Social:Excited delirium

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Short description: Controversial syndrome associated with extreme agitation and delirium

Excited delirium (ExDS), also known as agitated delirium (AgDS) or hyperactive delirium syndrome with severe agitation, is a controversial and widely rejected diagnosis characterized as a potentially fatal state of extreme agitation and delirium.[1][2] It has typically been diagnosed postmortem in young adult black males who were physically restrained by law enforcement personnel at the time of death.[3][4]

Symptoms are said to include aggressive behavior, extreme physical strength and hyperthermia. Mainstream medicine does not recognise the label as a diagnosis: it is not listed in the Diagnostic and Statistical Manual of Mental Disorders or the International Classification of Diseases, and is not recognized by the World Health Organization, the American Psychiatric Association, the American Medical Association, the American Academy of Emergency Medicine,[5] or the National Association of Medical Examiners.[6]

Excited delirium diagnosis has been particularly associated with taser use. A 2017 investigative report by Reuters found that excited delirium had been listed as a factor in autopsy reports, court records or other sources in at least 276 deaths that followed taser use since 2000. The Taser manufacturing firm Axon published numerous medical studies promoting the diagnosis along with their product.[7][8][9]

There have also been concerns raised over the use of sedative drugs during an arrest following claims of excited delirium. The drugs ketamine or midazolam (a benzodiazepine) and haloperidol (an antipsychotic) injected into a muscle have sometimes been used to sedate a person at the discretion of paramedics and sometimes at direct police request.[10] Ketamine can cause respiratory arrest, and in many cases there is no evidence of a medical condition that would justify its use.[3][11] The term excited delirium is sometimes used interchangeably with acute behavioural disturbance,[12]:1 a symptom of a number of conditions which is also responded to with involuntary injection with benzodiazapines, antipsychotics, or ketamine.[13]:624[14]:152

A 2020 investigation by the United Kingdom's forensic science regulator found that the diagnosis should not have been used since it "has been applied in some cases where other important pathological mechanisms, such as positional asphyxia and trauma may have been more appropriate".[15] In the U.S., neurologists writing for the Brookings Institution called it "a misappropriation of medical terminology, used by law enforcement to legitimize police brutality and to retroactively explain certain deaths occurring in police custody".[16] The American Psychiatric Association's position is that the term "is too non-specific to meaningfully describe and convey information about a person."[3] The Royal College of Psychiatrists has deprecated use of excited delirium, recommending non-diagnostic descriptions for highly agitated states such as acute behavioral disturbance.[17]

History

Throughout the 19th and early-20th century, "excited delirium" was used to describe an emotional and agitated state related to drug overdose[18] and withdrawal[19] or poisonings,[20] similar to catatonia or Bell's mania with some believing them to be the same condition.[21] The term "excited delirium" (ExDS) began to be used as a diagnosis to explain deaths in police custody especially during or after restraint in Miami, Florida in the 1980s. This practice followed publication of a 1985 article titled "Cocaine-induced psychosis and sudden death in recreational cocaine users", co-authored by deputy chief medical examiner for Dade County, Florida,[22] Charles Victor Wetli.[23][24] The article was published in the Journal of Forensic Sciences and reported that in five of the seven cases they studied, deaths occurred while in police custody. In 1988, Wetli claimed that a series of nineteen women, all Black prostitutes, had died of the condition due to "sexual excitement" while under the influence of cocaine, but police later announced they had found a serial killer responsible for those deaths.[25] The legitimacy of the condition has since been controversial with most of the medical community not recognizing it, and it is not listed in the Diagnostic and Statistical Manual of Medical Disorders (DSSM).

