Autism-induced “excited delirium syndrome”?
May 29, 2007 by Kristina Chew, PhD
Filed under Health
“Autism-induced ‘excited delirium syndrome’ ” is what the Riverside County sheriff’s deputies say 21-year-old Raymond Lee Mitchell died from. Mitchell died on July 19, 2006, in a hospital following a struggle with deputies at the Perris house where he lived. His mother, Wanda Mitchell, had called 911 “saying she needed authorities to pick up her son.” Mitchell is reported to have said “‘No police. I’m ok‘”; he died in his own bedroom. As reported in the May 28th SF Gate.com, Mitchell’s mother has filed a wrongful death lawsuit against the sheriff’s deputies; the sheriff’s officials claim that “autism-induced ‘excited delirium syndrome’” can lead to sudden cardiac arrest.
His mother’s attorney rejects that claim, saying it’s a common defense among law enforcement agencies sued over in-custody deaths.
“That’s what they always say,” attorney Carl Douglas said.
Douglas believes Mitchell died of positional asphyxiation after several officers piled on top of him.
Sheriff’s spokesman Jerry Franchville said deputies are trained for encounters with people with autism, mental illness and other special needs. Besides what authorities claim is the cause of death, he refused to release results of an investigation into matter.
A February 27, 2007, NPR story notes that “The medical diagnosis called excited delirium is the subject of intense debate among doctors, law-enforcement officers and civil libertarians. They don’t even all agree on whether the condition exists.”
It is real, it isn’t only associated with ASDs. It could happen to anyone, but they would have to get really really agitated. The threshold for it to happen is lower for people with ASDs, and also people who are on stimulents.
Scalpel or sword had a couple blogs about it
http://scalpelorsword.blogspot.com/2007/05/beyond-threshold.html
http://scalpelorsword.blogspot.com/2007/03/more-on-agitated-delirium.html
What it is, is the body going into overload, overdrive, pull out all the stops, crank up metabolism as high as it will go in order to “run from a bear”, the classic “fight or flight”.
It is a “fight to the death”, or die trying kind of metabolic state. People in this state will keep struggling until they die, and because they have exhausted all their body’s resources, they cannot be revived.
I doubt that it does, looks like the same sort of get out clause the cops always use.
However there might be a case in point when Laurentius espies a particular fine example of the genus electricity pylon.
Wordsworth could not have put it better.
My heart leaps up when I behold a Rainbow in the sky.
yes leaping hearts is a form of cardiac problem n’est ce pas?
If the coppers had copped on old Willy and his daffodils they might have questioned him as to whether he possesed a valid licence for his poetry and trampled on him in the meantime.
http://www.youtube.com/watch?v=VXbrSALG684
I do not believe that “excited delirium syndrome” exists as a separate entity.
What I believe happens is that the person being subdued has their airway cut off in many circumstances, and no one notices and corrects it.
I blogged about it more fully here.
Club 166, I think that “excited delirium syndrome” does exist as a separate entity. It is similar to, and analogous to the hyperpyrexia of malignant neuroleptic syndrome. It is what happens when metabolism gets out of control.
The mitochondria get turned on to full capacity, the ATP they are generating gets disipated as heat. The mitochondria operate full out until protective mechanisms shut them down. If too many get shut down, in the wrong organ, then you get multiple organ failure and death. It is fundamentally not about “hypoxia”, or not enough oxygen. It is a level deeper than that, not enough mitochondria to supply ATP.
In neuroleptic malignant syndrome it is the neuroleptic that gets metabolism out of whack. In excited delerium syndrome is it the body’s own regulatory mechanisms triggered by adrenalin.
The same thing happens with lots of stimulents.
Here is a review article on malignant hyperthermia.
http://www.ojrd.com/content/2/1/21
It is good, and discusses some of the commonalities and some of the unknowns. Most of the research has been on hyperthermia induced by a few anesthetic gases. They are only the trigger, there can be other triggers. There are a few cases of malignant hyperthermia induced by exercise and emotional stress.
I think that is the most likely explanation of what happened here.
How to prevent it? I don’t know, maybe a beta blocker such as propranolol? Something to turn down the gain of the positive feedback that is cranking metabolism up.
