about we're focused on the potential lethality of the taser. on the top, you see the normal cardiac function. this is an example from what i have done in the operating room where i stopped the heart in order to rescue the heart. luckily, we have a very effective antidote. 99% effective antidote. the first example, you will see on the right. on the bottom is a commonly deployed device. these are meant for use by a layperson. very little training required. these have been shown to be highly effective in rescuing somebody from cardiac arrest.

this slide is key in terms of demonstrating the survival percentages from cardiac arrest. it may not be visible there, but you have a 50% survival rate if the rescue someone within two minutes. the key to resuscitation is prompt recognition that somebody has cardiac arrest. what are some of the conditions that increase your vulnerability? if you without prior heart attacks, heart failure, much higher risk. hydromel in states are known contributors to increased seven -- adrenaline states are known contributors to increased

cardiac states. in the operating room, much higher rates of sudden cardiac arrest. that simulates what the real situation might be. obviously, you will face suspects on cocaine and those drugs also increase your vulnerability. acidosis as well as another condition commonly seen in diabetics might increase your risk. the distance between the chest and heart is critical. i am going to skip this in terms of the effects of taser application. it has been debated post-cardiac arrest and sudden death after taser deployment that if you

find no autopsy findings, it is inconclusive. the finding of no finding an autopsy supports an electrical cause of death. very briefly, i will review some taser animal studies. this was a simulated model. three other independent studies have shown ventricular fibrillation during a critical part of the cardiac cycle. one of the conclusions from the animal study is that it is critical for the rest. that is why the warning for of boarding the chest -- avoiding the chest. how about human studies? this is a weapon that is going to be impossible to study in an

ethical matter. what has been done, you have heard that the -- the risk for cardiac arrest. we also have an instance of taser-induced cardiac arrest captured on a pacemaker. it can overwhelm the ekg. this particular situation was captured by a pacemaker. exactly at the time of the taser the event was recorded. the data supports a cause and effect in the proper vector, a potential for lethality of the taser.

this recent article came out in may of 2012. he reviewed eight taser causes of sudden collapse. these are eight cases, there are hundreds of cases of collapse. it is hard to prove cause and effect for all of them. these are eight cases were he had actual evidence. let me focus on our study, which was published in 2009 in the american journal of cardiology. we sent out to measure some of these a facts. in a real-world setting, do we decrease in sudden death? do we decrease officer shootings? do we decrease officer injuries? this study was designed to do that by looking at a survey of

126 california cities what using tasers. we looked at these rates in these 50 cities. one of the things i will focus on in terms of methodology is the importance of proper control group. some of these other rigid the comparison is with a different cities. when you're comparing different cities, different crime rates, different times of the year, it is difficult to compare apples and oranges. this was the major finding of our study. you will see on the left, the five years prior to taser deployment ec a sudden death rate of 0.8 per 100,000 arrests. jury difficult to quantify the amount of time a taser was

utilized because the data -- we used instead the very low recorded arrest rates for every city. you will see the sudden death rates is not zero. we all recognize there was a rate of sudden death prior to tasers being introduced. after that first year, the rate came down to 1.4 per 100,000. the baseline is still 40% above baseline. much of that six and a% increase was mitigated by the second year. -- 600,000 -- 600% increase was mitigated by the second year. >> you lost me between the difference between this study and the doj study.

>> we surveyed 50 cities, many more than nine doj study did. we compared each city with themselves. over a 10-year period. we were able to abrogate all of this data. each individual police department -- we have the power to do this particular analysis. to address the last presentation, the chief asked me, it is this conclusive? we're not introducing something where you can prove cause and effect. we're looking at events in aggregate. if you look at the statistics -- that statistic means that this

finding could it only happened by chance. you would have to throw a pass over 1000 times. this is almost conclusive that there is a real effect with that taser. off to the first year, it comes down to 1.4. i will highlight some of my recommendations. how about the big question of a firearm death? we looked at this particular question as well. we saw an increase in doubling of officer-related shootings in the first year of taser deployment. you see that spike in the first year, which comes down to near baseline after that first year. these are the rates of -- i will

