Page 76 - Journal of Special Operations Medicine - Spring 2015

Figure 1 National Institute of Justice Pocket Reference Card on Excited Delirium.

enter and render care. Dispatchers should also ensure that subjects manifesting signs of ExDS are experiencing
that an adequate number of police officers are dis­ an acute, potentially life­threatening condition.
patched to safely control the situation. As discussed
previously, an average of four officers is required to ef­ Forceful restraint is nearly always required in ExDS.
fectively achieve control of a typical suspect with ExDS. Once the necessary police and EMS resources are in
place, suspects failing to respond to verbal commands
First arriving officers responding to a disturbance of and resist arrest should be taken into custody quickly
the public peace or disorderly conduct should initially and efficiently in a manner that minimizes a struggle. In
assess individuals for indicators of ExDS. If signs of many instances, inducing neuromuscular incapacitation
ExDS are present, then officers should take into con­ with a CEW may be the safest and most efficient manner
sideration that the subject may be irrational, potentially to achieve control. While there is no medical evidence to
violent, and dangerous. The law enforcement objectives suggest that prone or supine restraints have any detri­
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of initially responding officers are to protect the public mental effects on these individuals, minute ventilation
and the suspect from harm and contain the suspect un­ is generally above normal and officers should assess for
til additional police and EMS resources arrive. If EMS respiratory distress. If present, the officer should place
has not been dispatched, then officers should request the suspect in a position that does not restrict breathing.
that they respond. If possible, first responding officers Breathing is least affected by placing the individual on his
should contain the disturbance and employ deescalation side in the recovery position. Once police officers achieve
techniques and minimize unnecessary stimuli that can physical control and disarm the suspect of any weapons,
further excite or provoke the suspect. Deescalation tech­ EMS providers should be permitted to conduct a medi­
niques include avoiding the use of emergency equipment cal survey, administer sedation to reduce struggling, if
(lights and sirens) and of canines and not shouting at the needed, and initiate resuscitative measures as indicated.
suspect, all of which may escalate an unstable situation.
Persons with ExDS may not understand and comply Patients who continue to resist despite with verbal calm­
with verbal commands and may resist usually effective ing and deescalation techniques should be sedated be­
control tactics such as pepper spray, impact batons, joint cause continuing to struggle with physical restraint is
locks, kicks, and punches. Officers must acknowledge associated with a high risk for sudden death, particularly
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66 Journal of Special Operations Medicine Volume 15, Edition 1/Spring 2015