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Saturday, May 17, 2008

"Excited delirium" blamed for deaths

May 17, 2008
Adrian Humphreys, National Post

The message inside the meeting room was one thing -- "we're not talking about Tasers" one speaker said three or four times during a presentation to 250 police officers and paramedics -- but the chatter outside was quite another.

"I've been Tasered twice -- once sober and once drunk," said an officer during the break. "How many times have you used yours?" another asked a colleague. A third complained her force now makes her fill out a form every time she uses her Taser, while another described it as "kind of freaky" zapping someone for the first time.

As emergency personnel reached past the baskets of apples, cookies and chips during conference breaks, talk quickly turned to the Taser, the police-issue stun guns thrust into the public spotlight when an agitated Polish immigrant in Vancouver's airport collapsed and died after being hit by police Tasers and held to the ground.

Controversy over the increasing use of Tasers and the attention accorded in-custody deaths is, after all, why most are here, in Guelph at a conference hosted by the local police force on recognizing the signs of excited delirium.

While the Taser draws most of the heat, debate over precisely why people die after a brisk battle with police to restrain them -- whether using a Taser or not -- is growing as more attention is being paid to a condition that is only now being popularized.

On one hand, the officers and medics who are called to deal with the agitated and disturbed

people say they know the phenomenon well. They have seen the irrational responses, bizarre behaviour and hyperactivity of the people; they have felt their superhuman strength as they struggle.

Police readily grab hold of the medical terminology of "excited delirium" to describe it.

That excited delirium is a condition almost exclusively associated with a struggle with police, however, creates concern with some. One does not hear of a person dying of excited delirium during a barroom brawl or a fight with a spouse or when out camping or shopping.

"Anytime you see a specific condition being referenced in only one context it raises serious question," said Graeme Norton, the director of the public safety project with the Canadian Civil Liberties Association.

Opponents in the United States go further, saying the term is used to mask over-aggressive police force.

Excited delirium is a term that has been accepted in the United States by the National Association of Medical Examiners, but not by the American Medical Association. It has been dismissed as a "pop culture phenomenon" in the pages of the Canadian Medical Association Journal and listed as a contributing cause of death in several coroner's reports in Canada.

At Thursday's conference, such debate was pushed into the background. As the presentations progressed, few in the room seemed to be nonbelievers.

A jerky video projection showed a large young man -- naked and agitated -- walking down the street with only passing compliance with orders to stop that are repeatedly called out by a growing cluster of police officers anxiously fingering canisters of pepper spray in their latex-gloved hands.

When the man starts punching out large sections of a wooden fence, the officers move in, bathing him in spray and piling on him as he pushes back with apparent superhuman strength.

As the video of the confrontation finishes, Chris Lawrence, a trainer with the Ontario Police College, turns to conference attendees and parodies what critics of police are saying: "We'd like you to negotiate with this individual; we can't understand why you just can't talk to these people."

The room erupts in knee-slapping laughter.

"We don't do this because we want to; we do this because we have to," he said of police restraint techniques, including Tasers, pepper spray, batons, handcuffs and physical holds.

Mr. Lawrence studied 407 police-related deaths in Ontario that went to inquest and are archived at the police college. He found 35 cases where excited delirium was deemed a factor, either by name or by mention of common features. The first death was in 1988.

Only one involved a Taser, although more recent examples may still be in the inquest system and are not included in his study. All but one of the 35 victims was male. Their average age was 34.

He found excited delirium deaths occurred over the years on every day of the week, but most often on weekends. All of the victims were either substance abusers (overwhelmingly cocaine) or suffering mental illness (most often schizophrenia) but rarely both at the same time. He found cases where the temperature was 31C and cases where it was -7.2C; cases in the biggest city and in rural northern Ontario.

"We cannot seem to eliminate the problem," he said.

Dr. Christine Hall, an emergency room doctor with the Vancouver Island Health Authority, addressed critics who dismiss excited delirium because it is not listed in the

Diagnostic and Statistical Manual of Mental Disorders, the standard guidebook to psychiatric diagnosis.

"It is not a diagnosis -- get over it," she said. "It is a state, a condition."

She compared it to other conditions, such as abdominal pain. Appendicitis might be the diagnosis for someone with abdominal pain. Excited delirium, she said, is a symptom or condition of an underlying disorder.

She echoed the contention that police restraint is typically necessary. "Psychiatrists do not undertake talk therapy with delirious people … the medic's job is not to capture people," she said. "Physicians and nurses do not undertake treatment on people who are trying to kill them."

Dean Popov, paramedic practice manager at Sunny-brook-Osler Centre for Prehospital Care, told the conference that no matter what police and medics do in these cases, it could end badly: "The outcome may still be negative, even if everything is done properly. We truly don't 100% know what is causing this yet."

See also: Excited-Delirium

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