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First they said that we were killing them by use of neck restraints. Then it was the pepper spray that was new at the time to the police scene. Next we were accused of killing subjects by way of positional asphyxia, when we placed the handcuffed and possibly leg shackled or hobbled person in the prone position. Then we were told that no, it wasn't the prone position, it was the weight we were putting on the subject's back in the arrest process referred to as compression asphyxia. Now, the focus is on the TASER with countless accusations that the use of this excellent electronic control device is killing subjects.
Science and scientific research has proven: neck restraints were not causing the deaths. Thanks to the work of Drs. Ted Chan and Tom Neuman, research has proven that Positional Asphyxia as presented in the 1990s does not exist; Compression Asphyxia theories have been dispelled with researchers finding that several hundred pounds of weight on a subject's back does not lead to asphyxia; OC spray has likewise been proven safe in medical studies; and the TASER has been found to be safe in countless medical studies.
What then is causing suspects to die in the arrest process?
A little-known phenomenon called excited delirium has been largely responsible for suspects' deaths in custody. This directly concerns you and other street officers and investigators because the fallout of a suspect dying in police custody can be tremendous. Good law enforcement officers are currently under indictment and facing murder charges in this country because a subject, suffering from excited delirium died while they were trying to control him.
Is excited delirium (ED) a new phenomenon? Not at all--Dr. Luther Bell first reported the incidence of manic behavior and death in 40 of 1,700 psychiatric patients over 12 years and published his findings in 1849. The symptoms as noted by Bell in psychiatric patients were mania, violent behavior, need for restraint, refusal of food, Inability to sleep, fatigue deteriorating to exhaustion and circulatory collapse. Although you may run into a mentally ill subject off his meds, overmedicating himself, or combining alcohol or illicit drugs with his psychotropic medications, most of the subjects police officers will have to deal with in an ED state are under the influence of illegal drugs.
The first ED case I became involved in was around 14 years ago, when an off-duty officer from my agency was on the highway en route to an extra job. A car driven by a subject under the influence of LSD and over-the-counter meds and in a manic state intentionally crashed into other vehicles and began running through traffic. The suspect died after our officer and citizens on the scene stopped and controlled him. Although the prosecutor and coroner at that time thought that ED was only cocaine-related, we were able to show research that linked LSD to in-custody related deaths as well. Since this case, my agency has had at least half a dozen ED deaths.
What causes death in some people in an ED state? Metabolic acidosis? Impairment of dopamine receptors in the brain? Heart attack? Who knows, and it doesn't matter to the street officer. Officers must understand the symptoms of ED, the risk of sudden death in ED subjects and effective means of controlling persons in this state.
Signs and Symptoms
According to Darrel Ross and Ted Chan in their book, Sudden Deaths in Custody (Humana Press, 2006) the following are Common Presenting Features of excited delirium syndrome:
- Acute psychotic behavior
- Violent agitation
- Altered mental status and delirium
- Bizarre behaviors (e.g., jumping through windows)
- Profuse sweating
- Incoherent speech (screaming and shouting)
- Extraordinary strength and endurance
- Lack of response to painful stimuli
- Extreme exertion and hyperactivity
A poster child example of what a subject experiencing ED might look like is the naked guy smashing out glass windows or running through traffic. Although ED behaviors frequently result in the police being called, make no mistake--it is a medical emergency and must be treated as such. I was once asked by paramedics, "What should we do in an ED situation before the police arrive?" My answer was to stay in the paramedic unit and not do anything unless the person has collapsed. EMS and paramedic personnel simply do not have the correct equipment to control an ED subject.
If dispatchers can be briefed to recognize an ED-type call (the naked guy running amok situation) they should dispatch enough police personnel to the call as well as the EMS squad. Although persons in an ED state can be extremely dangerous (Canadian ED expert Chris Lawrence calls it "primal types of resistance") they are also extremely fragile, and all attempts should be made to get enough people on scene to control the person quickly and get them in the hands of paramedics as soon as possible. In the mental health industry it is recommended that five to six people respond to control a patient in a violent psychiatric episode. For many agencies that may be all but impossible, but trying to handle an ED subject by yourself or with only one backup is foolhardy. In times past the "polyester pile" (also known as pig piling) was used to control a violent mental patient. This type of tactic is dangerous, as it may only prolong the struggle increasing the risk of death. Since any type of pain related technique or tool (OC spray or baton) will not be effective due to impairment of the subject's pain receptors, the best method is to use the TASER. Once enough people are on scene, make a quick plan. Officer Smith uses the TASER to drop the subject. Officers Doe, Jones, and Johnson then move in to control then handcuff and/or leg-shackle the subject. TASER International will not make official recommendations as to how many cycles a person in an ED state should be given, leaving it up to the agency to decide. However, it is certainly true that control must be achieved quickly. Once the person is handcuffed, EMS personnel should move in quickly with warnings of the ED state that should be passed along to emergency room medical staff as well.
Police and Excited Delirium
You and your agency must learn as much as you can about ED. Detectives must be educated so that a proper investigation can be completed. Investigators should, for instance, insist that medical examiner staff record core body temperature to document hyperthermia. Agency use-of-force trainers must train line officers and investigators in the incidence and symptoms of excited delirium, and tactics to control these subjects. If an ED death is suspected, coroners or medical examiners must be educated to recognize ED as a possible cause of death.
Due to the political interests that arise in an in-custody death case, officers should be afforded full legal rights and representation. I would strongly suggest that you do not make a voluntary statement about the incident, but rather choose to remain silent. If an agency compels a statement under threat of termination (or won't let you go home until you give a statement, as one agency recently did) then you have Garrity protection and your statements can only be used for internal disciplinary reasons.
Protection of your rights may seem like overkill, but it absolutely is not. As I write this, five members of the Summit County Sheriff's Office in Ohio are under indictment and facing trial for charges from murder to felonious assault. In what I can only describe as an inept investigation and prosecutorial overzealousness, these deputies now face possible imprisonment for doing their jobs in a very bad situation. Good news has recently come however. Recently in Common Pleas (State) court, TASER International and the City of Akron won its civil suit against the Medical Examiner's office. The ME's report must be changed to eliminate TASER as a cause of death in this case and two others. According to the judicial order, the ME's report must list this cause of death as "undetermined" versus the "homicide" ruling that was listed.
You may never run into a subject under the effects of excited delirium, but if you do, you must recognize the condition of the person you face. You must get enough police personnel and the proper tools to control them quickly and then you must hand them off to EMS as soon as possible. The proper combination of training, tactics and medical protocols will improve your and the subject's chances at survival, but if you or another officer is involved with an in-custody death case, protect your rights.
If you are interested in donating to the legal defense fund for these deputies, you may do so through the Furnace Street Mission. This is tax deductible donation. 100% of your contribution will go to their legal defense. Just mark your contribution "Officer Defense."