Factors Associated With Excited Delirium
Deaths in Police Custody

Published in the journal of Modern Pathology
in November, 1998 [Mod Pathol 1998;11(11):1127-1137]

AUTHOR: Darrell L. Ross, PhD.

"Chas Comments":

I disagree that these incidents are "increasingly" occurring. Rather, I believe they are being recognized and studied ... talked about and published ... more often now, than they were in the past. Still, I find that this article contains a lot of helpful information.

Unfortunately, I have a few "problems" (complaints / disagreements) with portions of Ross' "Discussion" section. (He doesn't cite an official "Conclusion" - but the end of his "Discussion" section is pretty much a "Conclusion.")

What follows is the text of the "Discussion" paragraph (the last paragraph of Ross' article). My complaints and disagreements appear in BLUE text.

"Police administrators are encouraged to develop policies and procedures that direct law enforcement personnel in the use of multiofficer physical control techniques that are designed to subdue a person quickly. Other policies that authorize proper restraint equipment and that also identify proper transportation procedures should be developed."
Ross neglects to suggest what any of this "proper" stuff might consist of.

"Training that can assist police officers in recognizing factors associated with excited delirium, recognizing individuals susceptible to sudden death, monitoring strategies once the person is restrained, proper use of authorized restraint equipment, and appropriate transportation procedures should be designed."
Again, Ross neglects to suggest what any of this stuff might consist of.

"Restraint equipment that controls a violent subject's legs independent of the wrists, such as a leg-wrapping strap device, which allows the subject to be in an upright and seated position at the scene or during transport, should be used."
This sounds as though Ross is associated (or at least acquainted with) one or more of the manufacturers of a DEVICE designed to "avoid hobble restraint." I do NOT endorse these DEVICES. Primarily because, almost universally, they ONLY address the avoidance of HOBBLE RESTRAINT. Except for The Hugger, these devices do NOT address the problem of FORCEFUL-PRONE-RESTRAINT. And, forceful-prone-restraint is the BIG "BOOGEY MAN," when it comes to Restraint Asphyxia - NOT hobble restraint!!!

"The restraint procedure of hogtying should be used judiciously and in situations in which there is no alternative method for restraining the violent person. The subject should be placed upright or rolled on his side quickly after restraint, and his vital signs should be monitored."
Here's my big disagreement with this article!

By writing the above, Ross has just "endorsed" the continued use of "hogtying" or hobble restraint! That's just, plain, WRONG! Use of hobble restraint is right out - unless use of forceful-prone-restraint is BANNED FIRST, and officers have been educated as to WHY it was banned.

ADDITIONALLY: By suggesting that a hogtied individual could be placed in an "upright" position, Ross demonstrates the complete absence of ANY understanding of the hobble restraint position! Someone in hobble restraint is physically prevented from anything other than prone or SIDE (lateral) positioning. It is impossible to sit a hobble restrained individual "upright." (I suspect that Ross is confused, and thinking about those "anti-hobble restraint" devices - not actual hobble restraint.)

ADDITIONALLY: Police officers (the folks this article is written about - and somewhat FOR) do NOT have the equipment or training to "monitor vital signs" in any kind of meaningful manner. Nor are they trained or equipped to respond to any vital sign abnormalities, should they happen to note them! LASTLY (re: THIS point): "Monitoring vital signs" does NOT prevent Restraint Asphyxia from forceful-prone-restraint. Stratton et al have shown that, even when a prone-hobble-restrained individual is monitored by a PARAMEDIC, once restraint-related positional asphyxia occurs - once the vital signs being "monitored" are missing - the individual is dead. End of story. Thus, Ross' advisement to use a lethal restraint position and "MONITOR VITAL SIGNS" is entirely ludicrous.

"If the individual suddenly exhibits tranquillity after an extreme struggle and shows other signs of medical distress, medical attention should be immediately summoned."
See above: That's TOO LATE!

"Additional investigations that study excited delirium and the changes caused by dopamine receptors in cocaine abusers and police restraint should be conducted. Such information might be useful to police in developing alternative restraining measures."
Although some might consider this statement an, "easy out," at least Ross acts RESPONSIBLY, by inferring that his assessment of these cases are not the "end all" and "be all" o' the subject!

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