Positional Asphyxia and Excited Delirium

Individuals who exhibit extreme agitation and engage in violent struggles may be experiencing a condition known as excited delirium. This medical condition can, at times, lead to the death of the person involved. Excited delirium can be triggered by a variety of factors, including the use of drugs, alcohol, underlying psychiatric issues, or a combination of these factors.

Common Signs and Symptoms of Excited Delirium Include:

  1. Exceptional physical strength
  2. An unusually high pain tolerance
  3. Impaired cognitive function
  4. Disorientation
  5. Hallucinations
  6. Panic or shouting
  7. Violent behavior
  8. Paranoia
  9. Profuse sweating and feeling hot to the touch (increased body temperature)

A sudden calmness observed after a period of frenzied activity can be a sign of exceptional risk. It’s important to note that specific restraint positions can elevate the risk of death. Ensuring the subject’s head is adequately supported to prevent airway blockage is crucial. Avoid placing subjects face down or employing hog-tying techniques. If a subject appears to be in physical distress, seek immediate medical assistance.

After restraining a subject with handcuffs while they are in a prone position, as soon as it is safe and feasible, roll them into the recovery position. This step is essential for their well-being.

If a Subject stops breathing, call 911 and advise that a life threatening condition is apparent and follow directions provided by Police or Paramedics.

Excited Delirium is a complex and controversial medical condition characterized by a sudden and severe agitation, extreme distress, and delirium. Individuals experiencing excited delirium often exhibit the following symptoms:

  1. Extreme Agitation: They may become highly agitated, aggressive, and resistant to intervention. This state of extreme arousal is often accompanied by bizarre or irrational behavior.
  2. Altered Mental State: People with excited delirium often display confusion, disorientation, hallucinations, or delusions. They may not be responsive to verbal commands or may exhibit incoherent speech.
  3. Hyperactivity: Individuals may experience heightened physical activity, such as running, struggling, or excessive movement, often accompanied by excessive sweating.
  4. Imperviousness to Pain: A common characteristic is an apparent insensitivity to pain, which can lead to self-inflicted injuries as the individual may not feel pain.
  5. Aggression: They may display violent or combative behavior, including aggression toward others or themselves.
  6. Paranoia: Paranoia or a heightened sense of fear and distress is often present.
  7. Hyperthermia: Individuals with excited delirium can experience extremely high body temperatures, which can lead to severe medical complications.
  8. Respiratory Distress: Breathing difficulties can occur due to the high metabolic rate and excessive physical exertion. In some cases, respiratory failure may develop.

The exact cause of excited delirium remains a subject of debate, but it is often associated with substance abuse (particularly stimulant drugs), mental illness, and certain medical conditions. Excited delirium is a life-threatening medical emergency, and individuals experiencing it require immediate medical attention. Law enforcement agencies are often involved in cases of excited delirium, and the management of such cases can be challenging.

Positional Asphyxia:

Positional asphyxia is a potentially fatal condition that can occur when a person’s body position restricts their ability to breathe adequately. It often arises in situations where an individual is physically restrained or immobilized. Key factors associated with positional asphyxia include:

  1. Body Position: The person’s body position, often with the chest and abdomen restricted, can impede normal breathing. Examples include being placed face down or in a position where their chest is compressed against a hard surface.
  2. Impaired Lung Expansion: The body position can prevent the full expansion of the lungs, which limits the person’s ability to inhale oxygen and exhale carbon dioxide.
  3. Respiratory Distress: The individual may experience respiratory distress, characterized by labored breathing, reduced oxygen intake, and increased carbon dioxide levels in the blood.
  4. Altered Mental State: Lack of oxygen can quickly lead to confusion, agitation, or a loss of consciousness.
  5. Potentially Fatal Outcomes: If not relieved promptly, positional asphyxia can lead to respiratory failure, cardiac arrest, and death.

Positional asphyxia often occurs in law enforcement or security contexts when physical restraint techniques are used. As a result, there has been significant attention to training and guidelines for law enforcement to prevent this condition and recognize when it is occurring. Proper positioning, monitoring, and ensuring that individuals in custody or restraint are able to breathe are crucial to preventing the potentially deadly consequences of positional asphyxia.

In summary, excited delirium is a medical condition characterized by extreme agitation, confusion, and physical hyperactivity, often associated with substance abuse, while positional asphyxia is a life-threatening condition that can result from the restriction of an individual’s ability to breathe due to their body position, often occurring in the context of physical restraint. Both conditions require prompt medical attention and careful management to prevent severe health consequences or fatalities.

