Posts Tagged ‘Excited delirium’

Before you can use it, you need to know what it is.

Excited delirium is a condition which is thought to be caused by drugs, alcohol, a psychiatric illness or a combination of these, and may lead someone to struggle against restraint beyond the normal point of exhaustion. Features of excited delirium include agitation, excitability, paranoia, aggression, great strength, numbness to pain and elevated body temperature. It most often comes to light when a person is being arrested or dealt with in a custody suite.  In some cases, the subject can die.

In such cases, police officers can be suspended from duty, accused of or subject to the inference that they were somehow responsible or negligent in dealing with the deceased.

Typically, the police may receive a report of an individual showing signs of physical agitation resulting in their attendance. The individual fails to respond to the officer’s presence and communications or over reacts.  It is recommended that in such cases the subject should be treated as a medical emergency at this point and not a criminal suspect.

However, this is where things often start to go downhill as the lack of reaction or over reaction is then misinterpreted by officer as defiance and at this point the police frequently use force to take charge of the individual.  The officers will go hands on too early, which compounds the situation and raises the risk of sudden death.

English: Police issue X26 TASER

Instead of using force from the outset, the officer should contain the person without crowding them: obtain medical support: calm the person down with only one officer at a time communicating with the subject.  If there is no immediate risk to them or the public, the officer should stand back and resist antagonising the subject or embarking on a physical struggle with them.

It is suggested that the discharge of a Taser to help subdue the subject may only end up contributing to their death as it has been claimed by some that shock can cause cardiac arrest and/or can increase stimulation (adrenaline) and lactic acid levels which causes acidosis which stops the heart.

The more electronic discharges given to a person, the more risk there is.  Instead, if the subject must be tackled, overwhelming physical force should be applied my more than one officer.  However, if they do have to take physical control of the subject, the officer must never obstruct or interfere with their breathing.  Restraints such as handcuffs and Velcro bindings may have to be used.

A. David Berman (“Institute for the Prevention of Deaths in Custody” Vice President) gave (to Sudden Death, Excited Delirium & In-Custody Deaths Conference) examples of clues to a person who may have Excited Delirium and at risk of sudden death:

Psychological Behavioural Clues:

  • Demonstrates intense paranoia (e.g. fearful hiding)
  • Extreme agitation
  • Rapid emotional changes (e.g. laughing, crying, sadness, anger, panic etc.)
  • Disorientated about time and place, time and purpose
  • Disorientated about self (visions of grandeur)
  • Hallucinations (e.g. hears voices, talks to invisible people and/or inanimate objects
  • Delusional
  • Scattered ideas about things
  • Easily distracted (cannot follow commands)
  • Psychotic in appearance
  • Described as “just snapped” or “flipped out”
  • Makes people feel uncomfortable (including officers)

Communication Behavioural Clues

  • Screaming for no apparent reason
  • Pressured, loud, incoherent speech (mumbling)
  • Grunting, guttural sounds
  • Talks to invisible people
  • Irrational speech

Physical Behavioural Clues

  • Demonstrates violent behaviour
  • Demonstrates bizarre behaviour
  • Aggression towards inanimate objects (particularly glass, mirrors, shiny objects and materials)
  • Running into traffic e.g. at parked or oncoming cars
  • Running for no apparent reason, running wildly
  • Stripping naked (trying to get cool)
  • Superhuman strength
  • Resists violently whilst and after being restrained
  • Muscle rigidity
  • Diminished sense of pain
  • Self induced injuries (cuts self with sharp objects)
  • Says “I can’t breathe” (indicative of respiratory distress, escalating into respiratory arrest)

These clues only help identify the person as a high risk candidate for a sudden death and are not a diagnosis.

Could any of the above feature in one of your stories and if so how?

Don’t forget to book your place on the Crime Fiction – Making it Real weekend workshop March 2012