4.26⁄⁄⁄ 13.06⁄⁄⁄ 4.20⁄⁄⁄ 16.53⁄⁄⁄

Assault 1.42⁄⁄⁄ – 1.38⁄⁄ – 1.43⁄⁄⁄ – 1.38⁄⁄ –>1 officer 1.39⁄⁄ 0.52⁄ 1.27⁄ – 1.32⁄ – 1.30⁄ –>1 suspect 1.37 0.24 1.45 0.25⁄ 1.48 0.24⁄ 1.44 0.25⁄

Female 0.48⁄⁄⁄ 1.39 0.47⁄⁄⁄ 2.08 0.47⁄⁄⁄ 1.57 0.47⁄⁄⁄ 2.14Mixed race 2.46 – 2.76⁄ – 2.71 – 2.76 –Impaired 0.95 – 0.95 – 0.95 – 0.95 –Constant 0.18⁄⁄⁄ 0.04⁄⁄⁄ 0.20⁄⁄⁄ 0.035⁄⁄⁄ 0.19⁄⁄⁄ 0.04⁄⁄⁄ 0.19⁄⁄⁄ 0.034⁄⁄⁄

Pseudo-R2 0.20 0.24 0.21 0.24

Notes. The coefficients for InjuryP 2 correspond to the logit formed from the two categories(major injury +minor injury) and no injury; the coefficients for InjuryP 3 correspond to the logitformed from the two categories (major injury) and (minor injury + no injury);⁄p < .05, ⁄⁄p < .01, ⁄⁄⁄p6 .000; coefficients are odds ratios; pseudo-R2 =McFadden’s.Model 1.1 = punctures not counted.Model 1.2 = punctures counted.Model 2.1 = punctures not counted, CEW only.Model 2.2 = punctures counted, CEW only.

Table 3 Generalized ordered logit models of severity of suspect injury collapsingnon-CEW force types

Model 1.1 Model 1.2 Model 2.1 Model 2.2

Variable InjuryP 2 InjuryP 3 InjuryP 2 InjuryP 3 InjuryP 2 InjuryP 3 InjuryP 2 InjuryP 3

CEW 0.57⁄⁄ – 5.35⁄⁄⁄ 0.14⁄⁄⁄ 0.04⁄⁄⁄ – 1.56 0.03⁄⁄⁄

Non-CEW 0.26⁄⁄⁄ 0.01⁄⁄⁄ 0.17⁄⁄⁄ 0.01⁄⁄⁄ 0.09⁄⁄⁄ 0.00⁄⁄⁄ 0.09⁄⁄⁄ 0.00⁄⁄⁄

CEW�Non-CEW – – – – 26.06⁄⁄⁄ – 4.70⁄⁄⁄ 71.07⁄⁄⁄

Assault 2.24⁄⁄⁄ – 2.21⁄⁄⁄ – 2.30⁄⁄⁄ – 2.23⁄⁄⁄ –>1 officer 2.60⁄⁄⁄ – 2.54⁄⁄⁄ – 2.49⁄⁄⁄ – 2.49⁄⁄⁄ –>1 suspect 1.07 – 1.03 – 1.06 – 1.01 –Female 0.40⁄⁄⁄ 1.52 0.42⁄⁄⁄ – 0.41 – 0.42⁄⁄⁄ –Mixed race 2.23 – 2.36 1.41 2.19 1.59 2.27 –Impaired 0.92 – 0.92 – 0.91 – 0.92 –Constant 0.71 0.49⁄⁄⁄ 1.09 0.75 2.06⁄⁄ 1.25 1.94⁄ 1.28Pseudo-R2 0.12 0.16 0.13 0.17

Notes. The coefficients for InjuryP 2 correspond to the logit formed from the two categories(major injury +minor injury) and no injury; the coefficients for InjuryP 3 correspond to the logitformed from the two categories (major injury) and (minor injury + no injury); ⁄p < .05, ⁄⁄p < .01,⁄⁄⁄p6 .001; coefficients are odds ratios; pseudo-R2 =McFadden’s.Model 1.1 = punctures not counted, non-CEW force types collapsed.Model 1.2 = punctures counted, non-CEW force types collapsed.Model 2.1 = punctures not counted with interaction term, non-CEW force types collapsed.Model 2.2 = punctures counted with interaction term, non-CEW force types collapsed.

