Police Officers Safety Assoc
Presents
Arrest Related Deaths
and Excited Delirium Syndrome
www.posai.org
Police Officers Safety Assoc. - Affordable Realistic Tactical Training
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The Police Officers Safety Association
is a subsidiary of the
Disabled Police and Sheriffs Foundation.
A 501(c)(3) non-profit organization
whose primary mission is to develop,
produce and distribute training programs
to law enforcement officers.
All of our programs are
Distributed free of charge.
Police Officers Safety Assoc. - Affordable Realistic Tactical Training
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Permission is granted to copy or distribute
this programs as long as
the Police Officers Safety Assoc.
is given credit as the source.
Police Officers Safety Assoc. - Affordable Realistic Tactical Training
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This is the PowerPoint file that
accompanies the video presentation
of the same name.
Our videos are located at
www.posai.org
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Presented by
Jerry Staton
Affordable Realistic Tactical Training
Arrest Related Death Specialist
Senior Master TASER Instructor
Certified Litigation Specialist
Retired Austin PD – 25 years
Force Science Analyst
Not an Attorney
Police Officers Safety Assoc. -
Not a Doctor
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Arrest Related Deaths
Police Officers Safety Assoc. - Affordable Realistic Tactical Training
Course Goals
Improve the odds for patient survival
Provide current information on ExDS
Encourage teamwork approach
Limit the risks to all parties
Police Officers Safety Assoc. - Affordable Realistic Tactical Training
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Disclaimer
Information you are about to receive was
current when developed. No one should
rely on information contained herein
for an unreasonable period of time.
Police Officers Safety Assoc. - Affordable Realistic Tactical Training
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Who Needs Training?
First responders need to know what to
expect from other first responders.
Police Officers Safety Assoc. - Affordable Realistic Tactical Training
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Who Else Needs Training?
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Excited Delirium Syndrome
A medical condition that
requires police intervention
Police - capture, control, & restrain
EMS/Fire - sedate, treat, transport
Police Officers Safety Assoc. - Affordable Realistic Tactical Training
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Identifying Label
Label for any person displaying a
specific set of behaviors or traits
which puts them at risk for
sudden death.
Police Officers Safety Assoc. - Affordable Realistic Tactical Training
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ExDS Death
Sudden death during or after an
agitated chaotic event involving
hyper activity + a negative autopsy.
Consider the similarities to SIDS.
Police Officers Safety Assoc. - Affordable Realistic Tactical Training
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Sudden Death
The World Health Organization
Defines SD as cardio-respiratory
collapse that occurs within 24 hours
of the onset of symptoms.
Police Officers Safety Assoc. - Affordable Realistic Tactical Training
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Time Not on Your Side
Death often occurs within one or two
hours of the onset of erratic behavior.
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Brief History
Sudden death is not new:
1406
1849
1881
1980s
Earliest known writing
Dr. Luther Bell (Journal of Insanity)
1st used Term “Excited Delirium”
Term made popular describing
cocaine related deaths
Police Officers Safety Assoc. - Affordable Realistic Tactical Training
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1837-1949
Similar observations recorded from
other medical professionals, some
resulting in death, others survived
Police Officers Safety Assoc. - Affordable Realistic Tactical Training
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1949-1960
After 100+ years
sudden death reports stop
Sedation most likely reason
Patients frequently medicated
(neuroleptic & antipsychotic drugs - thorazine)
Police Officers Safety Assoc. - Affordable Realistic Tactical Training
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1960s SDs Reappear
Patients self-medicating
Mental institutions closing
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1970s Chokeholds + Restraint
LVNR
Sleeper Hold
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1980s Hogtie (Restraint)
Deaths blamed on positional asphyxia
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1990s OC Spray + Restraint
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Currently ECDs + Restraint
If you are look for a common link
Police Officers Safety Assoc. - Affordable Realistic Tactical Training
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Look Beyond the Obvious
Not likely the force used
Some correlation with restraint
The strongest link is the condition of the
person being restrained
Police Officers Safety Assoc. - Affordable Realistic Tactical Training
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Not a Disease
Plaintiff’s attorneys argue Excited Delirium
is not a medically listed disease
They are right
The AMA, NAME, and the American
College of Emergency Physicians
have recognized ExDS
Police Officers Safety Assoc. - Affordable Realistic Tactical Training
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Excited Delirium
Not recognized as a disease
and not found in the ICD-10, or DSM-4
numerous similar diseases are listed.
