01/24/2023
A look at the reality, everyday complexities and potential fallout of violence.
๐ ๐๐๐๐๐๐๐ ๐๐๐๐ ๐๐ ๐๐๐๐๐๐ ๐๐๐๐๐๐๐ ๐๐ ๐๐ ๐๐๐ ๐๐๐๐๐ ๐๐
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๐๐๐๐๐๐๐ ๐๐๐๐๐๐๐๐.
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๐๐๐ ๐๐ ๐๐๐ ๐๐๐๐ ๐๐๐ ๐๐๐๐๐๐๐, ๐ ๐๐๐๐ ๐๐ ๐๐๐๐ ๐ ๐๐๐๐๐๐ ๐๐๐๐๐.
An Officers story
Picture the scene (Night Shift)
It is an unusually quiet Sunday evening for a usually remarkably busy city centre Police Station. The officer is on night duty with a colleague working on the front desk. The evening is going quite well and seems like the usual Sunday night, there are people coming in to collect family or friends who have been in custody, others coming in to report crimes, to give statements etc. It is about 23:00hrs when a familiar face walks in from the street, it is a local homeless guy who is looking for a warm and a chat, its quiet now so the officer tells him he can sit quietly in the corner but if it gets busy, he will have to leave. The Officer sometimes let the odd homeless guy keep in the warm as they all tend to trust him.
It is now around 01:00hr when a guy walks in crying and looking really agitated, shaking, and sweating profusely, the officer asks, โcan I help you sir?โ With that, the guy turns around and walks off laughing! Half an hour later he returns, still crying, again the officer asks if he can help him, the man then replies โif I had a gun and I was to pull it out no one would know, would they as I cannot see any CCTV in here! โ now the station does not have cameras in the front office and the matter had been raised on a few occasions prior to this event, the officer says โNot really, not really but I am here to offer you help, no matter what it is, I can try to help you!โ. Again, the guy walks away laughing.
The front office had once again gone quiet until approximately two hours later when the same guy walks into the station and gets on his knees and begins to prey, one minute he is crying and the next laughing which was changing one minuet to the next, still sweating and not listening to anything or anyone and seems to be in a manic type state. The homeless man tells him to talk to me and that I can help him. The Officer keeps asking him if he is ok but the guy on his knees is still preying and it seems as though he does not realise people are talking to him. Suddenly the guy gets up off his knees and pulls out what the Officer believed to be a gun and points it towards the officer, the officer stepped back, and his colleague hits the emergency shutter button, but it was that slow the guy jumped over the counter. The Officers colleague then hides under the desk as this man is potentially armed with a firearm leaving the officer on his own. The guy then disappears into the station. The officer immediately calls for assistance via the front office radio up to the RAD (Radio Allocator Dispatcher, or commonly known as the Controller). The controller tells the Officer that no one is available in the station, but Fi****ms have been called and are responding. meanwhile the officer goes on search for the man and after about half an hour of searching finally finds him in the basement of the Police Station. The officer approaches the man with extreme caution at the same time attempting to calm the man down, but he just ignores the fact that the officer is even there and is oblivious to what is happening around him. The man is standing shouting to an imaginary person, he is soaking with sweat. The officer approaches him on his own without waiting for back up as there are people behind the door that the man is standing by, so it was the officer felt it was his duty to make sure the other people were safe. All means of communicating with the man had failed and so the officer approaches looking for visible signs of a weapon. The officer takes his arm, and the man throws him off like he is a rag doll. The Officer tries again but the guy throws him off. The officer walks up behind him kicking him behind the knees at the same time bringing the guy backwards and wrestles with him, the guy has amazing strength and starts to fight the officer off, the officer just cannot control him. At this point, the fi****ms team turn up and take over the situation; there were approximately 10 officers at that time trying to control the man. He is finally restrained, and all the officers carry the guy up to the custody suite where he is detained. When he was searched there was an imitation firearm found on his person. The duty Dr was called, and it turned out that the guy was suffering from Excited Delirium after taking cannabis and crack co***ne. The parents of the guy said how much of a nice man he was and that he enjoyed a smoke and never had any problems before. The story turned out that his friends mixed crack with his Ma*****na, and he never knew which in turn caused ED and resulted in him being arrested.
That story is true and in fact the officer was me. Coming across someone with ED is a scary experience and no matter what you know, it does not help. We must approach it is a different way.
