Public Safety Committee on April 28th, 2008

[Bonnie Brown, Liberal, Oakville, ON]

All of us, and I suppose you as well, would think that if this is an electric shock, one would expect it would look somewhat like electrocution. You say that in electrocution, the person usually becomes non-responsive within 15 seconds. But isn't that because the source of the electrocution is still operative? In other words, if you stick your fingers in the plug.... Do you know what I mean? The 15 seconds would be 15 steady seconds of electric shock. Is that not so?

[Dr. Graeme Dowling]

No, if you stick your finger in the socket, what typically happens—and most people don't know this—is that the person being electrocuted says, “Ouch, that hurts”, and then they walk around and it's 10 to 15 seconds later that they drop. The reason for that, just so you understand this, is that when they put their finger into the socket, their heart went into that funny rhythm we call ventricular fibrillation; but believe it or not, their brain can function fully for 10 to 15 seconds without their heart beating. So if your heart stops beating for any reason, you will stay conscious for 10 to 15 seconds; then your brain feels it.

That's the reason for the 15-second time delay.

[Bonnie Brown, Liberal, Oakville, ON]

Thank you, Mr. Chair, for now anyway.

[The Chair, Conservative, Garry Breitkreuz]

Thank you very much.

We'll go now to the Bloc Québécois and Monsieur Ménard.

[Serge Ménard, Bloc, Marc-Aurèle-Fortin, QC]

Thank you.

You told us that electrocution would cause the heart to stop in less than 15 seconds. That means that death cannot be attributed to electrocution after 15 seconds.

[Dr. Andrew McCallum]

Correct.

[Serge Ménard, Bloc, Marc-Aurèle-Fortin, QC]

In cases where electrocution does not result in death within 15 seconds, are there nevertheless some effects that continue for the next few minutes?

[Dr. Andrew McCallum]

I'm not sure I understand your question. Are there other effects, besides cardiac effects, that could continue after the application of the electrical activity? Is that the question? Because there are.

[Serge Ménard, Bloc, Marc-Aurèle-Fortin, QC]

Let me restate my question. In the ordinary course of things, it is very rare for someone who has been electrocuted but not killed to continue being involved in a very stressful situation after the electrocution—for example continuing to resist police officers or to take part in a battle.

Someone who accidentally electrocutes himself backs away, and nobody jumps on top of him after that. Do you see what I mean? Is it possible that the individual would be more vulnerable after the electrocution than before as far as resisting those who are trying to restrain him?

[Dr. Andrew McCallum]

My personal view is that we don't know. The most honest answer is that we do not know that.

Is it possible? Yes, it is.

[Serge Ménard, Bloc, Marc-Aurèle-Fortin, QC]

I will give you a personal example. I have had an electric shock once or twice in my life. There was enough of an electric charge for one of the elements on the electrical panel that I had accidentally touched to burn. I did not die because of this, but I was very frightened, and I moved away from the panel. I do not think I would have been able to continue fighting with someone who might have been trying to arrest me.

Could the combination of events be an issue here? Would I have died if someone had jumped on top of me rather than coming to help me?

[Dr. Graeme Dowling]

I understand what you're saying, but I don't think that's what happens. You're almost implying an additive effect. Part of what you're saying is that because you touched that electrical source, your adrenalin levels are high. If someone came into the room and said “boo” or scared you, because of the increased adrenalin levels, could you have an arrhythmia and potentially die? I think, quite frankly, that is a possibility. I think it's a very slim possibility, but it's possible.

The thing we always have to bear in mind with these patients in excited delirium is that their adrenalin levels are absolutely through the roof. I don't think they could possibly go any higher. It doesn't matter what we do to them restraint-wise, it's putting them at greater risk, and yet to get them the medical help they need, we have to restrain them. That's why I kind of like the words “conundrum” or “catch 22” that were used. You're darned if you do and darned if you don't.

[Serge Ménard, Bloc, Marc-Aurèle-Fortin, QC]

You have raised an important point, but since we have very little time, I am going to continue my argument to its conclusion.

You said, by way of explanation, that the person had died of delirium tremens. As I understand it, delirium tremens is a psychological state that seems to have some physical consequences.

Can you tell us what physical phenomenon results in such a psychological state and ultimately causes death? Is it an excess of adrenalin?

[Dr. Andrew McCallum]

To use the terms exactly, delirium tremens is a specific medical condition associated with alcohol withdrawal. What we're talking about is excited delirium, which is not acknowledged as a medical condition but is known to law enforcement personnel, paramedics, coroners, and forensic pathologists. It is a syndrome caused by a variety of sources, most particularly what are known as sympathomimetic drugs, which include cocaine and the amphetamine drugs, but it is also associated with acute psychoses, such as schizophrenic states and bipolar affective disorder exacerbations.

In my view, the problem with this state is that all of the excititory functions in the physiology of the person are switched on. There is full discharge of adrenalin, which causes the heart rate to go up. Adrenalin, by and of itself, is a risk for heart rhythm abnormalities, even from an internal source. There's a rise in the body temperature. In that sense, it's somewhat like heat stroke, which we know can be fatal as well. Any time a person has an elevated body temperature there is a risk of damage to the brain and the enzyme systems of the body. As well, the person has maximal production of a substance called lactic acid. That occurs because of the failure to deliver oxygen properly to all the tissues that are exercised, particularly the muscles, which are the major consumer of oxygen in this state, especially when the person is fighting, wrestling, and trying to get away from the threat they perceive.