The supposed risk factors vary including "bizarre behavior generating phone calls to police", "failure to respond to police presence", and "continued struggle despite restraint". It supposedly endows individuals with "superhuman strength" and being "impervious to pain". It is disproportionately diagnosed among young Black males, and has clear undertones of racial bias.[26]

In 2023, the state of California became the first in the United States to ban the use of "excited delirium" as a cause of death.[27][28]

Description

People diagnosed with excited delirium are frequently claimed to have acute drug intoxication, generally involving phencyclidine, prolintanone, methylene­dioxy­pyro­valerone, cocaine, or methamphetamine.[29] Multiple other factors may be in evidence, including positional asphyxia, hyperthermia, drug toxicity, and/or catecholamine-induced fatal abnormal heart rhythms.[30]

Other conditions which can resemble excited delirium are mania, neuroleptic malignant syndrome, serotonin syndrome, thyroid storm, and catatonia of the malignant or excited type.[31]

Association with Taser use and police restraint

A 2017 report by Reuters found that excited delirium had been listed as a factor in autopsy reports, court records or other sources in at least 276 deaths that followed taser use since 2000, with diagnosis often based on a test conducted by Deborah Mash, a medical school professor and paid consultant to the Taser manufacturer Axon. In one case, within four hours of a man dying after being tasered, Axon had provided model press releases, instructions for gathering evidence of excited delirium, and advised that samples be sent to Mash.[7]

Amnesty International found that the syndrome was cited in 75 of the 330 deaths following police use of a taser on suspects between 2001 and 2008,[8] and a Florida-based study found it was listed as a cause of death in over half of all deaths in police custody, though many Florida districts do not use it at all.[32]

While diagnosis is habitually of men under police restraint, medical preconditions and symptoms attributed to the syndrome are far more varied.[33][clarification needed]

Males account for more documented diagnoses than females.[34] Often law enforcement has used tasers or physical measures in these cases, and death most frequently occurs after the person is forcefully restrained.[35][36][37] Critics of excited delirium have stated that the condition is primarily attributed to deaths while in the custody of law enforcement and is disproportionately applied to Black and Hispanic victims.[35][38][39] One study looking at cocaine-related deaths in the 1970s and 1980s in Florida, showed that the deaths were more likely to be diagnosed as excited delirium when involving young Black men dying in police custody and "accidental cocaine toxicity" when involving white people. A 1998 study found that "In all 21 cases of unexpected death associated with excited delirium, the deaths were associated with restraint (for violent agitation and hyperactivity), with the person either in a prone position (18 people [86%]) or subjected to pressure on the neck (3 [14%]). All of those who died had suddenly lapsed into tranquillity shortly after being restrained".[40]

In 2003, the NAACP argued that excited delirium is used to explain the deaths of minorities more often than whites,[41] and the American Psychiatric Association also notes that "the term excited delirium is disproportionately applied to Black men in police custody".[3] The American Civil Liberties Union argued in 2007 that the diagnosis served "as a means of white-washing what may be excessive use of force and inappropriate use of control techniques by officers during an arrest."[42]

The UK Independent Advisory Panel on Deaths in Custody (IAP) suggests that the syndrome should be termed "Sudden death in restraint syndrome" in order to enhance clarity.[33] Some civil-rights groups have argued that excited delirium diagnoses are being used to absolve law enforcement of guilt in cases where alleged excessive force may have contributed to patient deaths.[43][44][41]

Prominent cases include Daniel Prude, who was said to be in a state of excited delirium in 2020 when police put a hood over his head and pressed his naked body against the pavement. Prude, a Black man, lost consciousness and died. Excited delirium was also cited by the defense in State v. Chauvin, a murder trial related to the murder of George Floyd in 2020.[45] Prosecutor Steve Schleicher refuted the defense suggestion that Floyd had "superhuman strength" during his arrest because he was suffering from the condition.[46]

Ketamine

Ketamine or midazolam and haloperidol injected into a muscle have frequently been used, sometimes at direct police request, to sedate people alleged to be experiencing excited delirium.[10] Ketamine can cause respiratory arrest, and in many cases there is no evidence of a medical condition that would justify its use.[3][11] Following an injection the person must be transported to a hospital. In 2018, a Minneapolis hospital published a paper which reported that 57 percent of the people who had been injected for agitation needed intubation.[47]

Concern has been raised about the increasing usage of a claim of excited delirium to justify tranquilizing persons during arrest, with requests for tranquilization often being made by law enforcement rather than medical professionals. Ketamine is the most commonly used drug in these cases.[48] There have been deaths related to use of ketamine on restrained prisoners.[49] A controversial study into ketamine use was terminated due to ethics concerns.[50] The study was also linked to Axon via Jeffrey Ho.[50]