๐ช๐๐๐ง ๐ฆ๐๐๐ ๐๐๐๐๐ก๐๐ ๐๐ก๐ฆ๐ง๐ฅ๐จ๐๐ง๐ข๐ฅ๐ฆ ๐ฆ๐๐ข๐จ๐๐ ๐๐ก๐ข๐ช
On many occasions in my career, I have had to deal with individuals who were suffering from Excited Delirium (ED). It can be quite scary if you do not know what you are looking for and just go in with all guns blazing thinking you are dealing with just another aggressive individual. People suffering with ED are completely different and whatever physical skills you think you may have will not get you very far and that is why I teach our Pacifier concept. The only thing that springs to mind when explaining what the situation is like is โItโs like fighting against the terminatorโ
Please do not get mistaken by thinking I am talking about someone who may have taken drugs like He**in or Crack Co***ne, although they can have a lot of strength, this is a completely different thing. If you have not experienced, it before then please read on.
Excited Delirium (ED) is an acute behavioural disorder, with a range of symptoms. It has been linked to long-term drug use and mental illness. It is often attributed to deaths with Positional Asphyxia.
The need for understanding Excited Delirium is not just for professionals such as Police, Prison officers and medical staff but also for Self-Protection Instructors. Understanding the signs can help prevent a potentially dangerous situation. There are certain features associated with Excited Delirium that can be exhibited during the use of force encounter or in a Self Defence situation:
โ Pain tolerance https://www.youtube.com/watch?v=F4VeHOkt_o8 -
โ Constant/near constant activity
โ Not responsive to police presence
โ Superhuman strength https://www.youtube.com/watch?v=Uc3DJ0tq_FU
โ Rapid breathing
โ Does not fatigue
โ Naked/inappropriately clothed https://www.youtube.com/watch?v=Ai2bVK_BGHs
โ Elevated Body Temperature i.e.; Sweating profusely https://www.youtube.com/watch?v=gmxkC7wN7AE
โ Glass attraction/destruction.
โ Violent or bizarre Behaviour
โ Delirium
โ Agitation https://www.youtube.com/watch?v=6zQKfo_Q23g
โ Disorientation
โ Anxiety
โ Hallucinations
โ Speech Disturbances
If you happen to get caught up in a Violent encounter with someone suffering from Excited Delirium you will find that the person experiencing an episode of ED will not feel the exhaustion from fighting and will fight with everything they have got and then some. So, you must be prepared for a lengthy process that could ultimately either get yourself or the person suffering the episode killed.
In these circumstances the person attempting to defend themselves may respond with extra strength or manpower and this can end in an individual being restrained in a way that restricts oxygen intake, together with sudden exhaustion this can lead to death through lack of oxygen.
The risk of unknown medical issues together with the escalation in the use of force can cause multiple complications even death, Video shows male being arrested and excessive use of force by Police officers to a man with Excited Delirium, make note of the officer kneeling on the restrained man's back. https://www.youtube.com/watch?v=GdzpoS8pTks&has_verified=1
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Lacking the necessary knowledge to identify probable cases of Excited Delirium, you could be at a disadvantage in terms of safety for yourself, the individual having the ED episode, and the public. So, it is in the interest of yourself and the publicโs safety to provide training to ensure positive outcomes in cases of ever encountering someone who has Excited Delirium.
Training should include mental health issues, crisis-intervention, de-escalation, First Aid, CPR, and the Use of force.
There may not be too much you can do to fully mitigate the risks of excited delirium, but you may well be confronted by someone with excited delirium. Knowing what to look for can help. A mnemonic for recognising the symptoms:
NOT A CRIME, created by emergency physician and EMS medical director Dr. Michael Curtis:
N: Patient is naked and sweating from hyperthermia (opposite of hypothermia) body temperature of over 40ยฐc
O: Patient exhibits violence against objects, especially glass
T: Patient is tough and unstoppable, with superhuman strength and insensitivity to pain
A: Onset is acute, witness say the patient โjust snapped!โ
C: Patient is confused regarding time, place, purpose, and perception
R: Patient is resistant and will not follow commands to desist
I: Patientโs speech is incoherent, often with loud shouting and bizarre content
M: Patient exhibits mental health conditions or makes you feel uncomfortable
E: Emergency should request early backup and rapid transport to the Hospital
As with all violent situations someone faced with someone in a state of Excited Delirium should try and de-escalate the situation using verbal calming techniques. Due to the nature of acute behavioural disorder a personโs reaction to de-escalation techniques may be very unpredictable and so restraint may be needed. This should be kept to a minimum using a level of force that is justifiable, reasonable, and proportional to the individual case. If restraint is needed keeping a person in the prone position should be avoided at all costs and they should be constantly monitored.
