Excited delirium can give a subject what has been described as superhuman strength with an incredible pain threshold. Never take on an apparent excited delirium subject alone. You may need two, three or more officers to stabilize the subject. Photo AP/The Daily News Journal, Rachelle Morvant
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Incident 1: Police receive a call about a heavy-set male walking on the shoulder of the interstate. Reports indicate he was almost struck by a passing motorist. An officer responds, finds the subject and transports him off the expressway. The subject appears agitated, uptight and somewhat incoherent. The officer suspects the subject may be suffering from some type of emotional disorder.
An ambulance and a backup unit are requested. The subject is anxious about being in the back of the squad, so the officer allows the subject to stand outside the car. While waiting for the EMS crew, the subject decides to walk back to the expressway. He’s detained by the officers but becomes very aggressive and hostile. Vertical stabilization efforts prove ineffective, as well as all attempts at soft, empty-hand control. Two more units arrive, and even with four officers holding his arms and legs, the subject throws them around like rag dolls.
The officers eventually manage to ground stabilize the subject, and within a minute or two, the subject appears to calm down. The ambulance crew arrives, and the officers notice the suspect has stopped breathing. Efforts to resuscitate him prove successful, but the subject suffers severe brain damage and lapses into a coma.
Incident 2: An officer is patrolling a remote area of his county shortly before 0200 hrs. A call comes in of a suspect walking down a major road carrying what witnesses describe as a rifle. He responds and observes a young male walking along the shoulder of the road with a long-gun in his right hand. He notifies dispatch to send a backup and activates his overheads.
The suspect initially complies with the officer’s commands to put down the gun but then rabbits down the road. The officer grabs the gun, secures it in his truck and starts to follow the suspect in his vehicle until the suspect runs through some backyards. The officer tries to keep up with the subject but loses sight of him after a few minutes.
Suddenly, the officer’s car radio crackles, and he receives a call that an unknown suspect has just thrown a large planter through a dining room window of a home two lots away. The officer runs over to find his suspect with a second large planter in his hand about to toss it through another large window. With help from the homeowner, he manages to get the suspect handcuffed and into an arriving unit’s back seat.
The suspect starts to kick the cage and back window with his feet. He kicks off a radar antenna that was glued to the rear window and bends the cage into a V at the center. Seconds later, the rear passenger window is kicked out. While the officer is on the radio requesting an ambulance, the suspect dives through the broken window head first, lands on the ground and starts to thrash around and scream wildly. Another officer tries to restrain the subject. Within a few minutes, the suspect calms down. By the time EMS arrives, he’s silent and still. He’s pronounced DOA within the hour at a local ER.
Incident 3: Two units answer a domestic call in the early evening. The subject, a 17-year-old male, is smashing up his room, and his parents can’t control him. Two officers enter the home and find the wild-eyed subject hyperventilating, half-dressed and screaming incoherently. The officers use mace to handcuff the subject. They radio ahead for security at the local ER to stand by to receive an EDP.
During the trip to the hospital, the subject goes supine in the back seat and starts to kick out one of the rear windows. After failing to break out one rear window, he starts on the other and manages to get most of the glass out. Before the officers can slow down the cruiser to stop, the suspect gets up on his knees, dives head first out the window and lands on the shoulder of the expressway.
The cruiser finally stops, and the officers run back to attend to the lad, whose face looks like a pound of ground sirloin. The rest of his body is twisted into a question mark and his hands are still cuffed behind his back. The officers request EMS.
The officers attempt to stabilize the suspect, but he kicks out at the officers. Two baton strikes to his feet make contact but only result in a gurgle of a laugh followed by, “Ah, hit me again, I love it, I love it.”
Finally, the officers perform a three-man swarm on the still-struggling subject to roll him onto his stomach to get him on his side and up on his buttocks. But a few seconds later, he’s quieted down significantly and is breathing very slowly. EMS arrives and transports the youth to the hospital. The subject survives but remains in a coma to this day.
ED Subject Management
All three stories are true. The first two were cases I’ve been asked to examine for two large departments being sued for excessive force. The third is firmly etched in my still-functioning brain after 15 years of beach-bumming retirement—I was the street boss who rolled up on the scene minutes before the ambulance transported the youth to the hospital.
