Papers and Evidence

A reader posted a link to Douglas Zipes’s 2014 article, “TASER Electronic Control Devices Can Cause Cardiac Arrest in Humans,” published in Circulation. Its stated purpose is “to present information to support the conclusion” that the TASER X26 can cause cardiac arrest. This paper is best understood as an evidence-based argumentative essay or narrative review, but not as original empirical research, a systematic review, or proof that Tasers caused the reported deaths. At the time it was published, Circulation paired it with Kroll and colleagues’ contrary article, “TASER Electronic Control Devices and Cardiac Arrests: Coincidental or Causal?” The literature itself later described the two papers as “polarized opinions.”

The human-death argument in this paper relies heavily on causal reconstruction from a small, outcome-selected case series. This paper cherry picked eight cases already displaying the outcome sought by the study’s author, then worked backwards from that point to support the author’s previously held opinion. People subjected to Tasers in real encounters may simultaneously have:

  • Severe physical exertion and sympathetic activation
  • Stimulant intoxication
  • Underlying cardiac disease
  • Restraint or impaired ventilation
  • Trauma
  • Delayed recognition and resuscitation
  • A pre-existing medical crisis that prompted police contact

Without an appropriate comparison group, these alternative causes cannot be reliably separated from the electrical exposure. Close timing strengthens suspicion, but it does not by itself identify which factor caused the arrest.

There is also a denominator problem. Studying eight concerning cases can show that a proposed phenomenon might have occurred. It cannot estimate risk without knowing how comparable exposed people fared or how often similar arrests occurred without TASER exposure.

The paper begins with the conclusion it intends to support and selects and interprets evidence toward that end. It’s also noted that the author, Zipes, works as a paid plaintiffs’ expert in litigation involving TASER, which creates a relevant potential allegiance conflict. That does not invalidate his arguments, but it should be considered when assessing case selection and interpretation. It disturbs me that the author doesn’t disclose that in the paper itself. Other issues making me believe it can’t be relied upon includes the use of opinion phrases:

  •  I think
  •  In my opinion
  •  all in-custody deaths after ECD shocks are not likely a direct result of the shock, a number probably are.
  • should,
  • in all likelihood,

Those sorts of phrases just aren’t used in evidence based medicine. Evidence, not opinion, is what drives these papers.

Turning to the cited works in the footnotes, he uses three of his own previous opinion pieces, a blog, and articles, and letters to the editor from several newspapers as evidentiary support for this paper. Hardly unbiased and not primary source material.

The opposing literature also has significant industry relationships, so the counter-paper should not automatically be treated as neutral either. Research in this area has notably been associated with competing legal and commercial interests.

Had I turned in a paper like this for one of my own classes, my professor would have likely given it a C-. This isn’t anything I would run around citing as evidence of anything. It reads like a paper written by an industry shill (the legal profession needs ‘experts’ to give opinions in front of gullible juries) to establish his bona fides.

This is a paper arguing from biological plausibility, animal experiments, limited human observations, and cherry-picked forensic cases that TASER-induced cardiac arrest is possible to support his career as an ‘expert witness’ for lawyers wanting to cash in from suing Taser.

Meanwhile, there are studies out there showing Taser shocks are not out there causing fatalities.

In one study of 1,201 actual Taser uses, 178 involved anterior probe configurations potentially capable of producing a transcardiac vector. There were no immediate deaths or apparent fatal dysrhythmias—including in the transcardiac group. The statistical upper bound for an immediate fatal event in the entire cohort was approximately 0.3%, not literally zero. Bozeman et al.

Other consecutive field cohorts have similarly found very few serious outcomes. A systematic Bayesian analysis combining three cohorts found one death among 2,728 exposures, but could not necessarily attribute that death directly to the weapon. Its authors estimated a likely mortality risk of roughly 2–5 deaths per 10,000 exposures, while emphasizing that the data were too limited for precision and should not be mechanically applied to individual cases. Rich and Brophy systematic review

A 2021 systematic review examined 33 human experimental studies. They generally found few acute adverse effects apart from dart wounds and did not show clinically important arrhythmias. But the review also identified serious limits:

  • Subjects were usually healthy and physically fit.
  • Exposure was generally only five seconds.
  • Real-world high-risk populations were poorly represented.
  • No long-term outcomes were studied.
  • Many studies had elevated risk of bias.
  • About half were at least partially manufacturer-funded.

