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Stressors Besides The Police Often Involved In Sudden Cardiac Death

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To learn more about a subject of growing concern to law enforcement, researchers in England and Greece pored through 2,400 cases of sudden, unexpected cardiac death (SDC) and identified 110 that occurred either during or within 30 minutes after stressful events, not all of them related to contact with police.

“An event was considered stressful if it involved physical restraint, altercation, exams/school/job stress, receiving bad news, dying in police custody,” or being in an auto accident without major injuries, the researchers explain. All cases in their pool lacked “signs of direct trauma…or other obvious causes of death.”

The researchers reviewed all available medical records and one of the study team conducted a pathological analysis of all of the victims’ hearts, although details of this component were not specified. Here are their key findings:

  • “Acute episodes of psychological stress raise blood pressure” and cause other physiological changes, including effects on the heart. “The connection between the heart and the brain has long been recognized,” the study notes. “In a setting of personal danger, or when there is a perceived threat of injury, high adrenaline surges are a physiological response, and an individual can be ‘scared to death’ or ‘die of fright.’ “
  • The main “emotional stressors” associated with SCDs were altercations (45%) and restraint against which the subject struggled (31%). Restraint, however, was initiated more often by psychiatric staff, institutional security personnel, and friends collectively than by police.
  • Sudden deaths associated with acute psychological stress tend to strike relatively younger victims. The mean age for males in the study (the vast majority) was 35 and for females, 40.
  • About 20% of the cases showed a history of psychiatric disease. All these were under medical monitoring by mental health professionals and were receiving psychiatric medication. “[I]t is well established that such patients have a higher incidence of sudden death,” the researchers write. “[A]ntipsychotic drugs further exacerbate this risk even at low doses.”
  • 25% of cases were obese.
  • About 90% tested negative for drugs or alcohol. When these substances were present, they were detected only at non-lethal levels.
  • Most subjects (60%) had a normal heart structure, with only modest minorities evidencing heart muscle abnormalities or coronary artery disease.

In summary, the researchers write, “it is important to raise awareness [about SCD] in law-enforcement agencies and mental-health facilities….

“Medico-legal autopsies are essential for the recognition and correct investigation of SCD under stress…. [T]he mechanism of sudden death under stress may be multifactorial, resulting from a cascade of predisposing risk factors…. A thorough autopsy with toxicology is therefore critical to establish the correct cause of death and, when applicable, the acquittal of police or medical psychiatric staff from any wrongdoing.”

Chris Lawrence, a use-of-force expert and trainer with the Ontario (Canada) Police College, referenced this study in his update on in-custody death research at the recent annual training conference of the International Law Enforcement Educators and Trainers Assn. (ILEETA), as did at least two other instructors there.

An important take-away from the study, Lawrence told Force Science News, is that “even in cases where police are not involved, people can and do suddenly and unexpectedly die from a variety of reasons.

“Some people have tried to oversimplify the SCD problem by tying it exclusively to police restraint. But it can be a lot more complex than that. Despite excellent training and a very cautious approach in dealing with and arresting suspects, there still may be an undesirable outcome–and that does not necessarily mean the police did something wrong.”

The study, headed by Dr. Lydia Krexi of the medical school at Aristotle University of Thessaloniki, Greece, is titled “Sudden cardiac death with stress and restraint” and appears in the journal Medicine, Science and the Law. An abstract can be accessed free, along with a link to a paid download of the full study by clicking here.

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