Force Science News #221:
When you don’t see what’s visible: The inattentional blindness factor & more
Training note: It's always an honor to announce a new troop of Certified Force Science Analysts! Congratulations to the 74 graduates of the most recent Force Science Certification Course, conducted last week, and a big thank you to our host, the Scottsdale Police Department and the excellent staff at the training center! This impressive group of students from three countries--including Hong Kong--represented 37 agencies from 11 states/provinces. Well done!
In this issue:
I. New study: Fast, effective EMS option for excited delirium cases
I. New study: Fast, effective EMS option for excited delirium cases
Preliminary results from a new, ongoing study tend to support a growing trend in the management of dangerous subjects in the throes of Excited Delirium Syndrome (ExDS).
The findings should be part of the dialog if you are working on a joint law enforcement/EMS protocol for addressing this perplexing problem, as recommended in Force Science News #201 (4/9/12).
The study, being conducted by Dr. Michael Curtis, former EMS medical director for Portage County, WI, is documenting cases among seven Wisconsin ambulance services whose paramedics have administered the drug ketamine, a potent sedative, to physically violent individuals before transporting them to a hospital. Curtis, an ER physician in Stevens Point, WI, says more than 50 cases involving agitated and combative behavior have been noted so far. Roughly 80% met the descriptors for ExDS, he estimates.
Given in the proper dosage, ketamine has proven to be "extremely effective" in sedating almost all of these subjects into a calm, controllable state within three to five minutes, Curtis told FSN, adding that "all survived with no unexpected adverse side effects." The sedation typically sustained for 20-30 minutes --long enough for the subjects to reach a medical facility where treatment to reduce their symptoms could be pursued.
Many experts believe that rapid calming reduces the extreme physiological stress caused by an extended struggle with police and continued agitation after restraint that contribute to the risk of death in ExDS events. "Moreover, before emergency medical professionals can deliver a lifesaving treatment, they have to initiate an IV, which is often impossible until the patient is made calm," Curtis says.
Traditionally, ketamine has been used as an anesthetic or analgesic (pain reliever), Curtis explains. But of late, an increasing number of EMS units in the US have begun injecting it in ExDS subjects and other violent parties, once police have established sufficient restraint to allow it. The ideal dosage, Curtis says, appears to be 5 mg per kg of a subject's weight (450 mg for a 200 lb. subject, for example). More can be administered if necessary without dire consequences, he says.
In a recently published paper, a team led by Dr. Jeffrey Ho, a prominent researcher of in-custody deaths, reports on two cases in which ketamine was used successfully as part of an ExDS response.
In one case, police were called to handle a 35-year-old chronic cokehead, partially nude in 11-degree weather, who was acting bizarrely and trying to enter a closed business. The cops found him raving nonsensically, "remarkably strong," and unresponsive to manual pain-compliance. Even though eight officers eventually proned him out, he continued to bang his head on the pavement until an EMS responder delivered a 500-mg intramuscular injection of ketamine through his clothing and into his butt. Within four minutes, he was calm. He arrived alive at a hospital and there was "returned to normal" with no negative after-effects.
In the second case, police responded to a domestic and confronted a highly agitated, partly nude 40-year-old B/M with a history of schizophrenia and substance abuse. He was screaming requests to speak with God and engaged officers in "a significant fight" before he was Tasered into submission. The police had wisely summoned EMS early in the call, and once the subject was down a medic injected ketamine. This subject was calm in about three minutes--"overall success with no complications," Ho writes. (An abstract of this study can be accessed at: http://www.ncbi.nlm.nih.gov/pubmed/23231451)
"Law enforcement and EMS need to work together to handle excited delirium cases," Curtis says. "Neither can do it alone. Police need to realize they are dealing with a medical/psychiatric emergency, and EMS needs to be prepared to move in quickly and get the subject sedated immediately and transported by ambulance to the ER. For best results, there has to be a community-wide protocol, involving agencies that are not always accustomed to working together."
Curtis presented a preliminary report on the Wisconsin experience and a review of professional literature related to ketamine and ExDS at the latest annual conference of the Institute for the Prevention of In-Custody Deaths.
[Contact information: Dr. Curtis, Michael.Curtis@ministryhealth.org; Dr. Ho, firstname.lastname@example.org. Our thanks to attorney Michael Brave, president of LAAW International, for alerting us to these studies.]
II. Force Science principles reflected in 2 new books
Two new books--one on conducting responsible use-of-force investigations and the other on recovery from law enforcement- or military-related PTSD--have drawn praise from Force Science-associated trainers.
• Use of Force Investigations: A Manual for Law Enforcement by veteran firearms instructor Kevin Davis is described by Force Science Analyst Brian Willis as a "comprehensive work [that] covers critical case law decisions as well as the scientific research you need to know in order to effectively conduct" OIS or other force investigations.
