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Police Officers Safety AssocPolice Officers Safety Assoc
Presents
Arrest Related Deathsand Excited Delirium Syndrome
Police Officers Safety Assoc. - Affordable Realistic Tactical Training
www.posai.org
Police Officers Safety Assoc. - Affordable Realistic Tactical Training 2
The Police Officers Safety Associationis a subsidiary of the
Disabled Police and Sheriffs Foundation.A 501(c)(3) non-profit organization
whose primary mission is to develop,produce and distribute training programs
to law enforcement officers.
All of our programs areDistributed free of charge.
3Police Officers Safety Assoc. - Affordable Realistic Tactical Training
Permission is granted to copy or distributethis programs as long as
the Police Officers Safety Assoc.is given credit as the source.
4Police Officers Safety Assoc. - Affordable Realistic Tactical Training
This is the PowerPoint file thataccompanies the video presentation
of the same name.
Our videos are located atwww.posai.org
Police Officers Safety Assoc. - Affordable Realistic Tactical Training 5
Jerry StatonJerry StatonAffordable Realistic Tactical Training
Arrest Related Death Specialist Senior Master TASER Instructor
Certified Litigation Specialist Retired Austin PD – 25 years
Force Science Analyst
Not an Attorney Not a Doctor
Presented by
Arrest Related DeathsArrest Related Deaths
Police Officers Safety Assoc. - Affordable Realistic Tactical Training
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Course GoalsCourse Goals
Improve the odds for patient survival
Provide current information on ExDS
Encourage teamwork approach
Limit the risks to all parties
Police Officers Safety Assoc. - Affordable Realistic Tactical Training
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DisclaimerDisclaimer
Information you are about to receive was current when developed. No one shouldrely on information contained hereinfor an unreasonable period of time.
Police Officers Safety Assoc. - Affordable Realistic Tactical Training
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First responders need to know what to expect from other first responders.
Who Needs Training?Who Needs Training?
Police Officers Safety Assoc. - Affordable Realistic Tactical Training
Affordable Realistic Tactical Training 10
Who Else Needs Training?Who Else Needs Training?
11
A medical condition that requires police intervention
Police - capture, control, & restrain
EMS/Fire - sedate, treat, transport
Excited Delirium SyndromeExcited Delirium Syndrome
Police Officers Safety Assoc. - Affordable Realistic Tactical Training
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Label for any person displaying aspecific set of behaviors or traits
which puts them at risk forsudden death.
Identifying LabelIdentifying Label
Police Officers Safety Assoc. - Affordable Realistic Tactical Training
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ExDS DeathExDS Death
Sudden death during or after an agitated chaotic event involving
hyper activity + a negative autopsy.
Consider the similarities to SIDS.
Police Officers Safety Assoc. - Affordable Realistic Tactical Training
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Sudden DeathSudden Death
The World Health Organization Defines SD as cardio-respiratory
collapse that occurs within 24 hours of the onset of symptoms.
Police Officers Safety Assoc. - Affordable Realistic Tactical Training
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Time Not on Your SideTime Not on Your Side
Death often occurs within one or two hours of the onset of erratic behavior.
Police Officers Safety Assoc. - Affordable Realistic Tactical Training
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BriefBrief HistoryHistory
Sudden death is not new:
1406 Earliest known writing1849 Dr. Luther Bell (Journal of Insanity)1881 1st used Term “Excited Delirium” 1980s Term made popular describing
cocaine related deaths
Police Officers Safety Assoc. - Affordable Realistic Tactical Training
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1837-19491837-1949Similar observations recorded fromother medical professionals, some resulting in death, others survived
Police Officers Safety Assoc. - Affordable Realistic Tactical Training
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1949-19601949-1960
After 100+ years sudden death reports stopSedation most likely reason
Patients frequently medicated(neuroleptic & antipsychotic drugs - thorazine)
Police Officers Safety Assoc. - Affordable Realistic Tactical Training
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1960s SDs Reappear1960s SDs Reappear
Patients self-medicatingMental institutions closing
Police Officers Safety Assoc. - Affordable Realistic Tactical Training
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1970s Chokeholds + Restraint1970s Chokeholds + Restraint
LVNRSleeper Hold
Police Officers Safety Assoc. - Affordable Realistic Tactical Training
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1980s Hogtie (Restraint)1980s Hogtie (Restraint)Deaths blamed on positional asphyxia
Police Officers Safety Assoc. - Affordable Realistic Tactical Training
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1990s OC Spray + Restraint1990s OC Spray + Restraint
Police Officers Safety Assoc. - Affordable Realistic Tactical Training
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Currently ECDs + RestraintCurrently ECDs + Restraint
If you are look for a common link
Police Officers Safety Assoc. - Affordable Realistic Tactical Training
Look Beyond the ObviousLook Beyond the Obvious
Not likely the force used Some correlation with restraint
The strongest link is the condition of the person being restrained
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Plaintiff’s attorneys argue Excited Delirium is not a medically listed disease
They are right
The AMA, NAME, and the American College of Emergency Physicians
have recognized ExDS
Not a DiseaseNot a Disease
Police Officers Safety Assoc. - Affordable Realistic Tactical Training
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Excited DeliriumExcited Delirium
Not recognized as a disease and not found in the ICD-10, or DSM-4 numerous similar diseases are listed.