As excited delirium is classed as a medical emergency and so the first line should be realising the difference between a violent outburst and excited delirium. If it is thought that someone is suffering from acute behavioural disorder emergency medical help should be sought out straight away so that they can be helped.
We now know that it is extreme mental & physiological excitement, characterised by extreme agitation, hypothermia, hostility, exceptional strength & endurance without fatigue.
Causes of Excited Delirium can be from a number of factors such as; Substance Abuse, Mental illness, Combination of Substance abuse & Mental illness.
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Unpredictable Reaction to: Co***ne, Methamphetamine, P*P, Discontinuation of anti-depressant medication.
๐ ๐๐ก๐ง๐๐ ๐๐๐๐ก๐๐ฆ๐ฆ
History of Depression, Schizophrenia or Bipolar Disease - History of Other Psychotic Background.
๐ฆ๐๐๐ก๐ฆ ๐๐ก๐ ๐ฆ๐ฌ๐ ๐ฃ๐ง๐ข๐ ๐ฆ
โ Hyperthermia โ overheating
โ Foaming at the mouth
โ Drooling
โ Dilated pupils
โ Unbelievable Strength
โ Impervious to Pain
โ Aggression
โ Hyperactivity
โ Elevated Pulse Rate
โ Extreme Paranoia
โ Incoherent Shouting / Noises
โ Bizarre and Violent Behaviour
โ Removal of Clothing
โ Able to Offer Effective Resistance to pain and fight for Extended Time
๐๐ข๐ ๐ฃ๐๐๐๐๐ง๐๐ข๐ก๐ฆ
โ Hyperthermia (dangerously high temperature)
โ Blood Acidosis
โ Electrolyte Imbalances
โ Breakdown of Muscle Cells Leading to Heart Arrhythmia
โ Susceptible to Ventricular Fibrillation
๐๐๐๐ฅ๐๐ฉ๐๐ง๐๐ก๐ ๐๐๐๐ง๐ข๐ฅ๐ฆ
โ Ineffective Respirations Caused by Extended Prone Restraint (positional asphyxia)
โ Extended Violent Resistance
โ Delayed Emergency Life Support
โ Death
๐ฅ๐๐๐ข๐ ๐ ๐๐ก๐๐๐ง๐๐ข๐ก๐ฆ
โ Emergency response, if possible, when Excited Delirium is recognised
โ Extra Training for all who may face people with excited delirium
โ Delay struggle/restraint process until enough personal are on hand to perform rapidly and safely
โ Immediate Emergency support upon restraint
โ Use of Force Options (pain compliance may not be effective)
โ Control Holds
โ Impact Weapons may not be effective (Remember the laws on use of force for your country)
โ Tasers โ Single Application **If in a country that the use of Tasers are legal** (not effective in pain compliance mode)
โ Restraint Positions
โ Avoid Extended Time in Prone Position
โ On Subjects Side
โ Supine
โ Monitor Vital Signs
โ Transportation
โ To Hospital by Ambulance
โ Restrained for Transport
โ Officer to Accompany Ambulance
๐๐ข๐ก๐๐๐จ๐ฆ๐๐ข๐ก
This is a life-threatening medical emergency which often presents itself as a law enforcement problem but can possibly happen within a Self Defence situation, effecting physical control may be dangerous and difficult and despite all precautions, death may still occur as the result of the excited delirium.
โ๐๐ ๐ฎ๐ค๐ช ๐๐ง๐ ๐๐ฃ๐จ๐ฉ๐ง๐ช๐๐ฉ๐ค๐ง๐จ, ๐ ๐ฌ๐ค๐ช๐ก๐ ๐ง๐๐๐ค๐ข๐ข๐๐ฃ๐ ๐ฉ๐๐๐ฉ ๐ฎ๐ค๐ช ๐ฉ๐๐๐๐ ๐ฉ๐๐๐จ ๐๐จ ๐ฅ๐๐ง๐ฉ ๐ค๐ ๐ฎ๐ค๐ช๐ง ๐๐ช๐ง๐ง๐๐๐ช๐ก๐ช๐ขโ
D J Norton
