Frequency of signs of excited delirium syndrome in subjects undergoing police use of force: Descriptive evaluation of a prospective, consecutive cohort

Hall, Christine; Kader, Adam; McHale, Anne Marie Danielle; Stewart, Lauren; Fick, Gordon H.; Vilke, Gary M.

doi:10.1016/j.jflm.2012.05.008

Cited by 48 publications

(40 citation statements)

References 23 publications

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“…To date, a single prospective epidemiologic study of the characteristics of individuals undergoing police UoF has been carried out that documents the frequency with which the published features of ExDS were encountered. 19 In that study, the only individual who died demonstrated all ten features of ExDS during the police UoF event prior to death. In order to determine whether the ability to detect and document those features remains consistent across police officers in different communities, and to further evaluate whether a feature or cluster of features is suggestive of significant pathophysiology, the following study was undertaken.…”

Section: Introductionmentioning

confidence: 86%

“…3,17,18 This has been argued to indicate that an individual is in a highly abnormal state, one that could only be described as a medical emergency. 18 While individuals who have died of ExDS often display a high number of features, 19 it is currently unknown if a particular feature is more likely to co-occur with a large number of other features and whether a feature or smaller cluster of features is illustrative of underlying pathophysiology, or predicts death. It is possible that the evaluation of consistent symptomatology in live persons, before ARD, could determine a tipping point at which death ensues.…”

Section: Introductionmentioning

confidence: 99%

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Distinguishing features of Excited Delirium Syndrome in non-fatal use of force encounters

Baldwin

Hall

Bennell

et al. 2016

Journal of Forensic and Legal Medicine

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We demonstrate that there is the ability for law enforcement officers to consistently recognize and report features of ExDS that have been associated with ARD. The varying presence of features across the examined categories indicates that some features are more distinguishing than others, which may enable narrowing the scope of features that represent ExDS and understanding its pathophysiology. The current debate surrounding whether or not ExDS exists limits first responders and emergency physicians in their ability to increase awareness, improve training and interventions, and design appropriate policy and response protocols to reduce ARDs.

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Section: Introductionmentioning

confidence: 86%

Section: Introductionmentioning

confidence: 99%

Distinguishing features of Excited Delirium Syndrome in non-fatal use of force encounters

Baldwin

Hall

Bennell

et al. 2016

Journal of Forensic and Legal Medicine

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“…There are issues with the translation of laboratory studies, which are primarily conducted on healthy volunteers, to the community setting where subjects' physiology is often complicated by the presence of alcohol, stimulants or acute psychiatric distress, including the state of extreme psychomotor agitation and altered consciousness known as excited delirium. [17][18][19][20][21] There remains a deficiency in the systematic collection of high-quality data on the relationship between subject positioning and occurrence of sudden in-custody death under real-world conditions. While several case series exist that document outcomes in proned subjects, the true effect of positioning cannot be examined for its role in sudden in-custody death if only prone positioning is evaluated.…”

Section: Of 19mentioning

confidence: 99%

Restraint in police use of force events: Examining sudden in custody death for prone and not-prone positions