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excluded in the injury measure (Model 1.1), CEWs neither increase nordecrease the odds of injury when other specific force types are controlled

(OR = 1.09, p = .627). When punctures are included in the injury measure (Model2.1), CEW increase the odds of minor/major injury (OR = 14.49, p6 .001), but

not the odds of major injury (OR = .92, p = .839). Again, this indicates that theeffect of CEWs increases the odds of minor injury rather than more serioustypes of injury, when the injury measure includes puncture wounds.

Models 2.1 and 2.2 in Table 4 use the CEW Only and CEW+measures. Asshown in Model 2.1, the direction of the effect of CEW Only is in the expected

direction when punctures are excluded, but the effect is not statisticallysignificant (OR = .67, p = .391). The direction of the effects for CEW+ suggest

that when other types of force are used in conjunction with CEWs, the odds ofminor/major injury increase, while the odds of major injury decrease. These

effects, however, are not statistically significant (OR = 1.34, p = .319 andOR = .40, p = .163, respectively). As shown in Model 2.2, however, when punc-

tures are included, CEW Only and CEW+both significantly increase the odds ofminor/major injury (OR = 18.77, p6 .001 and OR = 12.33, p6 .001, respec-tively), but not the odds of major injury (OR = 1.65, p = .395 and OR = .65,

p = .411). This once more indicates that the effect of including puncturewounds as injuries increases the odds that incidents result in minor injuries

rather than major injuries.Based on the bivariate logistic regression results, we conclude that when

punctures are excluded, CEWs either reduce injuries among suspects or arebenign in their effects. When punctures are included, regardless of whether

a CEW is used alone or in combination with other types of force, CEWsincrease the odds of injury. We also find that regardless of the inclusion ofpunctures as injuries, the relationship between CEWs and suspect injury

depends on whether or not other types of force are used in combination withCEWs. This suggests that incidents that combine different use of force

tactics have a different injury profile than those involving only CEWs. Unfor-tunately when there are multiple force tactics involved in a single incident,

we cannot discern from these data which specific force tactic produced theinjury.

The results from the models of injury severity, while somewhat morecomplex, tell a similar story. When punctures are excluded, CEWs reduce the

odds of both major and minor injuries or their effects were benign, neitherdecreasing nor increasing the odds of major and/or minor injury. When punc-tures are included, CEWs increase the odds of minor injury, but they reduce

the odds of major injury or had no effect on the odds of major injury. Furtheranalyses reveal that the odds of minor and major injuries tend to increase

when other types of force are used in addition to CEWs, regardless of whetheror not punctures were included in the injury measure. As discussed below, we

believe these findings have a number of important implications for research,policy, and practice.


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Discussion

The data used in the present study provide an opportunity to distinguish injuryoutcomes using a more traditional definition of CEW-related injury compared

to the atypical and more expansive definition recommended by Terrill andPaoline (2011). Our results confirm Terrill and Paoline’s speculation about the

role of measuring dart punctures as injuries from CEW deployments. Weconclude that the direction and size of the reported impact of CEW use on

suspect injury rates is based, in part, on how CEW injuries are defined,measured, and analyzed. It is clear from our results that when routine CEWpunctures are excluded from the injury measure, CEWs are associated with

reductions in injuries to suspects or are benign, neither increasing nordecreasing injury rates. It is also clear that including CEW punctures as injuries

consistently inflates injury rates, whether or not they were used in conjunctionwith other types of force.

Definition of Injury

While we agree that CEW punctures may create minor wounds, we do not

believe these wounds meet the standard definition of injury typically used bylaw enforcement officials and the courts. Further, we believe that attempts to

measure and include routine CEW punctures as injuries could lead to greaterrestrictions on the use of CEWs and concomitant increases in the number of

injuries and the severity of injuries to both suspects and officers. Rather than asimple academic debate, the implication of measuring puncture wounds as

injuries has potential serious consequences. The strongest empirical evidenceavailable regarding the injury-reduction effects of CEWs is based on studies

