Of?cer/Agent: DEPARTMENT OF HOMELAND SECURITY Date Printed: 08/14/2012

US. Customs and Border Protection 

REPORTABLE USE OF FORCE INCIDENT DATA

SECTION A - INCIDENT IDENTIFICATION INFORMATION

Incident Number: Incident Title: Orig. SIR No.: Event No:
Inbound absconder/ECD Taser
deployment

ce: Owning Organization: Reporting Of?cial:
Office of Field Tucson Field Operations/San Luis
Operations

 

 

 

 

 

 

 

Telephone Number:

 

 

 

Type of Incident: Local Time Day Date of Incident:

Firearm IE Intermediate Device I: Other 1 7 3 5 Wednesday 3 3 2 0 1 1

Number of Number of Involved CBP Other Of?ces [Agencies Involved:
Subjects: Of?cers/Agents:



 

 

 

 

 

 

 

SECTION - INCIDENT LOCATION INFORMATION

 

 

 

 

Address: City: State: County:
AZ Yuma
Longitude: Latitude:

 

 



 

 

 

 

 

Character of Premises:
Urban, Moderately Populated, Station/Institution, Outdoors

 

Illumination:
If Natural Illumination: If Arti?cial Illumination:
Daylight Not Applicable, Good lighting

Environmental Conditions: Estimated Ambient
Temperature (0 F):

 

Dr Calm Desert
y, I 

 

 

 

Additional Comments (relevant to the incident information page):
applied for entry to th ehicle lanes at the San Luis,

   
 

 

 

in a vehicle driven by The vehicle and occupants
were escorted to secondary for further inspe subject was escorted into the
inspection office as a possible impostor to a During the inspection,

  
 
  
  

was
top. CBPO

 
 
 
 

ran out of the office and attempted to flee into Mexico. Officer
outbound operations when he heard an officer cle second

    
   
     

looked to icle secondary and obser run vehicle secondary
PO attempted to intercept had to deploy his
ECD on i subd The ECD he front of the
and right arm. fell and struck the on the asphalt.
appeared eedin back of his head. EMT CBPOM initiated C-spine
ation on to prevent any ju emerge es were able to

  

was combative and had to be

respond and contimedical care for
restrained in order to receive medical car . 

orted egional Medical
Center for further evaluation. On 03/31/11 at approximately 013 was flown to
Phoenix, AZ to St. Joseph's Hospital for further medical care. rrently at the
hospital in critical condition and will remain in the hospital 5 released by the

attending physician.

 

 

 

CBP Form (07/11) Law Enforcement Sensitive Page 1 of 6

SECTION C - INVOLVED OFFICER / AGENT INFORMATION
Name:

Title:

(b)(7)(C), (b)(6)

CBP OFFCR

Service EOD:
(b)(7)(C), (b)(6)

Duty Location EOD:

Duty Location:

Tucson Field Operations/San Luis
Sex:
✖

Hand Usage:
Male

✖

Female

Duty Status:
✖

On Duty

Right-Handed

Left-Handed

Attire:
✖

Off Duty

Height:

Weight:

6'0''

224

Total YEARS Law Enforcement Experience:

Uniformed

Plain Clothes

Federal: 5

State: 0

Age:

29

Wearing Body Armor:
✖

Local: 0

No

Yes

Operational Activity:

(Outbound - ATCET)

SECTION D - INVOLVED OFFICER / AGENT INJURY INFORMATION
Injured:
Yes

No

Describe Any Involved Officer/Agent Injuries or Other Needed Information:

Referred for Additional Medical Attention:
Yes

No

SECTION E - WEAPONS USED BY OFFICER / AGENT
Firearm Information:
Ownership:

CBP

Personal

Serial Number:

Last Qualification Date:

Manufacturer:

Qualification Score:
Model Name/Number:

Cal ber:

Type:

Round Type (if Shotgun):

Firearm Shooting Information:
Posture:

Posture Orientation:

Cover Usage:

Weapon Grip:

Target Elevation:

Aiming Method:

Firing Mode:

Estimated Distance (Express in Yards):
Minimum:
Maximum:
0

Collateral Damage:

Bystander / Other Person(s) Hit

Rounds Fired:

0

Property Damaged

Comments Concerning Collateral Damage:

CBP Form 318-E (07/11)

Law Enforcement Sensitive

2
Page ______

6
of _______

 SECTION E (Continuation) - WEAPONS USED BY OFFICER / AGENT
Intermediate Device Information:
Device:

Device Type:

ECD (Electronic Control Device)

TASER(b) (7)(E)

Description:
Intermediate Device Deployment Information:
Posture:

Posture Orientation:

Standing

Facing Squarely

Cover Usage:

Weapon Grip:

No Cover

Gun hand only

Target Elevation:

Aiming Method:

At/Above Eye Level
Firing Mode:

Estimated Distance (Express in Yards):
Minimum:
Maximum:
1

Did Collateral Contamination Occur?:
Yes

No

Time Needed for Decontamination (Express in Minutes):
0-10

Unknown

Collateral Damage:

2

Bystander / Other Person(s) Hit

11-20

More than 20

Property Damaged

Comments Concerning Collateral Damage:

Other Force Information:
Device Type:

Description:

Comments:

Other Force Deployment Information:
Posture:

Posture Orientation:

Cover Usage:

Estimated Distance (Express in Yards):
Minimum:
Maximum:

0

Collateral Damage:

Bystander / Other Person(s) Hit

0

Property Damaged

Comments Concerning Collateral Damage:

SECTION F - INVOLVED OFFICER / AGENT SHOOTING INFORMATION
(Data Merged with Section E Above by Weapon)

SECTION G - INVOLVED OFFICER / AGENT TRAINING INFORMATION
What Training (in addition to Basic Academy) Assisted the Involved Officer/Agent:

Emergency medical Technician

Training Recommendations:

CBP Form 318-E (07/11)

Law Enforcement Sensitive

3
Page ______

6
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 SECTION H - SUBJECT INFORMATION
Type:
✖

Description of Animal:

Reason (Animal):

Person

Animal

Defense

Euthanize
Sex:

Name (Last, First, Middle):

(b)(7)(C), (b)(6)

✖

DOB or Age:

Height:

Weight:

(b)(6);(b)(7)(C)

5'10''

150 - 199 lbs

Male

Female

Unknown

Wearing Body Armor:
Yes

✖

No

Unknown

Attire:
✖

Civilian

Paramilitary

Police

None

Deceased

SECTION I - SUBJECT FIREARM (AND MISC. WEAPONS) INFORMATION
Firearm Information:

Unknown

Type:

Round Type (if Shotgun):
Shot

Cal ber:

Serial Number:

Slug

Other:

Manufacturer:

Model Name/Number:

Add Firearms (Use Supplemental Sheet for Additional Suspect Firearms):

✖

None

Rounds Fired:

See Supplemental

Subject Other Weapon Information (NOT Firearm):

SECTION I-A - FORCE / WEAPON(S) USED ON SUBJECT
Weapon:

TASER

Officer/Agent:
(b) (7)(E)

(b)(7)(C), (b)(6)

Subject:

✖

Effective at Stopping Immediate Threat:

Yes

No

Yes

No

Comments:
Did Weapon or Device Function Properly / Perform As Expected?:

Not Applicable

Comments:
Subject Injured:

Yes

CBP Form 318-E (07/11)

No

Unknown

Referred for Additional Medical Attention:

Law Enforcement Sensitive

Yes

No

4
Page ______

Unknown

6
of _______

  

ADDITIONAL COMMENTS

 

Officer/Agent Comments:

to inc
CBPO
ficer

  

CBPO CB CBPO
CBPO BPO Yuma 

Subject Comments:
applied for entry to th ehicle lanes at the San Luis,
in a vehicle driven by . The vehicle and occupants
were escorted to secondary for further inspe subject was escorted into the
inspection office as a possible impostor to a During the inspection,

ran out of the office and attempted to flee into Mexico. Officer? was
outbound operations when he heard an officer cle second top. CBPO
looked to icle secondary and obser run vehicle secondary
PO- attempted to intercept BPO - had to deploy his
ECD on i subd The ECD k! he front of the

and right arm. fell and struck the on the asphalt.
appeared eedin back of his head. EMT CBPO initiated C?spine

ation on_ to prevent any emerge es were able to
respond and conti

ju
edical care for- was combative and had to be
restrained in order to receive medical car .

orted egional Medical
Center for further evaluation. On 03/31/11 at approximately 013

was flown to
Phoenix, AZ to Hospital for further medical care. rrently at the
hospital in cri ion and will remain in the hospital

5 released by the

 

    

 

 
 
 

 

    

   
 
    

attending physician.

 

 

 

CBP Form (07/11) Law Enforcement Sensitive Page 5 of 6

SUPPLEMENTAL
Use this supplement to record involved Officer/Agent firearms and /or Subject weapons that are additional to those shown on the
original form. Firearms or other weapons used by ADDITIONAL Involved Officers/Agents and or Subjects should be shown on
ADDITIONAL FORMS submitted for those parties.
SECTION A - INCIDENT IDENTIFICATION INFORMATION
CBP Reportable Incident Number: Original SIR Number:

(b) (7)(E)

CBP Form 318-E (07/11)

Name of Primary Involved Officer / Agent:

(b)(7)(C), (b)(6)

Law Enforcement Sensitive

6
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6
of _______