These three scenarios are examples of what most medical experts call “excited delirium” (ED). Just when you thought you knew it all about how to handle emotionally disturbed persons (EDPs), a new type comes along to throw a whole new monkey wrench into the subject management works. Recognizing that most cops have just enough first-aid training (i.e., Band Aids 101) to qualify them to handle a hang nail, this column focuses on tactics the average street dog might be able to perform if they encounter an apparent ED subject on a radio run.
Excited delirium, according to most medical experts, is defined as “a state of extreme mental and physiological excitement characterized by a host of behavioral manifestations: exceptional agitation and hyperactivity, overheating, excessive tearing of the eyes, hostility, superhuman strength, aggression, acute paranoia and endurance without apparent fatigue.” In everyday police lingo, that means every cop’s worst nightmare.
Most experts agree ED is fairly rare. Ongoing research attempts to uncover more about the causes and protocols for handling ED subjects. But one thing is certain. “Excited delirium is a medical emergency that presents itself as a police problem,” says William Everett, a cop-turned-attorney who has extensively studied excited delirium and now advises police agencies on how to handle ED calls.
The reality of police work is that you may be the first responder who must control an ED subject until medical personnel arrive. ED calls, like many other 911 dispatches, are usually toned out as other types of jobs, such as a domestic-violence call, a “prowler-now” run, an apparent drug OD or maybe even an incident of a “diabetic in crisis.” Your first priority at an apparent EDP-type situation is to recognize it may be a case of ED and to get EMS on the way, Code 3.
With that fact in mind, what can you do to control and contain a suspected ED subject while you await the EMS crew and keep yourself safe at the same time? First, get help. Never take on an apparent ED subject alone. Their strength can only be described as superhuman, and their pain threshold can be incredible. Two, three or even four officers will be needed to control an ED subject. Keep in mind, most EMS crews won’t approach an ED subject,
or any other EDP for that matter, until that person is safely secured.
Second, standard force-continuum escalation or sequential progression of force options may prove impossible. Presence may prove ineffective for reasons outlined later. Verbal direction may not work, soft, empty-hand control techniques may also prove ineffective and the usual pain-compliance or leverage techniques might have to be abandoned. Likewise, pepper spray and impact-weapon options may also prove futile. Many experts suggest a single Taser use (in the firing mode, not via drive stun) is the best option, followed by a quick four- or five-point swarm that doesn’t impede respiration: One officer at each arm, two more at the knees/legs. A fifth officer can control the head.
The optimal word here is quick. If you’ve ground stabilized the subject in the prone position, quickly get them on their side. While debate exists as to whether the prone position contributes to ED deaths, most medical practitioners suggest getting them off their stomachs as soon as possible. Then quickly get them into the hands of medical professionals. Ideally, the medics in your area are all Advanced Life Support (ALS) certified. In some cases, chemical restraints (tranquilizing agents) may be needed to bring ED subjects down from that extreme emotional state of agitation and/or violence.
Signs & Symptoms of ED
While there’s no exact ED subject profile, the following characteristics have been developed by several field experts. ED subjects are likely to be males in their early 30s. Most are substance abusers, including alcoholics. The one from my jurisdiction was on PCP (phencyclidine); another on cocaine. Studies show a third (34 percent) suffer from some sort of mental illness. Many evade police, so officer presence may not deter the erratic behavior of most ED subjects.
There also seems to be a connection to running into traffic, like our freeway example in Incident 1. Also, for some unknown reason, there seems to be an attraction to glass, as two of our opening incidents documented. Other symptoms include grunting or making animal-like noises, biting, scratching or speaking gibberish. A severe widening of the eyes has been reported in some cases, where the whites are visible all around the iris. Partial or complete nudity is not uncommon; experts aren’t certain if this relates to the overheating that ED subjects can experience, or if it relates to their break from reality, but look for evidence of the subject being overheated or sweating profusely. One very common trait among ED subjects is that immediate calming-down effect after an all-out fight, described by some medial experts as “sudden tranquility.”
One final word of caution: This is an informational article only and is not intended to constitute ED training. It was designed to help officers recognize when they might be dealing with an ED subject and what tactics they might be able to employ to contain and control that person while waiting the arrival of EMS. Agencies are strongly encouraged to seek out competent professional ED training as well as the multitude of information available. I’m happy to email a short list of resources to those who request it.
I would like to credit former police officer and attorney William Everett, author Chuck Remsberg and Dr. Jeffrey Ho, MD, as well as the folks at the Force Science Research Center, for their assistance with this article.