Tasers and In-custody Deaths: The EMS Perspective
description
Transcript of Tasers and In-custody Deaths: The EMS Perspective
![Page 1: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/1.jpg)
1
Tasers and In-custody Deaths: The EMS Perspective
Michael D. Curtis, MDEMS Medical DirectorSaint Michael’s Hospital – Stevens PointSaint Clare’s Hospital – WestonMinistry Health Care
![Page 2: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/2.jpg)
2
![Page 3: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/3.jpg)
3
Objectives
Tasers Excited Delirium Physical Restraints Medical Management
![Page 4: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/4.jpg)
4
Approximately half of the 620 law
enforcement agencies in Wisconsin use
Tasers.
![Page 5: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/5.jpg)
5
![Page 6: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/6.jpg)
6
Advantages of the Taser
Less risk of injury to law enforcement officers when subjects actively resist
Less risk of injury or death to subjects from law enforcement use of force
Photo Source: Taser International Instructor Certification Course V12, November 2004
![Page 7: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/7.jpg)
7
Thomas A. Swift’s Electric Rifle (TASER)
M26 Taser. Manufactured by Taser International
Source: http://www.keme.co.uk/~mack/M26.jpgSource: http://www.pointshooting.com/m26black.jpg
![Page 8: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/8.jpg)
8
Probes
Blast Doors
AFIDs Laser Sight
LIL: Low Intensity Lights (LEDs)
Trigger
Enhanced GripZones
DPM: Digital Power Magazine
DPM ReleaseButton
Stainless SteelShock Plates
SafetyIlluminationSelector
Stainless SteelSerial No. Plate
High Visibility Sights
Air Cartridge
TASER Wire
X26 Taser
Source: Taser International Instructor Certification Course V12, November 2004
![Page 9: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/9.jpg)
9
M26 Taser
Source: Taser International Instructor Certification Course V12, November 2004
![Page 10: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/10.jpg)
10
Tasers, in and of themselves,
are not lethal weapons.
![Page 11: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/11.jpg)
11
Tasers Use Electricity
Taser: 50,000 Volts
Static Electricity door knob 35,000 – 100,000
Volts Van De Graaff
Generator: 1 – 20 Million Volts
Photo Source: Taser International Instructor Certification Course V12, November 2004
![Page 12: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/12.jpg)
12
Tasers Use Electricity
It’s not the voltage it’s the amperage that is dangerous
Tasers use high voltage, but very low amperage M26: 3.6 milliamps (average current) M26:1.76 joules per pulse X26: 2.1 milliamps (average current) X26: 0.36 joules per pulse
X26 Taser delivers 19 pulses per second
![Page 13: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/13.jpg)
13
Tasers Use Electricity
Cardiac Defibrillators use 150 – 400 joules per pulse
The safety index for the fibrillation threshold ranges from 15 – 42 depending on the weight of the subject Source: PACE 2005; 28:S284-S287. Pig study Variable current/constant pulse frquency
![Page 14: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/14.jpg)
14
Aim like a standard firearm at center of mass Use sights and/or laser Rule of Thumb: 1 foot (.3m) spread for every 7
feet (2.1m) of travel
(m) .6 1.5m 2.1m 3m 4.5m 6.4m 7.6m
Target Distance (ft) 2′ 5' 7' 10' 15′ 21′ 25′ Spread (in) 4″ 9" 13" 18" 26" 36″ 38″
(cm) 10cm 23cm 33cm 46cm 66cm 91cm 109cm
Probe Trajectory
![Page 15: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/15.jpg)
15
Taser Effects
High voltage affects nerves Leads to intense muscle contraction Does not affect muscles directly
![Page 16: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/16.jpg)
16
Tasers have caused injuries, but most
Taser-related injuries are minor.
![Page 17: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/17.jpg)
17
Taser Injuries
Muscle Contraction Injuries Stress fractures Muscle or tendon strain or tears Back injuries Joint injuries
Injuries from Falls May be serious depending on the height
![Page 18: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/18.jpg)
18
Taser Injuries
Minor Surface Burns Due to arcing
Tasers will ignite flammable liquids and gasses Potential for serious burns
Penetrating Eye Injuries
![Page 19: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/19.jpg)
19
Taser Darts
![Page 20: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/20.jpg)
20
Taser Dart Injuries
The skin at the puncture site is cauterized A swift tug will remove the barb easily
Taser users receive this training Wipe site with alcohol prep Consider a band-aid
![Page 21: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/21.jpg)
21 Source: Taser International X26 User Course V12, November 2004
![Page 22: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/22.jpg)
22
News media sources have implied a cause and effect relationship between Tasers and in-custody deaths…
![Page 23: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/23.jpg)
23
Concern About Tasers 147 in-custody taser-related deaths
since 1999 Source: Robert Anglen, Arizona Republic
August 8, 2005 The number is growing Draws significant negative media attention Outcry from human rights activists
Amnesty International http://web.amnesty.org/library/index/ENGAMR511392004
![Page 24: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/24.jpg)
24 Source: Seattle Post-Intelligencer
![Page 25: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/25.jpg)
25
There is no scientific evidence to date of a
cause and effect relationship between
Tasers and in-custody deaths.