In 2019, Elijah McClain, a Black man, was arrested by police officers after receiving a 911 call which reported a man walking, waving his arms and wearing a ski mask. The officers said that he was exhibiting "crazy strength" when they attempted to arrest him but all three said that their body cams had fallen off and thus there was no video of what they claimed to be a violent struggle. McClain weighed 140 pounds and was 5 feet 6 inches tall. He was handcuffed and then a choke hold was used twice, once "successfully" meaning that McClain lost consciousness. When paramedics arrived they administered enough ketamine to sedate a 220-pound man.[51] He went into cardiac arrest a few minutes later. In a report of the case on 60 Minutes, John Dickerson interviewed the District Attorney who justified the use of ketamine, adding that since excited delirium could not be ruled out as a cause of death it would be impossible to win a homicide case because "you can't file a homicide charge without cause of death."[45][52][53]

Taser use

According to an article in the Harvard Civil Rights–Civil Liberties Law Review, since 2000, over one thousand people in the United States have died shortly after being tased, with the deaths sharing several commonalities: "the deceased often were mentally ill or under the influence of drugs at the time of death, they tend to have been shocked multiple times by officers during arrest, and they often share an exceptionally rare cause of death, 'excited delirium.'"[54]

Axon Enterprise, formerly Taser International, provides training for police on recognizing excited delirium and several prominent proponents of the diagnosis are retained by Axon,[7] with diagnosis often based on a test conducted by Deborah Mash, a paid consultant to Axon. In one case reported by an investigative report done by Reuters, within four hours of a man dying after being tasered Axon had provided model press releases, instructions for gathering evidence of excited delirium, and advised that samples be sent to Mash for lab work to establish a diagnosis.[7]

Axon has paid thousands of dollars to proponents of the excited delirium diagnosis, including Charles Wetli who first proposed the term, who have repeatedly used "excited delirium" as a defense in liability suits and to shield police officers from criminal liability for deaths in custody. Harvard Civil Rights–Civil Liberties Law Review reports that "Axon has actively pursued litigation against some medical examiners who attribute deaths to tasers rather than excited delirium. These lawsuits seem to have a chilling effect on medical examiners' work; a 2011 survey found that 14% of medical examiners had modified a diagnostic finding out of fear of litigation by the company."[55]

In Canada , the 2007 case of Robert Dziekanski received national attention and placed a spotlight on the use of tasers in police actions and the diagnosis of excited delirium. Police psychologist Mike Webster testified at a British Columbia inquiry into taser deaths that police have been "brainwashed" by Taser International to justify "ridiculously inappropriate" use of the electric weapon. He called excited delirium a "dubious disorder" used by Taser International in its training of police.[56] In a 2008 report, the Royal Canadian Mounted Police argued that excited delirium should not be included in the operational manual for the Royal Canadian Mounted Police without formal approval after consultation with a mental-health-policy advisory body.[57]

Rejection by most medical associations

Excited delirium is not recognized by the World Health Organization, the American Psychiatric Association, the American Medical Association, and not listed as a medical condition in the Diagnostic and Statistical Manual of Mental Disorders[3][42] or International Classification of Diseases.[58] Dr. Michael Baden, a specialist in investigating deaths in custody, describes excited delirium as "a boutique kind of diagnosis created, unfortunately, by many of my forensic pathology colleagues specifically for persons dying when being restrained by law enforcement".[32] In June 2021, the Royal College of Psychiatrists in the UK released a statement that they do "not support the use of such terminology [as ExDS or AgDS], which has no empirical evidential basis" and said "the use of these terms is, in effect, racial discrimination".[59]

A 2020 scientific literature review looked at reported cases of excited delirium and agitated delirium. The authors noted that most published current information has indicated that excited delirium-related deaths are due to an occult pathophysiologic process. A database of cases was created which included the use of force, drug intoxication, mental illness, demographics, and survival outcome. A review of cases revealed there was no evidence to support ExDS as a cause of death in the absence of restraint. The authors found that when death occurred in an aggressively restrained individual that fits the profile of either ExDS or AgDS, restraint-related asphyxia must be considered the more likely cause of the death.[60]

