George Floyd and Police Training To Treat Excited Delirium

This is another piece on the continuing series about George Floyd. This piece looks at police training for people with Excited Delirium.

As I have already described in previous posts, and as the Complaints against the officers have demonstrated, the officers responding to the call about George Floyd had already called an ambulance before George Floyd was ever restrained. Additionally, the medical state of “Excited Delirium” was explicitly mentioned by the officers on the body camera video, and their decisions on how to keep and restrain George Floyd were responses to this belief.

For this reason, I thought it would be appropriate to explore the basics of what police are trained to do when encountering someone with Excited Delirium. This will be relevant to the trials of the officers.

Training Example 1: Identifying Excited Delirium

This link contains a training video from a police-training organization that helps officers understand how to identify Excited Delirium cases. Viewer beware, it is quite disturbing and contains some blurred out nudity.

What is significant is that they describe it as a “medical emergency situation that presents itself as a law-enforcement situation.”

They state that one should first get the appropriate number of officers (usually between 4-6), and also get EMS personnel on the scene as soon as possible, as well.

The behaviors indicating Excited Delirium are broad, but the ones this video points out are Sweating, Incoherent Speech, and Uncontrolable shaking and shivering.

There is also a video of a naked man who does not look particularly “athletic” or strong simply walking up to a wooden fence and punching straight through it with his bare hands. Its quite impressive, but also quite scary.

Relation to the George Floyd Death

There were a total of 5 officers in the area, with four apprehending George Floyd, which corresponds to this training advice. Since George Floyd was handcuffed before he began exhibiting symptoms, only three officers were used to restrain him.

In my review of the video evidence, it is clear that before he is restrained, an ambulance has been called. At one point when George Floyd is on the ground, he can be heard saying “My face is gone.” By the time the famous cell-phone video begins, George Floyd has already urinated on himself, and he continues to struggle and grunt in pain, uncontrollably.

Training Example 2: The “textbook” case of Excited Delirium

This link contains a training video from police body-worn-camera footage that contains an “ideal” response to someone with Excited Delirium. Viewer beware, it is quite disturbing and contains bad language (but no nudity).

Unlike the George Floyd arrest, the 911 call comes from a private home, and the officers do not have the individual handcuffed in the same way. There are also more officers responding than the case of George Floyd. The individual is also naked at this point.

Relation to the George Floyd Death

Similar to the George Floyd situation, the individual states that he is going to die. He also had guttural and strained groans. He repeatedly demands to be released. He also calls for his mother.

Unlike George Floyd, the individual is verbally threatening physical violence against the officers, including “We have a shovel in the back! Get the shovel and break his back!” At one point the individual says “Am I going to die?” And the officer responds: “You aren’t going to die. We’re going to a hospital” And the individual shouts back “THIS is going to die! THIS is going to die!”

Training Example 3: The Medical Response of Police to Excited Delirium

This link contains an article from March 2019 about how police should respond to cases that involve Excited Delirium. They also present some key misconceptions about the syndrome.

It notes that “Decreased stimulation” and “Physical restraint, combined with emergent sedation” is still the appropriate method of treating individuals with Excited Delirium.

According to the article, 10% of all violent arrests involve individuals exhibiting signs of Excited Delirium. It notes that Excited Delirium cases are more dangerous to officers than violent drunks.

It also notes that it is not true that officer restraint is the cause of death in cases of Excited Delirium, even though many individuals die while being restrained by officers. It has been noted that there is 20 years of medical literature showing that even without officers involved, individuals with Excited Delirium who are not approached by police are often surrounded by wet towels, empty ice trays, and stripped of clothes. It notes that hyperthermia (getting too hot) is associated with lethal cases of Excited Delirium cases.

Methamphetamine is one of the drugs associated with Excited Delirium.

Relation to the George Floyd Death

From the video evidence, George Floyd was restrained by the officers who had already called for EMS personnel. This is in keeping with this training. As we know from the Hennepin County Medical Examiner, George Floyd had Methamphetamine in his system. This is a causal agent of Excited Delirium.