Come off it, just because a rare syndrome exists is no reason for the cops to pull it out as an excuse everytime they want to murder someone and get away with it.
I suppose I shall have to ask the cops “excuse me while I pop my propranolol” when they are busy beating me up for looking autistic in a public place.
Me I get agitated all the time, how come I have not died from it yet?
For what possible reason would the cops want to murder a 21 year old autistic man?
Autism-induced excited delirium syndrome my bloody arse!
That’s a police surgeon using terminology on the most non-existent basis to cover up an incident of foul-play on the part of the police: they were reckless as to their actions on this man and are – to be honest – guilty of murder on that basis (certainly, it could be demontrated so in an English court of law).
If the guy died during their actions, and they did not know that he was about to die and immediately desist in their actions, then they were not paying full attention to what they were doing: ergo, reckless as to the consequences of there actions. This is all that is required to pin a murder charge on each police officer. And the police surgeon involved should be charged as an accessory after the fact.
Daedalus, the answer is fear, the same fear that prompted the cold blooded execution of an unarmed Brazilian on the tube.
Not all murder is punished on Earth.
One law for the cops another for the citizen, eg. Tony Martin, a farmer who killed in self defence but was convicted of murder.
daedalus2u,
I am very familiar with malignant hyperthermia (MH). At most, it occurs in 1:5000 cases. The usual time course of MH is 30 minutes to several hours. Not 5 minutes or less.
As a genetic condition, I challenge you to find me two cases where the person who died had a relative diagnosed with MH. It isn’t MH. There have been rare reported incidences of people spontaneously dieing after exercise and an MH like illness, but those are extremely rare.
I suspect that not all cases are airway related. I suspect that the majority that are not have either cocaine, methamphetamine, or PCP in their system. All of those can lead to accumulation of endogenous catechols (thru prevention of reuptake), leading to arythmias.
There may also be some where alcohol and head trauma contribute to a decreased loss of consciousness, making it easier for the subject to lose his airway.
But I still think that losing the airway at a time of high oxygen consumption -> not recognizing it -> cardiac arrest is a much more plausible scenario.
Joe
David, look at vignette #1
http://scalpelorsword.blogspot.com/2007/05/beyond-threshold.html
Here you have an ER doc observing what is going on (not participating), and the guy dies suddenly with no warning signs and cannot be revived by experts in ER medicine with all the facilities of an ER.
Was this ER doc an accessory for not knowing this guy was about to die? Was he not paying attention? Were the two ER techs and the male nurse accessories too? Were they not paying attention?
Your assumption that there would have to be warning signs of impending death obvious even to people not trained in medicine is unwarrented by this ER doc’s observations.
What happened to Raymond Lee Mitchell and, also to Kevin Colindres, has made me think more generally about the too-rapid use of physical force—of restraint—-on autistic persons, children included, when they exhibit aggressive or violent behavior. I suppose one immediate response is to stop the behavior and that involves grabbing and holding, and I can’t read about Marshall and Colindres without thinking about my own son. Because he does not talk much and is a bigger child now, I can see and sense fear in people when he is upset. And I know that sometimes Charlie has to have a difficult couple of minutes—-when he has to lie on a mat or something soft—and then the anger passes out of him. But efforts to hold on to him or, worse, to hold him down bring out something fierce; I think he feels he is fighting for his life—-even seeing a hygienist at the dentist immediately grab his hands makes me worried.
The Tony Martin case seems to be different than you suggest.
http://en.wikipedia.org/wiki/Tony_Martin_%28farmer%29
It is not “self-defense” to shoot someone who is running away.
MH is 1 in 5000 among people undergoing general anesthesia. We don’t know what the incidence is among people undergoing acute stress.
MH can be invoked by a number of different stimuli. My take on that is that it is a “natural” physiological process, somewhat like anaphylaxis. Sometimes you can recover from anaphylaxis, if you get the right kind of treatment quickly enough. If you don’t, there is a good chance you will die.
MH used to have a death rate of more than 80%. That was in a hospital setting with the patient already in the operating room and all hooked up.