(ICD-10 & DSM-4 used for billing)
Police Officers Safety Assoc. - Affordable Realistic Tactical Training
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Classification of Disease
Manic Excitement
Agitation
Abnormal Excitement
Delirium
Psychomotor Excitement Delirium, Mixed Origin
Psychomotor Agitation
Delirium, Drug-Induced
Police Officers Safety Assoc. - Affordable Realistic Tactical Training
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Four Phases of
Excited Delirium
Hyperthermia (not always)
Delirium w/agitation (super strength)
Respiratory arrest (breathing stops)
Cardiac arrest (PEA or asystole)
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Primary Causes
Physical (head injury)
Infectious (meningitis)
Psychologic (mental illness)
Metabolic (low blood sugar)
Pharmacologic (stimulates)
Police Officers Safety Assoc. - Affordable Realistic Tactical Training
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Physical Signs
Naked
Sweating
Running wildly
Running in traffic
Often demonstrate:
Violent behavior
Bizarre behavior
Aggression toward glass
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Superman?
Unlimited endurance
Superhuman strength
Reduced sense of pain
Violently resist:
capture / control / restraint
before / during / after arrest
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Physical Cues
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Psychological Issues
Hallucinations
Intense paranoia
Extreme agitation
Emotional changes
Disoriented about:
Time/Place/Purpose
Delusional
Scattered ideas
Easily distracted
Psychotic appearance
Described as:
Just snapped
Flipped out
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Communication
Limited ability to comprehend commands
Screaming for no apparent reason
Talking to imaginary people
Grunting, guttural sounds
Irrational speech
Agonal breathing?
Police Officers Safety Assoc. - Affordable Realistic Tactical Training
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Who’s At Risk
Global issue
91 - 99% male
31 - 44 years old
Bizarre behavior episode
Normally involves prolonged struggle
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Recognize
Warning Signs
You Are Not Being
Trained To Make A
Medical Diagnosis!
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Identify the Emergency
May wish to avoid having officers refer
to “Excited Delirium Syndrome”
No background for medical diagnosis
Police Officers Safety Assoc. - Affordable Realistic Tactical Training
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Need Different Mindset
STRUGGLING and RESISTING
can indicate an immediate
MEDICAL EMERGENCY
secondary to criminal prosecution
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A New Approach
Assess
Chart
Have
a Plan
Capture
Transport
Control Restrain Sedate
Police Officers Safety Assoc. - Affordable Realistic Tactical Training
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First Do No Harm
Don’t aggravate the underlying acidosis!
Minimize physical struggle
ECDs - great capture tool
“Cuff Under Power”
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When to Sedate
LEOs cuff under power
Consider sedating under power
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Four Rescuer Control
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Stop the Cycle
Chemical sedation can stop the battle
Reduce struggle against restraints
The sooner it is given
The sooner it starts working
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Follow the Studies
Latest independent study recently released by
National Institute of Justice :
Emergency medical treatment
Need EMS support ASAP
Sedation, hydration and cooling
These protocols being utilized by some systems
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Stimulant/Intoxication Triad
“TREAT THE TRIAD”
Acidosis
Rhabdomyolysis
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Package For Transport
Multiple handcuffs
Leg restraints
The Wrap
Hobble
TARP
RIPP
ERB
Police Officers Safety Assoc. - Affordable Realistic Tactical Training
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Crisis Intervention
Reasoning and talking may not work
Time is not on your side
THIS IS A MEDICAL EMERGENCY!
Police Officers Safety Assoc. - Affordable Realistic Tactical Training
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Needed Evidence
Collect, preserve, record:
AED printout
Heat shock proteins
Stimulant/drug levels
Core body temperature
Blood pressure reading
Methylone & Mephedrone
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Police Officers Safety Assoc. -
Affordable Realistic Tactical Training
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Training is Necessary
Recognize the behaviors
Attempt to de-escalate when safe to do so
Wait for backup before making contact
Get the physical encounter over rapidly
Sedate and transport in ambulance to ER
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Police Officers Safety Assoc
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The Police Officers Safety Association is always
striving to improve our programs.
Please email feedback on this program to
dkenik@posai.org.
Thank you.
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