Training Text 4: Medical Review on Excited Delirium

This link contains an academic review of the issue of Excited Delirium. Not only does it present in situations of drug use, it also presents in psychiatric patients.

However, there is an important correlation to drug use and fatality among those exhibiting Excited Delirium syndrome. As the paper states:

Fatalities. This effort may provide insights into causes of death and biomarkers of this syndrome. Data could come from accredited medical examiners, who are required to keep blood samples after post-mortem exams, as well as their reports. Data should be collected only on those clearly determined to be ExDS cases. In addition to ExDS fatalities in psychiatric patients, this effort is likely to focus on cocaine-related ExDS fatalities. “The largest group is chronic cocaine users,” stated panel member and cardiac researcher, Dr. Steven Karch who, in a recent study of the neurochemical changes in 100 decedents, found that 96 were cocaine users and four were methamphetamine abusers. None were known to have had previous psychiatric hospitalization. [emphasis added]

Significant in this review is the manner of death associated with Excited Delirium, which is “sudden cardiopulmonary arrest and death.”

Relation to the George Floyd Death

From the video evidence, George Floyd was restrained by the officers who had already called for EMS personnel.

George Floyd’s reason for death was “cardiopulmonary arrest,” according to the Hennepin County Medical Examiner. This is a common manner of death for individuals who die of Excited Delirium. The Medical Examiner also noted that George Floyd was suffering from Fentanyl intoxication and recent Methamphetamine use.

Training Example 5: Reducing Deaths Among Law Enforcement Responses to Excited Delirium

This link contains an article that is primarily aimed at reducing deaths among individuals experiencing Excited Delirium when they are approached by the police.

In the section on “Treatment,” the following instruction is given:

When subjects are identified as potentially exhibiting excited delirium, rapid control of the situation and timely execution of medical evaluation are important. Protocols vary by region according to local EMS policies and in many cases are driven by consensus opinions. Subjects with excited delirium often do not respond to verbal redirection. Additionally, attempts at physical control may not be as effective given extreme levels of strength and resistance to painful stimuli. Ongoing physical struggle can worsen a subject’s innate fight-or-flight system, which can raise a patient’s temperature, cause changes in the body’s acid-base balance, and increase the risk of sudden death. 

Medications are required to sedate ExDS patients to expedite the medical evaluation, decrease their fight-or-flight response, and avoid further harm to both the subject and those involved in the patient’s care.

In the section titled, “Conclusion,” the article states as follows:

Law enforcement agencies should undertake a concerted effort to increase awareness among officers of ExDS to include information to help identify symptoms and to establish protocols to engage the medical community. Armed with this information, officers will be in a better position to engage EMS for an urgent evaluation, treatment, and transport to the hospital. Using teamwork to safely and efficiently control these patients will lead to improved outcomes.

Relation to the George Floyd Death

This information is highly relevant to why the officers continued to restrain George Floyd until the EMS personnel arrived.

Based on the evidence that four officers attempted to restrain George Floyd while calling an ambulance beforehand, that appears to be what the four officers did. Unfortunately, the tactic did not work.

Conclusion

As we know from the evidence included in the Complaints against the officers, the officers were actively discussing Excited Delirium and debating how to handle George Floyd under the belief that he was suffering under this syndrome.

In a previous work, before I had looked into the police training on individuals wtih Excited Delirium, I hypothesized that due to Derek Chauvin’s intense attention to George Floyd during the entire period of the restraint, it was likely that he was following some sort of training. I assumed that the officers were taking the only steps they knew how to take in an attempt to save George Floyd’s life.

Now that I’ve seen the run-of-the-mill police training on this subject, I am quite confident that is the case. For that reason, I firmly believe the four officers will be declared innocent and should be declared innocent.

Unfortunately, I believe we will have a hard time avoiding massive riots (as we have already seen) when that verdict comes back, if people do not know why it is going to happen.

That is why I have written and why I continue to write. I humbly ask for the reader to do whatever you feel is required of yourself, as a fellow citizen, to help me prevent that destruction.

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