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Do's and don'ts of handling "excited delirium" suspects: Part 1 -- Special ILEETA Conference series

Part 1 of 2

By Chuck Remsberg
PoliceOne Senior Contributor

A subject in the throes of excited delirium "may be so far down the road to destruction" that realistically you have little hope of doing more than "witnessing his death. Even if you're able to manage the situation perfectly, he may still die."

That stark message was delivered at the recent annual training conference of the International Law Enforcement Educators & Trainers Assn. (ILEETA) by Canadian academy instructor Chris Lawrence as a reality check for officers who have to deal with one of today's most perplexing street problems: the sudden and seemingly inexplicable physical and mental melt-down of an individual that can easily boomerang into a tactical, media and courtroom nightmare.

Futile as the prospects may be, you have to do something when you confront what looks like an ED event. "The subject may in fact be experiencing some other type of medical emergency (like a diabetic crisis) that could readily be helped by appropriate medical intervention. To just stand by, hoping he'll calm down, may unnecessarily doom him.

In any case, restraining people who are dangerously beyond self-control, whatever the cause, is one of your jobs as a cop. The trick is to not make a situation that's already desperate and foreboding even worse.

In a couple of years, you may have a more promising protocol for suspected ED calls. An in-depth study of the problem involving San Diego PD, Las Vegas Metro and a wide variety of Canadian police agencies is just getting underway by Dr. Christine Hall of the University of Calgary medical faculty. Among other things, she intends for the first time to investigate extensively the sufferers of ED episodes in hope of finding clues that will help police and medical personnel more successfully resolve these incidents.

But in the meantime, based on what is currently known, what steps can you take-and avoid-to provide the maximum chance for you and the subject to safely survive a confrontation, while exposing yourself and your agency to the least amount of liability risk in the event the confrontation ends in the suspect's serious injury or death?

Chris Lawrence and his wife Sharon, who shared his ILEETA presentation, are part of a multi-disciplinary team of professionals that has comprehensively researched the existing knowledge of the ED phenomenon. Chris is the DT coordinator at the Ontario Police College and a member of the Force Science Research Center's technical advisory board. Sharon, also on the FSRC board, is a pharmacist with a background that includes cardiology research and clinical experience in a teaching hospital where she specializes in mental health care.

Here are highlights of what they reported to a standing room-only class of officers and trainers at ILEETA:


"As we learn more and more about excited delirium, we realize we know less and less about it," said Chris Lawrence. But in broad terms ED describes a condition in which, according to Sharon Lawrence, a subject abruptly displays aberrant behavior, becomes very agitated and possibly extremely violent, often (but not always) engages in a vigorous struggle with someone trying to control him and may end up dying suddenly.

An adrenalin peak appears generally to occur 3-5 minutes after significant exertion, and death frequently strikes after the subject has been handcuffed, although the episode may not turn fatal until a couple of hours or even a couple of days later. An autopsy typically reveals "no obvious mechanism of death."

Police intervention is often blamed when a death occurs, but professional literature records deadly ED-like episodes as early as 1650, long before Tasers, OC, hog-tying or other LE tools and techniques that some critics have tried to link to fatalities.

Based on a review of 29 ED-related deaths during a 15-year period in Ontario and confirmed in at least one US study, 97% of victims in fatal ED events are male, with an average age of 33. (Why women have such a low representation is not known, but keep in mind that ED subjects can be female.)

Over 80% are substance abusers, with cocaine (55%) and alcohol (17%) most common. A significant minority (34%) are associated with mental illness, 17% of those afflicted with schizophrenia and 10% with clinical depression. Some show evidence of both mental illness and drug ingestion, but ED seems to be "a substance-abuse problem more than a mental health issue," Chris explained.

"Virtually every known death has involved these core elements: substance abuse or mental illness, bizarre behavior and physical exertion."

The phenomenon appears to be largely "a warm-temperature event," and can be further aggravated by high humidity, he said. It's "not exclusively a big-city occurrence." And Sunday, "the end of the weekend," is statistically the most likely day for an ED onset, with Thursday through Sunday the heaviest span of days.


"It's asking a lot to expect a police officer with conventional training to accurately identify and diagnose ED," which is essentially a medical/psychiatric condition, Chris points out. But there does tend to be a "constellation" of indicators that should at least alert you that you are facing an especially volatile and dangerous situation and need to take special precautions in trying to resolve it. Symptoms itemized by the Lawrences include:

• An exaggerated version of the flight-or-fight response.

"These subjects will run at the first opportunity, without regard to context," Chris said. "They seem to be attracted to running in traffic, for example. Their aggression is unpredictable and can be unprovoked. They exhibit superhuman strength and tend to ignore painful stimuli. Struggling with them is like wrestling with King Kong."

• Attraction to glass.

"Smashing glass is common, although we don't know why." Subjects experiencing ED-type behavior often destroy other property as well. "These incidents tend to involve a lot of noise."

• "Animal-style" behavior.

This may include "grunting, biting, scratching, pushing-very primitive actions." Speech may seem unintelligible or "nonsensical," although it may actually be another language that sounds like gibberish because you don't understand it.

• "8-Ball" eyes.

They may be wi-i-i-i-i-i-i-ide open, so that white is visible on all 4 sides of the iris.

• Nudity.

Stripping naked may indicate a psychotic break from reality, or it may be associated with an overheated body. Sharon explained that the chemical imbalances in the brain that accompany mental illness "can throw off the body's ability to tolerate or expel heat." Often (but not always) there is profuse sweating and a feverish temperature.

• Impaired thinking.

This can include disorientation, hallucinations, an acute onset of paranoia, panic for no apparent reason, and the ignoring of obvious injuries.

• Sudden tranquility after frenzied activity.

"Physiologically we are designed to sustain a 'goal-oriented maximum exertion' for about 2 minutes. ED people can go far beyond this," Chris stated. Sharon added:

"Normally after exertion, the body's internal mechanisms then quiet down. But with ED subjects, the quieting response is a shut down because the normal feedback mechanisms seem to be impaired.

"The paradox is that although the subject exhibits superhuman strength and endurance, he may actually be physiologically fragile. If he has exhausted 5 or 6 officers as they are bringing him under control, his own state of exhaustion is likely to be pretty significant, perhaps more than his system can handle, particularly if he continues to struggle against restraints."

Read Part 2

[The Force Science Research Center, a strategic partner of PoliceOne.com and Calibre Press, published an article titled 10 training tips for handling "excited delirium" in its electronic newsletter Force Science News. This document contains additional important information for strengthening your personal and departmental training on this subject.]

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