UNEXPECTED DEATH RELATED TO RESTRAINT FOR EXCITED DELIRIUM - A RETROSPECTIVE STUDY OF DEATHS IN POLICE CUSTODY AND IN THE COMMUNITY

Background: Some people in states of excited delirium die while in pol ice custody. Emerging evidence suggests that physical restraint in cer tain positions may contribute to such deaths. In this study the author s determined the frequency of physical restraint among people in a sta te of excited delirium who died unexpectedly. Methods: The authors rev iewed the records of 21 cases of unexpected death in people with excit ed delirium, which were investigated by the Office of the Chief Corone r for Ontario between 1988 and 1995. Eyewitness testimony, findings du ring postmortem examinations, clinical history, toxicological data and other official documents describing the events surrounding the deaths were analysed. Specific reference was made to documented eyewitness:t estimony of restraint method, body position and use of capsicum oleore sin (pepper) spray. Because cocaine was detected in the blood of some of these people during the postmortem examination, the role of cocaine in excited delirium was examined by comparing the cocaine levels in t hese cases with levels in 2 control groups: 19 people who died from ac ute cocaine intoxication and 21 people who had used cocaine shortly be fore they died but who had died from other causes. Results: In all 21 cases of unexpected death associated with excited delirium, the deaths were associated with restraint (for violent agitation and hyperactivi ty), with the person either in a prone position (18 people [86%]) or s ubjected to pressure on the neck (3 [14%]). All of those who died had suddenly lapsed into tranquillity shortly after being restrained. The excited delirium was caused by a psychiatric disorder in 12 people (57 %) and by cocaine-induced psychosis in 8 (38%). Eighteen people (86%) were in police custody when they died. Four (19%) had been sprayed wit h capsicum oleoresin, and heart disease was found in another 4 at auto psy. The blood level of cocaine in those whose excited delirium was co caine induced was similar to levels found in recreational cocaine user s and lower than levels found in people who died from cocaine intoxica tion. Interpretation: Restraint may contribute to the death of people in states of excited delirium, and further studies to test this hypoth esis are recommended. Meanwhile, law enforcement authorities and other s should bear in mind the potential for the unexpected death of people in states of excited delirium who are restrained in the prone positio n or with a neck hold.