FT. LAUDERDALE (CBSMiami) – Fort Lauderdale Police said a call for a domestic disturbance of a man holding a woman hostage with a weapon ended with that man shot at the hands of police. Investigators tell us they were informed by people at the home that the man shot may have been using the drug flakka. (5/21/15)
MELBOURNE, Fla. ( myfox8.com) -- A man believed to be high on the new synthetic drug called “Flakka” attacked a police officer after claiming he was God and performing a lewd act on a tree, officials said. (4/16/15)
FORT LAUDERDALE, FL (miami.cbslocal.com) – Surveillance video captured a man using nearly super human strength fueled by the drug Flakka. He was trying to kick in the door at, of all places, Fort Lauderdale Police Headquarters. (4/7/15)
There is a newer recreational drug alpha-PVP ("flakka”, “gravel”, “$5 insanity”) taking over the designer drug trend; especially in FL. Alpha-PVP is an extremely potent stimulant; and is as addictive as its chemical cousin MDPV ("bath salts"). Flakka and bath salts are related to cathinone, a natural stimulant found in the khat leaves traditionally chewed in Northeast Africa and Arabian Peninsula regions. Structurally these drugs are similar to methamphetamine and MDMA. Flakka comes in crystalline rock form (it looks like the opaque crystals that line the bottom of fish tanks) which can be swallowed, snorted, injected, or used in an e- cigarette and vaped. The duration of the effects of the drug can last as few as 3-4 hours, but can also linger for several days. The effects of flakka are very dose specific. The difference between a little bit and just a little bit more can produce significant adverse health effects such as heart problems, agitation, aggression, psychosis, and in some case a life threatening syndrome known as ‘excited delirium.
The rise of flakka use is staggering. In 2014, there were 2,720 cases of alpha-PVP detected in crime labs across the country, there were none in 2010. One of the draws of flakka is that it is cheap and easy to get; it can be purchased for less than $1 a dose. While the synthetic stimulant contained in alpha -PVP, was banned and labeled a Schedule 1 drug by the U.S DEA in early 2014, there was not a wide scale dissemination of this information in the lay press. The current street drug supply is reportedly made in laboratories in China, India and Pakistan.
An Overview of Excited Delirium for Officers
The dispatch call is for multiple units to respond to pick one (disturbance, mentally ill subject, or unknown trouble). There will probably be multiple reporting parties. A man is yelling and screaming downtown; he has smashed in several stores' windows; he is nude. When you arrive you find you cannot communicate with him. He is grossly incoherent, obviously hallucinating. The subject is either acutely mentally ill, under the influence of drugs, or both. He aggressively advances towards citizens who have stopped for the show. It is time to contain and control him. He needs to go somewhere--jail or a mental health facility. As you approach he immediately initiates a fight with apparent superhuman strength. You may have already employed a less-lethal weapon to little or no affect; you may have employed another dose or even tried a different less-lethal tactic to no avail. Other officers respond and six of you engage in a protracted physical encounter. You finally get him handcuffed, and apply leg restraints. Paramedics have been called to the scene. While you wait, the subject still fights the restraints. Suddenly he stops struggling, and you realize he has also stopped breathing and he has no pulse. Attempts by officers and paramedics to resuscitate him are futile. The subject is pronounced dead at the hospital. On autopsy, the coroner may not find sufficient evidence to establish a cause of death, or rule it accidental or natural (heart attack).
Excited delirium syndrome (ExDS) is a serious and potentially deadly medical condition involving psychotic behavior, elevated temperature, and an extreme fight-or-flight response by the nervous system. Failure to recognize the symptoms and involve emergency medical services to provide appropriate medical treatment may lead to death. Fatality rates of up to 10% in ExDS cases have been reported representing a substantial risk for litigation for law enforcement departments. Patients often die within 1 hour of police involvement; 75% of these deaths occur at the scene or during transport.
Risk Factors for Excited Delirium
- Males (especially between the ages of 30-40)
- Preexisting psychiatric disorder (bipolar disorder or schizophrenia)
- Stimulant drug use (cocaine, methamphetamine, synthetic cathinones, PCP)
- Obesity
- Other causes: head trauma, adverse reactions to medication.
The Excited Delirium Syndrome
There is no consensus on excited delirium among major medical groups. The American College of Emergency Physicians and the National Association of Medical Examiners recognize the condition, but others — including the American Medical Association and American Psychological Association — have not taken a stand. Professionally, I have encountered two cases of ExDS while working with law enforcement in the field. These cases are REAL. One ended well, with the client getting fast and appropriate life-saving treatment. The other case didn’t go so well.
