The Changing Face of ‘Excited Delirium’

Before police were eventually led to using Tasers against Meriden residents Donovan Graham in 2008 and Noel Mendoza this June, both exhibited characteristics commonly associated with excited delirium syndrome. The men were sweating profusely, showed signs of respiratory distress and when approached, became aggressive and attacked police with superhuman strength and seemingly endless endurance.

Officers were left with no choice but to use force, especially as efforts to calm the men turned violent, and both eventually died following their struggle with police; Graham as a result of Excited Delirium according to autopsy reports and Mendoza from a cause not yet determined. Tasers were ruled out as a cause in both deaths.

Excited delirium has grabbed the media spotlight over the past decade, especially as the medical community has debated its merits and civil rights groups question the effects of Tasers in such cases.

Now the Meriden Police Department is working to better understand the condition and find the most effective way to create a community-wide approach to respond to excited delirium syndrome cases and help provide the care needed to save the lives of not only officers, but those suffering from the condition.

“What we are fighting against is a perception,” said Meriden Deputy Chief Timothy Topulos. “There is a perception that (excited delirium) is a diagnosis for those killed by Tasers, but research shows that it is a very real condition. Our job is to develop and implement policy and training to keep everyone safe and give those exhibiting such conditions the best opportunity to survive.”

Meriden police, fire officials, EMS personnel and MidState Medical Center staff came together Wednesday at police headquarters for an informational training session from Lt. Michael Paulus of the Champagne Police Department in Champagne, Ill.

Paulus, a graduate of the School of Police Staff and Command, has earned the title of Certified Force Science Analyst after completing training in Forensic Analysis at the Institute for the Prevention of In-Custody Death.

He said to best combat deaths from excited delirium, law enforcement officers must first understand the condition and how to respond.

What Is Excited Delirium Syndrome?

“Excited Delirium is a state of extreme mental and physiological excitement, characterized by extreme agitation, hyperthermia, hostility, exceptional strength and endurance without apparent fatigue,” wrote A. Morrison and D. Sadler state in ‘Death of a psychiatric patient during physical restraint. Excited Delirium – A case report,’ published in Medical Science Law in January 2001.

The study helped change the way the condition was seen in the medical community and led the National Association of Medical Examiners shortly after. In 2009, the American College of Emergency Physicians recognized the condition as an emergency medical issue.

“It’s not a diagnosis. Excited delirium syndrome in itself can be symptoms of other specific medical disorders that result in a noticeable state,” Paulus said.

Excited delirium has appeared in American medical treatises for nearly 200 years, but contemporary medical studies did not occur until it was made popular in the works of Dr. David Fishbain and Dr. Charles Wetli in the 1980s.

Paulus said growing incidents began to occur around the nation, and the condition reached the media spotlight in 1998 after a San Diego man died after being hog-tied when he became combative with officers.

In the case of Price v. County of San Diego, medical studies ruled out positional asphyxia as the cause, effectively leaving excited delirium as the cause of death in the case, he said.

Others including the National Association for the Advancement of Colored People and the American Civil Liberties Union note that despite studies in support of Excited Delirium Syndrome, there is no diagnosis for such a condition in the most widely accepted clinical books.

The Diagnostic and Statistical Manual of Mental Disorders and the International Statistical Classification of Diseases and Related Health Problems do not include excited delirium syndrome as an official disease or disorder, making its diagnosis within patients impossible in a clinical setting.

These have led those in the NAACP and ACLU, as well those opposed to stun gun use, to blame Tasers, stun guns and police brutality for deaths that were said to have been caused by excited delirium, Paulus explained.

The Cause and Signs of Excited Delirium Syndrome

The Institute for the Prevention of In-Custody Deaths, or IPICD, has classified the syndrome as a medical emergency that requires field observation to identify.

“It is not a diagnosis we are asking of law enforcement,” Paulus said. “It is strictly a field observation. There are specific physical characteristics of excited delirium syndrome that stand out. It is a medical emergency that presents itself as a law enforcement problem.”

The IPICD, in partnership with law enforcement agencies and medical researchers nationwide, conducted a study into cases of excited delirium and found it can present itself with any combination of metabolic, pharmacologic, infectious and psychological conditions.

Excited Delirium is largely a male issue, with 91 to 99 percent of those exhibiting the syndrome being men, and is most seen in those ages 31 to 45, according to the IPICD.

“In most cases, the person showing symptoms is involved in a struggle and geography is not a factor. Deaths usually follow bizarre behavior and are often sudden,” Paulus said. “Those exhibiting excited delirium will show extreme strength and combativeness until suddenly, they are calm. Then they are dead.”

The IPICD study showed that predisposing factors for excited delirium, discovered after death, include alcohol or drug use and withdrawal, dehydration, low blood sugar, epilepsy, underlying psychiatric diseases and cardiomegaly.

Symptoms present themselves in a physical state with the following:

• Dilated pupils
• Profuse sweating
• Hyperthermia
• High core body temperature
• Skin discoloration
• Foaming at the mouth
• Uncontrollable shaking or shivering
• Respiratory distress