Police modify ‘excited delirium’ response

Jen Lawson

Tuesday, Feb. 22, 2005 | 11:06 a.m.

"Excited delirium" may sound like how a gambler feels after winning at Megabucks, but medical experts say it's a condition that could lead to death during a violent struggle, and Metro Police have adopted a new policy on how to handle people in such a state.

The policy, which went into effect Feb. 9, says that if police encounter someone who appears to be in the throes of excited delirium -- combative, violent, aggressive toward objects, hot and sweaty, shaking, screaming, paranoid, removing clothing and injuring him or herself -- police must treat it as a medical emergency, not a crime.

Metro handled two high-profile cases last year in which men believed to be in a state of excited delirium, William Lomax and Keith Tucker, died after struggles with officers that included 50,000-volt shocks with Taser guns.

"We're not putting a label on someone to write off a dead suspect," said Deputy Chief Mike Ault, who spearheaded the policy. "We are trying to come up with a protocol to save these people's lives."

The main idea of the policy is this: Officers are required to contain or gain control of the person as fast as possible to keep them from harming themselves and others.

Then officers must quickly get medical care for those with excited delirium -- a condition said to be brought on by cocaine, methamphetamine and PCP -- instead of taking them to jail for charges such as resisting arrest, obstruction or disorderly conduct.

In a highly publicized 2001 case, police arrested a French national, Phillipe LeMenn, who was apparently going through an episode of excited delirium.

He was taken to the county detention center on a disorderly conduct charge after a violent struggle with police. He continued fighting with the jailers, then collapsed and died in his cell.

According to the policy, officers are permitted to resort to force to get the person under control, including using pepper spray, a baton or Taser if necessary. But first they are required to try to calm the person down verbally, call officers on the department's crisis intervention team to the scene to help and call emergency medical personnel.

Dr. Dale Carrison, director of emergency medicine at University Medical Center and a former deputy sheriff in Orange County, said the new procedure will help ratchet down situations so that force is not used as quickly.

"The time to get to the Taser is increased significantly," he said. "I think this (policy) is a good step. They're giving police officers options."

However, not everyone is embracing the policy wholeheartedly.

The ACLU of Nevada gave it tentative approval, but general counsel Allen Lichtenstein said it should have been instituted long ago.

"If the situation can be dealt with without an extreme use of force, it should be," Lichtenstein said. "That they are looking for ways to address this is a positive thing."

But, he added, "excited delirium" is police jargon, and it should not be used as a way to justify force or explain away a death.

Gary Peck, executive director of the ACLU of Nevada, was more critical. "This term is no more persuasive than 'sudden inmate death syndrome' as a way to explain why people die during altercations with police," Peck said.

Metro Deputy Chief Mike Ault disagrees. In August 2004, he attended a symposium of police executives in Washington, D.C. The topic was Taser use and in-custody deaths.

He returned to Las Vegas inspired to institute a new policy regarding excited delirium.

People have been dying in police custody under similar circumstances for as long anyone can remember, Ault said. As with the current controversy over Taser use, when pepper spray first came out there was a call to ban it because people were dying, Ault noted.

Ault said it is apparent to him that the tool isn't what is causing death, rather it is a medical condition that becomes deadly during periods of over-exertion.

"We are getting away from blaming the tool," Ault said. "These people reach a certain state where they can become aggravated to the point where their heart stops in a physical confrontation with police, regardless of what tool was used."

"We are recognizing excited delirium, treating it as a medical condition and trying to calm the situation," he continued. "You have to get them into custody quickly, get them cooled down quickly. We are no longer taking them to the jail where they rant and rave and get into fights with jailers."

But Peck said police shouldn't underestimate the potential danger of using Tasers. He pointed out that it's too early to say that the tool isn't to blame as no independent tests have been done on Tasers, except those performed by the manufacturer. The department should consider stopping or limiting Taser use until its safety can be assured, Peck said.

The phenomenon of excited delirium began emerging in medical journals in the late 1980s. It was first called "in-custody death syndrome" and described unexplained deaths when there was no apparent cause other than an arrest.

Sen. Joe Heck, R-Henderson, a doctor who serves as Metro's medical director, said excited delirium, also called agitated delirium, is a valid medical condition and can be brought on by the use of a stimulant.

Carrison used a runaway train analogy to describe someone in a state of excited delirium.

"It's going to go and go until it runs into something or someone jumps on and slows it down," he said. "What happens in the body is similar to what occurs during the fight-or-flight state. You're like a cocked and loaded gun about to go off."

Excited delirium-related deaths tend to follow 911 calls reporting a sweaty, frenzied man acting bizarre and causing a disturbance. Such behavior is linked to the ingestion of cocaine, methamphetamine or PCP.

The body temperature skyrockets, panic sets in and the person becomes incoherent and starts screaming, Carrison said. Officers sometimes find that the person has stripped naked and is completely out of control.

Carrison recalled a case five or six years ago in which a naked man fled from police, then jumped up and ripped a branch from a tree and started jamming it into his body. Sometimes people slash themselves with knives or bash in windows with their fists.

When in a state of excited delirium, "you don't want anyone around you because you think everyone around you is going to cause you more harm," he said. "You start throwing things, breaking things, you look wild-eyed."

Inside the body, the blood becomes acidic and metabolic acidosis sets in. Adrenaline levels, body temperature and the heart rate shoot up. A mind-body disconnect occurs, Ault said, and the person gains unusual strength and is immune to pain.

If the person becomes over-exerted and there is no medical intervention, a heart attack could occur.

Excited delirium would not be listed as a cause of death, but it could be considered a contributing factor, Clark County Coroner Mike Murphy said.

After researching the issue, Ault developed the policy for Metro in which those believed to be in a state of excited delirium, even if they are combative toward police, are considered to be in medical distress.

The policy says if it's possible, police should wait until medics arrive before trying to get the person into custody for medical treatment.

Officers should use two sets of handcuffs linked together to avoid further discomfort, help the person sit upright or lay on the side to make breathing easier and calm the person down by explaining the situation and that medical help is on its way.

If the person continues to fight with officers, they are permitted to use force as a last resort.

Officers are required to follow up by filling out a form that would commit the person to a mental health facility, and if a crime has occurred, book the person into the detention center in absentia or have an arrest warrant issued.

The department is training its officers on excited delirium, Ault said, and emergency medical personnel will also undergo training in accordance with Metro's policy.

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