Excited Delirium is Now Recognized by the American College of Emergency Physicians as an Unique Syndrome

The American College of Emergency Physicians formally recognized excited delirium as a unique syndrome at the Scientific Assembly in Boston last month, taking an initial step toward identifying its causes and preventing the deaths that can occur in these patients.

Excited Delirium Syndrome (ExDS) has long been the sole purview of medical examiners, largely because the syndrome is often only diagnosed on autopsy. But as Mark L. DeBard, MD, the chairman of the ExDS Task Force, said, ACEP's approval of the task force white paper allows emergency physicians not only to recognize the syndrome and save lives, but to force it into the consciousness of law enforcement and emergency medical services.

Marty Johnson Appears on EMSEducast.com and discusses Excited Delirium and EMS Legal Aspects

EMS Educast.com recently had Marty Johnson as a guest and discussed Excited Delirium and Legal Aspect. Listen to the podcast and hear Marty tell about his experiences with Excited Delirium and facing Murder Charges. Marty also answers quested from the EMS Educast hosts and gives his unique perspective as only he can.

Our colleagues in Miami-Dade County, Florida, first described the syndrome of excited delirium associated with cocaine abuse. The symptoms of excited delirium include bizarre and/or aggressive behavior, shouting, paranoia, panic, violence towards other people, unexpected physical strength, and hyperthermia. Throughout the United States and Canada, these cases are frequently associated with psychostimulant abuse, representing the extreme end of a psychiatric continuum of drug abuse effects. However, reports of acute exhaustive mania, physical restraint, Pepper Spray or TASER and sudden death also have been reported that are not related to abused drugs, suggesting further that an underlying central nervous system disorder was the precipitating cause of lethality. Such victims of excited delirium have provoked allegations of police misconduct, unnecessary force and improper TASER deployment.

Patients exhibiting signs of excited delirium present unique challenges for EMS

Historically, a naked, screaming and agitated individual standing in a busy roadway during rush hour traffic required only law enforcement response. Police were expected to remove the subject from the roadway and take him to an appropriate facility. When force was used to subdue the subject, injuries were commonplace, and fire departments and EMS responded at the request of the police and treated the injuries. Medical treatment was focused upon clearing the subject for incarceration into a jail facility. Unfortunately, this scenario often resulted in the untimely and unnecessary death of the subject.

You respond to a “man who’s acting strangely holding a bat.” On arrival, you see several police cars with lights flashing in the intersection. As you approach the scene, a police officer informs you they were called for a naked man who was screaming and breaking car windows. You see the subject in the middle of the street. He’s a large, obese man who’s wielding a bat and screaming, “Make them stop!”

During a three-day period in June 2004, 3 individuals died after being restrained by police in Florida, Minnesota, and California. All had exhibited bizarre behavior necessitating police intervention. All arrests involved struggle and subsequent restraint, including one situation where the individual was struggling with neighbors prior to police and EMS arrival. All arrests eventually required the deployment of OC spray, a TASER device, or both. In the California case, the suspect was evaluated and cleared by EMS prior to being transported to jail. Within two miles from the scene, the patient began to complain of difficulty breathing and subsequently died. In the Minnesota case, the suspect became unresponsive shortly after being cuffed, and was pronounced dead at a local emergency department. In the Florida case, the patient was taken to an emergency department where he died. All final autopsy reports are pending at this time.

Do you want to see an actual Excited Delirium incident? Not only an actual Excited Dilirium Incident, but an incident with a good outcome. Appleton Winconcin shows how Excited Dilirium can be handled when law enforcement and EMS train together and work together to provide a good outcome out of possible disaster.