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Friday, October 26, 2007

Could paranoid rage be the real killer?

October 26, 2007

Incoherent and violent, a person in a state of 'excited delirium' is likely to suffer cardiac arrest, doctors suggest

The man was seen wandering the airport terminal, shouting and acting out aggressively. Several police officers arrived at the scene to arrest him, but struggled to subdue him.

Shortly after being handcuffed, the man stopped breathing, and never recovered.

Robert Dziekanski suffered that short and sad series of events earlier this month at Vancouver International Airport, dying minutes after the RCMP stunned him with taser guns before handcuffing him.

Stéphane Michaud met a similar fate in Ottawa International Airport two years ago, dying minutes after being taken down by Ottawa police officers.

Two men at two airports. Two sudden and troubling deaths. And one big difference: Police did not use a taser on Mr. Michaud - emergency medical personnel sedated him just before he died.

These deaths, and two others in Quebec in recent weeks after police used tasers, have sparked renewed controversy over police use of the nominally non-lethal devices, which use a brief surge of electricity to disable and subdue a person. For some, the mounting toll - 18 deaths in custody involving tasers since the devices were introduced earlier this decade - is a simple equation. If someone dies shortly after being tasered, the device killed them.

But some physicians and coroners say a heart attack induced by electrical shock should be nearly instantaneous, not come minutes or hours later. "If it's more than two seconds, he didn't die from the taser," said David Evans, Ontario's regional supervising coroner for investigations.

Most people who are tasered don't have long-lasting ill effects, according to the limited body of statistics. And then there is the seeming paradox of people such as Mr. Michaud, whose death in custody resembles that of a taser victim, except that he wasn't shocked.

The common denominator, according to a controversial theory, may be something called "excited delirium," a bundle of symptoms that describes someone in the grip of a paranoid rage. Incoherent and violent, a person with excited delirium is also likely to be sweating profusely - and to like smashing glass. Often, cocaine or crystal meth is a trigger, although mental illness or alcohol withdrawal can also precipitate it.

All too often, such an episode ends with a lapse into a tranquil state, and cardiac arrest.

Mr. Dziekanski and Mr. Michaud fit that profile to a large degree, although there is no indication that either took illicit drugs or were mentally ill. A witness to Mr. Dziekanski's arrest has said he smelled of alcohol. For both men, autopsies did not reveal any anatomical cause of death.

Two recent deaths in Quebec in less than a month after the use of a stun gun have the Quebec government scrambling for answers. On Sept. 18, Quebec City police used a taser gun to subdue Claudio Castagnetta, an Italian immigrant who died two days later allegedly from self-inflicted wounds after banging his head while in custody. Mr. Castagnetta appeared disoriented and confused when he entered a convenience store barefoot. When police arrived, he refused to leave.

Witnesses said Mr. Castagnetta, 32, resisted attempts to handcuff him and was shot several times with a stun gun. His friends and family insisted that he never took drugs.

Mr. Castagnetta's father insisted that Claudio suffered no mental illness. However, Claudio's lawyer said her client described himself as bipolar.

The provincial police opened an investigation last week into the death of Quilem Registre in Montreal. Officers said they stopped him for driving erratically, and were forced to use the stun gun when Mr. Registre, who was apparently heavily intoxicated, became aggressive.

Earlier this week, a task force set up by the Quebec ministry of public security rejected calls for a moratorium on the use of tasers. One member of the task force warned it is risky to use the devices on the mentally ill. René Blais of the Quebec Poison Control Centre said such people fight after receiving an electric shock, driving up their body temperature and their need for oxygen. The physical reaction can be deadly, he warned, but tasers are not the direct cause.

Christine Hall, a researcher and an emergency-room physician in Victoria, says neither science nor statistics back up the contention that tasers are lethal. Even the older versions of the weapon deliver a relatively small jolt, about 1 per cent of that flowing from a defibrillator, far short of the current required to induce cardiac arrest.

No link has ever been established in Canada between the use of the devices and a death in custody, she notes. The 16 cases she has studied involved individuals who were agitated and destructive. Other studies have shown most taser uses don't cause even minor injury.

Proving that will require more than a patchwork of statistics. For the moment, there is no database on sudden in-custody deaths, and no national database for taser use, largely because many police forces do not record when they use the devices, as they do when officers use firearms. Ontario police officers fill out a use-of-force report when they use tasers, but Dr. Hall says she knows of only two forces in the province, London and Waterloo, that have compiled statistics.

Eight police forces in Quebec use the taser, yet no provincewide protocol exists on how it should be used and what type of medical attention is required afterward. Police forces in Montreal and Gatineau administer immediate medical aid, but other jurisdictions do not.

Dr. Hall is preparing to launch a study of sudden in-custody deaths in four cities, including Victoria and Calgary, to find patterns that would explain the causes of excited delirium.

Excited delirium

Common behaviours of people in this state include:

Unbelievable strength and endurance

Imperviousness to pain

Ability to resist several police officers

Hyperthermia, or elevated body temperature

Heavy sweating

Bizarre and violent behaviour

Aggression and hyperactivity

Extreme paranoia

Incoherent shouting

Source: British Columbia Police Complaints Commission


50,000 volts at .oo4 amps elevates blood pressure and heart rate and can, some say, be a factor in cardiac arrest.

How Tasers work:

1. The shot

Tasers fire two electrodes at the ends of long conductive wires attached to the gun's electrical circuit.

2. The hit

The electrodes have small barbs so that they will grab onto an attacker's clothing. When the electrodes are attached, the electrical pulses will try to move from one to the other, affecting the attacker's electrical nervous system.

3. Inside the body

The current mimics/interferes with the body's own electrical signals.

Electrical signals tell the nerve cells to release a communication chemical to muscle cells all over the body.

4. Shutdown

The current will tell the attacker's muscles to do a great deal of work in a short amount of time, temporarily impairing the subject's ability to control his own body.

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