![Page 26: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/26.jpg)
26
Taser Use in Police Training
Over 150,000 police volunteers No deaths
![Page 27: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/27.jpg)
27
In-Custody Deaths…
Why do some people die following a violent confrontation with police?
What role does the taser play, if any? What can police officers do to prevent in-
custody deaths?
![Page 28: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/28.jpg)
28
Typical Scenario
Male subject creating a disturbance Triggers 911 call Obvious to police that subject will resist Struggle ensues with multiple officers
May involve OC, Taser, choke holds, batons, etc.
![Page 29: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/29.jpg)
29
Typical Scenario
Physical restraints applied Subject subdued in a prone position Officers kneeling on subjects back Handcuffs, ankle cuffs Hogtying, hobble restraint or TARP
Prone vs. lateral positioning Transported in a squad car to jail
![Page 30: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/30.jpg)
30
Typical Scenario
Continued struggle against restraints Sometimes damages squad car
Apparent resolution period Subject becomes calm or slips into
unconsciousness Labored or shallow breathing Followed unexpectedly by…
![Page 31: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/31.jpg)
31
Typical Scenario
Death Resuscitation efforts are futile Los Angeles County EMS Study
18 ED deaths witnessed by paramedics (all were restrained)
In 13 – rhythm documentedVT and asystole were most common
No ventricular fibrillationAll failed resuscitation
Source: Am J Emerg Med; 2001:19(3), 187-191
![Page 32: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/32.jpg)
32
Typical Scenario
The press: Subject “died after being shocked with
taser” Implies cause and effect
The Fallacy: “Post hoc ergo proptor hoc”
![Page 33: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/33.jpg)
33
Typical Aftermath
Several weeks later – autopsy results… Cause of Death
Excited delirium Illicit stimulant drug abuse Concurrent medical problems Minimal injury from police confrontation
It wasn’t the taser after all Officers exonerated
![Page 34: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/34.jpg)
34
Typical Aftermath
Meanwhile the officers… Placed on administrative leave Subjected to investigation Face threat of potential criminal charges Face threat of potential civil litigation Subjected to public outcry Experience personal and family stress Contemplate a career change
![Page 35: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/35.jpg)
35
Several forensic pathology studies have cited excited
delirium, not Tasers, as the cause of death.
![Page 36: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/36.jpg)
36
What is Excited Delirium?
A controversial theory An imminently life threatening medical
emergency… Not a crime in progress!
![Page 37: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/37.jpg)
37
What is Excited Delirium?
Diagnostic criteria Characteristic behavioral components Metabolic Acidosis Hyperthermia Identifiable cause
Stimulant drugs Psychiatric disease
It does not explain all behavior that leads to confrontation with police
![Page 38: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/38.jpg)
38
Pathophysiology
Central nervous system effects: Changes in dopamine transporter and
receptors Accounts for behavioral changes Accounts for hyperthermia
![Page 39: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/39.jpg)
39
Behavioral Components: Delirium Delirium:
“Off the track” Confusion Clouding of consciousness Shifting attention Disorientation Hallucinations Onset rapid – acute Duration brief – transient
![Page 40: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/40.jpg)
40
Behavioral Components:Psychosis
Psychosis: Bizarre behavior and thoughts Hallucinations, paranoia
![Page 41: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/41.jpg)
41
Behavioral Components:Excited (Agitated) Extreme agitation, increased activity
Aggravated by efforts to subdue and restrain
Not likely to comply after one or two tasers
![Page 42: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/42.jpg)
42
Behavioral Components:Excited (Agitated)
Violent or aggressive behavior Towards inanimate objects, especially
smashing glass Towards self, others or police
Noncompliant with requests to desist Superhuman strength Insensitive to pain
![Page 43: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/43.jpg)
43
Excited Delirium
Hyperthermia High body temperature 105 – 113 oF Drug’s effect on temperature control center
in brain (hypothalamus) Tell-tale signs:
Profuse sweating Undressing – partial or complete
![Page 44: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/44.jpg)
44
Excited Delirium
Hyperthermia Aggravated by
increased activity the ensuing struggle warm humid weather (summertime) dehydration certain therapeutic medications
![Page 45: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/45.jpg)
45
Excited Delirium
Metabolic Acidosis Potentially life threatening
Elevated blood potassium level Factors: dehydration, increased activity
Survivors: Kidney damage due to muscle breakdown May require dialysis
![Page 46: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/46.jpg)
46
Excited Delirium: The Usual Suspects
#1 Cause: Stimulant Drug Abuse Acute intoxication Superimposed on chronic abuse Acute intoxication triggers the event
![Page 47: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/47.jpg)
47
Excited Delirium: The Usual Suspects Underlying psychiatric disease
First described in 1849 before cocaine was first extracted from cocoa leaf
Mania (Bipolar Disorder) Psychosis (Schizophrenia)
Noncompliance with medications to control psychosis or bipolar disorder Unusual – #2 Cause
Rare: New onset schizophrenia
