1. 1 Police Officers Safety Assoc Presents Arrest Related Deaths and Excited Delirium Syndrome Police Officers Safety Assoc. - Affordable Realistic Tactical Training www.posai.org

2. Police Officers Safety Assoc. - Affordable Realistic Tactical Training 2 The Police Officers Safety Association is 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 are Distributed free of charge.

3. 3 Police Officers Safety Assoc. - Affordable Realistic Tactical Training Permission is granted to copy or distribute this programs as long as the Police Officers Safety Assoc. is given credit as the source.

4. 4 Police Officers Safety Assoc. - Affordable Realistic Tactical Training This is the PowerPoint file that accompanies the video presentation of the same name. Our videos are located at www.posai.org

5. Police Officers Safety Assoc. - Affordable Realistic Tactical Training 5 Jerry Staton Affordable Realistic Tactical Training Arrest Related Death Specialist Senior Master TASER Instructor Certified Litigation Specialist Retired Austin PD – 25 years Force Science Analyst Not an AttorneyNot a Doctor Presented by

6. Arrest Related Deaths Arrest Related Deaths Police Officers Safety Assoc. - Affordable Realistic Tactical Training

7. 7 Course 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

8. 8 Disclaimer Information you are about to receive was current when developed. No one should rely on information contained herein for an unreasonable period of time. Police Officers Safety Assoc. - Affordable Realistic Tactical Training

9. 9 First responders need to know what to expect from other first responders. Who Needs Training? Police Officers Safety Assoc. - Affordable Realistic Tactical Training

10. Affordable Realistic Tactical Training 10 Who Else Needs Training?

11. 11 A medical condition that requires police intervention Police - capture, control, & restrain EMS/Fire - sedate, treat, transport Excited Delirium Syndrome Police Officers Safety Assoc. - Affordable Realistic Tactical Training

12. 12 Label for any person displaying a specific set of behaviors or traits which puts them at risk for sudden death. Identifying Label Police Officers Safety Assoc. - Affordable Realistic Tactical Training

13. 13 ExDS 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

14. 14 Sudden 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

15. 15 Time 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

16. 16 Brief History Brief History Sudden death is not new: 1406 Earliest known writing 1849 Dr. Luther Bell (Journal of Insanity) 1881 1 st used Term “Excited Delirium” 1980s Term made popular describing cocaine related deaths Police Officers Safety Assoc. - Affordable Realistic Tactical Training

17. 17 1837-1949 Similar observations recorded from other medical professionals, some resulting in death, others survived Police Officers Safety Assoc. - Affordable Realistic Tactical Training

18. 18 1949-1960 After 100+ years sudden death reports stop Sedation most likely reason Patients frequently medicated (neuroleptic & antipsychotic drugs - thorazine) Police Officers Safety Assoc. - Affordable Realistic Tactical Training

19. 19 1960s SDs Reappear Patients self-medicating Mental institutions closing Police Officers Safety Assoc. - Affordable Realistic Tactical Training

20. 20 1970s Chokeholds + Restraint LVNR Sleeper Hold Police Officers Safety Assoc. - Affordable Realistic Tactical Training

21. 21 1980s Hogtie (Restraint) Deaths blamed on positional asphyxia Police Officers Safety Assoc. - Affordable Realistic Tactical Training

22. 22 1990s OC Spray + Restraint Police Officers Safety Assoc. - Affordable Realistic Tactical Training

23. 23 Currently ECDs + Restraint Currently ECDs + Restraint If you are look for a common link Police Officers Safety Assoc. - Affordable Realistic Tactical Training

24. Look Beyond the Obvious Not likely the force used Some correlation with restraint The strongest link is the condition of the person being restrained 24 Police Officers Safety Assoc. - Affordable Realistic Tactical Training

25. 25 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 Disease Police Officers Safety Assoc. - Affordable Realistic Tactical Training

26. 26 Excited 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

27. 27 Manic Excitement Abnormal Excitement Psychomotor Excitement Psychomotor Agitation Agitation Delirium Delirium, Mixed Origin Delirium, Drug-Induced Classification of Disease Classification of Disease Police Officers Safety Assoc. - Affordable Realistic Tactical Training

