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Do’s and don’ts of handling “excited delirium” suspects: Special ILEETA Conference series

Final of a 2-part series

By Chuck Remsberg
Police1 Senior Contributor

In Part 1, we shared excited delirium expert and Police1 columnist Chris Lawrence’s insights into the definition of ED and what behavior may be associated with someone in the midst of an ED event.

In this next installment, we reveal the things you should do when faced with a subject who may be experiencing ED, and things you shouldn’t do.


If the symptoms you see and intelligence on the suspect’s background you gather from available witnesses convinces you he may be experiencing ED, the following considerations may help you protect yourself, your agency and potential civilian victims, as well as the subject himself, the Lawrences advised.

1. Recognize that you’re dealing with a medical emergency that requires prompt transport to a health facility. Get EMS to the scene ASAP. If Advanced Life Support service is available, get it there also. “You want to transition your approach to this situation from a simple law enforcement intervention to a coordinated response to a medical emergency,” Sharon explained. “We need to remind the public that there can be no medical assistance until the subject is controlled.”

2. “Transport requires control, and control requires force,” Chris asserted, “and officers will need to exert greater effort that the subject, otherwise control will not be established.” Later this critical truth may need to be explained to a naive jury.

For now, call for abundant backup. Overwhelming the suspect with manpower is likely to be your most realistic and effective tactic for establishing control. Expect a high level of resistance. The more officers you get involved the less likely anyone will be seriously injured.

3. If it is safe to do so, responding officers should kill sirens, headlights and overheads at the scene. This will decrease stimulation that may otherwise only heighten the subject’s hyper status.

4. Understand that hallucinations the suspect may be experiencing “will seem very real to him,” Chris cautioned. “You can’t know for certain what he may be seeing or hearing. For all you know, his attacking you may in his mind be an effort to ‘save’ you from some danger he believes is coming.” Reasoning with him is not likely to be an effective option. Remember that “things can go sideways at any time, without warning.”

5. You and the others most likely will need to take the suspect to the ground. “The ground gives you a stable, consistent surface where you can use mechanical leverage rather than brute strength” to restrain him, Chris said.

6. Initially the suspect may need to be proned on the ground for handcuffing, but as soon as possible roll him onto his side to give him the best possible breathing capability.

7. Without hog-tying him, CONTROL HIS LEGS. “This is vital,” Chris said. “Otherwise, once he’s on his side he can put the soles of his feet back on the ground and bring his legs back up into the fight.” Chris recommended a hobble restraint strap around the ankles that you can step on after it is cinched.

8. For transport, the ankle restraint strap should be tied to the end of the ambulance gurney. This will help protect EMS personnel from thrashing legs and keep the suspect from pulling his legs free of the stretcher strap that is usually placed across the knees.

9. Explain in your report of the incident why you chose whatever force options you used and point out what you did to help assure prompt and effective medical attention for the subject.

10. If the suspect does die, ask medical personnel to take core body temperature readings at regular intervals even after death. In some ED cases, subjects have shown a temperature as high as 108 degrees even 2 hours after they’ve died. These measurements may help the medical examiner to establish a firm cause of death.


The natural outcome of ED may prove to be highly negative, regardless of your best efforts. Don’t help the Monday-morning quarterbacks make things look even worse by taking inappropriate actions that you should avoid. According to the Lawrences:

1. Don’t Taser the subject in the stun mode. In ED, he’s impervious to pain, so he won’t feel it and won’t be controlled by it. You’ll only end up connecting the Taser to his death (if he dies) without winning any benefit.

2. Don’t deliver more than one cycle of Taser barbs if you decide to try that control option. Use the Taser to create a window of opportunity during which you can try to restrain him. Multiple Taser cycles are not recommended where you believe the subject may be experiencing ED.

3. Don’t deploy pepper spray. Again, no pain for him…no gain for you. Even the pain of baton strikes may not stop his aggressive behavior, and repeated forceful strikes may cause injuries that increase the risk of an adverse outcome.

4. Try not to cause any impairment to the suspect taking full breaths. That means avoid spit hoods, towels over his face—anything that lessens fresh air coming in or retains exhaled air. The subject needs to take in oxygen and to get rid of carbon dioxide. Use of a neck restraint may lead to a misperception by the suspect that you are shutting off his breathing. If he thinks he can’t breathe, this becomes his reality in his psychotic state.

5. Avoid transporting the subject in a police car unless no other option is available. The average adult is longer than the car is wide. An ED subject is not likely to sit quietly on the seat for you. Laying him on his belly is not recommended, and laying him on his side will often result in windows being kicked out. Transport to a hospital via ambulance whenever reasonably possible.

Although compared to other types of high-risk calls ED incidents are rare, training for them is vital, the speakers stressed. “The time to do training is not after you have an ED death,” Sharon declared. She advised also to let your community know that you are working to prepare your troops to deal with this problem. “It shows you are proactive, anticipating and addressing problems before they strike.”

Charles Remsberg has joined the Police1 team as a Senior Contributor. He co-founded the original Street Survival Seminar and the Street Survival Newsline, authored three of the best-selling law enforcement training textbooks, and helped produce numerous award-winning training videos.