Police officers and EMS workers have either dealt with it or have heard of others who have: Positional asphyxiation, Sudden in Custody Death Syndrome (S.I.C.D.S.) and Restraint Related Death, to name a few. Sometimes we win the law suit and sometimes we lose; either way, a person is dead that didn’t need to be.
The term “Excited Delirium” has been tossed around since the 1800’s, but good luck getting that on a death certificate or used in a court of law after a subject dies in custody. Until now, that is. Doctors are starting to recognize this issue as a real thing, with science to back it up. This is a good thing for police and EMS workers alike. The only problem with it, however, is that we must recognize the warning signs and act accordingly.
Excited Delirium is a very fatal condition and no amount of CPR or other life-saving actions can be effective in preventing this event from happening; too much happens to the body because of this condition to be fixed with our current level of medical knowledge. So, what is happening to the body? A combination of lethal metabolic events that destroys hemostasis (the body being in balance) and attacks every organ system is the short answer. At a closer look:
- Hypoglycemia – Low blood sugar levels
- Hyperthermia – Excessive body temperature
- Hypoxia – Low oxygen in the blood and to the brain
- Tachycardia – An excessively high heart rate
- Acidosis – Excessive amounts of acids in the body. The Ph balance of the body has a very narrow range
When a subject runs from police, their heart rate and temperature climb, causing the hyperthermia and tachycardia; the tachycardia and physical exertion leads to hypoxia and hypoglycemia. Once the subject is restrained, if they continue to fight against the restraints, they build up lactic acid. Lactic acid is what causes you to feel the burn when you work out. When you stop, so does the production of lactic acid. If you don’t stop however, lactic acid keeps building and acidosis is the result. Now, add in a subject who is using drugs that elevate the heartrate and cause the individual to not eat for several days; the tachycardia, hyperthermia, and hypoglycemia are made that much worse. So, what can we do?
As soon as officers notice a subject is going into fight or flight and they have a reason to believe that they will keep fighting against the restraints, EMS needs to be called in for a person experiencing excited delirium and they need to be sure that the team that shows up will be Advanced Life Support, or ALS. This is because the only thing that can be done is chemical restraint. The paramedic will do what is called Rapid Sequence Intubation (R.S.I.), where they put the subject into an unconscious state and support their airway. This is the only way to keep them from fighting and eventually dying.
At this point, you may be asking what the paramedic can look for to know they will be dealing with excited delirium. Before the patient dies, the aforementioned conditions should be noted. If the subject is placed on an ECG before they go under, but go down before RSI is completed, you will see tachycardia go straight to asystole. There is your definitive clue that excited delirium killed them. As noted earlier, there is very little chance they will recover. We must still try though, right? This is not a normal cardiac arrest and, therefore, normal protocols will not work. Epinephrine will do nothing. The subject must be cooled, the acidosis must be reversed, oxygen applied, and glucose administered. This will give them the best chance at survival. It probably won’t work because too many body systems are damaged at one time, but if they have any chance at survival, that is it, coupled with rapid transport.
Once all of that is done: document, document, and document; then, document some more. Doctors are starting to recognize this condition, but without documentation, this type of death will always be the result of positional asphyxiation, Sudden in Custody Death Syndrome (S.I.C.D.S.), and Restraint Related Death.
Disclaimer: The content in this article is the opinion of the writer and does not necessarily reflect the policies or opinions of US Patriot Tactical.