New Expert Report On Excited Delirium Stresses 4-Point Protocol

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An international panel of experts, including 2 MDs involved in Force Science training, has recommended a 4-step protocol as offering the best hope for a successful outcome when dealing with suspected cases of excited delirium. Already in use by some progressive departments in the US and Canada, the endorsed procedures should serve as “models for other communities,” the panel says in a pending report.

The core elements, along with supportive descriptive information, have been incorporated in a quick-reference card for first responders that is reproduced in the report:

  1. Clearly identify ExDS [excited delirium syndrome] cases, based on common signs and symptoms;
  2. Rapidly control the afflicted individual with adequate law enforcement personnel;
  3. Sedate the subject (by EMS personnel) immediately after police control is established;
  4. Transport him or her to a medical facility for follow-up treatment and evaluation, with documentation of the case.

“[T]hese protocols have helped save lives,” one panel member was quoted.

The 34-member panel was assembled by the Weapons and Protective Systems Technologies Center at Pennsylvania State University under a National Institute of Justice directive to evaluate existing research about excited delirium and its role in in-custody deaths, with the goal of providing guidelines for law enforcement and corrections personnel.

Among other leading researchers and practical authorities on the subject, the panel includes Dr. Christine Hall of the University of Vancouver and the Vancouver Island Health Authority and Dr. Matthew Sztajnkrycer of the Mayo Clinic, both faculty members of the certification course in Force Science Analysis.

At this writing, the 50-page report, “Special Panel Review of Excited Delirium,” is under peer review at NIJ and an official publication date has not been set. Once reviewed, the NIJ will determine how to best disseminate the document. Meanwhile, some panelists have published a synopsis of the group’s findings, available for a fee. Click here for details.

After a thorough review of existing evidence, the panelists agreed on a number of critical points:

  • Although it may not be identified consistently in medical literature as excited delirium, “the syndrome is indeed real” and, in Hall’s words, is not something “made up by cops” to explain force encounters gone bad. The National Assn. of Medical Examiners and the American College of Emergency Physicians recognize it as an identifiable condition.
  • The ExDS “clinically recognizable features” include “extreme mental and physiological excitement, extreme agitation, hyperthermia, hostility, exceptional strength, and endurance without apparent fatigue.” The syndrome has been identified by researchers as “associated with sudden death,” although a majority of persons experiencing it are believed to survive.
  • “Prior chronic drug use,” particularly of cocaine and methamphetamine, may damage the heart to the extent that it becomes “predisposed” to failure under the stress of struggling and being restrained.
  • Because ExDS is “a medical problem masquerading as a police call,” as 1 panelist put it, the initial response needs to be “a multi-disciplinary effort,” involving dispatchers, officers, and EMS personnel. Dispatchers need to be trained to ask pertinent questions and officers need to know signs and symptoms to distinguish an ExDS encounter from “rowdy bar behavior” and get medical aid on the scene promptly.
  • While verbal techniques may be attempted, “rapid and overwhelming” physical tactics are likely to be necessary to gain control of ExDS subjects. As 1 police training video notes, the goal “is to restrain the subject with the minimum amount of fight” because “the more they fight, the greater the chance for a negative outcome.” A conducted energy device (Taser) can be “a fast way to restrain.”

In conclusion, the report states that the 4-step protocol “will likely continue” to save lives. The panel expects that this will be confirmed as agencies collect data on these incidents, including “saves” and not just those that end in in-custody death.

Whether these recommendations “will reduce lawsuits is uncertain,” the report notes, “but they will likely help agencies defend against them, especially if they adhere to a policy of copious documentation—both at the scene and at autopsy.”

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