Position of the American College of Emergency Physicians

Following a 2009 review by an internal task force, the American College of Emergency Physicians (ACEP) accepted excited delirium as a "real and unique syndrome."[61] At that time their list of symptoms describing the condition stated:[62]

[The patient is] usually agitated, often speaking or yelling uncontrollably and pacing or running with no purpose. They often threaten others verbally or physically; they sweat profusely, appear ill, and are unable to control themselves. Often, their condition is associated with mental disorders or the use of drugs such as cocaine. Their actions make for riveting television, and alarm law enforcement officials and EMTs.

Commenting on ACEP's position, in a 2020 position paper the American Psychiatric Association stated:[3]

The concept of "excited delirium" (also referred to as "excited delirium syndrome" (ExDs)) has been invoked in a number of cases to explain or justify injury or death to individuals in police custody, and the term excited delirium is disproportionately applied to Black men in police custody. Although the American College of Emergency Physicians has explicitly recognized excited delirium as a medical condition, the criteria are unclear and to date there have been no rigorous studies validating excited delirium as a medical diagnosis.

Three of the members of ACEP's task force were linked to Axon, the corporation that manufactures Taser stun guns. Axon frequently blames excited delirium for stun-gun-related deaths.[7]

ACEP then created a new task force to investigate this syndrome and their report led to a new ACEP position statement in April 2023 which recognized the syndrome, but discouraged the term "excited delirium":[63][64]

The American College of Emergency Physicians (ACEP) recognizes the existence of hyperactive delirium syndrome with severe agitation, a potentially life threatening clinical condition characterized by a combination of vital sign abnormalities (e.g., elevated temperature and blood pressure), pronounced agitation, altered mental status, and metabolic derangements.... ACEP does not recognize the use of the term “excited delirium” and its use in clinical settings.

Later in 2023, they also withdrew the 2009 paper, saying that it was outdated.[28][65] In a statement, the ACEP said it had "withdrawn its approval of this [the 2009] paper" and that "[t]he term excited delirium should not be used among the wider medical and public health community, law enforcement organizations, and ACEP members acting as expert witnesses testifying in relevant civil or criminal litigation".[65]