The authors therefore concluded that observed risk was low in the studied populations, but that the studies could not establish safety for intoxicated, medically vulnerable, highly agitated, or physiologically exhausted people—the population of greatest concern. 2021 systematic review

A structured review of 37 human studies found no evidence of dangerous physiological changes, cardiac ischemia, or immediate or delayed dysrhythmias after exposures of up to 15 seconds. It concluded that an otherwise alert, asymptomatic patient generally does not require routine ECG testing or prolonged cardiac monitoring solely because of Taser exposure. Emergency-medicine review

The highest risk of injury from a Taser shock isn’t the shock itself, it’s the effects of the shock. There are numerous cases where Taser shocks have resulted in environmental injuries such as falls from height. Tasers have a low but nonzero capacity to cause death. Fatalities through falls and environmental trauma are clearest. Direct electrical induction of ventricular fibrillation appears biologically possible and may explain a small number of cases, but it is not demonstrated as a common field outcome. Existing safety studies substantially constrain the likely frequency but do not exclude rare events, especially in vulnerable people, chest-probe placements, prolonged or repeated discharges, or complicated restraint situations.

The rate of injury from various types of force:

Force methodAll included studiesHigher-quality studiesTypical injury pattern
OC/pepper spray20.2%6.0%Eye, skin and airway irritation; usually transient
Taser/CEW24.5%26.8%Dart punctures, abrasions and fall injuries; serious injury uncommon
Baton/club30.4%40.7%Contusions, lacerations and fractures
Hands-on physical force59.4%31.4%Contusions, sprains, fractures and restraint-related injury
Police dog43.4%95.7%*Deep bites, tissue, vascular and nerve damage

As you can see, injuries from hands on force, dogs, and batons all exceed those from Tasers. Only chemical spray injuries happened less frequently, and those come with their own risks and don’t really work on intoxicated individuals, especially when dealing with Meth and Cocaine intoxication.

Moving too Far to the Left

You know the Democrat party is moving too far to the left when even Bill Maher says they sound too much like communists, and his vote may be in play. Watch the video in this post, it’s worth it.

Medical Tourism

We recently had a woman (just last month) who came in with a post-op issue that would require another surgery to repair. I told her most surgeons won’t touch another surgeon’s patient if there is a problem, because they don’t want to get sucked into the lawsuit that will likely result. That was when she dropped the factoid on us- the surgery had been done in Costa Rica because the surgeon, hotel, and air fare was about one third the cost as having the surgery done here. We tried to get her admitted to have it repaired, but we couldn’t find a single surgeon willing to take the case.

It’s like trying to find a carpenter who will remodel your house while the house is on fire.

As an emergency nurse, I periodically (a couple of times a year) see patients who come in with post procedure complications. There was the woman who had to have her right ass cheek removed when the silicone injection she got in South America became infected.

The fact is, it’s cheaper to have these things done in other countries because the standards are lower there. You are rolling the dice.

I understand the draw- my own doctor is screwing me over. Back in February, I went in for a 6 month checkup (I go every six months because I am diabetic). The visit was billed to insurance at $500. The blood work (CBC, CMP, TSH, A1C and a Lipid panel) was billed out at $2399. Insurance got it down to $1408. For routine labs. So the total bill for a semi-annual checkup was almost $3,000. I told the lab that I am not paying that. Had I known what the bill was going to be, I would never have agreed to it.

I agree that medical billing is deceptive and often high. There is no way to know what they will bill you ahead of time, because many won’t post a price list. I can understand saying “Hey, we can’t tell you what this hospital visit will cost, because we don’t yet know what the problem, the testing, or the solution will be,” that makes sense. What doesn’t make sense to me is how a hospital won’t disclose what they charge for a CBC, or a CT scan. Trump tried to force that, but the stupid TDS sufferers and the health care companies banded together to defeat it.