During MH body temperature can rise at 1-2 degrees C per 5 minutes. The transition from a temperature that can be survived to one that cannot be survived may occur in a few minutes.
“When the body temperature increases by 6 degrees C a situation not compatible with life is formed. ”
http://nic.sav.sk/logos/books/scientific/node48.html#SECTION00540000000000000000
We don’t know the fastest rate that temperature can go up in a human because any time such an increase occurs who ever observes it is obligated to attempt to stop the life-threatening increase ASAP.
It is rare for people to die in police custody with no marks on their bodies and with no traumatic wounds. Differentiating between acute hypoxia and acute MH on autopsy is likely difficult. The only tests for MH susceptibilty use muscle biopsy and test that living muscle in vitro. I see no way to do those tests postmortum.
It is possible that the police simply abused and killed this man for no reason. It is also possible that he developed acute excited delirium.
Assuming that police are wantonly irresponsible and deliberately kill individuals they don’t like via abuse at their capricious whim suggests certain interventions to prevent this in the future. Interventions that individuals who would wantonly and capriciously kill would likely not carry out.
Assuming the police did not intend to kill this man, the solution would be to understand why he did die, and to understand what role certain police actions played in his death, and understand how to change those interventions in the future so that events such as this become less likely.
Perhaps there are times when vigorous confrontation may be appropriate to prevent or reduce injury, and perhaps times when it is not appropriate. Understanding when those different times occur is not going to happen without cooperation of all interested parties.
Asteroids occasionally happen but when looking at the fall of the Soviet Union such a rare event need not be invoked.
If you think pumping bullets at point blank range into an unarmed and restrained man is not murder then you differ from the opinion of the metropolitan police for whom it is not the first time that they have acted as societies licensed executioners who sometimes get the wrong man.
http://en.wikipedia.org/wiki/Jean_Charles_de_Menezes
The mendacity of police in tight spot is scarcely to be credited in a civilised society but the evidence is clear enough, they lie and misinform at every level.
Menenez might not have been any safer in the Favellas of Rio but death squads are not merely a South American phenomenon
Kristina, I suggest that perhaps when stressful situations can be anticipated, such as going to the dentist, perhaps a beta-blocker ahead of time might be useful. I have taken propranolol in such circumstances and it is quite effective for situational anxiety. It really does block the racing heart, the anxiety that occomppanies anxiety without feeling “doped up” (at least for me).
I think the analogy to anaphylaxis is appropriate. If you are susceptible to anaphylaxis and are going to have an unavoidable exposure to an antigen, prophylactic antihistamine might be appropriate.
This is an all too common tragedy – death by restraint.
It’s inexcusable, in this situation, that this happened – in his own home. Imagine how he felt with full grown men(?) literally suffocating him.
It was an abuse of power and force upon an individual who probably had impulse control issues.
I feel terrible for the mother, but perhaps the outcome would have been less tragic if she had called medical personnel instead.
This is just another example of ignorance among police officers and other professionals and it’s not acceptable.
I think that they should be charges with 2nd degree murder.
Something has to happen so that this kind of abuse of force by cops, who get a hard-on, by exerting their control over someone with a disability (which probably caused the crises in the first place), doesn’t continue.
Murder by discrimination in my book. Ignorance and just plain ignoring the cause of the behavior which prompted the call.
If my son needs help or is endangering himself within our home, I’d call his doctor, even at the risk of him being hospitalized temporarily.
We’re all starting to learn, those of us who are parents of autistic kids, that the police are the last people you’d want to call for help. It seems to be getting worse instead of better and they seem to have no remorse about covering up for each others crimes.
daedulus2u,
MH is almost exclusively associated with anesthetic agents and the muscle relaxant succinylcholine (anectine). As the incidence of MH is 1:5000 to 1:65,000, and these individuals may only extremely rarely develop a similar syndrome with dehydration and heavy exercise, you are positing something that would be responsible in something like 1 in several hundred thousand to a 1 in a million individuals.
Also, temperature rise is a late sign in MH. Unexplained tachycardia and increased CO2 production occur first. While rare cases can progress very rapidly, again this leaves you with a needle in a haystack explaining a not uncommon occurrence.