See also

References

  1. ↑ Obasogie, Osagie K. (2021). "Excited Delirium and Police Use of Force". Virginia Law Review 107 (8): 1545–1620. ISSN 0042-6601. https://www.jstor.org/stable/27135603. 
  2. ↑ Ives, Mike (October 11, 2023). "California bans 'excited delirium' as cause of death". New York Times. https://www.nytimes.com/2023/10/11/us/excited-delirium-california-police-brutality.html. 
  3. ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 Position Statement on Concerns About Use of the Term "Excited Delirium" and Appropriate Medical Management in Out-of-Hospital Contexts (Report). American Psychiatric Association. https://www.psychiatry.org/File%20Library/About-APA/Organization-Documents-Policies/Policies/Position-Use-of-Term-Excited-Delirium.pdf. 
  4. ↑ Strömmer, E. M.; Leith, W.; Zeegers, M. P.; Freeman, M. D. (2020). "The role of restraint in fatal excited delirium: a research synthesis and pooled analysis". Forensic Science, Medicine, and Pathology 16 (4): 680–692. doi:10.1007/s12024-020-00291-8. PMID 32827300. 
  5. ↑ "AAEM Excited Delirium Statement". AAEM. https://www.aaem.org/UserFiles/ExcitedDeliriumStatement.pdf. 
  6. ↑ "NAME Excited Delirium Statement 3/2023". NAME. https://name.memberclicks.net/assets/docs/Excited%20Delirium%20Statement%203%20-%202023.pdf. 
  7. ↑ 7.0 7.1 7.2 7.3 7.4 "Shock Tactics: Taser inserts itself in probes involving its stun guns" (in en). https://www.reuters.com/investigates/special-report/usa-taser-experts/. 
  8. ↑ 8.0 8.1 Jouvenal, Justin (2015-05-06). "'Excited delirium' cited in dozens of deaths in police custody. Is it real or a cover for brutality?" (in en-US). Washington Post. ISSN 0190-8286. https://www.washingtonpost.com/local/crime/existence-of-excited-delirium-ruling-in-va-womans-death-has-experts-split/2015/05/06/b1cc9499-ddaa-474c-9e8a-9ae89a9ae679_story.html. 
  9. ↑ "Police keep using 'excited delirium' to justify brutality. It's junk science." (in en-US). Washington Post. ISSN 0190-8286. https://www.washingtonpost.com/outlook/chokehold-police-excited-delirium/2020/07/17/fe907ec8-c6bc-11ea-b037-f9711f89ee46_story.html. 
  10. ↑ 10.0 10.1 "Review, clinical update, and practice guidelines for excited delirium syndrome". Journal of Special Operations Medicine 15 (1): 62–9. 2015. doi:10.55460/7NEE-ZX24. PMID 25770800. 
  11. ↑ 11.0 11.1 Applebaum, Paul S. (11 May 2022). "Excited Delirium, Ketamine, and Deaths in Police Custody". Psychiatric Services 73 (7): 827–829. doi:10.1176/appi.ps.20220204. PMID 35538746. https://ps.psychiatryonline.org/doi/10.1176/appi.ps.20220204. 
  12. ↑ "Acute behavioural disturbance (ABD): guidelines on management in police custody". Royal College of Emergency Medicine. https://fflm.ac.uk/wp-content/uploads/2019/05/AcuteBehaveDisturbance_Apr19-FFLM-RCEM.pdf. 
  13. ↑ Cameron, Peter; Little, Mark; Mitra, Biswadev; Deasy, Conor (2019-05-23) (in en). Textbook of Adult Emergency Medicine E-Book. Elsevier Health Sciences. ISBN 978-0-7020-7625-1. https://books.google.com/books?id=VuWZDwAAQBAJ. 
  14. ↑ McKnight, Rebecca; Geddes, John (2019-05-15) (in en). Psychiatry. Oxford University Press. ISBN 978-0-19-875400-8. https://books.google.com/books?id=tiCWDwAAQBAJ. 
  15. ↑ Forensic Science RegulatorGuidance: The Use of 'Excited Delirium' as a Cause of Death (Report). https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/929746/Excited_Delirium_Guidance_2.pdf. 
  16. ↑ Budhu, Joshua; O'Hare, Méabh; Saadi, Altaf (10 August 2020). "How "excited delirium" is misused to justify police brutality". https://www.brookings.edu/blog/how-we-rise/2020/08/10/how-excited-delirium-is-misused-to-justify-police-brutality/. 
  17. ↑ Royal College of Psychiatrists (2022) College Position Statement PS02/22: ‘Acute behavioural disturbance’ and ‘excited delirium
