Looking for guidance on a protocol for Excited Delirium calls? A recently updated training bulletin from San Jose (CA) PD might be a good starting point.
“It’s the closest thing to a policy on the subject that I’ve been able to find,” says Wayne Schmidt, executive director of Americans for Effective Law Enforcement, the organization that tracks legal issues pertaining to policing. Schmidt told Force Science News that he has searched for months for departmental policy statements on ED, with little success.
San Jose’s 4-page document, created by the agency’s R&D Unit and issued to all personnel by Chief Robert Davis, is designed to help officers identify and manage ED situations so that “risks to all those involved, including the delirious individual,” are minimized. The bulletin notes that ED is “a serious medical condition…a disturbance of consciousness” in which the afflicted subject’s violent resistance to arrest “for prolonged periods may increase the risk of death.”
Step 1, the bulletin says, is to recognize symptoms suggestive of a delirious state, “which can be caused by several factors, including, among others, chronic drug use (particularly cocaine or methamphetamine abuse), substance withdrawal, and/or mental illness.” Cues may include: “rambling and incoherent” speech, disoriented or delusional comments and behavior, the removal of clothing (because of “elevated body temperature”), imperviousness to pain, unusual strength, violence toward objects, hyperactivity, attraction to glass, and more than a dozen other indicators.
While officers lack the psychiatric expertise to make a firm diagnosis, a reasonable suspicion that “an individual may be in an excited delirium state” requires that the subject “be treated as if he/she is in a medical crisis and will require medical attention,” the bulletin stresses. In other words, “the incident shall be managed as a medical emergency, in addition to whatever other law enforcement response may be required…including the use of reasonable force.”
Specifically, the bulletin offers these recommendations:
If information from a reporting party leads the dispatcher to believe that an ED situation is at hand, “EMS personnel are to be dispatched and advised to stage at a location a safe distance from the scene until notified by officers that the scene is secure.” If practical, “a minimum of 4 officers…will be dispatched to the incident,” and they will be advised of the EMS location.
As soon as they are notified at the staging area that the scene is secure, “EMS personnel will respond to the scene, evaluate the individual involved, administer appropriate care, and monitor the individual until he/she is delivered to an emergency medical facility.”
First, request EMS if they have not been initially dispatched. If the subject is unarmed and appears not to pose an immediate threat to self or others, “officers shall, if practical, contain the subject while maintaining a safe distance and remove others who might be harmed.” In a decision to arrest, try to gain the subject’s voluntary cooperation with these tactics:
- “Attempt to ‘talk the person down.’”
Ideally, only 1 officer conducts conversation, but if the subject is “unresponsive or non-compliant with the first officer, attempts to communicate should be made by other officers present.” Officers should “project calmness and confidence and speak in a conversational and non-confrontational manner. Statements should include reassurance and [emphasize] that the officer is trying to help.
“Whenever possible, determine if the person can answer simple questions.” This will give an idea of the subject’s level of coherence. “Officers should also turn down their radios.
- Because of the subject’s mental state, “statements and questions may need to be repeated several times. The person may also be fearful and extremely confused…so officers should be patient. If the subject is contained and does not appear to pose an immediate threat, there is no rush. It may take some time for the subject to calm down.”
- “Attempt to have the individual sit down, which may have a calming effect.”
- “Refrain from maintaining constant eye contact, as they may be interpreted as threatening.”
- If a relative or someone else “who has rapport with the individual can safely participate, enlist his/her assistance” in trying to gain compliance.
- If the subject is armed or combative or otherwise poses an immediate threat, officers shall employ “reasonable and necessary” force to protect themselves and others and take the person into custody. “To the extent practical,” try to minimize the “intensity and duration” of any resistance and “avoid engaging in a prolonged struggle.” It may be possible to limit resistance by using several officers “simultaneously to restrain the subject quickly.”
- Once the subject is in custody and the scene is safe, EMS personnel should be called from the staging area. Some ED subjects “have gone into cardiac arrest shortly after a struggle,” so the person’s “breathing shall be monitored at all times and the person’s position adjusted to maximize the ability to breathe.” The subject should be “transported by ambulance to an emergency medical facility for evaluation and treatment.”
Regardless of procedures, ED is a high-risk situation for all involved. As the San Jose bulletin acknowledges, “It is possible for a person in this condition to die, even when officers take all reasonable precautions.”
Dr. Bill Lewinski, executive director of the Force Science Research Center at Minnesota State University-Mankato, notes: “San Jose’s suggestions for calming an agitated subject are based on classically taught, tried-and-true method for dealing with EDP’s on the street. They are psychologically solid and have been practiced successfully with severely disturbed individuals.” (A good primary source for such methods is the textbook “Understanding Human Behavior for Effective Police Work,” by Harold Russell and Allan Beigel. It’s available (used) for as little as $5 on Amazon.com.)
Lewinski continues: “As the training bulletin points out, excited delirium subjects may be unresponsive to dialog and may need to be controlled by overwhelming force. And that raises training issues. In addition to instruction on the proper application of the TASER in these situations, officers need to learn and practice how to work effectively as a team to control these violently resisting subjects. Just grabbing a wrist here and an ankle there in an ad hoc fashion, rather than employing a coordinated group tactic, may only result in unnecessary injury and a prolonged crisis.”
One tactic for group control, the Star Technique, is described in an article by popular DT trainer Gary Klugiewicz, a member of FSRC’s National Advisory Board, on his website at: http://acmisystems.net/html/articles.asp
[Note : Wayne Schmidt will be distributing the full San Jose training bulletin on ED as part of the handout material for AELE’s next “Officer-Involved Lethal and Less-Lethal Force Seminar,” scheduled for Nov. 12-14 in Las Vegas. For more information on that program, go to www.aele.org
[Meanwhile, San Jose PD’s R&D Unit can be reached at 408-277-5200.]