I don’t think blaming MH is a viable argument.
As a final nail in the MH coffin, if someone died from this type of reaction, then taking a history from family members would reveal relatives that this happened to in the operating room (theater), and testing of their relatives would reveal susceptible individuals. I am aware of no cases where this is so. Again, please find me two cases where this is so (as one case might serendipitously have a family history but not be the cause). MH does not occur in everyone, only in those with a genetic predisposition.
Now something else that you might consider is Neuroleptic Malignant Syndrome, which looks similar to MH, and is triggered by individuals on neuroleptic drugs, such as Risperidone (Risperdal). The only problem with that theory is that again, it is a fairly rare occurrence, usually occurs in relationship to injected drugs (not by mouth), and one of the hallmarks of this syndrome is muscle rigidity, not flailing about.
So that leaves me still advocating that we need no new syndrome to explain how people die after being violently taken into custody. My three primary reasons are:
1) Intentional or unintentional loss of airway leading to cardiac arrest,
2) Decreased level of consciousness from alcohol, other sedative drugs, or head trauma leading to unrecognized loss of airway and cardiac arrest, or
3) Certain stimulant drugs (cocaine, methamphetamine, PCP) leading to decreased re-uptake of endogenous catechols and arythmias, with cardiac arrest following.
daedalus2u,
Taking propranolol for situational anxiety is a time honored tradition. It works especially well for things like giving lectures to large groups.
But there is a far cry from preventing situational anxiety to preventing “death by restraint”.
In the cases where the deaths were due to drugs causing an accumulation of endogenous catechols, propranolol by itself would probably not be the best course. It would block beta receptors, but not alpha receptors, which are also activated. Unopposed alpha receptor stimulation would still result with great increases in blood pressure leading to stroke, even though the beta receptors were blocked.
And in the cases of airway compromise, giving beta blockers might slow the process initially (thru slowing oxygen consumption), but would not stop the process.
So prophylaxing with beta blockers (even if it was feasible) doesn’t seem to be a very good solution to me.
Kristina,
The Mitchell and Collindres cases should be troubling to all of us.
There are certainly times when actively physically subduing a person are indicated. But I think we all should be able to agree that when a person is non-violent when you come upon them is NOT one of these times.
I don’t necessarily think that the majority of police are malevolent. I think many are ignorant, and a one hour class taken during training (in dealing with people with mental and behavioral disabilities) is hardly sufficient training. Police need ongoing training in dealing with disabled individuals, and in deciding to use violence against citizens in general.
As one of my martial arts teachers used to say, “Violence is the language of the ignorant.”
As to calling the police in the first place, I’m not sure that there a lot of choices in some cases. Medical personnel (ambulance attendants, paramedics) are not going to get into physical confrontations with patients. If someone refuses to go with them, they’re going to either leave or call the police.
Certainly the family might take a family member themselves to the hospital, but if the person is large, strong, and uncooperative, they should be able to rely on the police to assist them. The police should be able to put themselves into a different mindset for these type of encounters, and use different “rules of engagement” rather than relying on the one which guides them when subduing a violent subject resisting arrest immediately after committing a crime.
Club 166,
How many individuals have been killed by “death by restraint”. Even one is “too many”, but have there been “enough” for it to not be considered a “rare” occurance? I don’t think so.
The incidence of the dominant mutation that causes anesthesia induced MH is estimated to be 1:3000 to 1:8,500
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17456235&query_hl=26&itool=pubmed_docsum
MH is observed in other animals, pigs, horses, dogs. There are multiple genetic predispositions.
MH due mutations on the RYR-1 gene have been well studied, and they cause a sensitivity to inhalation anaesthetics. There are other causes of MH, the details of what causes them are unknown. Are they genetic? Do they cause hyperthermia under other circumstances too? Are there other conditions that lower the threshold for hyperthermia in stress? It simply is not known.
People are only subjected to violent restraint very rarely. We have no idea what the incidence of MH in response to violent restraint actually is because there are essentially no data on it. It isn’t a study that can be done because the endpoint is death.
