NCCHC: “STRONG” response to excited delirium can prevent sudden death

This video shows Appleton, Wis. police responding to an excited delirium situation last June, providing interesting perspective into the nature of an inflicted subject.

“Excited delirium is a medical emergency masquerading as a corrections problem.”

Todd Wilcox, MD, MBA, CCHP-A, is the Medical Director of Salt Lake County Jail, and that was one of his messages to attendees of a session held at the 2009 National Commission on Correctional Health Care (NCCHC) Annual Meeting in Orlando at the end of October.

During his presentation, Dr. Wilcox reviewed recent research and shared currently recommended response and treatment for this life-threatening syndrome, which has a quick onset and has been associated with stimulant drug use such as cocaine, amphetamines, and PCP in addition to use/overuse of antipsychotic medications.

Strong Indicators
The mnemonic (word-memory aid) “STRONG” can help you to identify the presenting characteristics of excited delirium.

S-Superhuman strength: The individual is often able to accomplish feats of strength or overcome a group of officers
T-Thought disorder: A large number of ED cases involve psychiatric illness
R-Resisting violently: Hysterical resistance to containment attempts
O-Overheating: High body temperatures are often seen, including stripping off clothing
N-No pain: Pain from a TASER or pepper spray has no impact and just prolongs the fight
G-Get Help: The main goal is capture and treatment. The situation will not improve until medical treatment is obtained

Strong Actions
Dr. Wilcox recommends using enough force to have an instant win. Do not engage the person until you are over-prepared for the situation. Let the person continue to act out until ready to intervene. Measured escalation of force, common in correctional settings, is not appropriate in this situation.

The situation will not improve until medical treatment is given. However, the superhuman strength, violence, and irrational thought make take-down and delivery to emergency care challenging. Wilcox advocates the use of a TASER shield for response to ED. The shield has been successful in rapid take-down situations at Salt Lake County Jail.

Medical Response
Initiate the Emergency Medical Process (Man-down and Ambulance Service) as soon as ED is considered in an inmate take-down situation. Once ED is underway, treatment is necessary to reduce the chance of sudden death. New research indicates this constellation of symptoms can be caused by massive release of hormonal response to stress, which overloads the body’s resources. Changes in electrolytes can lead to cardiac arrhythmias. Sudden cardiac death with lack of response to medications or CPR can rapidly ensue.

With training, awareness, and preparation, excited delirium can be handled successfully at your facility.

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