Excited delirium

Excited delirium is a controversial term used to explain deaths of individuals in police custody, in which the person being arrested, detained, or restrained is highly agitated and may be under the influence of stimulants. [cite web |url=http://www.msnbc.msn.com/id/15001627 |title=Suspects' deaths blamed on ‘excited delirium’. Critics dispute rare syndrome usually diagnosed when police are involved |accessdate=2007-04-29 |publisher=Associated Press |work= ] It has been listed as a cause of death by some government medical examiners.Fact|date=March 2008 [ [http://canadianpress.google.com/article/ALeqM5jHZCd9nDd_33d9uGxPEzI3uHPmIA] ] The cause of death only appears where police are involved in restraining individuals.cite web |url=http://www.npr.org/templates/story/story.php?storyId=7608386 |title=Death by Excited Delirium: Diagnosis or Coverup? |accessdate=2007-02-26 |publisher=NPR |work= ] cite web |url=http://abcnews.go.com/Health/story?id=2919037&page=1&CMP=OTC-RSSFeeds0312 |title=Excited Delirium: Police Brutality vs. Sheer Insanity |accessdate=2007-03-13 |publisher=ABCNews |date=March 2, 2007 ] The term has no formal medical recognition and is not recognized in the Diagnostic and Statistical Manual of Mental Disorders. There may also be a controversial link between "excited delirium" deaths and the use of Tasers to subdue agitated people. [cite web |url=http://www.npr.org/templates/story/story.php?storyId=7622314 |title=Tasers Implicated in Excited Delirium Deaths |accessdate=2007-04-29 |publisher=NPR |work= ] In August 2007, three months before Robert Dziekański died shortly after being tasered at Vancouver International Airport, Royal Canadian Mounted Police changed its protocol on Taser use, from discouraging multiple Taser shocks to suggesting that multiple shocks may bring a subject under control more quickly, under certain circumstances. It was suggested that multiple taser jolts may lessen the risks of prolonged and dangerous struggle. [cite web |url=http://www.theglobeandmail.com/servlet/story/RTGAM.20071124.taser-RCMP24/BNStory/National/?page=rss&id=RTGAM.20071124.taser-RCMP24|title=RCMP revised taser policy to allow multiple jolts|accessdate=2007-11-24 |publisher=The Globe and Mail |work= ]

Disputed validity

Some civil-rights groups argue that the term is being used to absolve police of guilt while possibly overly restraining people during arrests. This does not include those deaths in chemical dependence treatment, EMS, hospital, or psychiatric care facilities who die while being restrained or while in seclusion.

Eric Balaban of the American Civil Liberties Union said: "I know of no reputable medical organization — certainly not the American Medical Association (AMA) or the American Psychological Association (APA) that recognizes excited delirium as a medical or mental-health condition." Melissa Smith of the American Medical Association said the organization has "no official policy" on the disorder.

Grame Norton, director of the public safety project of the Canadian Civil Liberties Association argues that "Anytime you see a specific condition being referenced in only one context it raises serious question." Other critics assert that the term is used to mask police brutality. Although the term "excited delirium" has been accepted by the National Association of Medical Examiners in the United States it has been rejected by the American Medical Association while the "Canadian Medical Association Journal" dismisses it as a "pop culture phenomenon".cite news
last = Humphries
first = Adrian
title = 'EXCITED DELIRIUM' BLAMED FOR DEATHS - 'Not About Tasers'
work = National Post
publisher = CanWest
date = 2008-05-17
url = http://www.nationalpost.com/news/story.html?id=522228
accessdate =2008-05-19 ] The condition is not recognized by the "Diagnostic and Statistical Manual of Mental Disorders".

Police psychologist Mike Webster testified at a British Columbia inquiry into Taser deaths that police have been "brainwashed" by Taser International to justify "ridiculously inappropriate" use of the electronic weapon. He called "excited delirium" a "dubious disorder" used by Taser International in its training of police.cite news
last = Hall
first = Neil
title = Police are 'brainwashed' by Taser maker; Psychologist blames instructions
work = Vancouver Sun
pages = A1
publisher = Canwest
date = 2008-05-14
url = http://www.canada.com/vancouversun/news/story.html?id=28218a80-11db-47a3-baf9-90b7dc2618aa
accessdate = 2008-08-30 ]

However the first description of this syndrome was published in 1849 by the superintendent of Massachusett's McLean Asylum for the Insane, Luther V. Bell, M.D.. [cite journal
last = Bell, MD
first = Luther V.
year = 1849
month = October
title = On a Form of Disease resembling some advanced stages of mania and fever, but so contradistinguished from any ordinarily observed or described combination of symptoms, as to render it probable that it may be an overlooked and hitherto unrecorded malady
journal = American Journal of Insanity
volume = 6
pages = 97–127
publisher = American Psychiatric Association
doi = 10.1176/appi.ajp.6.2.97
url = http://ajp.psychiatryonline.org/cgi/content/citation/6/2/97
accessdate = 2008-04-08 ] ` Since then, it has been variously known as "Bell's Mania", "agitated delirium", "excited delirium" and "acute exhaustive mania". Most of the early papers describing the condition speak of a prolonged period of increasingly bizarre behaviour, usually over several days or weeks. In those who have consumed cocaine or amphetamines, the course is accelerated to several hours.