employing quasi-experimental designs that found the introduction of CEWs sig-nificantly reduced rates of injury to both officers and citizens (MacDonaldet al., 2009; Taylor & Woods 2010). The withdrawal of CEWs or severe restric-

tions placed on their use (based on alternative findings using invalid measuresof injury) would therefore be expected to lead to an actual increase in the

number and severity of injuries during police–citizen encounters.The proper definition and conceptualization of injury is a difficult one that

has produced much controversy in the medical profession (Langley & Brenner,2004; Robertson, 1998). A common theoretical definition of injury in the

medical profession is “damage to the body produced by energy exchanges thathave relatively sudden discernible effects,” which is often used to distinguishbetween injuries and diseases (Langley & Brenner, 2004). Absent in this theo-

retical definition, however, is a usable operational definition, where clearlymany circumstances of bodily damage that would fit under the theoretical

definition would not be operationalized as injuries and vice versa (Langley &Brenner, 2004). It is therefore not surprising that criminal justice researchers

also struggle with this concept when applied to police use of force situations.

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We argue, however, that punctures caused by CEWs do not rise to the conven-tional level of injury as commonly defined in the medical, legal, and criminal

justice professions.First, routine CEW punctures on approved target areas are minor flesh

wounds that are likely similar in pain and severity to receiving an injectionwith a medium-gage hypodermic needle or a blood draw at a doctor’s office orhospital.7 Just like injections and blood draws, CEW punctures can result in

minor pain, bleeding, and bruising. The minor wounds associated with injec-tions and routine blood draws, however, are not documented as injuries by

hospitals or physicians, as long as the wounds occur within the normal andapproved operating parameters of the device used. Granted, the circumstances

for the use of CEWS are different than medical procedures, and in most casesinjections and blood draws are given with explicit patient consent, but that is

not always the case. For example, in emergency medical situations, medicalpersonnel routinely use injections and blood draws without patient consent,

and again the minor wounds associated with these procedures are not docu-mented as injuries to nonconsenting patients.

Consider another medical example: surgical incisions. Clearly, a surgical

incision is the result of an intention act by a specialist using a tool designed toaid in his/her craft. In this case, based on his/her training, a surgeon uses a

tool (typically a scalpel) that, by design, results in tissue damage. Neverthe-less, surgical incisions on patients are not considered injuries in the medical

profession. The same logic can be applied to police use of CEWs. In this case,a trained professional (police officer) uses an approved tool (CEW) to aid in

his/her craft (gain citizen compliance while attempting to simultaneouslyreducing the likelihood of citizen and officer injury). The resulting expectedminor punctures from proper police deployment of CEWs should not be consid-

ered “injuries” any more than a proper surgical incisions resulting from a doc-tors’ use of a scalpels.

Also consider the results of the application of other police uses of forceincluding exposure to OC spray, which may cause eye, lung, and skin irritation.

In addition, joint locks and handcuffs may cause skin irritation and temporarypain. We argue that unless a CEW (or OC) causes an unintended and more

serious injury (e.g. a CEW dart puncture of the face, eye or other unapprovedtarget), these routine minor wounds that are expected as part of the

deployment of the device should not be included in a measure of injury. Inter-estingly, if the effects of CEWs and OC are not experienced (dart puncturesand eye/lung irritation) it means the devices did not work as intended and

probably did not produce the desired effect of gaining citizen compliance.8

This suggests that if we adopt Terrill and Paoline’s recommended measure of

injury, every successful deployment of these devices would result in coded

7. The TASER X26 dart is .8mm in diameter (.031 inch) (Webster, 2009, p. 99), equivalent to anapproximately 21 gage hypodermic needle.8. We are indebted to an anonymous reviewer for this insight.


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“injuries” to suspects. What then, would be the point of conducting researchto determine if CEWs increase or decrease injuries? Accurately measuring inju-

ries as proposed by Terrill and Paoline would result in the measurement of aconstant rather than variable to be explained; and as a result, CEWs would be

the highest injury-inducing use of force tactic.

