Unexpected Death Related to Restraint for Excited Delirium:
A Retrospective Study of Deaths in Police Custody
and in the Community

Published in the Canadian Medical Association Journal (CMAJ)


Pollanen MS, Chiasson DA, Cairns TJ, and Young JG. Unexpected death related to restraint for excited delirium: a retrospective study of deaths in police custody and in the community. CMAJ, Jun 1998; 158(12): 1603-7.

Milliken D. Death by restraint. CMAJ, Jun 1998; 158(12): 1611-12.

CHAS' COMMENTS regarding the article's original ABSTRACT
follow the upcoming PDF FILES.

On September 15, 2004, I replaced the previously-posted scanned pages of this article with its much nicer PDF file version!

Followed by a much nicer PDF file replacement of the previously-posted scanned pages of "Death by Restraint," an Editorial Letter published in the same CMAJ issue, written by Donald Milliken, MD; Chief of the Department of Psychiatry, Capital Health Region, Victoria, BC (Canada).

Followed by the PDF file of a never before posted (HERE) 1999 Letter To The Editor about the Pollanen et al 1998 study article; written by two prominent Austrian restraint asphyxia researchers:
Roggla G, Roggla M. Death in a hobble restraint. CMAJ, July 1999;161(1):21

If you don't have an Adobe Acrobat PDF file program, you can download a FREE version HERE.

Unexpected Death Related to Restraint for Excited Delirium:
A Retrospective Study of Deaths in Police Custody and in the Community

Death by Restraint

Death in a Hobble Restraint


Of the 21 people studied, 20 were men. I think a study of why women seem much less likely to experience "excited delirium" (or to be forcefully-prone-restrained) should be done!

None of these people were "hobbled." 18 were placed in forceful-prone-restraint – 3 were restrained by "pressure applied to the neck." Only 8 of the 18 prone-restrained individuals were documented as having been subjected to "chest compression from the body weight of the 1 to 5 people restraining them." However, you must recognize that: even though such compression was not reported, that doesn't mean chest compression didn't occur in the other cases! It only means that it wasn't "documented," or admitted to, in the other cases.

What I find "important" about the "drug-induced" aspects examined in this study: Cocaine (and benzoylecgonine) was present in a minority of the subjects studied – only 8 of the 21 people (38%) had cocaine on board. The majority of study subjects had NON-DRUG-INDUCED excited delirium.

Of the 8 "drug-induced" subjects, those with "cocaine levels" had a content "similar to that of recreational users but much lower than that of people who died of cocaine intoxication." "The blood level of benzoylecgonine in people with cocaine-induced excited delirium fell between the levels for recreational users and those who died of cocaine intoxication." In other words, NONE of these 8 individuals had "lethal" levels of a cocaine-related drug on board! Thus, none of their deaths could be attributed to "drug overdose."

My favorite part of this article, is the first line of the "INTERPRETATION" section:

"The most striking finding of this study was that all of those who died unexpectedly during or after an episode of excited delirium had been physically restrained."

Some Medical Examiners (in a blatantly obvious effort to shift the "blame" for death away from those who applied forceful-prone-restraint to an individual who DIED during same), attempt to argue that "excited delirium" states – alone! – may be responsible for an individual's DEATH. However, I've never read about, nor anecdotally heard of, a single case study that identified someone dying ONLY because they had been running around in the throes of "excited delirium."

Therefore, unless a Medical Examiner can site research or case studies identifying "excited delirium" states – alone! – to have been responsible for an individual's DEATH, it is entirely unreasonable and unsupported for "excited delirium" to be identified as a "cause of death." It may be "contributory!" But, people do not "die" from "excited delirium" - alone!

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Email Charly at: c-d-miller@neb.rr.com
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