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A Knee in the Neck of Excited Delirium

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A Knee in the Neck of Excited Delirium News A knee in the neck of excited delirium ome call it an entirely manufac- tured psychological condition. S The police believe it is not only legitimate, but potentially fatal. The latter, though, may have a vested interest in perpetuating the no- . tion that “excited delirium” is a valid c n I , medical condition, given the heat l a n o i they’ve taken following last year’s death t a n r e of Polish citizen Robert Dziekanski at t n I Vancouver International Airport after R E S A being shot by a taser, a hand-held T weapon that uses compressed air to di- The TASER X26 stores time, date, duration, temperature and energy cell status of over rect a jolt of electricity up to 10.6 metres 1500 firings. Powered by lithium energy cells with a 10-year shelf life, the X26 is the away. taser of choice for most police departments and retails for US$799. TASER Interna- Did Dziekanski die from “excited tional, Inc., says it has sold the devices to 175 Canadian law enforcement agencies. delirium” or multiple taser shocks? And what about the officer’s knee pressed into his neck? A controversial condition, “excited Active delirium can increase risks Dziekanski touched down in Vancou- delirium” has been defined as being associated with physical restraints, ver on Oct. 14, 2007, following a 13-hour characterized by agitation, incoherence, Dawe says. But when someone suffer- flight from Poland and for 8 hours bizarre behaviour, high temperature, ing from delirium dies, determining roamed the immigration lounge, stead- superhuman strength, a high tolerance the cause is problematic. Was it delir- fastly insisting that his mother would for pain — and sometimes, the compul- ium? The taser? Restraint? A complex soon meet him. She, meanwhile, sion to break or bang on glass. Those interplay of all the above? awaited his arrival in the baggage claims who study it say it can be brought on by Dawe says “excited delirium” is a area, while airport officials did nothing drug use, alcohol withdrawal, low pop culture phenomenon and doesn’t to ensure the pair could connect. Lost, blood sugar, mental illness or extreme have much currency among psychia- confused and unable to speak English, fatigue. It does not, however, appear in trists, although police, coroners and Dziekanski used office chairs to build a the American Psychiatric Association’s forensic pathologists use it. makeshift barricade between a pair of Diagnostic and Statistical Manual of University of Miami Professor of Neu- glass doors as if to ensure that no one Mental Disorders (DSM). rology Dr. Deborah Mash, who has stud- could remove him from his meeting But “delirium” — minus the “ex- ied the condition for 20 years, says “sud- place with his mother. Obviously frus- cited”— does. den death in the context of emotional trated, he began to throw computer Dr. Ian Dawe, director of Psychiatric stress is well-known. Just because there equipment onto the floor and against a Emergency Services at St. Michael’s Hos- isn’t something called ‘agitated delirium’ glass wall. The police were summoned pital in Toronto, explains delirium as “a or ‘excited delirium’ — that vernacular is and in stunning sequence of events cap- fluctuating level of consciousness,” a set not in the DSM-IV — doesn’t mean that tured on video by an eyewitness’s cell of symptoms that stereotypically appear the symptom set is not in the DSM, be- phone, Dziekanski was pinned the floor, together as a result of intoxication or an cause it is. We have evidence to suggest shot by a taser and eventually died. underlying medical condition. it’s a brain disease.” Public outrage prompted the federal The DSM says most sufferers of delir- Mash argues the condition is the re- government to call an investigation ium fully recover but some don’t as sult of an interaction between genes and into officers’ use of tasers. The Com- “delirium may progress to stupor, coma, environment: the gene remains silent mission for Public Complaints Against seizures, or death, particularly if the un- until triggered by something like alco- the RCMP [Royal Canadian Mounted derlying cause is untreated.” hol, drugs, stress or sleep deprivation — Police] released an interim report on Dawe says there are 2 kinds of delir- anything that affects dopamine. “It’s al- Dec. 12, 2007, recommending restric- ium: active and hypoactive. People suf- ways the same. The presentation is the tions on the weapon’s use. A coroner’s fering from the former might behave same, the behavioural syndrome is the inquest will commence in May. more or less as Dziekanski did: they same, the hyperthermia is there, and the