“Excited delirium” is not a new problem for law enforcement. Rather, it has existed for as long as mental illness or drug addiction. It was first described in 1849 as mental patients “moving into a state of excessive agitation, leading to collapse and death.”

Although that’s a bit too simplistic of a description, even given over 150 years of study, the definition is still accurate. Subjects are often sweating profusely without regard to weather or clothing. They can be angry, manic and erratic. Often aggressive, they will fight with those trying to help. They suddenly become completely compliant, seem to pass out, and then, without proper care, they can die. This transition from aggression to compliance and death can take a matter of minutes. Although often associated with drug abuse, this isn’t always the case and may be associated with mental illness. When it comes time to make an arrest, be aware of this and you might be able to save a life.

Critical Response

It is critical to remember that this occurs and has occurred for years without regard to any involvement by law enforcement. Currently, police are frequently called to deal with non-law-enforcement issues—mental illness being one of them. Violent and erratic behavior result in a police response regardless of why. Few police officers are trained mental health professionals. Even worse, officers typically arrive when the subject is in the final stage of excited delirium. Simply put, a subject may die regardless of police involvement, and quickly, making it a cop’s worst nightmare.

Law enforcement is seemingly always behind the curve. As the subject escalates their use of force, violence or aggression, officers must react. That reaction time places the officers, public and even the subject at risk. Officers must identify the force, select a response, and then initiate—that response time is critical to the officer’s survival. This is true without regard to why the force is used. An officer seldom has time to “diagnose” a mental patient prior to reacting to their aggression. This places law enforcement in an incredibly untenable position.

As an officer, you must deal with the subject’s aggression or use of force as quickly and safely as possible, just like any other situation. Where it changes is post-arrest. You must act immediately to get the subject medical help. When it comes to excited delirium, you are really providing assistance to the medics. If it is a mental subject, the faster custody occurs, the better. Medical attention and transport should be arranged immediately. Even with immediate medical attention, they may not survive, but without that attention, it is certain. So, use force that is reasonable and necessary based upon the actions of the subject and get them medical attention immediately.

Learn to React

As those suffering from mental illness or drug abuse confront police with more violence and aggression, officers are forced to respond. Unfortunately, it is often the suspect’s response that receives scrutiny, while little attention is given to its cause. It is critical to remember that we, as LE officers, are asked to react to the actions of others. However, that does not preclude our need to learn. The more we know about the real problem, the better we can deal with it after the necessary force is applied. It is incumbent upon agencies and officers to understand the symptoms and signs so immediate medical attention can be provided. It may not change the force an officer must use in response to the subject, but it may save a life afterwards. Excited delirium is definitely one of the cases where the more you know, the better off you are. It just may save a couple lives and possibly a career or two.

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October 2012

“Excited delirium” is not a new problem for law enforcement. Rather, it has existed for…