Our health care here in this country is great. It’s the deceptive shell game pricing that is the issue.

Illegal Alien Gonna Arrest You

Stop me if you’ve heard this one. ICE agents arrested a New Orleans police recruit back in January. He was set to graduate and become a police officer. He had already been issued a gun despite the fact that he could not legally carry a weapon as an illegal alien under Federal law. Larry Temah originally entered the United States legally in 2015 on a visitor visa from Cameroon.

In 2016, he was granted conditional residency after marrying a U.S. citizen. However, in 2022, his application for permanent residency was denied due to fraud. Temah was ordered to appear in immigration court three times but continued to disregard U.S. law by not showing up, resulting in the immigration judge ordering him removed in absentia. He did not have valid work authorization.

It’s a felony for a person who is an illegal alien to possess a firearm or ammunition. Think about that- the cop who is arresting you may just in fact be a felon.

It should come as no surprise- the police chief of New Orleans is a DEI hire herself- she was the police chief of Oakland until 2020, when she got fired. She ran over two people with her car back in 2024. Did I mention she gets paid $340k a year?

This opens a bigger can of worms: When an illegal immigrant cop comes to confiscate your guns and arrest you while themselves committing the felony of unlawful firearms possession, is it legal to resist with force? What about their fellow cops? How many of THEM will side with their illegal immigrant police brethren? Isn’t that an accessory?

Sworn to uphold the law, my ass. However, I am betting when shit does go sideways, these illegal immigrant cops will be loyal to whoever is writing their paychecks.

Likely Not the Cops

I know I give cops a lot of shit on here when they screw up. This case out of El Paso is not one of those times. Let’s watch the video, then we can discuss it.

Watching the video, it appears like this man is on some sort of drugs. This isn’t a mental health breakdown in my opinion. The cop uses his TASER.

There are some in comments to the above post, claiming the TASER was used too many times and stopped the man’s heart. That’s not the case. A TASER delivers 3 joules of energy. A defibrillator delivers 200-360 joules to an adult heart. There simply isn’t enough energy in a TASER to stop a person’s heart. In the cases of in-custody death that occurred after TASER deployment, it turns out the decedent had cocaine on board nearly every time.

One thing that may have contributed to the death was something called positional asphyxia. When a person is handcuffed with his hands behind his back and is placed in a prone position, the chest can’t fully expand and the person can die as a result. In that case, the cops would have been at fault to at least some extent. A person whose hands are cuffed behind him MUST NOT be placed in a prone position, especially if they are already exerting themselves in an attempt to breathe, such as immediately following an extended wrestling match with arresting officers, as per guidelines from the US Department of Justice.

The cause of most explained in-custody deaths is a little-known phenomenon called positional asphyxia, in which body position interferes with the ability to breathe. Several pre-existing factors are identified that increase an individual’s susceptibility to positional asphyxia, including cocaine-induced frenzied behavior, other drugs and/or alcohol intoxication, violent struggle resulting in restraint of subject, and unresponsiveness during or immediately after struggle. A subject’s pre-existing risk, coupled with their body position when subdued or in transit, can combine to substantially increase their risk of sudden death from positional asphyxia. 

This is why I recommend to all paramedics and nurses that they not transport or treat anyone whose hands are cuffed behind their back, especially not in a supine or even prone position. The patient should be sitting up, or can have both hands cuffed to a bed or stretcher. The Joint Commission (TJC) standards outline strict rules and requirements for managing patients in restraints or seclusion, emphasizing that these measures are high-risk emergency interventions.

Hospitals must have explicit written protocols detailing continuous or frequent observation:

  • Patients must be monitored continuously or at frequent intervals determined by hospital policy (often documented every 15 minutes)
  • Restraining a patient in a prone (face-down) position is highly restricted due to the severe risk of positional asphyxia; patients should typically be kept in a supine position with the head of the bed elevated if aspiration is a risk
  • Staff must regularly assess and document the patient’s physical status, including vital signs, skin integrity, circulation in restrained limbs, hygiene, and the offering of nutrition, hydration, and toileting

Still, I think (looking at this video) the base cause here was whatever drugs were in this man’s system.