Previous Lessons Regarding the Measurement of the Use of Force

Terrill and Paoline’s call to reconsider the measurement of a key constructin use of force research is reminiscent of similar concerns raised by at least

one of these authors over a decade ago. In the previous circumstance, itwas the measure of “force” itself that was called into question (Terrill,

2001). As Garner et al. (2002) demonstrated in their comprehensiveliterature review, there were dramatic differences in the measurement and

operationalization of police use of force across studies. Terrill and hiscolleagues (Terrill, 2001; Terrill & Mastrofski, 2002), along with others(Garner, Hepburn, & Buchanan, 1995; Klinger, 1995) advocated for the

examination of police use of “coercion” rather than “force,” and called forthe measure of police coercion on a continuum that included even the most

minor actions that were not routinely considered by police agencies or thecourts as uses of force (e.g. verbal commands, verbal threats, handcuffing,

Terry frisks, etc.). Most controversial was the inclusion of handcuffing as aform of coercion, or in some studies, use of force. Even though restraining

arrestees with handcuffs is considered standard procedure by police agenciesacross the country (for officer safety reasons and to prevent flight) and notconsidered by agencies as a use of force, it was often included in academ-

ics’ measures of force. Including handcuffing in a measure of force, bydefinition, would indicate that all (or nearly all) arrestees across the coun-

try have been subjected to police use of force. Further, the Bureau ofJustice Statistics’ Police–Public Contact Survey, the largest national data

collection effort on police use-of-force and other outcomes in the USA, doesnot consider handcuffing as a use of force (Eith & Durose, 2011).

Researchers’ expansion of force measures to include actions that lawenforcement and others do not consider to be uses of force has resulted in a

disconnect between research and practice. As might be expected, the inclusionof handcuffing (and other nontraditional measures of force) resulted in adramatic increase in research reporting percentages of police–citizen encoun-

ters that involved use of force. For example, in one use-of-force study examin-ing Project on Policing Neighborhoods data, Terrill (2003) reported that of the

3,544 police encounters with criminal suspects that were examined, 58.4%involved the use of verbal and physical force, 21.0% involved the use of only

physical force, but only 4.7% involved physical force when handcuffing and patdowns were excluded.

As a result of this change in measurement that artificially inflated thereported prevalence of use of force incidents, this body of research is

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unhelpful to practitioners and police executives seeking to better understand-ing correlates of force. Police executives interested in implementing policies

and training to reduce the use of force will find little or no value in currentreports using these expanded measures of force. When expanded measures of

use of force include actions that are not recognized by law enforcement offi-cials or the courts as uses of force, the resulting reported correlates of forceare virtually meaningless for policy and training. Contrary to early use of force

studies, much of the recent academic research debating the measurement ofthe use of force seems unconnected to actual police practice and public conse-

quences.While expanding the measures of use of force may be considered an

important academic endeavor, police agencies and the public are continuallysearching for effective means to reduce the use of force. With the exception

of a handful of recent studies examining the impact of less-lethal weapons(e.g. MacDonald et al., 2009; Smith et al., 2007), the research community has

little to offer about the types of policies, equipment, training, and managerialoversight that are most effective at reducing use of force incidents withoutcompromising officer safety. The research on CEWs is most promising because

it addresses critical issues regarding injuries that are important to both thepolice and the public.

Policy and Research Implications

Even if one believes that the puncture wounds should be measured andincluded as injuries, efforts to do so are likely to prove fruitless. Just as homi-cides are more reliably reported than more minor crimes, force-related

deaths, and major injures are more reliably reported than minor injuries. Thus,we can assume that even if agencies required the reporting of routine CEW

punctures, full compliance will be elusive (this includes the present study andwe assume that CEW punctures and other forms of minor injury, such as

skin/eye irritation from pepper spray and other physical force tactics, wereunderreported). Indeed, none of the agencies studied by Terrill and Paoline,

and few of those studied by Smith et al. (2009) had policies requiring thereporting of routine CEW punctures. In the original Smith et al. (2009) study,

some officers in 6 of the 12 agencies reported dart punctures as injuries whileother officers in the same agencies did not. This finding is consistent withTerrill and Paoline’s reporting that officers are provided little guidance on the

criteria for suspect injury associated with the use of CEWs. For example, inthe Seattle Police Department (one agency studied by Smith et al. (2009) that

captured detailed information on injuries associated with CEWs), dart punc-tures were reported as injuries in 47.8% of the 437 cases where dart contacts