Excited delirium is a life threatening medical emergency that requires acute care. Excited delirium causes a person's sympathetic nervous system to shift into overdrive. The sympathetic nervous system is responsible for the up or down regulation of most of the body's homeostatic functions; including the release of adrenalin, heart rate, body temperature, and pain perception. It is essential that law enforcement officers recognize the symptoms of excited delirium so that appropriate emergency medical care is initiated early. If you are not sure if someone is exhibiting excited delirium behavior, err on the side of caution.
Excited Delirium presents as a cluster of physiologic and behavioral symptoms which include:
- Unbelievable strength
- Imperviousness to pain
- Ability to offer effective resistance against multiple officers over an extended period of time
- Hyperthermia (temperatures can spike to between 105-113°F)
- Sweating
- Shedding clothes or nudity
- Bizarre and violent behavior
- Aggression
- Hyperactivity
- Extreme paranoia
- Incoherent shouting or nonsensical speech
- Hallucinations
- Attraction to glass (smashing glass is common)
- Confusion or disorientation
- Grunting or animal-like sounds while struggling with officers
- Foaming at the mouth
- Drooling
- Dilated pupils
Control techniques can be extremely difficult because subjects often demonstrate unusual strength and insensitivity to pain, as well as instinctive resistance to the use of force. Once the subject in excited delirium is subdued the complete drama is revealed. Remember, the subject was in a medical crisis before you arrived on scene way before anyone went hands on. It is likely he is near complete exhaustion, despite how he presents. Physical restraint, tasers, and OC spray can all compound the overwhelming effects on his already compromised sympathetic nervous system.
Excited delirium is associated with a number of dangerous physical consequences including hyperthermia, changes in blood acidity, electrolyte imbalances, a breakdown of muscle cells, cardiac arrhythmias and ventricular fibrillation. The typical excited delirium death involves the subject slipping into a state of sudden tranquility, either during or after the struggle and restraint, followed by cardiac arrest.
Ten Essential Tips for Law Enforcement Officers and Agencies
- Protocol: Law enforcement agencies must establish a protocol in advance for dealing with subjects in excited delirium. On-going education is required.
- Dispatch: Dispatchers should be trained to recognize indicators of excited delirium and ask the reporting party follow-up questions. If excited delirium is suspected, the dispatcher should alert officers for their safety. They should notify paramedics to be on standby.
- Backup: If the first officer on scene believes that he/she is dealing with an individual experiencing excited delirium, they should call for backup (several officers if possible) immediately. Advanced life support paramedics should be called to stand by. If feasible, wait for paramedics to stage before attempting to control the subject.
- Containment: The first officers on scene should focus on containing the subject, making sure he cannot hurt any other individuals. Unless there is an immediate public safety threat, officers should not approach the individual until substantial law enforcement backup has arrived and paramedics are nearby.
- Control: The quicker control can be established, the better. The longer the physical confrontation goes on with an excited delirium suspect, the higher the risk of an in-custody death.
- Restraint Position: Officers are traditionally trained to place a controlled subject in a prone position. However, the prone position may make it more difficult for an individual to breathe. This is especially true for a person experiencing excited delirium. Once the excited delirium subject is in custody, and during paramedic transport in an ambulance, the individual should be placed in a supine position or on their side (left side is preferred). If the restrained subject suddenly stops resisting, monitor him for pulse and breathing. Initiate CPR as indicated.
- Maximum Restraint: There is a strong correlation between the use of maximum restraint (hog-tie) and sudden in-custody deaths. If feasible, this type of restraint should not be employed on subjects experiencing excited delirium. If it is employed, lessen the amount of restraint at the first feasible moment.
- Use of Force Options: Part of the excited delirium protocol for any agency should include tactics and use of force options for establishing control of the excited delirium subject. Subjects with excited delirium may have superhuman strength and can be impervious to pain, making pain-based techniques relatively ineffective.
- Empty hand techniques should be applied as part of a multiple-officer takedown team
- OC spray may be ineffective on an individual who does not respond to pain
- Impact techniques (i.e. batons) may be sufficient to stop movement in a subject's leg or arm, but these techniques may not result in pain compliance.
- TASERs may be effective, as they temporarily override the central nervous system, providing officers a window of opportunity to control and restrain the subject. Research has linked multiple TASER applications with an increased risk for sudden death of subjects in excited delirium. If you do deploy your taser, one TASER firing in the probe mode is suggested.
- Transport: Excited delirium is a medical emergency and all subjects should be transported to hospital by ambulance. Paramedics need to closely monitor the subject's heart rate, blood pressure, respirations, CO2 levels, pH levels, and temperature.
- Debrief: As with any critical incident, agencies and involved personnel should debrief after an encounter with an excited delirium subject, especially if the individual died in-custody
Although excited delirium deaths are considered “rare”, this syndrome kills anywhere from 250 to 600 people nationwide every year. Be vigilant for the symptoms, and be safe. People under the influence are routinely unpredictable and potentially very violent.