The RCMP claim excited delirium can be agitated, irrational, and hard to phenomenon of sudden death is there. was the cause of death. Media and civil communicate with. The hypoactive And it doesn’t matter whether they were liberties groups are skeptical about form, meanwhile, makes people quiet restrained, or hogtied, or pepper both the cause, and the condition. and withdrawn. sprayed or tasered — it’s the same.” CMAJ • March 11, 2008 • 178(6) 669 News “This is a condition where law en- Dr. Charles Wetli coined the term “ex- rounded by 7 officers. They place no forcement doesn’t have a lot of options cited delirium” in 1985 to explain sud- weight on him and eventually turn him … now, if you just left someone with den death in recreational cocaine users. on his back and sit him upright. Noth- excited delirium in the woods, I mean, Yet, so convinced are police that “ex- ing is done that might constrain the sus- what would happen to them? We don’t cited delirium” is a legitimate condition pect’s breathing, a point PoliceOne.com know the answer. We’ve had purported that PoliceOne.com, an international is careful to caution against. excited delirium deaths where there information website for police officers, The latter is by no means moot — were no police involved.” includes a direct link to an excited delir- the link between restraint, excited Yet, here’s the rub. Those who die of ium training video created by the Las delirium and oxygen supply has long “excited delirium” usually do so while Vegas Police Department. In the video, been the subject of debate and concern. in police custody, often after having Sherriff Bill Young even asserts that ex- A 1998 review of 21 cases of unex- been tasered. cited delirium leads people to blame po- pected deaths in people in a state of ex- To be sure, it’s not a disease in- lice for deaths they didn’t cause. cited delirum — 18 of which were people vented by the RCMP. In fact, they are The video explicitly recommends us- in police custody — found that all “sud- late to the adoption of “excited delir- ing tasers to override the central nervous denly lapsed into tranquility shortly after ium” as a condition. As early as 1849, system, incapacitating the suspect just being restrained (CMAJ 1998:158[12]: Dr. Luther Bell described the inexplica- long enough for officers to properly re- 1603-07). In all 21 cases, the victims had ble sudden death of psychotic patients strain him. In a dramatization, a hand- been restrained either face-down or as “acute exhaustive mania,” while cuffed suspect lies on the ground, sur- through pressure applied to their necks. In 12 cases, excited delirium was brought on by a psychiatric disorder. In 8 cases, cocaine was the culprit. In 8 cases, the Box 1: Tasers victims suffered chest compression from Basics the weight of 1–5 people. The trademarked name TASER® is an acronym for the “Thomas A. Swift Electric The study concluded that “the possi- Rifle,” the name given to the electroshock weapon invented by Jack Cover as a bility that positional asphyxia con- means of incapacitating people by causing temporary paralysis. Tasers use tributes to unexpected death in people compressed nitrogen to propel 2 electrodes that are connected to the weapon by conductive wire. An electrical signal is then passed through the wires to the point in states of excited delirium cannot be where the probes, which travel at a speed of over 48.76 m per second, make ignored.” Those suffering from excited contact with the target’s body or clothing. Manufacturers say that while the device delirium were in need of more than the produces 50 000 volts, “only short pulses of 400 volts actually enter the body.” The usual amount of oxygen, yet the tech- average electrical current delivered is pegged at 0.0021 amperes. niques used to restrain them could re- Models strict their ability to breathe. There are 2 main police models, the X26 and M26 (and variants therein). TASER International has recently begun marketing a new civilian model almost as a Dawe is sympathetic to people faced fashion accessory, coming in “leopard print” or colours like “metallic pink” and with the task of controlling situations “electric blue.” Among other options is the TASER shockwave, which like Dziekanski’s. “I wouldn’t want to simultaneously fires 6 cartridges to “saturate” an area. Under development is the lay blame on anyone.” He’d like to en- XREP, a wireless taser round that can be fired from a 12-gauge shotgun. hance cooperation between police, Range paramedics and mental-health profes- Depending on the type of cartridge used, tasers can be deployed for up to 10.67 m, sionals, so that police could have “a although the range for stun guns sold to civilians is about half that.
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