with suspects were verified. If this represents the “typical” experience ofagencies with CEWs, then we might expect about half of all CEW deployments

in dart mode to produce dart probe penetration to the skin. Yet in the Phoenix


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Police Department (another agency examined by Smith et al. (2009)), only 56of the more than 800 CEW deployments (6.9%) in dart mode produced a

reported puncture injury. Again, this suggests the lack of an agency mandateto report CEW dart punctures as injuries. Taken together, the available evi-

dence from agencies that have participated in two of the largest CEW-relatedinjury studies to date (Smith et al., 2009; Terrill & Paoline, 2011) suggests thatmost law enforcement agencies do not require the reporting of CEW dart punc-

tures as injuries in the typical case of minor skin penetration in a nonsensitivearea.

Given the scrutiny that use of force incidents often produce and the carewith which many agencies document such incidents, a likely reason that agen-

cies do not require the reporting of CEW punctures as injuries is that they aredeemed unimportant and the natural consequence of the use of the weapon

itself, worthy of documentation only if the “injury” produced is unusual ormore severe than expected. Further, although Terrill and Paoline recommend

the use of prospective observational studies as a remedy for measurementconcerns, as a practical matter they hardly seem worth the time, effort, andexpense to capture such trivial wounds. Prospective observational studies such

as those advocated by Terrill and Paoline are highly inefficient as they have tosample a large number of police–citizen interactions over a long period of time

to capture enough uses of physical force of any meaningful magnitude, no lessinjuries of any substance. Public safety will be better served by measuring and

studying ways to reduce more serious injuries to both officers and citizens.We agree with Terrill and Paoline that policing scholars should come to an

agreement on how to define force-related injuries. However, the inclusion ofroutine punctures from CEWs as injuries moves the definition of force-relatedinjuries in the direction of an “all harms” orientation, which raises the question

of whether other injuries should be operationalized as well. Should the painexperienced from being “tased” or from the application of a pain compliance

technique without visible injury be included in injury measures? Should rednessand irritation to the skin from an officer grabbing a citizen or from pepper spray

be included as injuries? It is interesting to note that the TASER Internationalliterature cited by Terrill and Paoline to make their case for defining CEW punc-

tures as injuries also mentions skin irritation, yet little attention is given intheir discussion to including this as an injury. Moreover, they assert that the

use of CEWs may cause socio-psychological injury, which raises the question ofwhether or not to include suspect psychological and emotional distress as inju-ries as well. This expansion of the definition of injury would eventually make

the measure of “injury” virtually synonymous with the use of any force or eventhe arrest process itself, which would make any analysis on the connection

between force techniques and any form of injury pointless.The decision to include or exclude dart punctures as injuries while at the

same time excluding other harms from the definition of injury highlights thatthe definition of injuries resulting from force incidents is a social construct. We

agree with Terrill and Paoline that the effort to define this construct should be

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evaluated “in light of the practical implications of our research” (p. 28). Giventhis consideration, whether or not CEW routine punctures are included as an

injury does not appear to be informative to a more general policy decision onwhether agencies should adopt CEWs or eliminate them from their force reper-

toire. Based on the findings presented here, counting dart punctures as asuspect injury only creates a significant correlation between CEW use and minorinjuries (when measured along a continuum of injury). Thus, the appropriate

question is whether the inclusion of dart punctures as an injury informs policyconsiderations on when CEWs should be used relative to other force options.

In consideration of the analysis of suspect injuries alone (see Table 4,Models 1.2 and 2.2), the force options coded as “other force” (canine, impact

munitions, batons, etc.) should be placed above CEWs on the force continuumgiven they represent the only force options associated with a significant

increase in serious injuries (though ideally, their individual effects should beexamined). At the same time, the analysis suggests CEWs should be placed

above the level of pepper spray as a result of the significant decrease in minorinjuries associated with the latter option.9 The injury distinction resulting fromthe decision to include or exclude CEW dart punctures then rests in relation to

soft-hand, hard-hand, and takedown force options. When routine puncturesare excluded (Table 4, Models 1.1 and 2.1), CEWs, along with soft-hand

techniques, are not significantly associated with minor injuries, whereas hard-hand and takedown techniques are associated with significant increases in the

odds of minor injuries. If punctures are included, the odds of minor injuriesassociated with CEWs are considerably higher than hard-hands and takedowns

(Models 1.2 and 2.2). Thus, based on suspect injuries, accepting routine dartpunctures as injuries would suggest CEWs should be placed above hard-hardtechniques and takedowns as a force option.