This witch's brew--and that's the best description I can use for it, and I'm not sure what the translation of that would be--causes great risk to the person. I think Dr. Dowling and I would both agree that the person may well die just from the state itself. I personally have seen that in my emergency medicine practice, which is what I did before I was a coroner.

[Serge Ménard, Bloc, Marc-Aurèle-Fortin, QC]

That is exactly what I would like to understand. Does a discharge from a taser not result in an increased level of all the substances that the body produces when someone is very frightened? That is why I started at the beginning. When I received an electric shock but did not die of it, I was not in my normal state in the moments following the incident. I was very afraid, for one thing. Anyone can barely escape a serious accident and feel a great fear of dying at that time and actually have their heart stop beating. That is often what happens to people who are fighting with the police. If we add to all of that a discharge from a taser gun, would these phenomena be amplified to such an extent that they could result in the person's death? You can see why it is difficult to explain all of that in so little time, especially through translation.

[The Chair, Conservative, Garry Breitkreuz]

Yes, let's give some time for the answers here.

[Dr. Graeme Dowling]

The one thing to realize with excited delirium, and I mentioned this before, is that the adrenalin level is so high already that I'm not really sure that anything else we do can elevate it even more. I can't prove that; it's just a sense I have, but maybe I can add something.... Monsieur Ménard would like to get a better understanding of why, what's going on here. There is a theory--and I do wish to emphasize it's a theory--that in addition to the adrenalin levels being really high, there is a salt in the blood that we call potassium--if you've ever taken a salt substitute, that's potassium--and that level is really high. High adrenalin and high potassium can both cause the heart to beat abnormally, an arrhythmia, but when both of them are high, they protect against each other.

When you bring the person under control, when the person in excited delirium finally reaches that state of coming down, the person is exhausted and can do no more, the adrenalin stays high and the potassium suddenly drops. Now you have the two working together against the heart. That's why the most dangerous period with excited delirium, whether you've done chokeholds or taser or anything else, is within about three to five minutes of when the person has quieted down. That's when the heart stops.

When you look at the cases, if you have a chance to look at the timing, that's what you'll see. Everyone says it's when the person is brought under control, but I really think the only reason we get a person under control is that now the person has reached the stage of being completely done, with no more left. That seems to be the most dangerous time.

I'm not sure if that helps.

[The Chair, Conservative, Garry Breitkreuz]

Thank you.

Mr. McCallum, do you have anything further?

[Dr. Andrew McCallum]

No.

[The Chair, Conservative, Garry Breitkreuz]

Thank you.

We'll now go over to Ms. Nash. Do you have any questions at this point?

[Peggy Nash, NDP, Parkdale—High Park, ON]

Thank you.

Good afternoon to the witnesses.

Not that long ago there were media reports that Taser International had a history of taking legal action against coroners who were listing tasers as contributing to the cause of death. Can either of you comment on this?

[Dr. Graeme Dowling]

I haven't heard of it. I will acknowledge that Taser is very aggressive in defending its reputation. I attended a conference in Seattle--and I mentioned that two years ago--where Taser was presenting. The conference included Taser International, the American Civil Liberties Union, and, I think, Amnesty International. You can imagine having that group of people in the same room. It was an interesting combination--and there was a member of the Ontario coroner's office. It was wonderful because he had no bias.

At the very end, after all the discussion and Taser saying there was no association of deaths with their device, no proof, someone presented the one case I spoke to you about that worries me personally, where a taser was applied for three minutes. I was amazed at how the claws came out from Taser. I really was. I was a bit shocked. They were just all over this person.

I don't know. Not having put taser specifically onto a death certificate myself, I can't say what Taser International's response would be, and I'm not sure.... I haven't heard confirmation of that from the States.

[Dr. Andrew McCallum]

We've had no experience with that in Ontario, but like Dr. Dowling in Alberta, we've not had a case where we've assigned the cause of death to the taser.

[Peggy Nash, NDP, Parkdale—High Park, ON]

Thank you.

My understanding is that they are an aggressive company and they have taken legal action against some coroners, but I think they also have carrots as well as sticks. I'm wondering if you're aware that they have offered payment, financial consideration, travel expenses for those who are perhaps sympathetic or who they would like to be sympathetic to the taser. Neither of you has received any inducement from Taser?

[Dr. Graeme Dowling]

No, I have no association at all.

I can tell you I was quite amazed. I spoke about excited delirium and tasers at a conference that our office puts on every two years. It's training for medical investigators and police. I spoke, and I really didn't say anything different from what I've said to you folks today, but there was a member of the press there and they did an article that balanced, to me quite nicely, the issue of tasers and the issue of excited delirium, and they mentioned my name.

That week I had three calls from the States asking if I would appear as an expert witness in defence of excited delirium and taser use, and I said no. I just don't want to get involved in that. I don't feel that I'm truly an expert. I was amazed. It is a huge issue in the United States from a litigation point of view. It's huge.