Some cases have been attributed to police use of excessive force. In one case the victim, who was restrained and transported by friends, died when in the custody of medical personnel [cite web |url=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=11219123&itool=iconabstr&query_hl=1&itool=pubmed_docsum |title=Death of psychiatric patient during physical restraint. Excited Delirium. |accessdate=2007-03-13 |publisher=PubMed |date=January, 2001 ] . Police and EMS are usually called due to the signs/symptoms manifested by the victim due to concerns of public safety or criminal acts.

In a recent report by Compliance Strategy Group [http://www.compliancestrategygroup.com] (Kiedrowski's Report) addressed the concerns of excited delirium as used in policing. In the report entitled An Independent Review of the Adoption and Use of Conducted Energy Weapons by the Royal Canadian Mounted Police [http://www.rcmp-grc.gc.ca/ccaps/cew/kiedrowski_report_e.htm] the authors argued that the "concept of excited delirium" should be removed from the RCMP's training manual, policies and procedures. They referred to excited delirium" as "folk knowledge" which was only introduced to justify the use of tasers. Prior to the use of tasers by the police, excited delirium was not part of the police training. The report is an excellent review on excited delirum and policing. The Report also references material from London England where the term excited delirum has been removed from the policing policies and training manual.

ymptoms

Those signs/symptoms typically associated with excited delirium are: Fact|date=May 2007

* Bizarre and violent behavior, most commonly violence towards glass
* Removal of clothing, public nudity (even in cold weather)
* Aggression
* Hyperactivity
* Paranoia [http://www.zarc.com/english/other_sprays/reports/excited_delirium.html Alan W. Benner, Excited Delirium, 1996] ]
* Hallucination
* Incoherent speech or shouting
* Grunting or animal-like sounds
* Incredible strength or endurance (typically noticed during attempts to restrain victim)
* Imperviousness to pain (observed during violent acts or restraint)
* Hyperthermia (overheating)/profuse sweating (even in cold weather)

Other medical conditions that can resemble excited delirium are panic attack, hyperthermia, diabetes, head injury, delirium tremens, and hyperthyroidism. [cite web |url=http://www.policeone.com/writers/columnists/ChrisLawrence/articles/1182796/ |title= What other medical emergencies can look like excited delirium? |accessdate=2007-03-26 |publisher=PoliceOne.com |date=October, 2006 ]

Cases

Nathaniel Jones: his death while in custody of Cincinnati police was first attributed to excited delirium.cite web |url=http://www.cbsnews.com/stories/2003/12/09/60II/main587569.shtml |title=Was It 'Excited Delirium' Or Police Brutality? |accessdate=2007-02-26 |publisher=60 Minutes |date=December 10, 2003 ] In a lawsuit over Jones' death, some facts related to excited delirium were disputed.Jones v. City of Cincinnati, No. 1:04-CV-616, 2006 U.S. Dist. Lexis 75430, 2006 WL 2987820 (S.D. Ohio)] The defendants in the trial court proceedings asserted that: 1) the decedent was resisting arrest; 2) reasonable force was used in an attempt to restrain him; and 3) excited delirium was the cause of death. The plaintiffs claimed that: 1) the officers used excessive force; 2) the decedent died from compressive asphyxia caused by police officers whose entire weight was on his body; and 3) the decedent was not resisting but rather attempting to reposition his body so he could breathe. The trial court found that the plaintiffs sufficiently stated a claim of excessive force. No taser involvement.

Toney Steele: One of the first high-profile cases involving question of excited delirium, this drug addict died in San Diego after being restrained in the back of a patrol car. No taser involvement.

Kevin Geldart: died after police, in an effort to restrain him, shot him multiple times with a Taser gun and sprayed him with pepper spray.