![Page 48: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/48.jpg)
48
Stimulant Drugs
Cocaine The major offender On the rise due to “crack epidemic”
Toxicology studies show… Low to moderate levels of cocaine High levels of benzoylecognine (the major
breakdown product of cocaine) Suggests recent use superimposed on
chronic abuse
![Page 49: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/49.jpg)
49
Stimulant Drugs
Other known culprits include: Methamphetamine Phencyclidine (PCP) LSD
Cocaethylene = Cocaine + Alcohol Toxic to the heart Unknown role in excited delirium deaths
![Page 50: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/50.jpg)
50
Concurrent Health Conditions
Obesity Heart Disease
Coronary artery disease Cardiomegaly Hypertrophic cardiomyopathy Myocarditis Fibrotic heart
![Page 51: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/51.jpg)
51
Autopsy Proof
Specialized laboratories can identify changes in brain chemistry that are characteristic of excited delirium
Blood and brain tissue levels of benzoylecognine and cocaine Typical ratio 5:1
![Page 52: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/52.jpg)
52
Tasers and Excited Delirium Deaths It’s not the Taser Many in-custody deaths long before
tasers were ever used Documented in 1980s medical literature
Deaths of persons not in custody Found naked in bathrooms Wet towels Empty ice cube trays scattered about A futile effort to cool themselves
![Page 53: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/53.jpg)
53
Tasers and Excited Delirium Deaths It is unknown whether tasers have
different adverse effects on people with excited delirium than on healthy volunteers
Tasers No proximate temporal relationship
between taser use and death Multiple or continuous taser shocks
Taser International’s recent warning against repeated shocks
![Page 54: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/54.jpg)
54
Whether repeated or continuous Taser
shocks is safe remains unknown.
They should probably be avoided, if
possible.
![Page 55: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/55.jpg)
55
Restraints and In-Custody Deaths
What roles do physical restraint, restraining technique and restraint position play in excited delirium deaths?
![Page 56: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/56.jpg)
56
Physical Restraints
Source: Prehosp Emerg Care, 2003:7(1); 48-55.
![Page 57: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/57.jpg)
57
Physical Restraint Issues
Positional Asphyxia Deaths have occurred with subjects
restrained in a prone position Theory: restricts breathing The role of the position is unclear Little data to support causality Other factors are the likely culprits
![Page 58: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/58.jpg)
58
Physical Restraint Issues
No clinically significant changes in pulmonary function tests in healthy volunteers Am J Forensic Med Pathol. 1998
Sep;19(3):201-5.
![Page 59: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/59.jpg)
59
Physical Restraint Issues
Restraint Asphyxia Increased deaths in restrained patients Rat Study
3 fold increase in cocaine-related deaths among “restrained” rats
Life Sci. 1994;55(19):PL379-82. Whether these may be contributory
remains controversial, but still possible Not considered causal
![Page 60: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/60.jpg)
60
Physical Restraint Issues
Compression asphyxia What are the adverse effects on breathing
and circulation when one or more officers kneel on the subjects back as they handcuff him?
![Page 61: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/61.jpg)
61
Excited delirium is an imminently life-
threatening medical emergency.
![Page 62: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/62.jpg)
62
The “Freight Train to Death”
How police restrain or position the subject will not stop “the freight train to death”
![Page 63: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/63.jpg)
63
The behavioral features of excited
delirium include criminal acts, but…
![Page 64: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/64.jpg)
64
Excited delirium is not a crime in progress,
and responders must recognize the
difference, before it’s too late.
![Page 65: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/65.jpg)
65
Recognizing Excited Delirium
How they act How they look What they say and how they say it What they are doing How they make you feel How they respond to you How they respond to force How they respond to the taser
![Page 66: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/66.jpg)
66
Recognizing Excited Delirium
Agitation or Excitement = Increased activity and intensity Aggressive, threatening or combative –
gets worse when challenged or injured Amazing feats of strength Pressured loud incoherent speech Sweating (or loss of sweating late) Dilated pupils/less reactive to light Rapid breathing
![Page 67: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/67.jpg)
67
Recognizing Excited Delirium
Delirium = Confusion Disoriented
Person, place, time, purpose Rapid onset over a short period of recent time
“He just started acting strange” Easily distracted/lack of focus Decreased awareness and perception Rapid changes in emotions (laughter, anger,
sadness)
![Page 68: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/68.jpg)
68
Recognizing Excited Delirium
Psychotic = bizarre behavior Thought content inappropriate for
circumstances Hallucinations (visual or auditory) Delusions (grandeur, paranoia or
reference) Flight of ideas/tangential thinking Makes you feel uncomfortable
![Page 69: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/69.jpg)
69
Mnemonic: NOT A CRIME Naked – and sweating from hyperthermia Objects – violence against, especially glass Tough – unstoppable, insensitive to pain
Acute onset – “He just snapped!”