Hall

Votova

Heyd

et al. 2015

Journal of Forensic and Legal Medicine

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Despite continued cases of sudden in-custody death in subjects who are restrained, little is understood about the incidence of sudden death, its underlying pathophysiology, or its actual relationship to subject positioning. This paper reports data from 4828 consecutive use of force events (August 2006-March 2013 in 7 Canadian police agencies in 4 cities including Eastern and Western Canada. Methods: Human subjects committee approval was obtained in each city with approval for enrolment of subjects without consent. Consecutive subjects aged >18 years who were involved in a police use of force event were included regardless of the cause or outcome. Officers prospectively documented the final resting position of the subject, whether there was knowledge or suspicion that the subject was intoxicated with alcohol and/or drugs, suffering from emotional distress or any combination of those, the number and nature of a standardized list of features of excited delirium present, and the use of all force modalities alone or in combination. Our outcome of interest was sudden, unexpected in-custody death. Confidence intervals for differences were considered significant if the 95% confidence interval for the difference did not include zero. Assuming an alpha error of 5%, a beta error of 20%, a sample size of 1945 subjects per group gives our study 80% power to detect a difference of 0.5% in sudden death between the prone and not prone position. Results: During the study there were over 3.25 million consecutive police-public interactions; use of force occurred in 4,828 subjects (0.1% of police public interactions; 95% CI = 0.1%, 0.1%). 90% of subjects had complete information on positioning; none of the subjects without documentation of positioning died. Subjects were usually male (87.5%); median age 32 years. Subjects were abnormal with 81.5% of subjects documented to have one or more of alcohol and/or drug intoxication, and/or psychiatric/emotional distress at the scene. Significantly more subjects remained in a non-prone vs. prone position; yet over 2000 subjects remained prone. Although 5.3% more subjects with any assessed comorbidity were in the "not-prone" position, over 1500 with any assessed comorbidity were prone. Significantly more individuals with >3 features of excited delirium were not-prone while significantly more subjects with drug intoxication alone were in prone. There was no difference in CEW deployment in any mode between the positions. One individual died suddenly and unexpectedly; the individual was in the not prone position and exhibited all 10 features of excited delirium. No subject died in the prone position. In a worst case scenario our confidence intervals indicate, with a high degree of precision, that 99.8% of subjects would be expected to survive being in either the prone or notprone position following police use of force. Conclusions: Prone positioning is common following police-public interactions. In this study no subject died among thousands who remained in the prone position after po...

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“…As noted by Dr. G. Vilke, when excited-delirium syndrome is observed in an emergency department, the majority of patients can be treated, with an estimated mortality of 8-11% (50). In one cohort of consecutive subjects who experienced law-enforcement use of force and exhibited signs of excited delirium, the only death that occurred was in a subject with ten concomitant signs of the syndrome (51). Untreated excited delirium, though, is associated with a high mortality rate (52).…”

Section: Potential Involvement Of Excited Delirium During Incidents Imentioning

confidence: 98%

Exposures to Conducted Electrical Weapons (IncludingTASER^®Devices): How Many and for How Long are Acceptable?

Jauchem

2014

Journal of Forensic Sciences

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TASER(®) conducted electrical weapons (CEWs) are an important law-enforcement tool. The purposes of this study are a) to review recent literature regarding potential pathophysiological responses to applications of CEWs, and other related issues and b) to evaluate whether enough data exist to determine the acceptability of longer-duration (or repeated) exposures. This is a narrative review, using a multidisciplinary approach of analyzing reports from physiological, legal-medical, and police-strategy literature sources. In general, short-duration exposures to CEWs result in limited effects. Longer-duration or repeated exposures may be utilized with caution, although there are currently not enough data to determine the acceptability of all types of exposures. Data examined in the literature have inherent limitations. Appropriateness of specific types of CEW usage may be determined by individual police agencies, applying risk/benefit analyses unique to each organization. While more research is recommended, initial concepts of potential future long-duration or repeated CEW applications are presented.

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Frequency of signs of excited delirium syndrome in subjects undergoing police use of force: Descriptive evaluation of a prospective, consecutive cohort

Cited by 48 publications

References 23 publications

Distinguishing features of Excited Delirium Syndrome in non-fatal use of force encounters

Distinguishing features of Excited Delirium Syndrome in non-fatal use of force encounters

Restraint in police use of force events: Examining sudden in custody death for prone and not-prone positions

Exposures to Conducted Electrical Weapons (IncludingTASER^®Devices): How Many and for How Long are Acceptable?

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Frequency of signs of excited delirium syndrome in subjects undergoing police use of force: Descriptive evaluation of a prospective, consecutive cohort

Cited by 48 publications

References 23 publications

Distinguishing features of Excited Delirium Syndrome in non-fatal use of force encounters

Distinguishing features of Excited Delirium Syndrome in non-fatal use of force encounters

Restraint in police use of force events: Examining sudden in custody death for prone and not-prone positions

Exposures to Conducted Electrical Weapons (IncludingTASER®Devices): How Many and for How Long are Acceptable?

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Product

Resources

About

Exposures to Conducted Electrical Weapons (IncludingTASER^®Devices): How Many and for How Long are Acceptable?