Excited Delirium is a phenomenon considered a true medical emergency. It is a recognized brain disorder usually caused by high levels of alcohol intoxication or the ingestion of drugs like cocaine, methamphetamine and PCP. Although drugs are usually present in the system of a person exhibiting signs of excited delirium, there have been documented cases where no drugs were present in the patient’s system. (1)
EMS providers may be called to a scene by law enforcement to care for a patient who resisted arrest and is in the custody of law enforcement. Any time EMS is dispatched to a scene where a subject was known to resist law enforcement the EMS provider should suspect Excited Delirium. With some of the current training for law enforcement, EMS may be dispatched prior to the subject being in custody. For this reason, EMS should stage per local protocol until the subject is in custody and officers declare the scene secure.
With the safety of the EMS provider paramount, look for or receive the report of a sudden onset of bizarre and/or aggressive behavior. The patient may be shouting and exhibiting signs of paranoia. You may observe panic behavior with an attitude of violence toward others (specifically authority figures like police). There are numerous reports of people experiencing Excited Delirium having unexpected physical strength.
It may have been reported to have taken several officers, using a variety of tools (Mace, Taser, and baton strikes) and tactics to subdue the subject. It is reported that people experiencing Excited Delirium will be hyperthermic and tend to disrobe. Over 95% of all cases are reported to be males.
So, imagine a person, uninvolved, who walks up to your crash scene yelling about being stuck in traffic. He is loud and very animated. He is waving his arms and appears to be sweating profusely. He rips off his shirt, balls up his fists and challenges EMS and law enforcement. His speech is loud, rambling and sometimes in-coherent. The subject in this scenario is similar to a video circulating on the internet of an Oklahoma EMS crew assaulted at a crash scene.
Not all excited delirium cases are fatal but some are. In the cases of Fatal Excited Delirium, the patient appears clinically to consist of 4 distinct phases, which occur sequentially.
First there is an elevated temperature. Second is the onset of the agitated/excited delirium. Next comes respiratory arrest followed by death.(2) It is because of the recognition of these stages law enforcement agencies are training their officers to call for EMS response early when dealing with a person experiencing Excited Delirium. Officers have a responsibility to protect the subject after he is taken into custody.
Knowing the possibility of death can occur, the officers will enlist the help of EMS, since there is a belief that many in-custody deaths were a result of Fatal Excited Delirium. Police are being trained that unless the person experiencing Excited Delirium is a threat to others, he is more of a medical problem than that of a law enforcement one.
1)
http://www.exciteddelirium.org accessed 03-02-2010
2) Wetli CV, Mash D, and Karch SB. Cocaine-Associated Agitated Delirium and the Neuroleptic Malignant Syndrome. Am J Emerg Med 1996; 14: 425 - 428.