• Force Science instructor Dr. Alexis Artwohl calls The Rite of Return: Coming Back from Duty-Induced PTSD by traumatic stress expert Karen Lansing, "a valuable resource for Warriors [in] guiding them back from the trauma of combat, either foreign or domestic."
Both books incorporate Force Science research findings and/or protocols into their content. Both are available in soft-cover or Kindle versions from Amazon.com.
Use of Force Investigations
Despite the suggestion of its title, Willis points out in a foreword, Davis's book is not just for investigators, but covers "critical topics" for trainers, administrators, command staff, and street cops as well, "which can have a significant impact on officers' lives, agency morale, and public perception."
Early chapters focus in no-nonsense terms on some of the shortcomings of use-of-force instruction, policy, supervision, and performance. Davis points out that even veteran officers frequently have so little true understanding of what they can legally do regarding use of deadly force that they hesitate dangerously in responding to threats on their lives. Their confusion is often compounded by poorly written policies that don't mirror the law and by the reliance of trainers on such "aids" as obsolete force continuums.
He cites graphic, true-life examples of "common traps and mistakes" that can sabotage officers and agencies alike. As examples, why trying to read a suspect's "intent" is an inappropriate basis for making a deadly force decision...why an officer's field tactics should not influence an investigation...why departments that reward officers for not using force can set a dangerous precedent.
His recommendations for investigative procedures, many of them reinforced with convenient checklists, draw heavily on Force Science teachings. These range from the need for OIS investigators to understand such factors as perceptual distortions and inattentional blindness to the value of walk-throughs and post-shooting recovery time as aids to memory accuracy. He sanctions, for example, the cognitive interviewing approach in developing an officer's statement and cautions against some of the pitfalls of relying too heavily on video recordings of the confrontation in question.
Drs. Bill Lewinski, Alexis Artwohl, and Ed Geiselman are among the Force Science authorities cited throughout Davis's well-crafted text.
"This is a book to be studied," Willis writes. "This is a book to be reread. This is a book that cries out for you to underline and highlight important references and citations.... This is not a book to be...put on a shelf somewhere."
The Rite of Return
Sometimes called the Cop Whisperer, Karen Lansing is a certified trauma therapist who specializes in "lethal contact," particularly OISs. Having extensively trained with and counseled SWAT operators, street cops, and other "warriors and rescuers" who've experienced traumatic life-threatening or death-infused events, she says she's convinced of "one simple fact: PTSD will leave you stronger or weaker but never the same."
So, she urges, "choose strength."
Her book is not intended to be a stand-alone 12-step guide to doing so. Rather, it's meant as a pivotal supplement to 1:1 therapy. In it, she informs you, in part through compelling case histories, exactly how trauma impacts the human brain and how modern scientific research, utilized by a counselor who's knowledgeable about the police mindset and milieu, can help a traumatized officer get "back to the land of the living," symptom-free and functioning strongly.
Her first mission is to convince officers and administrators alike that post-traumatic stress is real, not an imaginary condition in a subject's head. It can strike after a single incident or as an accumulation over time. She once worked with an officer who listed over 50 traumatic incidents feeding a pool of stress in which he was drowning.
Whatever the origin, Lansing explains, the impact actually changes the brain. "The more you know about PTSD and the brain," she says, "the more you'll understand" the mechanisms of recovery. In detail, she explains the findings of Dr. Daniel Amen, who has extensively studied the brain images of officers who've survived shootings.
Throughout The Rite of Return, Lansing also references stress-related research findings from Drs. Lewinski and Artwohl of the Force Science Institute. She quotes as well from various reports transmitted by Force Science News.
In her professional therapy sessions with officers, Lansing successfully employs the technique known as EMDR (Eye Movement Desensitization and Reprocessing). This is a professionally directed treatment process, characterized by moving the eyes from side to side while remembering traumatizing or distressing experiences. This is believed to help in reducing the influence of these unpleasant recollections and release the brain to develop appropriate coping mechanisms. Various researchers have found EMDR to be effective in healing PTSD.
Besides explaining in layman's terms how this therapy works, Lansing offers guidance also on reducing the impact of stress by better managing sleep, anger, flashbacks, disturbing dreams, physical symptoms, and the building of helpful relationships.
A few years ago, Lansing spent time as a consultant to the Police Service of Northern Ireland, where she counseled officers who had experienced such traumas as RPG and mortar attacks, car bombs placed under their family cars, sniper fire, and violent riots. Allan Jones, a law enforcement trainer from those days now retired, comments in a preface to her book, "If you are going to be at a critical incident, or command those who are, or help with the post-incident fallout, you need to know about Karen Lansing and her work."
© 2017 Force Science Institute Ltd.