(ICD-10 & DSM-4 used for billing)
Police Officers Safety Assoc. - Affordable Realistic Tactical Training
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Manic Excitement
Abnormal Excitement
Psychomotor Excitement
Psychomotor Agitation
Agitation
Delirium
Delirium, Mixed Origin
Delirium, Drug-Induced
Classification of DiseaseClassification of Disease
Police Officers Safety Assoc. - Affordable Realistic Tactical Training
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Four Phases of Four Phases of Excited DeliriumExcited Delirium
Hyperthermia (not always)
Delirium w/agitation (super strength)
Respiratory arrest (breathing stops)
Cardiac arrest (PEA or asystole)
Police Officers Safety Assoc. - Affordable Realistic Tactical Training
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Primary Primary CausesCauses
Physical (head injury)
Infectious (meningitis)
Psychologic (mental illness)
Metabolic (low blood sugar)
Pharmacologic (stimulates)
Police Officers Safety Assoc. - Affordable Realistic Tactical Training
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PhysicalPhysical SignsSigns
NakedSweating
Running wildlyRunning in traffic
Often demonstrate:Violent behaviorBizarre behavior
Aggression toward glass
Police Officers Safety Assoc. - Affordable Realistic Tactical Training
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Superman?Superman?
Unlimited enduranceSuperhuman strengthReduced sense of pain
Violently resist:capture / control / restraint
before / during / after arrest
Police Officers Safety Assoc. - Affordable Realistic Tactical Training
Affordable Realistic Tactical Training 32
Physical CuesPhysical Cues
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Psychological IssuesPsychological Issues
HallucinationsIntense paranoiaExtreme agitationEmotional changesDisoriented about:
Time/Place/Purpose
DelusionalScattered ideas Easily distractedPsychotic appearanceDescribed as:
Just snappedFlipped out
Police Officers Safety Assoc. - Affordable Realistic Tactical Training
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CommunicationCommunication
Limited ability to comprehend commandsScreaming for no apparent reason
Talking to imaginary peopleGrunting, guttural sounds
Irrational speech Agonal breathing?
Police Officers Safety Assoc. - Affordable Realistic Tactical Training
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Who’s At RiskWho’s At Risk
Global issue
91 - 99% male31 - 44 years oldBizarre behavior episodeNormally involves prolonged struggle
Police Officers Safety Assoc. - Affordable Realistic Tactical Training
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Recognize Recognize Warning SignsWarning Signs
You Are Not BeingYou Are Not Being
Trained To Make ATrained To Make A Medical Diagnosis!Medical Diagnosis!
Police Officers Safety Assoc. - Affordable Realistic Tactical Training
Identify the EmergencyIdentify the Emergency
May wish to avoid having officers refer to “Excited Delirium Syndrome”
No background for medical diagnosis
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Need Different MindsetNeed Different Mindset
STRUGGLING and RESISTING can indicate an immediate
secondary to criminal prosecution
MEDICAL EMERGENCY
Police Officers Safety Assoc. - Affordable Realistic Tactical Training
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Assess
Capture
Control Restrain Sedate
Transport
Chart Have a Plan
A New ApproachA New Approach
Police Officers Safety Assoc. - Affordable Realistic Tactical Training
First Do No HarmFirst Do No Harm
Don’t aggravate the underlying acidosis!Minimize physical struggle
ECDs - great capture tool“Cuff Under Power”
40Police Officers Safety Assoc. - Affordable Realistic Tactical Training
When to SedateWhen to SedateLEOs cuff under power
Consider sedating under power
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Four Rescuer ControlFour Rescuer Control
Police Officers Safety Assoc. - Affordable Realistic Tactical Training
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Stop the CycleStop the Cycle
Chemical sedation can stop the battleReduce struggle against restraints
The sooner it is givenThe sooner it starts working
Police Officers Safety Assoc. - Affordable Realistic Tactical Training
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Follow the StudiesFollow the StudiesLatest independent study recently released by
National Institute of Justice :
Emergency medical treatment
Need EMS support ASAP Sedation, hydration and cooling
These protocols being utilized by some systems
Police Officers Safety Assoc. - Affordable Realistic Tactical Training
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Stimulant/Intoxication TriadStimulant/Intoxication Triad
Hyper
ther
mia
Acidosis Rhabdomyolysis
“TREAT THE TRIAD”
Agitation
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Multiple handcuffsLeg restraintsThe Wrap Hobble TARPRIPPERB
Package For TransportPackage For Transport
Police Officers Safety Assoc. - Affordable Realistic Tactical Training
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Crisis InterventionCrisis Intervention
Reasoning and talking may not work
Time is not on your side
THIS IS A MEDICAL EMERGENCY!
Police Officers Safety Assoc. - Affordable Realistic Tactical Training
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Needed EvidenceNeeded EvidenceCollect, preserve, record:
AED printoutHeat shock proteins Stimulant/drug levels
Core body temperatureBlood pressure reading
Methylone & Mephedrone
Police Officers Safety Assoc. - Affordable Realistic Tactical Training
Police Officers Safety Assoc. - Affordable Realistic Tactical Training 49
Training is NecessaryTraining is Necessary
Recognize the behaviors
Attempt to de-escalate when safe to do so
Wait for backup before making contact
Get the physical encounter over rapidly
Sedate and transport in ambulance to ER
50Police Officers Safety Assoc. - Affordable Realistic Tactical Training
51Police Officers Safety Assoc. - Affordable Realistic Tactical Training
For more FREE training programsVisit:
www.posai.og
Police Officers Safety AssocPolice Officers Safety Assoc
52Police Officers Safety Assoc. - Affordable Realistic Tactical Training
The Police Officers Safety Association is always striving to improve our programs.
Please email feedback on this program [email protected].
Thank you.