be the first to admit that we had inconclusive data. there were only four cities contributed to this particular outcome. there is not really any pattern. recently, we did an analysis looking at 50 cities. we looked at funding sources and looked to see if that influenced whether a conclusion of safety was made. you'll see that we have reviewed 50 cities, 23 of those studies were funded by taser and 27 were independent studies. taser funding or affiliation was 18-fold higher. the point here is that carefully

looking at the methodology, carefully looking at conclusions is important when looking at who is funding the study. if you design the study differently, you might have concluded differently. the methodology precluded the chance that it would have cost -- cause. what are the implications? there is a definitive crescas for the mechanisms -- a definitive risks for the mechanisms. i've mentioned the vector is critically important. i will mention that after our study was published, taser came out with their warning about not to taser the chest.

this taser was associated with that increase in that first year. there is a chance to decrease that can prevent that spike if we were to design policy. the other important point is that the number of times increases in the amount of times or increase the rates of cardiac arrest. if you allow me to editorialize as a physician, here is my recommendation. i have great respect for the dangers police officers face. tasers might serve very useful role in law enforcement. i recognize that it would be much preferable to a gun and many situations. policy should take into account the potential legal risk of

taser. the threshold of deployment should be just under what he would consider for a gallon. that threshold be strictly defined and not crossed. i read about other municipalities having -- that threshold creeds lower and lower. that is for you have the risk of cardiac arrest and unintended consequences. avoiding the chest, and i think taser agrees with that. you definitelyly want to avoid tasering in a young person. i think aed should be readily available for rapid

resuscitation. many police departments carry them in every police car. police officers are commonly the first responders in medical emergencies. i think carrying them in the trunk of police cars decreased cardiac arrests any way. if you have a weapon that could cause cardiac arrest, it makes sense to have the antidote in the trunk of a police car. they are very easy to use. it is cheap insurance in terms of resuscitating someone who might have cardiac arrest. that is all i have. thank you for your attention. [applause] >> thank you very much. i would love to have a copy of that last slide. i will make sure that every one of your recommendations isn't whatever policy we get too. >> if we could have copies of

the presentation. >> your presentation has become more refined. i think you were honest and forthright and you recognize the difference between the taser and firearm. i hope you would be willing to participate with us. >> our point would be to decrease that spike. if we could take away that spike, we have a chance to avoid the mistakes of other departments. >> thank you very much. >> further questions for dr. tseng? thank you for donating their time. [applause] >> the next person i had was from the aclu. we have a lot of people from the

public. i would like us to hear public comment. >> i am a criminal justice attorney. it sounds like many of you read the letter. thank you for during that period -- thank you ford during that period -- for doing that. tasers are not a simple alternative to fire arms. that has been discussed by many tonight. they can cause sudden death, a cardiac arrest. they do present a danger to the public, especially to address -- at risk groups. one of the reasons why we are

greatly concerned, the police department has not conducted the study of other available options. this is something that needs to go forward. i appreciate the discussion to keep the resolution. we think this should be a part of the process going forward. we also believe that the stakeholder should be involved in that process. we believe mental health professionals should be consulted. it would be great to consult with them, such as the doctor we just heard from. we really believe that process should continue going forward. we are all very saddened by the recent police shooting of another mentally ill in the grant. not all of the investigation -- details of the investigation had been made public. we are concerned that this is being used as a reason to get

tasers. how the department moved on their cit training program and develop the proper protocols, we may not have been in the situation. i know there is this risk of running towards the option of a taser in the face of this tragedy. but what can we have done last february that could have avoided this unfortunate circumstance? what we have said before is true. you not only cause excruciating pain, but they do provide a risk of serious injury and death. i am glad the chief's survived his experience, but we have many examples where that was not the case. if you are talking about being concerned about officer-involved

shootings, you have to be concerned about the deaths that occur from simple taser use. you do not know the physical and mental background of the person you are tasing. it has been medically proven that mentally ill folks can be higher at risk. we touched on in the letter, additional risks and negative outcomes. one of those is the high cost of equipment. the other is the risk of litigation against the city. one thing we have seen is a northern california, we have seen high settlements. i do not doubt that would be the case in san francisco. we have also seen taser

international itself, the court has held them not liable. shifting the liability to the municipalities. an officer was required to take part andy tased in a training and was injured. i believe the officer ended up having to pay for his own medical expenses. that is another thing to be aware of. there are equal protection challenges. i agree with the that getting legal advice and thinking about the legal ramifications is very important. the risk of alienation that can be caused by taser use is a great risk. the fact that it is so easily used. we do run a big risk of overuse.

