Okay, is that up?
An investigation by the AP and PBS Frontline revealed police and medics using injected
sedatives to deescalate people who have been deemed to have something called excited delirium.
We've now come to understand that excited delirium is a deeply flawed concept.
In many cases, the definition of excited delirium was built on racial stereotypes and probably
more fundamentally excited delirium was a concept that in many of these cases serve to shift
the focus from the actions of the first responders, restraint or chemical sedation by the police
or by EMS to the individual for using methamphetamine, for engaging in criminal activity, for in
some cases, suffering from mental health emergencies.
The use of medications is part of an excited delirium protocol in some departments to render
the person compliant.
This is often in combination with stun guns and pinning subjects face down, but the combination
can be fatal.
It happened to a man in Eau Claire County as described in the investigative reporting.
Excited delirium purportedly marked by high pain tolerance and superhuman strength is
a controversial and disputed diagnosis and should not be used to justify use of force
and medication.
That's according to our next guest, psychiatrist Dr. Julie Olin from the Medical College of
Wisconsin and Dr. thanks for joining us.
Thank you for having me.
Why do you say that excited delirium is a disputed diagnosis?
Excited delirium first came to be described in the 1980s, and that was in conjunction
with a rise in cocaine use, and there are very few professional medical organizations
that actually recognize excited delirium as a diagnosis, and without that recognition
and without that consensus of the medical community, there's been a lack of true diagnostic
criteria that folks agree on when using this term, which is called its use into dispute.
So if it's if it's not excited delirium, what are police and first responders and medics
responding to in the field that then have them using these injected sedatives?
So oftentimes an individual who might be described as displaying features of what has been come
to known as being known as excited delirium, they will look extremely agitated.
They will potentially be behaving in a bizarre manner.
The literature that has looked at this syndrome has described things like increased pain tolerance,
the individual looking sweaty, the individual breathing rapidly, and individual who looks
like they're they don't really get tired despite a lot of physical exertion.
And sometimes the literature also describes individuals who are not necessarily complying
with law enforcement official orders and or being inappropriately clothed.
In your research, what did you find about the outsized diagnosis of this excited delirium
and black or brown police subjects?
Usually there's a skewing of the use of this term with young men, young men of color and
young men of color who probably at a later phase of examination are found to be utilizing
some sort of what we call sympathetic or a stimulant like substance.
So the from all the investigation narrowed in on the use of injected drugs like ketamine
by police and medics.
What's your view of that use?
I work in the hospital setting in the hospital setting if an individual presents with agitation.
Typically the best accepted practice is as a physician to evaluate that person and try
to determine what is the most likely cause of that person's agitation and medications
are used as a tool then to treat and relieve that person of that agitated state.
So the use of medications in and of themselves is not necessarily problematic.
It's the use of a medication with oftentimes very incomplete data and with differing protocols
and dosing and again sort of starting with that not truly a medical diagnostic term to
sort of drive the intervention or the choice of the intervention that seems to be problematic
in these cases.
How troubling is it to you that excited delirium might be used as a justification for use of
force or injections of ketamine?
It is troubling and again I think you know as a physician and as a physician who practices
in solely emergent or acute settings this sort of case is hard for somebody like myself
to try to get to the bottom of and when you have folks who don't have the same amount
of clinical training sort of throwing out terms that sound like diagnoses to then drive interventions
with questionable safety involved and of course when these interventions result in
lethal outcomes when really that's probably not necessary that is disturbing.
Can you say that it is imperative to find consensus among medical professionals around
the diagnosis of excited delirium?
Has that yet been found that consensus?
No.
And are more people like yourself talking about it?
I think so.
We you know again my practice clinically is working shoulder to shoulder with emergency
medicine physicians and that sort of cross specialty collaboration and collaboration of
expertise in this space I think that's what's necessary to really find again consensus but
a real clear sense of what it is that we're trying to accomplish with utilizing terms
like this or trying to categorize clinical presentations like this.
All right we leave it there Dr. Julie Owen thanks very much.
Thank you.
For more on this and other shoes facing Wisconsin visit our website at pbswisconsin.org and
then click on the news tab that's our program for tonight I'm Frederica Freibert have a
good weekend.