Military Experts

I get so sick of people claiming to be experts with firearms because they earned a ribbon in the military. Let be give you a great example of that:

To support his supposed opinion, he makes the appeal to authority, claiming, well…

The Coast Guard pistol qualifier consisted of 30 shots taken from 3 yards out to 15 yards, with every shot worth up to five points. Expert requires the shooter to score 143 points or more, or about 96% of the scored shots earning the maximum of 5 points. So how hard is that? Here is a picture of the Coast Guard target.

The colored zones are worth from 1 to 5 points. The target is 25 inches by 40 inches. The 5 point zone is 8 inches by 14 inches, making the maximum 5 point area much larger than the IDPA 8 inch -0 zone. Here is where the course gets easy. A total of 48 shots are fired, and the best 30 of those shots are the ones that are scored. The rest of them are considered “practice shots” and are essentially scored as mulligans.

DistanceTotal rounds in published sequence
3 yards12
7 yards12
15 yards24
Total48

So to REALLY take a look at what it takes to be a Coast Guard pistol expert, the shooter fires 48 shots. Of those, only 60 percent of them have to hit the center of the target. The shots have to be fired in a certain about of time:

DistanceStringTime
3 yardsDraw and fire 24 sec
3 yardsDraw and fire 24 sec
3 yardsFire 2, reload, fire 210 sec
3 yardsDraw and fire 4, including a hand transition8 sec
7 yardsSame four strings4, 4, 10 and 8 sec
15 yardsDraw and fire 24 sec
15 yardsDraw and fire 24 sec
15 yardsDraw and fire 48 sec
15 yardsFire 4, reload, fire 420 sec
15 yardsKneel and fire 820 sec

I want you to note that not one of those stages says, “Draw, rack the slide, fire two.” Instead, he uses as an example, a Coastie shooting himself in the leg as his reasoning for not carrying one in the chamber. I pray this one is satire.

Speaking of Employers

After this morning’s post went live (I wrote it last night) I was supposed to go to work. I was scheduled to atart my shift at 10 am. I got a text from the charge nurse at 8 am, telling me I was being pushed back to 1 pm. That cuts a 12 hour shift down to only 9 hours, but since I am PRN, that happens all the time during the slow season (summer), so I have just learned to live with it. I’ve been on my way to work and been pushed back, having to turn around and go back home for a couple of hours. Not personal, just business. Still, the ED is a bit slower than planned on those days and they are saving a few dollars by having less people there.

So, having been rescheduled, I got in the middle of a couple of small projects. At 10:30, I got another text saying never mind, they are now swamped and they want me to head in.

No. I will head in when I am ready.

That is a game that I am not playing. There is a rule in nursing that they want you to call out at least two hours prior to your shift’s scheduled start so they can find coverage. As I said in the first paragraph of this post, I’ve been called off while already on the way. It’s just rude, but I live with it.

However, pushing my 10am shift back at 8am, only to change your mind at 10:30 is bullshit. I don’t want this to become a habit.

I was scheduled to come in at 10am. Then you unilaterally changed that schedule to 1pm. Now because you are suddenly busy, you are asking me to come in earlier than my shift.

So I will teach them a lesson about courtesy. I will let them be in the weeds until I am good and ready to come in. Again, paying me for my services doesn’t mean that you own me. Will they fire me? Of course not. They already don’t have enough nurses, and this is more the charge nurse’s fault for calling me off than it is mine.

If they decide to be irrational and fire me anyhow, I have options. I get at least 10 recruiting emails per week. There are half a dozen emergency rooms hiring within a 45 minute drive of my front door. Therre are also plenty of travel gigs. I don’t need to take abuse. Employers think that, because they can eventually hire someone to replace you, they can treat you as a consumable stock item. Next time you go to call me out so you can save a little money, remember this day when you were swamped without enough help.