My thought about using beta blockers was not to pharmacologically block the effects of excitation, but rather to reduce the positive feedback that leads a struggling person to struggle more, and so elicit greater restraint in a cop-struggling person scenerio. A person who is less anxious, will have a higher threshold for struggling, and should elicit less vigorous restraint inflicted upon him/her leading to less struggling.
I agree that a pharmacological approach is not desirable. But keeping people alive is more important than using only desirable approaches.
It would be nice to get the police to use different “rules of engagement”, but when a person is violently struggling with them, and is fighting back all of their attempts to restrain that person, I don’t know how realistic different “rules of engagement” are going to be. At some level of struggling and violence the “rules” are going to be the same.
Neuroleptic malignant syndrome or chemical induced hyperthermia occurs by accelerating metabolism.
http://ajp.psychiatryonline.org/cgi/content/full/156/2/169
One mechanism is via the calcium channel coded by the RYR-1 gene. There are other mechanisms too. This last paper has a good schema showing different physiological pathways that can be disrupted and lead to hyperthermia.
Rare occurances are difficult to study. Until something is well understood, it is presumptious to think that we understand it.
One thing that emerges from this topic for me is the issue of how to “manage” (not the best word) an autistic individual who is presenting with aggressive/violent behavior and whose physical appearance (size, lack of speech) might be misundertood by someone like the police. We’ve attended Crisis Management sessions with Charlie’s home therapists and learned what we’ve realized are martial arts sort of moves, in which (this is my paltry undertstanding) you don’t fight against the other person’s strength as (again, this is my understanding of this) follow the force of the other person’s energy. But this is a very different way of thinking about engaging with a person who is upset than the usual. ( I’ve written somewhat about this, in a different context, here.)
daedalus,
the instance you give (the vignette) is radically different from the situation under discussion here: this was an active intervention by a number of men against one man, all of who – as part of their training in using physical restraint – art trained to know when to stop.
your vignette was totally irrelevant to this discussion.
David,
The vignette was 5 men trying to restrain a man who was struggling and fighting, the 5 men included 2 cops, 2 ER techs, and a nurse, and the terminal phase was observed by an ER doc. Sudden death occured without warning as observed by the ER doc.
The case under discussion here is a number of men trying to restrain someone who was struggling and fighting. Sudden death occurred. You say there must have been warning obvious to the cops that death was imminent.
I don’t understand the basis for your statement. I don’t understand why you reject the vignette as irrelevant other than because it doesn’t fit the scenerio you want it to.
I agree that it is possible that the cops working together brutally and recklessly and wantonly abused this man until he was dead. I am skeptical that there was “abuse” if there were no marks or trauma where he was struck with objects or fists. That a large number of cops could violently abuse someone until he died yet not strike him a single time seems unlikely to me.
Obviously they did something “wrong” because the man ended up dead. I think it is simplistic to maintain that what ever they did “wrong” is obvious and can be addressed easily by modifying the training and behavior of the cops.
If, as I suppose, there is some physiology behind what is happening, the only way to know if the training modifications are “working” will be if the number of deaths go down. In effect, each future case of restraint become an “experiment”, a test of the hypothesis “the modified training will prevent all restraint deaths”.
daedalu2, thanks for the mention of the beta-blockers—helping Charlie to deal with his anxiety before he gets really nervous is a work in progress.
I think discussions on this topic need to continue, and to be heard by the parties involved.
daedulus2u,
While MH has been seen in other animals, it is only really significant in pigs. But I thought we were talking about humans?
The incidence of someone dieing from an exercise induced MH like reaction is so rare that it’s considered a reportable case. It is so rare that there are absolutely no physical restrictions placed on people with a history of MH. So one must assume that amongst people like triatheletes and marathon runners that there are those with the genetic predisposition. And yet they are not dropping like flies from something looking like this.
You’re the one that has proposed this rare mechanism (MH) is responsible. I tell you, as someone who has treated MH patients, that it doesn’t pass the sniff test. Of course I can’t say it’s impossible, just as I can’t say that they weren’t possessed by demons at the time they died. But since you’re the one that has proposed this, then it’s up to you to prove it.