i appreciate what the doctor said about crating the parameters. you have to be in a very high threshold of risk. that is great, and that is a great policy, but i worry in practice when you are out on the street and you have this plastic instruments with you. it is right there and they have lead -- and they lead to against using things you have been trained with in the academy. i also worry about the risk of disproportionate impact taser use on communities of color. if you are increasing police involvement and stopping and frisking people on the street, police now have taser as well, i worry about the situations we

are getting ourselves into. i would like to conclude by asking you to read our letter. we are free to answer any questions. we think we do not want to rush into this. i am 100% behind the commission's decision to hold off this vote. i think that was entirely proper and in line with the resolution from last february. i think we need to follow the resolution. i do not think the department should be rewarded for dragging its feet on implementing training. we need to make that a reality and we do not -- we need to give it more than lip service. we do not want the officers tracking their feet. -- dragging their feet. we need to make that an effective program, including the proper protocols.

it is things like that that could really make that program of effective and not just be looked service. it will be very important going forward. a lot of other cities do have tasers, but san francisco is a different city. i think we can be an example. we can be creative and we can use our resources and we can figure out a different way to do this. thank you for your time. >> i have to say the department did not drag its feet with regard to cit. we have completely embraced cit > we're not looking for wholesale

deployment of this device. we are asking for cit-only. i did not mean to be disrespectful to the speaker, but when you would suggest that this resolution that came out prior to me being chief, that absolute pushed it forward, i enacted a department bulletin within my first 30 days that slowed all the officers down, i think we have made tremendous strides. we found a gap the other day. there was also the politicizing of the family. i cannot tell you how sad i was to see the family here tonight. it is not about what happened, it is about the next person. my matter of conscience was, i want to do something tonight about the next person because i

do not want there to be a next person. >> i want to join in what he said. we have officers trained and i think we make a presentation. we are not here to throw stones. we should be more accurate in our presentation regarding that. the police department is doing the best they can given what they have. i appreciate the aclu's participation. the police department is doing the best they can with what they have to work with. some folks are not happy. i would like to see it move faster. there are realities. >> i appreciate there has been movement on the cit program. the full program has not been ruled out and that a small portion of the training has been done. it sounds like that is not on line with thwhat was set out lat

february. i appreciate the program but the information i have is that it has not been moving fast enough and we would like to see that happen. >> at the risk of being -- what is your reaction, we adopted cit. we brought it here because they had a way we thought was good. what is your reaction to that? that says something to me. >> that is a good question. we do not have enough information about why memphis did that. it appears they were having a big budget and staffing reductions. they were having slower than average response time than they had in the past. it is not my understanding they

said it did not work and therefore we have to go to tasers. there were circumstances we do not have here. i think we have a resource-rich department. we have great leadership. we would need to know more about this situation. >> there is a reason. it was a model program that they brought to us. they flew out here and said this is the way to go. they have altered that program to add this into it. they have not abandoned the program. there must be a reason. i do not know what their reason is. that was their model program. that was the memphis band. we do things differently in memphis. dealing with the folks who have mental health issues. at least for me, i would want to

know why would they introduce these devices into that particular program? >> we are happy to look into that. i think the answer is we do not know the background of what happened. san francisco is a different city. we could be the next model. we do not have to say because other cities have it, we have it. >> i know that. that argument can be used both ways. that was used when we got it. it means something to me because the model was held up, look a memphis, look at memphis. i am still looking at memphis. i have to do that. i am asking your reaction and you have given me that. >> i apologize. i was going to make a comment that staffing shortages is a huge consideration.

we're down 300 officers and i would echo what the commissioner said, when we have one of the state of the art police training but when he meant this model was found in trumpet, we said we do things different in san francisco when we were told we need to do it like memphis. that brings me tonight asking for this as well. >> it sounds like we need to know more about this situation. commissioner dejesus: what i think we need to talk about, a lot of the studies showed that the command staff or the leadership of the department embraces a program. they can do it as quickly as they want to. i