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Effectively managing a suspect with excited delirium requires training

By Jerry Staton, CLS
Special Contributor to Police1

If you are reading this article to learn how to recognize an excited delirium event, stop. I suggest you go to or and get details on what constitutes excited delirium (ED). Instead, the focus here is to identify and discuss the lack of understanding and cooperation between the various stakeholders involved with confronting and dealing with this difficult situation. If we continue to do what we have always done, we will continue to get similar results.

Ten years ago, few first responders had heard of the term excited delirium. Now if you do a Google search, thousands of hits fill your computer screen. Still, with all the information available on the subject, few first responders have had formal training on how to handle ED and fewer still have included cross training with other first responders. If you follow the links in hopes of getting all the facts you will find sites that assure the reader ED is real and the root cause of numerous otherwise unexplained deaths. Other sites focus on convincing the reader that ED is nothing more than an elaborate cover up for overzealous police work and excessive force. The availability of information is a double-edged sword in that it is often difficult to differentiate between material that is based on science and research versus material that is biased one way or the other.

If you are willing to get beneath the surface by attending training from true experts in the field you will accept that hundreds of otherwise unexplained deaths have occurred in which similar behaviors have been exhibited prior to a sudden death. The commonalities of presentation with similar results occur across a wide range of force options used to capture and control the individual, suggesting no single force option is responsible for these deaths.

In simpler terms, it is not the force being used but the person the force is being used upon that dictates the outcome of many of these mysterious deaths. Frequently the cause, manner, and mechanism of these deaths are difficult or impossible to determine and controversy exists over the medical examiner’s ruling. This is not a new occurrence. Similar unexplained deaths have been taking place in law enforcement for 150 years or more. So what has changed and why are arrest related deaths now getting so much media coverage?

Part of the answer is we now live in an instant communication society. An event occurs in Maine and we read about it within minutes in California. A morning headline in Canada makes the evening news in Australia. An arrest related death in Des Moines is just as easy to locate on a computer search as a death in New York or Los Angeles. The original story is often picked up by the national press and gets repeated, giving the impression of more than a single event.

Another issue is that police are sometimes forced to take into custody persons exhibiting bizarre and dangerous behavior. Firefighters and EMTs respond in an attempt to provide medical care and often have been unable to reverse the cascade of events which lead to sudden death. Many of these unfortunate deaths occur in mental institutions and or medical facilities, but these rarely get the media coverage associated with an arrest related death. A few otherwise similar events occur in isolation with no one restricting or restraining the person prior to their untimely death and again there are few headlines about such events unless the deceased is a celebrity. The arrest related deaths are the ones making the headlines and frequently involve a violent struggle with the police prior to the sudden death. These events are even more newsworthy when there is video, which is another of the technological advancements responsible for increased exposure.

The most frequent root cause for an arrest-related ED death is a long history of stimulate drug abuse. The second most likely trigger factor is a history of mental illness, bi-polar and schizophrenia being number one and two. Other root causes include a head injury, some types of infection, low blood sugar, extreme dehydration, or having experienced one or more grand mal epileptic seizures. With the increase of drug abuse in this country and the free flow of prescription stimulants like Ritalin to millions of kids, there is every indication we will see an increase in ED events in the coming years.

Experts in the field have been calling for joint training in which police, fire, and EMS collaborate to understand and manage this rare and unfortunate event. That sounds good on paper but how often does this joint training take place? Other stakeholders affected by the aftermath include hospital staff, medical examiners, attorneys, and a host of investigators working for any of the above. Getting them involved in the training is even more challenging. With a slow down in the economy and budgets stretched thin there seems to be very little of this joint training being conducted. No single entity is capable of handling this event alone.

EMS and fire rescue do not have the tools and skills necessary to capture someone with the potential for extreme violence. The police are not trained or equipped to administer the kind of medical care the patient requires. Even if these first responders are up to speed, the patient care may not be adequate if the local hospital has not dealt with an excited delirium event before, or have not had proper training to do so. It is not enough to continue to do what we have always done and expect different results. Without cross-training more of these unfortunate deaths are going to occur, and more first responders and care givers are going to be accused in a wrongful death case.

Jerry Staton retired after 25 years of police work to start a consulting and training business. Affordable Realistic Tactical Training has been in operation now ten years and has assisted thousands of students with UOF, risk management, firearms, combative skills, arrest related death and tactics training. As a Senior Master TASER® Instructor Jerry has certified over four thousand instructors and hundreds more end-users in the safe operation of these life saving devices. The combined 35+ years of experience along with thousands of hours of accredited training has allowed Jerry to be recognized as a police practices expert in numerous civil suits involving police use of force and TASER® devices. He can be reached at and would welcome your comments and/or questions.