I’ve given you a way to show that it’s reasonable. Find the names of some victims on the internet. Track down their families, do a thorough history, and get back to us. Once you find a high correlation of people that have MH in the family we’ll know you’re on to something.
As to treating with beta blockers. The amount that is used to treat performance anxiety is a lot less than what you’d need to significantly impair a “fight or flight” reaction. You’d have to totally beta block them, which requires a fairly hefty daily dose (as opposed to the occasional dose you can take for the performance anxiety thing). Totally beta blocking all people who might come into contact with the police is totally out of the question. There are too many side effects of the treatment to justify even considering this.
In regards changing “rules of engagement”, I’m afraid I might have not made myself clear. What I am referring to is avoiding physical contact at all, if possible.
Police are trained to rapidly take control of a situation. I would give all police officers similar training to hostage negotiators.
Instead of coming in, standing threateningly, and barking commands, they would be taught that in cases where the subject was not actively being violent to do things differently. They would take a non-threatening stance (one can still have a defensive stance and appear non-threatening to an opponent), talk softly and slowly, and try to empathize with the person. This takes TIME, and lots of it in many cases. Approaching situations in this manner defuses them, and leads to a lot less of them progressing to physical contact. It’s not as quick, and it’s not as viscrally satisfying as “taking someone down”, but it works.
For the situations that do lead to the need for physical intervention (and a certain percentage will), again they would be trained until they could remain calm in such situations. Whenever I see videos of incidents where police brutality is in question, I see at least some of the officers not in control of their emotions. How can I tell? They are the ones that are still striking the person after it’s obvious that they are not resisting. The ones whose faces are red while they are shouting at the suspect. I have been taught ” When you’re angry, don’t fight. When you fight, don’t be angry.” By maintaining a calm demeanor it is easier to get another person to settle down once you have subdued them. I hope this clarifies things.
Joe
Kristina,
Indeed, the “going with the flow” response that you describe is definitely the way to go. Such a response is the basis of arts such as judo, aikido, and tai-chi (tai-chi can be very effective as a martial art, if taught and practiced in the right spirit).
The aim is to meld with the energy flowing from the opponent, then use this energy to redirect them where you want them to go.
It definitely works though it’s the kind of thing (for me at least) where I have to train myself psychologically—instinct arises quickly in these situations. It certainly gives me a lot of confidence to know I can help Charlie through such a situation, especially now that he and I are of similar size.
You’re right, Kristina, in that a lot of the training is training yourself psychologically. But I think it’s a lot easier to train a parent to assist their own child in such a situation, than to train a police officer to. Police officers have to deal with a spectrum of different situations-many of those will involve really bad people who are actively trying to harm the officer or others around them. Only some will involve those who are acting out because of frustration or other reasons, but not really actively trying to hurt others. Also, you already naturally have empathy for your son. A new person coming into the situation does not. And finally, you’re female. It’s been my experience that it’s always easier to train females. They seem to let go of preconceived notions of how to act in physical encounters more easily (or perhaps it’s because they have less preconceived notions as they don’t tend to have as much a history of physical encounters as males do).
Joe
Joe, one of these days I think it would be well if you might write, or contribute much to, suggestions for training law enforcement officers and autistic persons in crisis situations.
Charlie had a head-banging “episode” at the mall several months ago. Security officers, all male, appeared almost instantly; to their credit, they waited for my word about what to do and were reserved. And they seemed to see Charlie as a disable child having a bad moment rather than a potentially violent adult, and I got the sense that they had had training about autism. But that incident made me more aware than ever of why I don’t see older children like Charlie out in public.
Club 166,
Yes, we are talking about humans, but humans can’t be experimented on in ways that might lead to their deaths. Marathons and other voluntary physical exertions are not “the same”, as maximally invoking the “fight or flight” response. Exposing someone to chemicals that invoke some of the symptoms of maximally invoked “fight or flight”, is not “the same” as maximally invoking the “fight or flight” response.
However, if you remember, the person who ran the first marathon, dropped dead as he finished (though that may be only legend).
People and other organisms can run themselves to death. Normally, this is rare because an organism can only do it once, and there are multiple protective mechanisms that prevent it. When those protective mechanisms are eliminated, or fail, or are over-ridden by concious or unconcious mechanisms, or by drugs, the incidence increases.
