1. Excited Delirium
Extreme mental & physiological excitement, characterized by extreme agitation, hyperthermia, hostility, exceptional strength & endurance without fatigue.

2. Excited Delirium Causes Substance Abuse Mental Illness
Combination of Substance Abuse and Mental Illness

3. Substance Abuse Unpredictable Reaction to: Cocaine Methamphetamine PCP
Discontinuation of anti-depressant medications

4. Mental Illness History of Depression, Schizophrenia or Bipolar Disease
History of Other Psychotic Background

5. Signs and Symptoms Hyperthermia – overheating Foaming at the mouth
Drooling
Dilated pupils
Unbelievable Strength
Impervious to Pain
Aggression
(cont.)

6. Signs and Symptoms Hyperactivity Elevated Pulse Rate Extreme Paranoia
Incoherent Shouting / Noises
Bizarre and Violent Behavior
Removal of Clothing
Able to Offer Effective Resistance to Multiple Officers for Extended Time

7. Complications Hyperthermia (dangerously high temp) Blood Acidosis
Electrolyte Imbalances
Breakdown of Muscle Cells Leading to Heart Arrhythmia
Susceptible to Ventricular Fibrillation
Death

8. Agrivating Factors
Ineffective Respirations Caused by Extended Prone Restraint (positional asphyxia)
Extended Violent Resistance
Multiple Taser Applications
Delayed Emergency Life Support

9. Recommendations
EMS response if possible when ED (excited delirium) is recognized
ED training for dispatchers
Delay struggle/restraint process until sufficient personal are on hand to perform rapidly and safely
Immediate EMS upon restraint
(cont)

10. Recommendations
Use of Force Options (pain compliance may not be effective)
Control Holds
Pepper Spray (may not be effective)
Impact Weapons (may not be effective)
Tasers – Single Application (not effective in pain compliance mode)
(cont)

11. Recommendations Restraint Positions
Avoid Extended Time in Prone Position
On Subjects Side
Supine
Monitor Vital Signs
(cont)

12. Recommendations Transportation To Hospital by Ambulance
Restrained for Transport
Officer to Accompany Ambulance

13. Excited Delirium
This is a life threatening medical emergency which often presents itself as a law enforcement problem
Effecting physical control may be dangerous and difficult
Despite all possible precautions death may still occur as the result of the excited delirium.