How to Respond to Excited Delirium

This mysterious condition is a primary cause of in-custody death. Campus officers must know how to recognize it and respond appropriately.

Because law enforcement officers are often required to control subjects in various stages of agitation, it is important for them to understand that some of these subjects will be in a state of extreme physiologic stress. This state is often called “excited or agitated delirium.”

The condition of excited delirium is associated with a high risk of sudden death and is recognizable by its constellation of symptoms and signs, which may include: agitation, incoherence, elevated body temperature, paranoia, inappropriate and often violent behavior, constant motion and feats of incredible strength.

There Is No Single Cause
Subjects experiencing excited delirium have died in various situations, sometimes after exposure to less-than lethal weapons. But research has been performed to determine their role in excited delirium, and no single cause has been identified. Most credible experts believe excited delirium allows a subject to exhaust himself to death and that this phenomenon is independent of any device or technique used upon the subject.

Excited delirium is generally considered to be a potentially life-threatening medical emergency because of the significant metabolic stress it can place on the body and the fact that the subject experiencing it does not recognize the seriousness of his condition.

Risk factors for developing this condition appear to include male gender, illicit stimulant abuse (usually long-term), a known underlying mental illness (especially schizophrenia and paranoid conditions), or a history of taking mental illness medications. There are probably numerous persons in healthcare and educational facilities who have several of these risk factors, and being aware of these subjects in advance gives officers an advantage.

What Campus Officers Can Do
There are generally two basic things members of law enforcement agencies can initiate in their work practices that will greatly assist these people with this medical condition.

Learn to Recognize the Condition – Perhaps one of the more difficult things to learn is recognition of excited delirium. While the subject’s behavior may be of law enforcement’s concern and the person must be controlled for the safety of themselves and those around them (a primary law enforcement duty), he or she must also be evaluated by medical professionals sooner rather than later. The only way this will happen is if the officer recognizes the condition early.

Delirious, agitated and inappropriate behavior are the best indicators of excited delirium. This is much different than the often slowed, dulled and inappropriate behavior of simple alcohol intoxication. Some common behavior themes in excited delirium cases are:

  • Inappropriately running in traffic
  • Partial or full public nudity
  • Inappropriate and unprovoked acts of violence such as attacking windows, homes, cars, lights, etc.

If officers recognize this behavior upon arrival and can correlate it with some of the risk factors or other symptoms/signs as described above, it is likely they are dealing with a case of excited delirium.

Call for Help – Upon recognizing an excited delirium case, officers should call for backup. These subjects are difficult to control and can demonstrate paranoia, inappropriate violence and feats of great strength.

Next, officers should call for an EMS response. Remember that excited delirium subjects are at high risk for sudden death. This is not the person to be placed unattended in the back of a squad car once he is controlled. If the subject goes on to have a problem, it is much better to have him in the back of an ambulance with EMS personnel in attendance. The officer’s goal should be to have EMS stage away from the scene but arrive as soon as the subject is controlled so he can be evaluated.

These subjects will likely need rapid and aggressive medical sedation and evaluation at a hospital. If initiating something like this on a campus would represent a change in the current modus operandi, law enforcement may need to alert the local EMS authority of this change in practice and explain why it is a good idea.

It is important for officers to learn to recognize this syndrome for what it is: a medical emergency. Campus law enforcement agencies should provide officers with appropriate training and resources.


    Dr. Jeffrey Ho is a board-certified emergency medicine physician and a Fellow of the American College of Emergency Physicians. He regularly consults with law enforcement agencies on issues of in-custody death.

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