Having a team of female cops would (I think) be a lot less threatening to a male or female in an excited state. Females tend to be better at reading such situations and diffusing them non-violently rather than escalating. When possible having female cops deal with people in this situation would work a lot better (I think).
Specifically requesting female cops might be a good idea. I suspect they would prefer helping people in distress over beating up on bad-guys more than male police. Getting the police hierarchy to appreciate that there are some things that female cops can do better than male cops might be a good thing for both of them. That going in like “gang-busters” might work for busting gangs, but not for calming overly excited individuals.
Daedulus2u,
I don’t understand. Are you saying marathoners are a good model, or a bad one?
One other question. If marathon running is not a good model for a state of maximal physical exertion with dehydration and release of endogenous catechols, than what state other than being forcibly taken into custody would you consider to be comparable? Surely there is some other things that happen in human existence (seeing your loved one die in front of you, getting into a major motor vehicle accident, being in combat) where a similar physiological state occurs.
Where are the case reports of sudden unexplained deaths in these circumstances? With hundreds of thousands troops in Iraq and Afghanistan getting car bombed, and the incidence of MH being 1:5000 to 1:65,000, surely some of those people would be dieing mysteriously with no wounds while in combat.
MH happens over a variable time course, and once started doesn’t stop when the stimulus is removed. If these people are dieing immediately after being restrained, where are the (even greater number, as most MH develops slowly) people dieing mysteriously hours after being forcibly restrained.
Finally, in regards females, I stated that I have found them easier to train as martial artists. That does not mean that males can’t be trained successfully, and I don’t think that males (or females) should be restricted from performing any duty for which they are qualified.
Joe
I think marathon running is a bad example. The only good examples would be people in actual life and death struggles with extremely high degrees of physical activity, such as running from a bear, fighting a bear in hand-to-hand combat, being in a fight that you know is going to be to-the-death and against very high odds.
I don’t think there are any comparable events in every day existance. For an event to be “comparable”, it woud have to have a mortality rate of ~50%. Climbing Mount Everest is only about 20%, so it is close, but doesn’t have the stuggle and fear factor, and is more chronic than acute.
I am not suggesting that males cannot be trained, but a male elicits different responses than a female does.
When Elian Gonzoles was rescued from his uncle who was holding him against his father’s wishes, the person assigned to pick up and carry Elian was a Hispanic woman, who did not wear body armor. The reason she chose to not wear body armor wasn’t because she was at no risk, it was because she knew that holding Elian against her body would be more calming for him than holding him against body armor. She made the judgement that the likelihood of Elian struggling were she to wear body armor was enough of a risk that it was safer for her to not wear it.
A white male could have done “the job”, of picking up Elian and carrying him to safety. The chances of Elian struggling with some big unknown white guy picking him up and carrying him off are (in my opinion) pretty high. No doubt a big enough and strong enough white guy could have picked up Elian and carried him off no matter how much he struggled. But that would have (in my opinion) involved much greater risk for everyone.
By definition, these situations are ones where the normal caretakers of an individual are unable to cope with him/her. The “risk factor” (in my opinion) is not so much with what the intervening person(s) do, but rather with what response they invoke in the person they are trying to contain and restrain.
…I don’t think there are any comparable events in every day existance. …
You don’t think being in combat, having people firing live ammunition at you qualifies?
I just don’t hear any reports of people dropping dead without any wounds in those situations, or others, for that matter.
It’s only after somebody has “layed hands on them” that these mysterious deaths occur.
Joe
Club 166
If it was hand-to-hand combat, yes it would be comparable because of the physical activity. In those situations, as soon as “the loser” weakens, he/she is (usually) struck/wounded sufficiently that the wound may be a sufficient cause of death. Having a weapon is such an advantage in such circumstances that usually there are wounds.
Being chased by a bear, but whether you are caught, or die suddenly, the bear eats you and destroys the evidence.
Being caught in a tidal wave or other flood and having to swim for your life might be comparable. People who die in those circumstances are said to have drowned because there is water in their lungs. It only takes one breath to fill one’s lungs and then have all the characteristic of drowning.
