Excited Delirium

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Presented by:Presented by: Jerry StatonJerry Staton

Affordable Realistic Tactical TrainingAffordable Realistic Tactical TrainingSenior Master TASER InstructorSenior Master TASER Instructor

In-custody Death SpecialistIn-custody Death Specialist

What first responders need to knowWhat first responders need to know

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Distinguish between Excited Delirium & mental illness

Provide best care for the patient

Minimize risk and liability to all firstresponders (police, fire, EMS)

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ED is a Medical Emergency

Police – Contain, Capture, Control, & Restrain

Medics - Sedate, Treat, & Transport

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A label for any person displaying a specific set of behaviors or traits

which puts them at an increased risk for dying while in your care.

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MetabolicInfectious

PharmacologicalPsychological

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Phase I: Hyperthermia (not always)

Phase II: Delirium (incoherent)

Phase III: Respiratory ArrestPhase IV: Cardiac Arrest

Who Needs Training

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All first responders need to know the capabilities of the other players.

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Plaintiff’s attorneys argue Excited Delirium is not a medically recognized disease.

They are right The American College of Emergency Physicians and the AMA have recently

recognized Excited Delirium as a Condition.

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Manic Excitement

Abnormal Excitement

Psychomotor Excitement

Psychomotor Agitation

Agitation

Delirium

Delirium, Mixed Origin

Delirium, Drug-Induced

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Bell’s maniaDelirium graveAcute delirium

Excited catatoniaLethal catatonia

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SuddenSudden

UnintendedUnintended

UnexplainableUnexplainable

Negative autopsyNegative autopsy

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Sudden Deaths in the U.S.

1849 Dr. Bell, 40 patients / 30 deaths 1881 Term ED in medical literature1849-1947 Similar reports of SD1948-1960 No SD reports (sedation)1960-1980 SD reports reappear 1980s Drastic increase in SD (cocaine)

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Indicators for ED are similar to ones exhibited by a mentally ill person or an overdose

Medical Emergency

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91 to 99% maleBetween the ages of 35-44 Usually involved in a struggleOften follows bizarre behavior The long-term use of illegal drugsMental issues (bipolar & schizophrenia)

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NakedRunning wildly

Running in trafficOften demonstrate:

Violent behaviorBizarre behavior

Aggression toward glass

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Unlimited enduranceSuperhuman strengthReduced sense of pain

Muscle rigidityViolently resist:

capture / control / restraintbefore / during / after arrest

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HallucinationsIntense paranoiaExtreme agitationEmotional changesDisoriented about:

Time/Place/Purpose

DelusionalScattered ideas Easily distractedPsychotic appearanceDescribed as:

Just snappedFlipped out

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Pressured, loud, incoherent speechScreaming for no apparent reason

Talking to imaginary peopleGrunting, guttural sounds

Irrational speech

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Pepper Spray Death

TASER Death

Hogtie Death

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Agitation & Exertion

HyperthermiaAcidosis &

Rhabdomyolysis

“TREAT THE TRIAD”

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Access

Capture

Control Restrain Sedate

Transport

Chart

Plan

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No medical research to verify sedation and/or chemical restraint is the best answerAvailable options currently in use

Valium (Diazepam)Haldol (Haloperidol)Versed (Midazolam) In use in two healthcare systemsKetamine (Ketalar) In use in two healthcare systems

Key – Administer enough to achieve sedation

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At the 2007 IPICD Conference the Miami-Dade program administratorannounced 37 incidents involving patients displaying ED symptoms

Deputy Chief J. Gardner

Zero Deaths

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Urgent and ImmediateExtra manpower needed

Crew safetyMultiple treatments (CPR)Police if transported with handcuffs

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Monitor patient (Pulse, Rate, Respirations)IV fluid administration (Normal Saline 0.09%)

ED patients typically need 20 L in first 24 hrsConsider using cooled fluids (60 degrees)

Counter Acidosis – Raise ph levelControlling ventilationAdministering Bicarb

IV Drip 50 Meq Bicarb/1000 ml NS rapid infusionMay repeat once

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Miami-Dade Fire/EMS Versed Sedation, Cooling and Bicarb

Nashville Fire/EMS Versed Sedation only

Champaign, Illinois Ketamine Sedation

Appleton, Wisconsin Haloperidol Sedation

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Patients behavior prior to and after arrival of responders (police)Capture, Control and Restraint techniques

TASER deployment and probe removalHandcuff vs Soft Restraints

Treatments and ResponseDetails, Details, Details

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Carefully review policies & proceduresLiability is important but should not be your number one priorityExcited Delirium is a MEDICAL EMERGENCYPolice and EMS need to train and work together in the management of Excited Delirium patients

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Presented by:Presented by: Jerry StatonJerry Staton

Affordable Realistic Tactical TrainingAffordable Realistic Tactical TrainingSenior Master TASER InstructorSenior Master TASER Instructor

In-custody Death SpecialistIn-custody Death Specialist