  18. ↑ McClelland, H. A. (October 1978). "Drug-Induced Delirium" (in en-US). Adverse Drug Reaction Bulletin 72 (1): 256–259. doi:10.1097/00012995-197810000-00001. ISSN 0044-6394. https://journals.lww.com/adversedrugreactbull/Citation/1978/10000/DRUG_INDUCED_DELIRIUM.1.aspx. 
  19. ↑ "Observations on the Use of Fluids and Lumbar Puncture in the Treatment of Delirium Tremens" (in en). Annals of Internal Medicine 12 (12): 2006. 1939-06-01. doi:10.7326/0003-4819-12-12-2006. ISSN 0003-4819. http://annals.org/article.aspx?doi=10.7326/0003-4819-12-12-2006. 
  20. ↑ "Surgical Memoranda". British Medical Journal 1 (844): 258–259. 1877-03-03. ISSN 0007-1447. PMID 20748463. 
  21. ↑ Takeuchi, Asia; Ahern, Terence L.; Henderson, Sean O. (February 2011). "Excited delirium". The Western Journal of Emergency Medicine 12 (1): 77–83. ISSN 1936-9018. PMID 21691475. 
  22. ↑ McGuinness, Terry; Lipsedge, Maurice (July 2022). "'Excited Delirium', acute behavioural disturbance, death and diagnosis" (in en). Psychological Medicine 52 (9): 1601–1611. doi:10.1017/S0033291722001076. ISSN 0033-2917. PMID 35546291. 
  23. ↑ "A knee in the neck of excited delirium". CMAJ 178 (6): 669–70. March 2008. doi:10.1503/cmaj.080210. PMID 18332375. 
  24. ↑ Wetli, CV; Fishbain, DA (July 1985). "Cocaine-induced psychosis and sudden death in recreational cocaine users". Journal of Forensic Sciences 30 (3): 873–880. doi:10.1520/JFS11020J. ISSN 0022-1198. PMID 4031813. https://pubmed.ncbi.nlm.nih.gov/4031813/. Retrieved 2021-09-01. 
  25. ↑ Garcia-Roberts, Gus (2010-07-15). "Is excited delirium killing coked-up, stun-gunned Miamians?". https://www.miaminewtimes.com/news/is-excited-delirium-killing-coked-up-stun-gunned-miamians-6367399. 
  26. ↑ Joshua Budhu, Méabh O'Hare, and Altaf Saadi Monday, How "excited delirium" is misused to justify police brutality, August 10, 2020
  27. ↑ "California becomes first state to ban use of "excited delirium" as cause of death" (in en). October 10, 2023. https://www.theguardian.com/us-news/2023/oct/10/california-police-brutality-excited-delirium-ban-cause-death-newsom. 
  28. ↑ 28.0 28.1 Johnson, Carla K. (2023-10-12). "A doctors group calls its 'excited delirium' paper outdated and withdraws its approval" (in en). https://apnews.com/article/excited-delirium-police-deaths-acep-4760e3cbed181503a2ac747ed5afeef6. 
  29. ↑ "Excited delirium deaths in custody: past and present". The American Journal of Forensic Medicine and Pathology 30 (1): 1–5. March 2009. doi:10.1097/PAF.0b013e31818738a0. PMID 19237843. 
  30. ↑ "Excited delirium, restraints, and unexpected death: a review of pathogenesis". The American Journal of Forensic Medicine and Pathology 31 (2): 107–12. June 2010. doi:10.1097/PAF.0b013e3181d76cdd. PMID 20190633. 
  31. ↑ "Excited delirium: Consideration of selected medical and psychiatric issues". Neuropsychiatric Disease and Treatment 5: 61–6. 2009. doi:10.2147/ndt.s2883. PMID 19557101. 
  32. ↑ 32.0 32.1 "Excited delirium: Rare and deadly syndrome or a condition to excuse deaths by police?" (in en). https://www.floridatoday.com/in-depth/news/2019/10/24/excited-delirium-custody-deaths-gregory-edwards-melbourne-taser/2374304001/. 
  33. ↑ 33.0 33.1 "Making Sense of 'Excited Delirium' in Cases of Death after Police Contact". Policing: A Journal of Policy and Practice 12 (4): 361–371. 2018-12-01. doi:10.1093/police/pax028. https://academic.oup.com/policing/article/12/4/361/3798702. 
  34. ↑ "Excited Delirium: A Systematic Review". Academic Emergency Medicine 25 (5): 552–565. May 2018. doi:10.1111/acem.13330. PMID 28990246. 
  35. ↑ 35.0 35.1 "An Officer Suggested George Floyd Had "Excited Delirium." Experts Say That's Not a Real Thing.". Slate. June 4, 2020. https://slate.com/news-and-politics/2020/06/george-floyd-police-junk-science-excited-delirium.html. "They note, for example, that it's disproportionately cited in cases where black and Hispanic men die in custody." 