Getting caught in an avalanch might do it. My understanding is that while the ice is moving you can move with it, and “swim”. Once it stops, it freezes up and you are trapped in whatever position you were in. If you are too deep you suffocate. Maybe some of those people die from this mechanism. If someone is killed by an avalance, there isn’t a great need to understand “the details”, so maybe they don’t do an autopsy that would distinguish between hypoxia 10 minutes after the avalanch stops from sudden death during the avalanch. I am not sure how (or if)those 2 can be distinguished.
Sudden death is not that uncommon. 300,000 people die each year, 3000 to 6000 in young people (under 35), usually associated with emotional stress or exercise.
http://www.mayoclinic.com/health/sudden-death/HB00092/rss=1
Then there is SADS, Sudden Arrhythmia Death Syndrome.
http://www.sads.org/shells/LQT%20facts–shell.pdf
Note that it is exacerbated by stress and physical activity. If we presume that SADS is “on a spectrum”, the incidence of “subclinical” SADS might be higher, and only triggered by much more severe stress and physical activity.
Sudden death among young athletes is not uncommon.
http://www.suddendeathathletes.org/about_sdia.asp
The most common deaths occur in basketball, a non-contact sport.
If a cause of death was something preventable, it should be prevented. If the cause was something other than police malfeasance, better actions by the police won’t fix it.
I am very sure that soldiers who are caught in a “firefight” (bullets whizzing by, mortars, grenades, etc.) experience an acute stress response. All you have to do is read first hand accounts of those who have been in combat. They describe the distorted sense of time, tunnel vision, loss of fine motor control and tremors common to the syndrome. The armed forces all recognize this, and send psychiatric personnel to the front to watch for psychiatric disorders developing when the stress response is not handled well.
And all that cardiac stuff that you refer to-hypertrophic cardiomyopathy, Marfan’s syndrome, long QT syndrome, etc. does indeed exist. They are all relatively rare, but all much more common than MH. I fail to see the connection you’re trying to make.
As for people that drown, the majority do not have water in their lungs. The glottis closes with the first few drops of water coming in. They essentially die from hypoxia/suffocation.
But even if you don’t buy my saying that the acute stress response/fight or flight syndrome occurs commonly in combat, then go and study relatives of those that die in the manners that you do recognize have that response. See if their relatives test positive for MH. Then get back to us.
Joe
excited delirium = murder by police officer
Excessive force and murder. Pure and simple. Its a fabricated term so law enforcement officers can justify excessive force.
I’m no physician or law enforcement professional so this is just an example of something that is online that is directed to law enforcement about detecting and handling “excited delirium” and some “signs” (I find the one about “usu. occuring” between Thurs and Sun to be somewhat eyebrow raising). I don’t vouch for this article–it’s just an FYI to know what kind of info some people might be working with, and decide whether it’s misleading or hooey altogether.
I concur with the recommendation that medical personnel be on hand if a multiple person restraint is contemplated. An interesting point raised is that it is stated that “excited delirium” precedes intervention, which doesn’t speak well to it spontaneously commencing as a function of the restraint. I can see, given some of the description, that someone might very well interpret an atypical response by someone who was scared and had limited verbal skills as “excited delirium” and overreact and apply excessive force.
A parsimonious explanation is that this is a result of restraint asphyxia or some medical issue aggravated by being prone restrained by 6 officers.
There’s alot of info online about the case and the filing, but I couldn’t locate a story on the resolution of the case or whether it’s still in hearings. I want to know how this turned out.
Autism, Advocates and Law Enforcement Professionals: Recognizing and Reducing Risk Situations for People With Autism Spectrum Disorders
Dennis Debbaudt
(Read the excerpt on Guido Rodriguez, Jr. to see how badly something very innocent can go wrong when first responders do not understand autism or how to interpret atypical responses. The case apparently led to systematic changes, but the preferable alternative would have been to have spared Guido the pain and suffering that he went through.)
The case of Kevin Colindres is one, tragic, example of what might happen when first responders are not trained regarding autism and atypical responses.