“I am concerned about excited delirium….”
Minneapolis Officer describing George Floyd
The recent release of court documents and body-cam footage surrounding George Floyd’s death predictably thrust Excited Delirium Syndrome (ExD) back into the news.
Following George Floyd’s death, media outlets had already begun to revive the false, anti-police narrative that ExD is nothing more than “pseudo-science,” invented to absolve officers from excessive force. Now, the Brookings Institute, a left-leaning think tank, has attempted to add intellectual firepower to the assault by publishing How “Excited Delirium” is Misused to Justify Police Brutality.
Written by three neurologists, including an Instructor of Neurology at the Harvard Medical School, the article gets straight to the point: ExD “is not recognized by the vast majority of medical professionals,” and is “used by law enforcement to legitimize police brutality.” In a new twist, the authors claim that ExD has “highly racist roots” and has been used in “an inherently racist manner.”
To bolster their position that ExD is an illegitimate medical diagnosis and primarily the product of corrupt and racist police, the authors point to Excited Delirium: A Systematic Review (2017).1 As it turns out, that research article, written by doctors and published in a peer-reviewed medical journal, doesn’t actually support the racist police theory.
It Exists and It Still Kills People
In Systematic Review, the researchers refused to discredit ExD, instead finding: “Our results suggest that excited delirium syndrome is a real clinical entity, that it still kills people, and that it probably has specific mechanisms and risk factors.” Anticipating allegations of bias, the authors assured readers of their total independence from law enforcement, chemical industries, or weapons manufacturers.
As for evidence of “racist police” using ExD to legitimize police brutality, Systematic Review again provided the Brookings authors no support.
Of the 66 independent studies fully reviewed by the medical researchers, only 9 included the ethnic origins of the ExD patients. Of these 9 studies, only 6 included research from the United States. One U.S. study identified an equal number of black and white patients, two U.S. studies identified a predominance of white patients, and three U.S. studies identified a predominance of black patients.
While the numbers don’t add up to support the racist police narrative, math isn’t the biggest problem facing the Brookings authors. Even among the scant research that identified a predominance of black ExD patients, none were assessing national trends. What’s worse, the Systematic Review didn’t indicate whether police were involved with any of the ExD patients in the referenced studies.
Even assuming the police were present in a percentage of those cases, there is no indication of whether any force was used, or injury sustained. Meaning there is no evidence that officers had a motive to manufacture an ExD diagnosis. Which brings me to my last point, diagnosing ExD is the prerogative of medical professionals, not the police.
The Vast Majority of Medical Professionals
If medical professionals want to debate the usefulness of the ExD diagnosis, I suppose that is a good use of their time. But to claim that ExD “is not recognized by the vast majority of medical professionals” is to ignore the National Association of Medical Examiners (which formally recognized ExD in 2004) and the American College of Emergency Physicians (which formally recognized ExD in 2009).2 Even the American Medical Association recognizes that ExD “is a widely accepted entity in forensic pathology.3
It is frequently argued that ExD is not found in the International Classification of Diseases (ICD-10) and is therefore not relied on by the American Medical Association or the American Psychiatric Association. What is conveniently left out of this argument is that the various conditions that can cause ExD are listed in the ICD-10.
ICD-10 and ExD
Medical professionals do not treat ExD as a unique disease, but rather as a group of symptoms with uncertain and varied causes. These potential causes of ExD can be grouped into five general categories: Metabolic, Neurologic, Psychiatric, Infectious, and Toxicologic. Among these five categories are more than 30 separate conditions believed to cause ExD.4 All 30 of these conditions are listed in the ICD-10.
Because there are a wide variety of conditions that can lead to ExD, emergency medical experts typically focus on the symptoms, which often include delirium, agitation, rapid breathing, accelerated heart rate, overheating, and excessive sweating.
Regardless of the cause, those experiencing ExD may feature bizarre and aggressive behavior, shouting, paranoia, panic, violence toward others, unexpected physical strength, high pain tolerance, a period of tranquility, and sudden cardiac arrest.
The varied causes of ExD, the overlap of its symptoms with other conditions, and its rare occurrence are just some of the reasons first responders are not expected to diagnose ExD. Even so, the absence of a specific diagnosis does not negate the seriousness of the behavioral and physical symptoms.
ExD by Any Other Name
Excited delirium symptoms warn of a potentially fatal medical condition. Officers properly trained to recognize ExD are more likely to practice arrest and restraint techniques that mitigate the risk to the patient. They are more likely to have planned, trained, and initiated a cooperative emergency response with dispatchers, emergency medical services, and hospital emergency staff.
If communities choose to send a team of highly trained and equipped medical professionals to supervise the management of ExD in the field, I suspect the police would welcome the assistance. However, critics who attack ExD in an attempt to undermine police credibility and advance a “racist-police” narrative, are risking the exact training officers need to recognize and respond to these life-threatening emergencies.
- Gonin P, Beysard N, Yersin B, Carron PN. Excited Delirium: A Systematic Review. Acad Emerg Med. 2018;25(5):552-565. doi:10.1111/acem.13330
- DeBard ML, Adler J, Bozeman W, Chan T, et al: ACEP Excited Delirium Task Force White Paper Report on Excited Delirium Syndrome, September 10, 2009, last accessed on June 24, 2020, at https://www.prisonlegalnews.org/media/publications/acep_report_on_excited_delirium_syndrome_sept_2009.pdf
- See REPORT 6 OF THE COUNCIL ON SCIENCE AND PUBLIC HEALTH (A-09), Use of Tasers® by Law Enforcement Agencies (Reference Committee D), at https://www.ama-assn.org/sites/ama-assn.org/files/corp/media-browser/public/about-ama/councils/Council%20Reports/council-on-science-public-health/a09-csaph-tasers.pdf
- Kasha Bornstein, Tim Montrief, MD, Mehruba Anwar Parris, MD. Excited Delirium: Acute Management in the ED Setting. Emer. Mgmt. Resident. April 8, 2019, last accessed at https://www.emra.org/emresident/article/excited-delirium/