Excited Delirium

Educating paramedics, firefighters and police officers is the first step to preventing in-custody deaths

     Having a coordinated strategy when called to deal with a violent patient has advantages for police, EMS and fire. Police can establish a stand-off location that is close to the scene but will provide a safe environment for EMS. Knowing what tools the police will probably use to contain and control the patient allows EMS and fire to bring appropriate equipment to the scene when called. Also, police, EMS and fire attending training together and being involved in planning strategies will build confidence in each other. When EMS or fire requests assistance with an "excited delirium" patient and it proves not to be, police will have a better understanding of why they were requested.

     Excited delirium is a difficult situation made worse when no public service agency claims responsibility for it. The only way EMS, fire and police can prevent excited delirium from becoming an in-custody death is with education, preparation and cooperation.


  1. Di Maio TG. Excited Delirium Syndrome: Cause of Death and Prevention. CRC Publishing, September 2005.
  2. Institute for the Prevention of In-Custody Deaths Incorporated. Roll Call Mini Poster, Dr. John Peters, 2006-2007.
  3. Reay DT, Flinger CL, Stillwell AD, Arnold J. Positional asphyxiation during law enforcement transport. American Journal of Forensic Medicine and Pathology 13(2), 1992.
  4. Ann Price et al. Plaintiffs v. County of San Diego et al, defendants, 1998.
  5. Chan TC, Vilke GM, Neuman T, Clausen JL. Restraint position and positional asphyxia. Ann Emerg Med 30(5):578-86, Nov 1997.
  6. EMS.gov, National Emergency Services Advisory Council, Draft Standards.
  7. Miami-Dade Fire Rescue Medical Operations Manual, Electronic Control Device, Protocol 33, June 2007.
  8. Chief John Gardner, Institute for the Prevention of In-Custody Deaths, 2007 Annual Conference, Las Vegas.
  9. TARP, RIPP Restraints Training Program, 1996.

     David Kleinman, NREMT-P, is a detective with the Arizona Department of Public Safety. He has worked as a patrol officer, motorcycle officer, staff training officer at the state law enforcement academy, air rescue paramedic and SWAT operator. He teaches BLS, ACLS, PALS, PHTLS and EMT/paramedic training at a local community college.