Dealing with a person suffering from Excited Delirium (ExDS) can be challenging, as these individuals are often highly agitated, unpredictable, and may pose a danger to themselves and others. It’s important for security guards to prioritize safety and follow a specific set of guidelines when encountering someone with ExDS. Here’s how a security guard should deal with such a situation:

  1. Assess the Situation:
    • Evaluate the scene for potential threats or hazards to ensure your safety and the safety of others. Keep a safe distance and avoid immediate physical contact if the person is agitated and aggressive.
  2. Call for Assistance:
    • Contact emergency services immediately. ExDS is a medical emergency, and individuals experiencing it require professional medical intervention. Provide the dispatcher with as much information as possible about the person’s behavior and condition.
  3. Maintain Communication:
    • Keep a safe distance while maintaining verbal communication with the person. Speak calmly and clearly, using a non-confrontational tone. Try to de-escalate the situation by offering reassurance and keeping them engaged in conversation.
  4. Request Medical Assistance:
    • If the person’s safety is at immediate risk due to their level of agitation or physical distress, request that medical professionals arrive on the scene promptly.
  5. Avoid Restraint Techniques:
    • Avoid using physical restraint or force to subdue the individual. This can exacerbate the situation and pose significant health risks. Instead, focus on maintaining a safe distance and preventing them from harming themselves or others.
  6. Ensure a Safe Environment:
    • If possible, create a safe environment by removing potential hazards or dangerous objects. Clear the area to minimize the risk of injury.
  7. Document the Situation:
    • Maintain a written record of the person’s behavior and your actions leading up to the arrival of medical professionals or law enforcement. Accurate documentation can be valuable for medical assessment and any subsequent legal proceedings.
  8. Do Not Administer Medications:
    • Under no circumstances should you attempt to administer any medication or substances to the person. Leave medical treatment to trained professionals.
  9. Monitor the Person:
    • Keep a close eye on the person’s vital signs and general condition. Note any changes in their behavior or physical state and relay this information to medical professionals upon their arrival.
  10. Cooperate with First Responders:
    • When medical professionals or law enforcement arrive, cooperate fully with their instructions. Provide them with any information you have gathered and follow their lead.

It’s crucial to understand that dealing with individuals suffering from ExDS can be risky, and security guards should prioritize safety and the individual’s well-being. Remember that professional medical intervention is necessary in these cases. The role of security guards is to maintain a safe environment, initiate medical assistance, and communicate effectively until medical professionals or law enforcement can take over. Proper training and adherence to established protocols are essential for handling these challenging situations.

Setting: A shopping mall in a busy urban area.

Security Guard: John, an experienced security guard.

Description: It’s a typical Saturday afternoon at the shopping mall, and John is on his regular patrol. He receives a call on his radio about a disturbance near one of the mall entrances. He quickly responds to the scene, where he finds a disheveled man, Michael, who is behaving erratically, shouting, and displaying aggressive tendencies.

Actions Taken by the Security Guard:

  1. Assessment: John approaches the situation cautiously, assessing Michael’s behavior from a safe distance. He notices that Michael is sweating profusely and appears highly agitated.
  2. Communication: John immediately contacts the mall’s central security office and requests medical assistance while maintaining a calm and reassuring tone when speaking to Michael. He introduces himself, offers his assistance, and asks Michael’s name to establish a rapport.
  3. De-escalation: John engages Michael in conversation, asking open-ended questions about his well-being and trying to identify the cause of his distress. He avoids making sudden movements and maintains a non-confrontational demeanor.
  4. Safety Measures: John ensures that a safe perimeter is established, preventing other shoppers from approaching the agitated man and thereby reducing the potential for harm to himself or others.
  5. Communication with Medical Professionals: John keeps the dispatcher informed about Michael’s behavior and condition, emphasizing the need for medical assistance due to the possibility of ExDS.
  6. Environment Safety: He also identifies any objects or obstacles that might pose a danger to Michael or other individuals and ensures they are removed from the area.

Outcome:

Shortly after John’s arrival, medical professionals from a nearby clinic arrive on the scene. They assess Michael’s condition and confirm that he is indeed experiencing ExDS. They take over his care, providing appropriate medical intervention and ensuring his safety. John provides a detailed account of the situation to law enforcement and medical personnel.

The successful management of this incident is attributed to John’s quick and thoughtful response, his ability to establish a rapport with Michael, and his adherence to de-escalation techniques. By prioritizing safety and seeking professional medical assistance, John played a vital role in ensuring that Michael received the necessary care, ultimately leading to a successful resolution of the situation.