  36. ↑ "Excited Delirium: Police Brutality vs. Sheer Insanity". ABC News. March 2, 2007. https://abcnews.go.com/Health/story?id=2919037&page=1. "Police and defense attorneys are squaring off over a medical condition so rare and controversial it can't be found in any medical dictionary — excited delirium. Victims share a host of symptoms and similarities. They tend to be overweight males, high on drugs, and display extremely erratic and violent behavior. But victims also share something else in common. The disorder seems to manifest itself when people are under stress, particularly when in police custody, and is often diagnosed only after the victims die." 
  37. ↑ "How America's broken autopsy system can mask police violence". The Guardian. July 2, 2020. https://www.theguardian.com/us-news/2020/jul/02/autopsies-police-killings-medical-misleading. 
  38. ↑ "'Excited delirium' cited as factor in many fatal police restraint cases. Some say it's bogus.". USA Today. https://www.usatoday.com/story/news/investigations/2020/06/13/excited-delirium-cited-fatal-police-cases-some-say-its-bogus/3178635001/. "For decades critics have pointed to the fact that the term is applied almost exclusively to in-custody deaths or that otherwise involve law enforcement." 
  39. ↑ "The Two Autopsies Of George Floyd Aren't As Different As They Seem". FiveThirtyEight. June 8, 2020. https://fivethirtyeight.com/features/the-two-autopsies-of-george-floyd-arent-as-different-as-they-seem/. "The dead people diagnosed with it tend to be young, black males who died in police custody, he said." 
  40. ↑ Pollanen, M. S.; Chiasson, D. A.; Cairns, J. T.; Young, J. G. (1998-06-16). "Unexpected death related to restraint for excited delirium: a retrospective study of deaths in police custody and in the community". CMAJ: Canadian Medical Association Journal 158 (12): 1603–1607. ISSN 0820-3946. PMID 9645173. 
  41. ↑ 41.0 41.1 "Excited delirium' as a cause of death". Los Angeles Times. 21 April 2003. http://articles.latimes.com/2003/apr/21/health/he-delirium21. 
  42. ↑ 42.0 42.1 "Death by Excited Delirium: Diagnosis or Coverup?". NPR. https://www.npr.org/templates/story/story.php?storyId=7608386. "You may not have heard of it, but police departments and medical examiners are using a new term to explain why some people suddenly die in police custody. It's a controversial diagnosis called excited delirium. But the question for many civil liberties groups is, does it really exist?" 
  43. ↑ "A knee in the neck of excited delirium". CMAJ 178 (6): 669–70. March 2008. doi:10.1503/cmaj.080210. PMID 18332375. 
  44. ↑ "Excited delirium: does it exist?". Perspectives in Psychiatric Care 39 (3): 93–4. 2003. doi:10.1111/j.1744-6163.2003.00093.x. PMID 14606228. 
  45. ↑ 45.0 45.1 "Police Repeatedly Cite 'Excited Delirium' In Killings, But It Has No Real Definition". https://www.npr.org/2021/04/07/985128452/police-repeatedly-cite-excited-delirium-in-killings-but-it-has-no-real-definitio. 
  46. ↑ "EXPLAINER: Why 'excited delirium' came up at Chauvin trial?". August 21, 2021. https://apnews.com/article/derek-chauvin-closing-statement-excited-delirium-3b60b3930023a2668e7fc63f903fc3aa. 
  47. ↑ Mannix, Andy. "Patients sedated by ketamine were enrolled in Hennepin Healthcare study". https://www.startribune.com/patients-sedated-by-ketamine-were-enrolled-in-hennepin-healthcare-study/486363071/?refresh=true. 
  48. ↑ "Two strangers, with the same first name, and a terrifying story about ketamine in policing". September 2020. https://www.cnn.com/2020/08/31/us/ketamine-use-in-police-stops/index.html. 