This evaluation of dart punctures, however, carries an injury inflation biasfor CEWs relative to other force options. As noted earlier, routine dart punc-

tures are similar to what is produced by a medium gage hypodermic needle,and if they are defined and counted as injuries under the guise of including all

physical harms, then we should also be counting any skin irritation that occursfrom the application of pepper spray, pressure point control tactics, joint

locks, handcuffing, and so forth. Under such a scenario, injury rates associatedwith these tactics also would increase to varying degrees. This would undoubt-

edly shift the evaluation of CEW injuries relative to other force options.Pepper spray, in particular, would have an injury profile exceeding that ofCEWs if routine dart punctures and skin irritation from OC are counted. These

effects, however, generally are less serious than lacerations, abrasions, orsignificant bruises. This is arguably the logic for why most use-of-force

researchers to date have not defined them as injuries, which we believe is the

9. Of course, we would expect the injury reduction effects of OC to reverse if, say, skin/eye irrita-tion were counted as injuries. In this case, pepper spray exposure would be synonymous withinjury.


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proper practice. Consequently, we believe the analytical models presented inthis study that exclude routine CEW punctures provide a more meaningful anal-

ysis of the risk of injury relative to other force options.Although officer injuries is not the focus of the present study, any policy

conclusions related to defining CEW dart punctures as injuries should also beconsidered in the light of their potential impact on officers. If dart puncturesare routinely counted as injuries, then CEWs will begin to be associated with

higher rates of suspect injury instead of lower rates. This may cause lawenforcement leaders to consider restricting the use of this weapon only to cir-

cumstances where blunt impact weapons or deadly force are permissible, oreven a more extreme move to eliminate department use of CEWs to reduce

rates of suspect injuries. Officers would then have to more often employeealternative forms of force that require physical contact between officers and

suspect (e.g. grabbing, takedowns, punching, kicking, and hand-held impactdevices), tactics that empirical research has consistently shown to be

positively associated with both suspect and officer rates of injury (Alpert &Dunham, 2000; Kaminski, Rojek, Smith, & Alpert, 2012; Meyer, 2009; Smithet al., 2007; Terrill & Paoline, 2011). For example, although Smith et al.

(2007) did not find a statistically significant association between CEWs andinjuries to officers, they observed that officer use of soft and hard empty hand

tactics significantly increased the odds of injury. Paoline et al., (2012) alsofound that hands-on weaponless tactics (grabbing/escorts, pressure point tac-

tics, takedowns, and empty hand/leg strikes) significantly increased the oddsof officer injury. The logical conclusion of these findings is that increases in

the use of tactics requiring physical contact increases the risk of suspect physi-cal resistance or outright assaults on officers, which increase the likelihood ofofficer injury. If defining routine CEW dart punctures as injuries results in

greater restrictions on the use of CEWs, officer injury rates are likely toincrease.

In summary, the weight of the available research to date suggests that CEWsreduce the odds of suspect and officer injury when minor dart punctures are

not counted as injuries. The fact that injuries tend to increase when othertypes of force are used in conjunction with CEWs and that CEW use alone is

associated with a decreased incidence of injury or the effects are benign sug-gests that CEWs are an effective option for stopping suspect resistance with

minimal harmful effects. Without question, CEWs often produce minor dartpunctures to the skin. From a cost/benefit perspective, however, this harmshould be balanced against the greater harm that is likely to occur if officers

must use alternative types of force to control a resistant suspect. The effortto redefine CEW-related injuries to include minor skin punctures associated

with the intended functioning of the weapon attempts to shift the rhetoric offorce in a manner that few researchers and even fewer practitioners have

heretofore seemed willing to embrace.

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Acknowledgements

This research was supported by funding from the National Institute of Justice(grant 2005-IJ-CX-0056). The description and findings presented within this

report are from the authors, and do not necessarily represent the officialpositions of National Institute of Justice. The authors would like to thank theanonymous reviewers for their constructive comments.

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