28. 28 Four Phases of Excited 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

29. 29 Primary Causes Primary Causes Physical (head injury) Infectious (meningitis) Psychologic (mental illness) Metabolic (low blood sugar) Pharmacologic (stimulates) Police Officers Safety Assoc. - Affordable Realistic Tactical Training

30. 30 Physical Signs Naked Sweating Running wildly Running in traffic Often demonstrate: Violent behavior Bizarre behavior Aggression toward glass Police Officers Safety Assoc. - Affordable Realistic Tactical Training

31. 31 Superman? Unlimited endurance Superhuman strength Reduced sense of pain Violently resist: capture / control / restraint before / during / after arrest Police Officers Safety Assoc. - Affordable Realistic Tactical Training

32. Affordable Realistic Tactical Training 32 Physical Cues

33. 33 Psychological Issues Hallucinations Intense paranoia Extreme agitation Emotional changes Disoriented about: Time/Place/Purpose Delusional Scattered ideas Easily distracted Psychotic appearance Described as: Just snapped Flipped out Police Officers Safety Assoc. - Affordable Realistic Tactical Training

34. 34 Communication Limited ability to comprehend commands Screaming for no apparent reason Talking to imaginary people Grunting, guttural sounds Irrational speech Agonal breathing? Police Officers Safety Assoc. - Affordable Realistic Tactical Training

35. 35 Who’s At Risk Global issue 91 - 99% male 31 - 44 years old Bizarre behavior episode Normally involves prolonged struggle Police Officers Safety Assoc. - Affordable Realistic Tactical Training

36. 36 Recognize Warning Signs You Are Not Being Trained To Make A Trained To Make A Medical Diagnosis! Medical Diagnosis! Police Officers Safety Assoc. - Affordable Realistic Tactical Training

37. Identify the Emergency May wish to avoid having officers refer to “Excited Delirium Syndrome” No background for medical diagnosis 37 Police Officers Safety Assoc. - Affordable Realistic Tactical Training

38. 38 Need Different Mindset STRUGGLING and RESISTING can indicate an immediate secondary to criminal prosecution MEDICAL EMERGENCY Police Officers Safety Assoc. - Affordable Realistic Tactical Training

39. 39 Assess Capture Control Restrain Sedate Transport Chart Have a Plan A New Approach Police Officers Safety Assoc. - Affordable Realistic Tactical Training

40. First Do No Harm Don’t aggravate the underlying acidosis! Minimize physical struggle ECDs - great capture tool “Cuff Under Power” 40 Police Officers Safety Assoc. - Affordable Realistic Tactical Training

41. When to Sedate LEOs cuff under power Consider sedating under power 41 Police Officers Safety Assoc. - Affordable Realistic Tactical Training

42. 42 Four Rescuer Control Police Officers Safety Assoc. - Affordable Realistic Tactical Training

43. 43 Stop the Cycle Chemical sedation can stop the battle Reduce struggle against restraints The sooner it is given The sooner it starts working Police Officers Safety Assoc. - Affordable Realistic Tactical Training

44. 44 Follow the Studies Latest 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

45. 45 Stimulant/Intoxication Triad Hyperthermia Acidosis Rhabdomyolysis “TREAT THE TRIAD” Agitation Police Officers Safety Assoc. - Affordable Realistic Tactical Training

46. 46 Multiple handcuffs Leg restraints The Wrap Hobble TARP RIPP ERB Package For Transport Police Officers Safety Assoc. - Affordable Realistic Tactical Training

47. 47 Crisis 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

48. 48 Needed Evidence Collect, preserve, record: AED printout Heat shock proteins Stimulant/drug levels Core body temperature Blood pressure reading Methylone & Mephedrone Police Officers Safety Assoc. - Affordable Realistic Tactical Training

49. 49

50. Training 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 50 Police Officers Safety Assoc. - Affordable Realistic Tactical Training

51. 51 Police Officers Safety Assoc. - Affordable Realistic Tactical Training For more FREE training programs Visit: www.posai.og Police Officers Safety Assoc

52. 52 Police 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 to dkenik@posai.org. Thank you.