Confused – person, place, purpose, perception Resistant – will not follow commands to desist Incoherent speech – shouting, bizarre content Mental Health or Makes you uncomfortable Early EMS Back-up
![Page 70: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/70.jpg)
70
Bad Behavior: Other Reasons
Alcohol intoxication or withdrawal Other drug use problems
Example: Cocaine psychosis Pure psychiatric disease Head injury Dementia (Alzheimer’s Disease) Hypoglycemia Hyperthyroidism
![Page 71: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/71.jpg)
71
Patients with excited delirium need rapid aggressive medical
intervention.
![Page 72: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/72.jpg)
72
Alternative Strategy
Attempt verbal de-escalation Summon back-up quickly Summon EMS as early as possible Use taser before a struggle ensues Jump the subject and administer tranquillizer Back off and contain the subject without
restraint Once calm transport (no restraints?) Minimize struggle and restraints Unrealistically simplified?? – Maybe!
![Page 73: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/73.jpg)
73
The first goal of therapy is to gain
control of the violent behavior.
![Page 74: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/74.jpg)
74
The “Ideal” Drug
Rapid effective tranquilization No repeat dosing
No significant adverse effects respiratory depression cardiovascular depression neurological adverse effects
Easy to administer (IM) Allows easy assessment of neurological
status on ED arrival
![Page 75: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/75.jpg)
75
In Search of The “Ideal” Drug
Benzodiazepines Neuroleptics Atypical antipsychotics Ketamine
![Page 76: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/76.jpg)
76
Benzodiazepines
Effective But usually require repeat doses Adverse reactions:
Hypotension Respiratory Depression Over sedation
![Page 77: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/77.jpg)
77
Neuroleptics and Atypical Antipsychotics
Rapid onset (10 – 15 minutes or less) Can be very effective in a single dose Prolong the QT Interval (Droperidol) Target dopamine D2 receptors
May exacerbate hyperthermia
![Page 78: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/78.jpg)
78
Ketamine
Very rapid onset of action (<5 minutes) Highly effective in a single dose Favorable safety profile in healthy
patients Potential adverse effects:
Adrenergic over stimulation in excited delirium
“Emergence reactions” in adults
![Page 79: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/79.jpg)
79
The second goal of therapy is to stabilize
the underlying pathophysiologic
processes.
![Page 80: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/80.jpg)
80
Other ALS Interventions
Dehydration/Metabolic Acidosis: IV NS X 2 W/O
Hyperthermia: Cool environment, disrobe, tepid mist and
fanning, cooling blankets Hyperkalemia?:
Fluids, Calcium Chloride, Sodium Bicarbonate, Albuterol
Rapid transport
![Page 81: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/81.jpg)
81
Fall Back Position
Proceed to customary practices at any point when This strategy appears to fail Safety appears to be endangered It is necessary to escalate the level of force
based on the threat level Don’t transport in a squad car Use the least amount of force needed
![Page 82: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/82.jpg)
82
Caveats
Never place an agitated and combative patient in an ambulance without physical restraints
Never transport a restrained patient without an officer present who can unlock the restraints
Should the transporting officer disable his/her weapons?
![Page 83: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/83.jpg)
83
Potential Pitfalls
Can’t wait for back-up or EMS ALS not available Struggle and restraints cannot be
avoided
![Page 84: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/84.jpg)
84
Summary Excited Delirium is an imminently life
threatening medical emergency, not a crime in progress
In-custody deaths likely related to excited delirium
Tasers – if used early – may help (remains unproven)
ALS medics can give potent tranquilizers Rapid aggressive medical stabilization
needed
![Page 85: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/85.jpg)
85
Summary Beware of potential side effects of
therapeutic drugs Treat for hyperthermia, dehydration,
metabolic acidosis and potential hyperkalemia
![Page 86: Tasers and In-custody Deaths: The EMS Perspective](https://reader035.fdocuments.in/reader035/viewer/2022070406/5681406c550346895dabea3e/html5/thumbnails/86.jpg)
86
The End
Questions? Thank You!
Michael D. Curtis, MDEMS Medical DirectorSaint Michael’s HospitalSaint Clare’s [email protected]