Roger Holyfield: the 17-year-old died in 2006 on the day after Jerseyville, Illinois police shocked him repeatedly with a Taser gun. "Holyfield died of natural causes after being restrained by the police, which occurred as a result of an episode of excited delirium", according to Jerseyville officials. [ [http://www.thetelegraph.com/onset?id=2341&template=article.html Top Stories: BREAKING NEWS: Report finds Tasered teen died of natural causes at www.thetelegraph.com] ]

Frederick Williams: died hours after police shocked him repeatedly with a Taser while in custody. After Williams' family announced they were suing, Taser International asserted that they would argue he died from excited delirium.cite web| url=http://www.npr.org/templates/story/story.php?storyId=7622314 |title=NPR : Tasers Implicated in Excited Delirium Deaths |accessdate=2007-09-07|publisher=NPR ]

Robert Dziekański: died at the Vancouver International Airport on October 14, 2007 after he was tasered by police. The RCMP and Taser International have ventured that the man died from "excited delirium" [ [http://www.cnn.com/2007/US/11/18/taser.death/index.html Man dies after police jolt him with stun gun - CNN.com] ] . It was reported that the distressed individual was acting in an erratic yet non-violent manner before four RCMP officers shocked him with a taser at least twice. After being pinned to the floor by the police he quickly became unresponsive and paramedics were unable to revive him when they arrived fifteen minutes after the incident. The officers did not attempt to perform CPR despite knowing he had no pulse. [ [http://www.cknw.com/news/news_local.cfm?cat=7428218912&rem=77107&red=80121823aPBIny&wids=410&gi=1&gm=news_local.cfm link to followup article reported by CKNW] , [http://www.cbc.ca/mrl3/8752/bc/ondemand/video/YVRTASERVIDEO.wmv link to video] ]

Austin Aylward Jr. died of Excited Delirium while in custody in Her Majesty's Penitentiary at St John's, Newfoundland on March 22, 2008.cite web |url=http://www.thetelegram.com/index.cfm?sid=123532&sc=79 |title=The Telegram - St. John's, NL: Local News | 'My son is dead?' |accessdate=2008-04-05 |author=Dave Bartlett |date= 2008-04-05 |publisher=The Telegram |quote=]

Lawrence Rogers died on August 31, 2002, after being transported to a hospital, following police attempts to restrain him. He died in the hospital and his survivors are suing the police and hospital. Melissa Waters v. City of Rochester, et al., No. 03-CV-6505-CJS (W.D.N.Y.).cite web |url=http://www.rochestercitynewspaper.com/archives/2002/9/Officer+down,+citizen+dead |title='Officer Down, Citizen Dead' |accessdate=2008-04-14 |author=City Newspaper |date=2002-09-11 |format= |work= |publisher=The City Newspaper |pages= |quote=] No taser involvement.

Stefan D. McMinn died on November 2, 2007, after being shocked about six times by two deputies at the Henderson County jail in Henderson County, NC. He went into cardiac arrest minutes after being shocked with the Taser and was taken to a hospital, where he was declared dead. McMinn was high on cocaine and drunk at the time. The pathologist who autopsied McMinn said that use of the Taser did not contribute to McMinn's death, but that cocaine, alcohol, and physical restraint likely did. [ [http://www.citizen-times.com/apps/pbcs.dll/article?AID=200880708147 Man died from 'excited delirium' | CITIZEN-TIMES.com | Asheville Citizen-Times ] ] McMinn's sickle cell anemia may have also played a role.

Howard Hyde died Nov. 22, 2007, about 30 hours after he was Tasered by Halifax police. He had been involved in a scuffle with jail guards at the Central Nova Scotia Correctional Facility in Dartmouth.Fact|date=September 2008

ee also

* Electroshock weapon controversy
* Sluggishly progressing schizophrenia
* Delirium tremens

References

External links

* [http://www.cbc.ca/news/background/tasers/excited-delirium.html Is 'excited delirium' at the root of many Taser deaths?] "CBC News" report by Armina Ligaya (2007).
* [http://www.theglobeandmail.com/servlet/story/RTGAM.20071130.wtaser30/BNStory/National/home?cid=al_gam_mostview Taser firms picked up coroner's lecture tab] "The Globe & Mail" (2007).
* [http://www.theglobeandmail.com/partners/free/infoway/ Symposium aims to define 'excited delirium'] "The Globe & Mail" (2007).
* [http://securities.stanford.edu/1033/TASR04_01/index.html Filings with S.E.C. & class actions for allegedly failing to disclose and misrepresention on safety.]
* [http://www.taser.com/research/Science/Pages/TASERBlameForInjuries.aspx Taser manufacturer's view]
* [http://www.cprc.org/tr/tr-2005-02_e.pdf Excited Delirium] Medical research review at the Canadian Police Research Centre
* [http://www.zarc.com/english/other_sprays/reports/excited_delirium.html Excited Delirium": A Two-Fold Problem ] S. Marshall Isaacs, M.D., San Francisco Department of Health, Paramedic Division, San Francisco, California