Dealing with a person suffering from Positional Asphyxia is a critical situation that requires immediate action to prevent life-threatening outcomes. Positional asphyxia occurs when an individual’s body position restricts their ability to breathe adequately, potentially leading to suffocation. Here’s how a security guard should handle such a situation:

  1. Recognize the Signs:
    • Be vigilant and aware of the signs of positional asphyxia. These may include the person’s inability to breathe, visible signs of distress, labored breathing, or altered mental status. It’s crucial to identify these signs promptly.
  2. Call for Immediate Assistance:
    • Contact emergency medical services (EMS) immediately. Positional asphyxia is a medical emergency, and the individual needs professional medical intervention without delay.
  3. Maintain Verbal Communication:
    • Approach the person calmly and maintain verbal communication. Ask them if they are okay and if they are experiencing any difficulty breathing. Encourage them to respond, even with a nod or a gesture.
  4. Remove Restrictive Items or Pressure:
    • If possible and safe, carefully remove any items or restraints that are contributing to the person’s positional asphyxia. This might include removing heavy objects, adjusting restraints, or assisting the person into a more comfortable position.
  5. Loosen Clothing:
    • If the person is wearing tight or restrictive clothing that could be exacerbating the situation, attempt to loosen it to improve their breathing.
  6. Monitor Vital Signs:
    • Continuously monitor the person’s vital signs, including their pulse and breathing rate. Note any changes and communicate this information to EMS personnel upon their arrival.
  7. Position the Person Prone:
    • In some cases, positioning the person prone (face down) may be contributing to positional asphyxia. If safe and necessary, turn the person onto their side to alleviate pressure on the chest and airway.
  8. CPR and First Aid Skills:
    • If the individual loses consciousness and stops breathing, initiate CPR if you are trained to do so. Start chest compressions and provide rescue breaths as necessary until EMS arrives.
  9. Provide Information to EMS:
    • When EMS personnel arrive, provide them with as much information as possible about the situation, including the person’s condition, actions taken, and any changes observed.
  10. Document the Incident:
    • Maintain a detailed record of the incident, including your actions and observations. This documentation may be valuable for medical assessment and legal purposes.

Positional asphyxia is a life-threatening condition, and the key priority is to ensure the person’s airway is clear and they can breathe freely. As a security guard, your role is to recognize the signs, call for immediate medical assistance, attempt to relieve the positional constraints, and monitor the person’s condition until professional help arrives. The individual’s safety and well-being should always be the primary concern.

Scenario: Successful Management of Positional Asphyxia

Setting: A sports event at a crowded stadium.

Security Guard: Lisa, an experienced security guard.

Description: Lisa is working at a popular sports event at the stadium. During the event, she notices a commotion in one of the seating sections. She quickly approaches the area to find a spectator, Mike, who is slumped in his seat and appears to be in distress.

Actions Taken by the Security Guard:

  1. Initial Assessment: Lisa approaches Mike, who is in a seated position and appears to be unconscious. She recognizes the signs of possible positional asphyxia due to Mike’s seating position.
  2. Immediate Action: Without hesitation, Lisa calls for emergency medical assistance, providing specific details about the situation and requesting immediate help.
  3. Verbal Communication: While waiting for medical personnel, Lisa tries to communicate with Mike. She asks nearby spectators if they’ve noticed anything unusual about his condition. She also encourages others to stay calm and clear the area to allow space for medical professionals.
  4. Loosening of Clothing: Lisa notices that Mike’s shirt is tight around his neck. She gently loosens his collar and removes any obstructive items like scarves or neckties to improve his airway.
  5. Careful Movement: With the help of another nearby security guard, Lisa carefully assists Mike into a more upright and comfortable position to alleviate pressure on his chest and airway. She continues to speak to him, urging him to breathe and stay conscious.
  6. Monitoring Vital Signs: Lisa keeps a close eye on Mike’s vital signs, checking for breathing and pulse. She provides real-time updates to the central security office and the incoming medical team.
  7. Response from Medical Personnel: The stadium’s medical response team arrives promptly. They immediately assess Mike’s condition, initiate medical intervention, and transport him to the stadium’s medical facility for further care.

Outcome:

Thanks to Lisa’s prompt response, recognition of the signs of positional asphyxia, and her ability to maintain calm and effective communication with those around her, Mike’s condition was identified and addressed in a timely manner. The combined efforts of Lisa and the stadium’s medical personnel contributed to a successful outcome. Mike received the necessary medical care, and the situation was resolved without further complications. Lisa’s quick thinking and well-coordinated actions played a crucial role in ensuring Mike’s safety and well-being during the sports event.