Ormrod Lecture October 2019: Police restraint – causes of death

Aw-Yong, Meng

doi:10.1177/0025802420915329

Cited by 7 publications

(5 citation statements)

References 8 publications

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“…Here in England and Wales, Dr Meng Aw Yong, medical director for Forensic Healthcare Services of the Metropolitan Police, lectures on the dangers of acute behavioural disturbance, not excited delirium, and says ABD is ‘itself not a definitive condition’ but rather a description of ‘a spectrum of behaviours, signs and symptoms’ (Aw-Yong, 2020, p. 228). Dr Aw Yong is seeking to persuade ambulance services to upgrade these cases to matters of the highest priority.…”

Section: The Future For Excited Deliriummentioning

confidence: 99%

‘Excited Delirium’, acute behavioural disturbance, death and diagnosis

McGuinness¹,

Lipsedge

2022

Psychol. Med.

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In the 1980s the traditional Hippocratic term excited delirium was transplanted from the bedsides of febrile, agitated and disoriented patients to the streets of Miami. Deaths in custody of young men who were intoxicated with cocaine and who were restrained by the police because of their erratic or violent behaviour were attributed to excited delirium. The blood concentrations of cocaine in these subjects were approximately ten times lower than the lethal level and other factors which might have contributed to the fatal outcome, such as the police use of neck-holds, choke-holds or ‘hog-tying’, were relegated to a minor role compared with the reframed ‘diagnosis’ of excited delirium. Over the course of the next few decades ‘excited delirium’ might be applied to virtually any highly agitated person behaving violently in a public place and who subsequently died in custody while being restrained or shortly afterwards. Expert witnesses, mainly forensic pathologists, testified that the deceased's death was probably inevitable given the perilous nature of excited delirium, even though this diagnostic entity lacked any consistent neuropathological basis and depended entirely on observed behaviour. This history of the rise and fall of this disputed diagnosis is a partial response to the sociologist Phil Brown's 1995 paper asking who benefits, or at least avoids trouble, by the identification and use of a diagnosis.

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Section: The Future For Excited Deliriummentioning

confidence: 99%

‘Excited Delirium’, acute behavioural disturbance, death and diagnosis

McGuinness¹,

Lipsedge

2022

Psychol. Med.

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“…Sadly, some deaths in the context of ABD have been linked to both physical restraint delivered by law enforcement professionals [ 8 , 9 ] and pharmacological restraint delivered by paramedics in the US [ 10 ]. In the UK, the role of some paramedics in restraint decision-making is evolving, with the recent introduction of pharmacological restraint in some Emergency Medical Services (EMS) [ 11 ], following the development of advanced paramedics (APs) and growing concerns in this area of practice. ABD patients typically present initially to police services in public spaces or in police custody [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

“…” [ 16 ]. Furthermore, restraint-related research in the in-patient psychiatric setting has highlighted that other healthcare professionals rely on tacit knowledge when making restraint decisions [ 17 ], an issue which may be particularly relevant to APs whose scope of practice has been recently developed to include pharmacological restraint [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Advanced paramedics’ restraint decision-making when managing acute behavioural disturbance (ABD) in the UK pre-hospital ambulance setting: A qualitative investigation

Lindridge,

Edwards,

Blackwood

2024

PLoS ONE

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Acute behavioural disturbance (ABD), sometimes called ‘excited delirium’, is a medical emergency. In the UK, some patients presenting with ABD are managed by advanced paramedics (APs), however little is known about how APs make restraint decisions. The aim of this research is to explore the decisions made by APs when managing restraint in the context of ABD, in the UK pre-hospital ambulance setting. Seven semi-structured interviews were undertaken with APs. All participants were experienced APs with post-registration, post-graduate advanced practice education and qualifications. The resulting data were analysed using reflexive thematic analysis, informed by critical realism. We identified four interconnected themes from the interview data. Firstly, managing complexity and ambiguity in relation to identifying ABD patients and determining appropriate treatment plans. Secondly, feeling vulnerable to professional consequences from patients deteriorating whilst in the care of APs. Thirdly, negotiating with other professionals who have different roles and priorities. Finally, establishing primacy of care in relation to incidents which involve police officers and other professionals. A key influence was the need to characterise incidents as medical, as an enabler to establishing clinical leadership and decision-making control. APs focused on de-escalation techniques and sought to reduce physical restraint, intervening with pharmacological interventions if necessary to achieve this. The social relationships and interactions with patients and other professionals at the scene were key to success. Decisions are a source of anxiety, with fears of professional detriment accompanying poor patient outcomes. Our results indicate that APs would benefit from education and development specifically in relation to making ABD decisions, acknowledging the context of inter-professional relationships and the potential for competing and conflicting priorities. A focus on joint, high-fidelity training with the police may be a helpful intervention.

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“…6,7 Authors in both the UK and USA have highlighted concerns about its use as the explanatory cause of death in situations where people have died under restraint, and in particular, its greater use in Black men. [8][9][10] However, others have argued that it merits recognition as a 'potentially life-threatening syndrome' linked to rapid deterioration and death, which is useful for emergency responders to be able to recognise. 1 In response to this ongoing controversy, the Royal College of Psychiatrists set up an Expert Reference Group to produce a position paper on the issue.…”

mentioning

confidence: 99%

Use of ‘acute behavioural disturbance’ in mental health records: differences over time and by ethnicity in a London NHS mental health Trust

et al. 2023

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Background Acute behavioural disturbance (ABD) is a controversial descriptor for presentations of severe agitation, aggression and physiological compromise. Aims To characterise the use of ABD-related terms in the electronic record of a large UK provider of mental health services during 2006–2021. Method The free text of all records relating to patient contacts with acute assessment mental health teams during 2006–2021 were searched for references to ABD. Identified text was coded for context of use and presence of clinical features of ABD described in the literature. Poisson regression was used to analyse differences in rates of use over time and between demographic groups. Results Mentions of ABD increased by an average of 1.12 (95% confidence interval (CI), 1.08–1.17) per year, with the greatest increase from 2019 to 2021. Black people were more than twice as likely as White people to have reference to ABD included in their assessments (rate: 2.4/1000 (95% CI 1.8–3.1) in Black people compared with 1.0/1000 (95% CI 0.8–1.3) in White people). The clinical characteristics in notes describing a current presentation of ABD rarely corresponded to those included in UK medical guidelines on ABD. Conclusions The term ABD in mental health notes appears to often, but not exclusively, be a synonym for severe agitation and conveys little meaning beyond this. However, the term's connection to a literature emphasising the high risk of physical health collapse and need for urgent treatment means that its disproportionate use in Black people may contribute to existing racial inequalities in the use of coercive measures during crisis presentations.

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Ormrod Lecture October 2019: Police restraint – causes of death

Cited by 7 publications

References 8 publications

‘Excited Delirium’, acute behavioural disturbance, death and diagnosis

‘Excited Delirium’, acute behavioural disturbance, death and diagnosis

Advanced paramedics’ restraint decision-making when managing acute behavioural disturbance (ABD) in the UK pre-hospital ambulance setting: A qualitative investigation

Use of ‘acute behavioural disturbance’ in mental health records: differences over time and by ethnicity in a London NHS mental health Trust

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