  49. ↑ "Excited Delirium: The controversial syndrome that can be used to protect police from misconduct charges" (in en). https://www.cbsnews.com/news/excited-delirium-police-custody-george-floyd-60-minutes-2020-12-13/. 
  50. ↑ 50.0 50.1 "Taser, Hennepin Healthcare have a research relationship". https://www.startribune.com/maker-of-taser-has-longstanding-research-relationship-with-hcmc/503392142/. 
  51. ↑ Ortiz, Erik (July 1, 2020). "Elijah McClain was injected with ketamine while handcuffed. Some medical experts worry about its use during police calls.". NBC News. https://www.nbcnews.com/news/us-news/elijah-mcclain-was-injected-ketamine-while-handcuffed-some-medical-experts-n1232697. 
  52. ↑ Tompkins, Lucy. "Here's What You Need to Know About Elijah McClain's Death". https://www.nytimes.com/article/who-was-elijah-mcclain.html. 
  53. ↑ "Excited Delirium: The controversial syndrome that can be used to protect police from misconduct charges". December 13, 2020. https://www.cbsnews.com/news/excited-delirium-police-custody-george-floyd-60-minutes-2020-12-13/. 
  54. ↑ "Special Report: How Taser inserts itself into investigations involving its weapons". August 24, 2017. https://www.reuters.com/article/usa-taser-experts-idINKCN1B4192. 
  55. ↑ Meyer, Matthew. "Police Call It "Excited Delirium." Civil Rights Groups Call It a Sham." (in en-US). Harvard Civil Rights-Civil Liberties Law Review. https://harvardcrcl.org/police-call-it-excited-delirium-civil-rights-groups-call-it-a-sham/. 
  56. ↑ "Police are 'brainwashed' by Taser maker; Psychologist blames instructions". Vancouver Sun (Canwest): pp. A1. 2008-05-14. http://www.canada.com/vancouversun/news/story.html?id=28218a80-11db-47a3-baf9-90b7dc2618aa. 
  57. ↑ "An Independent Review of the Adoption and Use of Conducted Energy Weapons by the Royal Canadian Mounted Police". Royal Canadian Mounted Police. 5 June 2008. http://www.rcmp-grc.gc.ca/ccaps-spcca/cew-ai/kiedrowski-report-rapport-eng.htm. 
  58. ↑ Current Practice in Forensic Medicine. John Wiley & Sons, Ltd. 2016. pp. 97–117. doi:10.1002/9781118456026.ch6. ISBN 9781118456026. 
  59. ↑ "Statement on Acute Behavioural Disturbance (ABD)". Royal College of Psychiatrists. 23 June 2021. https://www.rcpsych.ac.uk/news-and-features/latest-news/detail/2021/06/23/statement-on-acute-behavioural-disturbance-(abd). 
  60. ↑ Strömmer, E. M.; Leith, W.; Zeegers, M. P.; Freeman, M. D. (2020). "The role of restraint in fatal excited delirium: a research synthesis and pooled analysis". Forensic Science, Medicine, and Pathology 16 (4): 680–692. doi:10.1007/s12024-020-00291-8. PMID 32827300. 
  61. ↑ Hoffman, Lisa (2009). "ACEP Recognizes Excited Delirium Syndrome". Emergency Medicine News 31: 1. doi:10.1097/01.EEM.0000361897.32051.8e. https://journals.lww.com/em-news/fulltext/2009/10061/acep_recognizes_excited_delirium_syndrome.6.aspx. Retrieved November 9, 2021. 
  62. ↑ Sorelle, Ruth (2010). "ExDS Protocol Puts Clout in EMS Hands". Emergency Medicine News 32 (10): 1. doi:10.1097/01.EEM.0000389817.48608.e4. https://journals.lww.com/em-news/Fulltext/2010/10000/ExDS_Protocol_Puts_Clout_in_EMS_Hands.1.aspx. Retrieved May 12, 2021. 
  63. ↑ "ACEP's Position on Hyperactive Delirium" (in en). April 14, 2023. https://www.acep.org/news/acep-newsroom-articles/aceps-position-on-hyperactive-delirium. 
  64. ↑ "ACEP Task Force Report on Hyperactive Delirium with Severe Agitation in Emergency Settings". June 23, 2021. https://www.acep.org/siteassets/new-pdfs/education/acep-task-force-report-on-hyperactive-delirium-final.pdf. 
  65. ↑ 65.0 65.1 "ACEP Reaffirms Positions on Hyperactive Delirium" (in en). October 12, 2023. https://www.acep.org/news/acep-newsroom-articles/aceps-position-on-hyperactive-delirium. 



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