1 Police Officers Safety Assoc Presents Arrest Related Deaths and Excited Delirium Syndrome Police Officers Safety Assoc. - Affordable Realistic Tactical

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Police Officers Safety AssocPolice Officers Safety Assoc

Presents

Arrest Related Deathsand Excited Delirium Syndrome

Police Officers Safety Assoc. - Affordable Realistic Tactical Training

www.posai.org

Police Officers Safety Assoc. - Affordable Realistic Tactical Training 2

The Police Officers Safety Associationis 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 areDistributed free of charge.

3Police Officers Safety Assoc. - Affordable Realistic Tactical Training

Permission is granted to copy or distributethis programs as long as

the Police Officers Safety Assoc.is given credit as the source.


This is the PowerPoint file thataccompanies the video presentation

of the same name.

Our videos are located atwww.posai.org


Jerry StatonJerry StatonAffordable 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 Not a Doctor

Presented by

Arrest Related DeathsArrest Related Deaths


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Course GoalsCourse Goals

Improve the odds for patient survival

Provide current information on ExDS

Encourage teamwork approach

Limit the risks to all parties


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DisclaimerDisclaimer

Information you are about to receive was current when developed. No one shouldrely on information contained hereinfor an unreasonable period of time.


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First responders need to know what to expect from other first responders.

Who Needs Training?Who Needs Training?


Affordable Realistic Tactical Training 10

Who Else Needs Training?Who Else Needs Training?

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A medical condition that requires police intervention

Police - capture, control, & restrain

EMS/Fire - sedate, treat, transport

Excited Delirium SyndromeExcited Delirium Syndrome


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Label for any person displaying aspecific set of behaviors or traits

which puts them at risk forsudden death.

Identifying LabelIdentifying Label


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ExDS DeathExDS Death

Sudden death during or after an agitated chaotic event involving

hyper activity + a negative autopsy.

Consider the similarities to SIDS.


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Sudden DeathSudden Death

The World Health Organization Defines SD as cardio-respiratory

collapse that occurs within 24 hours of the onset of symptoms.


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Time Not on Your SideTime Not on Your Side

Death often occurs within one or two hours of the onset of erratic behavior.


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BriefBrief HistoryHistory

Sudden death is not new:

1406 Earliest known writing1849 Dr. Luther Bell (Journal of Insanity)1881 1st used Term “Excited Delirium” 1980s Term made popular describing

cocaine related deaths


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1837-19491837-1949Similar observations recorded fromother medical professionals, some resulting in death, others survived


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1949-19601949-1960

After 100+ years sudden death reports stopSedation most likely reason

Patients frequently medicated(neuroleptic & antipsychotic drugs - thorazine)


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1960s SDs Reappear1960s SDs Reappear

Patients self-medicatingMental institutions closing


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1970s Chokeholds + Restraint1970s Chokeholds + Restraint

LVNRSleeper Hold


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1980s Hogtie (Restraint)1980s Hogtie (Restraint)Deaths blamed on positional asphyxia


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1990s OC Spray + Restraint1990s OC Spray + Restraint


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Currently ECDs + RestraintCurrently ECDs + Restraint

If you are look for a common link


Look Beyond the ObviousLook Beyond the Obvious

Not likely the force used Some correlation with restraint

The strongest link is the condition of the person being restrained


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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

Not a DiseaseNot a Disease


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Excited DeliriumExcited 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)


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Manic Excitement

Abnormal Excitement

Psychomotor Excitement

Psychomotor Agitation

Agitation

Delirium

Delirium, Mixed Origin

Delirium, Drug-Induced

Classification of DiseaseClassification of Disease


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Four Phases of Four Phases of Excited DeliriumExcited Delirium

Hyperthermia (not always)

Delirium w/agitation (super strength)

Respiratory arrest (breathing stops)

Cardiac arrest (PEA or asystole)


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Primary Primary CausesCauses

Physical (head injury)

Infectious (meningitis)

Psychologic (mental illness)

Metabolic (low blood sugar)

Pharmacologic (stimulates)


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PhysicalPhysical SignsSigns

NakedSweating

Running wildlyRunning in traffic

Often demonstrate:Violent behaviorBizarre behavior

Aggression toward glass


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Superman?Superman?

Unlimited enduranceSuperhuman strengthReduced sense of pain

Violently resist:capture / control / restraint

before / during / after arrest


Affordable Realistic Tactical Training 32

Physical CuesPhysical Cues

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Psychological IssuesPsychological Issues

HallucinationsIntense paranoiaExtreme agitationEmotional changesDisoriented about:

Time/Place/Purpose

DelusionalScattered ideas Easily distractedPsychotic appearanceDescribed as:

Just snappedFlipped out


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CommunicationCommunication

Limited ability to comprehend commandsScreaming for no apparent reason

Talking to imaginary peopleGrunting, guttural sounds

Irrational speech Agonal breathing?


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Who’s At RiskWho’s At Risk

Global issue

91 - 99% male31 - 44 years oldBizarre behavior episodeNormally involves prolonged struggle


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Recognize Recognize Warning SignsWarning Signs

You Are Not BeingYou Are Not Being

Trained To Make ATrained To Make A Medical Diagnosis!Medical Diagnosis!


Identify the EmergencyIdentify the Emergency

May wish to avoid having officers refer to “Excited Delirium Syndrome”

No background for medical diagnosis


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Need Different MindsetNeed Different Mindset

STRUGGLING and RESISTING can indicate an immediate

secondary to criminal prosecution

MEDICAL EMERGENCY


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Assess

Capture

Control Restrain Sedate

Transport

Chart Have a Plan

A New ApproachA New Approach


First Do No HarmFirst Do No Harm

Don’t aggravate the underlying acidosis!Minimize physical struggle

ECDs - great capture tool“Cuff Under Power”


When to SedateWhen to SedateLEOs cuff under power

Consider sedating under power


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Four Rescuer ControlFour Rescuer Control


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Stop the CycleStop the Cycle

Chemical sedation can stop the battleReduce struggle against restraints

The sooner it is givenThe sooner it starts working


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Follow the StudiesFollow the StudiesLatest 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 TriadStimulant/Intoxication Triad

Hyper

ther

mia

Acidosis Rhabdomyolysis

“TREAT THE TRIAD”

Agitation


4646

Multiple handcuffsLeg restraintsThe Wrap Hobble TARPRIPPERB

Package For TransportPackage For Transport


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Crisis InterventionCrisis Intervention

Reasoning and talking may not work

Time is not on your side

THIS IS A MEDICAL EMERGENCY!


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Needed EvidenceNeeded EvidenceCollect, preserve, record:

AED printoutHeat shock proteins Stimulant/drug levels

Core body temperatureBlood pressure reading

Methylone & Mephedrone



Training is NecessaryTraining 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 AssocPolice Officers Safety Assoc


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1 Police Officers Safety Assoc Presents Arrest Related Deaths and Excited Delirium Syndrome Police Officers Safety Assoc. - Affordable Realistic Tactical